HomeMy WebLinkAboutPermit Building 1989-10-18
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CITY Uf SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIlERGY SOURCES:
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I~a ter Ilea ter AS
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INFOR/1ATION
726-3753
SQ. Ftg. I,'ain
~q. Ftg. Access.
SQ, Ftg. Other
Ilew Add Alter Pep.
-Fence Demo Change/Use
Other - -
LINE I
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Ranfle
Address
, Phonc$~J7
~luf of Hark:
'lF105.000,CX)
Buil(iina Permit Info:; Describe Work(;.,e"
Family nesidence With Attached Garaae\
Owner
Construction lender I, rTRsr
o f}-l(; $r:
(name)
F"\\-..\~ClX.. ~ 'So"-l
Add I'C~~
Jj~ .TAJTr:"RTO~ WALLs :tAJgrA/"L
JNle~ ~"AIA!:-S'~, 8AU/oI~W : sf~p"'1UJOM5
Phone f
(address' !lies. no. \ (exnires)
{ohane no. I
UES I GI< TEAI~
Primary
Structural
Electrical
/1echanical
CONTRACTORS
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Electrical J:>IHJE gft:DoMskL
(name)
(address' (lies. no_ \
(pxoires)
(ohane no. \
Plumbino
3X'1r MitrAl
.,2;.);;J. IN. b tL
7L/-&-3,B3
~9l./_ S .J..:J.:l,
gtJt.- 3q~
~~n~ra 1
~lechanical
PlUIIBING
ELECTRICAL
MECIlANICAl
? 5<:> 75'~
SQ. FT.
furnace/burner to
BTlI's
F F "- J:JJABGI.
I
NO.
FEF r.H~RGF
Nn
:.H
r.HIlJ!G.E. Nn
I,()
Each single fixture
Residence of
Relocated building
(new.fix. additional)
S.F. Residence
(J bath)
Duplex (I bath) each
Additional bath
New circuits a1ts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~cp hp~tpr ~nrl vpnt
Sewer
Temporary Construction
Change in existing
residence
mul'tf{amily, conlll. or
Industrial
/
Appliance vent
seoa ra te
Stationary evap.
cooler
Vent fan with
sin~:J1e duct
Vent system apart from
heatinQ or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
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,'- f\-.
~'a tel'" servi ce
,
/
I'
Of
COffi~./IND. FEEDERS
Install/alter/relocate
distrih. fppder.;
Storm Sewer
amps.
-:
/
Of
amps.
TOTAL CIlARGES
WHERE STATE L\I~ REQUIRES
shall not be vali~ until the
I
-7 G. "4 TOTAL CHARGES TOTAL CHARGES ~A'. /5: -e.
that the Electrical work be done by an Electrical Contractor, the electrical [1ortion of this pemit
label has been signed by an Electrical SU[1ervisor and returned to the Building Division
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ISSUANCF OF PFR!IIT
I Il^VE C^REFUlLY EX^"lINED the com[1leted ap[1lication for permit. and do hereb.y certify that all information hereon is true
and correct, and I further certify that any and all work nerformed shall be done in accordance with the Ordinances of the City
of Spri ng fi e 1 d and the laws of the Sta te of Orel]on pertai n i n9 to the work descri bed herei n. and tha t rm OCCUPAHCY will be made
of any structure without the permission of the Uuilding Division. I further certify that my registration with the Builder's
Uoard is in full force and effect as required by ORS 701.055. that if exempt the basis for exemptio is noted hereon. and that
:~::(::::::t:::::~s ~~~oYe~.W~::~liance with :PI:il::~:;5~~h~~ DATE~~~~.
FO~ OrFICE ,~~(~ -. - ~ J. I
Type/Const. 5-/~ Units /S~. Ft~. 11ain / x Value
Bedrooms Occy Load <: ~ SQ. Ft~. Access I x Val ue
Stories / Occ.y Group A-~ Sq. Ftg. Other&r_...._~.c Value-"'1""~'-
~ t[') .In'~ 15C~ TOTAL VALUATION
Conm/fna' Systems Development
Per Fee ::2 /~.~.::> CharQe (1.5~) .
Res
Per Fee
Zone c:.c..
Fi re Zone
Flood Plain
BUIlOING PERNIT J
Charges ane
Surcharges
__3_~..:~_
/6. '7~
_ _ __ Z-:E_~_
~.-7 :;-
Plan Ck.
65%/Bl do
Plan Ck.
30%/Bldo
AlAt
PLU!~BING PERMIT -./
Charges and
Surcha rges
ELECTRICAL PERI~IT ./
Charges and
Surcha rges
11ECIIAN I CAL PERMIT
Charges and
Surcharges
Fence
D-ma //YT$7'I/6~
"~~~.
/~--
.q[)
_ ___ _ _ _ __ _-=.: _Sidewalk
-.~
. .. A/C. Pav~ng.
v
"-.
TotaJ,~o~b.rermit
_~__i~~~_
.7S"
~
Curb Cut
"--.
TOTAL 4~1 ~O
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COMBINATION APPLICATION/PERMIT (CAP) "
y.
I. Applicant to furnish
A. Job Address
B. legal Description
1. ~xample- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot I. Block 3, 2nd Addition to
, . sprfngfield Estates... . . . ~
~. c': .. Namlf.\' ete. o{-'.o\;ner '"and cons trued on 1 ender
\~,D.::..EnergYJSources"l'",'\"'''''''''\ .." \. . " . '" .
-, ~ 4 'l~" ex~mple:':"neaf'electrical ceilfnQ/,or .fb'reed'air' Qas
2. examyle- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. examole- ]250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
checl< add. etc.
F. Building pennit information:
1. example ~ construct single family house with an
attached gar~ge
2. examole - remodel existing garage into family room
3. examD 1 e - convert s i n9 1 e famil y res i dence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
, Structural Specialty Code
H., . DES I GN TEAl-l AND CONTRACTORS .
,.t To avoid design or construction delays; Building
Division Staff must be able to contact app"rop"riate
persons regarding design information or job sHe
. corrections. etc.
II. Abbreviated Plumbing. Mechanical. & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules.
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be instdlled
B. Full Plumbing, Mechanical. and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP. the label must
electrical contractor for signature
supervisor. The general contractor
to sign the electrical label.
Ill. Applicant to sign and date
Whenever possible, the initia"l application will be used as
a worksheet only. Where possible, Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signature.
IV. Fees and Charges
Plan check fees are due and payable at the time of the
application, and no plans will be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued.
.,'
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,.
be delivered to the
by his electrical
is not authorized
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS Tb BE SATISFIED BEFORE OCCUPANCY:
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PE~IT VALIDATION
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\ Permit applic~nt exe,mp,i:\'fromre.!iiStrati'6n with the Builder's ~oard bel;ause,:
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Addi:t i ona 1 Projec,t Infof:'ll:lati on,:
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PLANS REVIEWED BY:
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name
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signature
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