HomeMy WebLinkAboutPermit Building 1990-6-1
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Address J6 ~I fb / I fop tJrI VL Phone
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(name)
Phone
(address) j1ics.
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CITY OF SPRINGFIELD
COflBHIATlON APPlICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Range
ValuE of Hork: ,.
?::? C:>O. ~ .
BUildina Pernlit Info: Describe Work(i.e.,
FamiJy nesidence With Attached Garaoe)
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INFORllATlON UN'
726-3753
Sq. Ftq. r.lain
~q. Ftg. Access.
Sq. Ftq. Other,
r~ew Add Alter Rep.
--Fence Demo Change/Use
Other- -
Build Single
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Con~truction Lender
Address
l1t~~(iN II:.Af1
no. )
(exo;res)
(ohane no.
Pri~ary 1hu.~ R JlALL E..Q .
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Structural
Electrical
C!D'1
\ '7\ v
Mechanical
CONTRACTORS
Plumbina
(name)
() i 1lft17Jh d f071Cs f
'77-./jV XIV~S
'A~ RrL/.
( address)
)(-Pas / ();)- / I
(lic~. no.)
(exoiresl
(ohone no.)
Genera 1
S tV &vbu.r e I vd... -11-1 c1 IlJ!.. 1'1;),-1 ~
521 g J 0 ![;--3Ir'lD ;).Lilt; ..: X'1:3D
Electrical
~1echani ca 1
PlUlm I NG
ELECTRICAL
MECHANICAL
NO.
FFE CHARGE N0
FFF r~ NO.
FF':- .lJ:IARG.E.
SQ. FT.
furnace/burner to
BTO's
Each single fixture
Residence of
Relocated building -
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath 1
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Snac~ ~Pntpr nnrl vpnt
Storm Sewer
p/' "5P'.#~A/~/;'--""""""S-
'1
:"
'1:"
Of
amps.
Appliance' vent
~eoarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
hea t i nq or A. C.
Mechanical exhaust
hood and dur:t
Sewer
Temporary Construction
Change in existing
rp<;. i d_e.nc~
multifamily, comm. or
Industrial
~Ia ter servi ce
CO~1./INO. FEEDERS
Install/alter/relocate
distrib. feeders
Wood stove/heater
,."...
I
0.-5/fRHZ7.
<;;,"p/1'- /*:;(/;d';:
;;?---
Of
amps.
,t;/ ~L7': /hN7/f'1 ~ ~ ~L
~ rAt/A- /? /<)E,~.i_!~
hA'~/T
TOTAL CHARGES ~~. /5. - TOTAL CHARGES TOTAL CHARGES .,MI.N. /:?. ~
WHERE STATE lAI~ REQUIRES that the Electrical work be done by an. Electrical Contractor. the electrical portion of this permit
shall not be vali1 until the label has been signe~ by an Electrical Supervisor and returned to the Building Division
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I SSUANCF OF PERllIT
I HAVE CAREFULLY EXAMINED the,completed application for permit, and do hereby certify that all information hereon is, t~ue
and correct, and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Oregon pertaining to the work described herein, and that rm OCCUPAHCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used.on tp;~ project.
IlAI-lE(p1ease print) ~""'C\,(.. \i2,,'t\\\tQG-O\l\bSlr.IIATUREL~j-( //U
FO~ OFF I CE USE Q;J(y P'
",S;('Ft9. llain v
Sq. Ftg. Access
Sq. Ftg. Other -S~.
O~.TE
tP -( - 'j L.
Zone
L::L
Tyoe/Const. ...;~ ,
Units
Occy load
Oecy Group
x
Fire Zone
8edrooms
x
Value
Value
Va1ue~.?":>.-
TOTAL VALUATION
Flood Plain
Stories
x
~
'"""1""-
BUILDING PERf1lT
Charges an~ 1\
Surcharges r
./ LJ C.A . Plan Ck. COIll1l/lnd Uo.'
___L:::Z.~~~__ 65%/Rldo Pl'r I='r:~
--? ;::, Pian Ck. Res
:7' ~.-' 30%/B1dQ Per Fee
~___/;;=-~_ Fence
I l5'" OfilllO
tf!LS3
'Systems Development
Charoe (1.5~)
1. ~.f3
....,.
PlU'1BING PERMIT
Charges and ~
Surcharges ---:;;
ELECTRICAL PERI~IT
Cha rges and
Surcha rges .
Sidewalk
TOTAL
J?)? <f?
1755.90
11ECHAN I CAl PERMIT.
Charges and \ ,
Surcharges \.f
A/C Paving
_ _ _ _ /2..~~ _ Curb Cut
-75
Total Comb. Permit
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-COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Ldne County Map Re~erence
II 03 43
2. example- Lot 1. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
.1. example- heat/electrical ceilinQ/or forced air qas
2. example- waterheaterjelectrical/or solar
E. Square footage or valuation, etc. ------
1. example- 1250 sq. fppt house, 500 sq. foot garage
.2. examyle~ if new project, check:ruew - if a~d1~ion, '
check add, etc. . .
F. Building permit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examele - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEM4 AND CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
11. 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 installed
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
fu 11 schedu 1 es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, tne label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is.not authorized
to sign the electrical label. ---
Ill. . Applicant to sign and date
Whenever possible, the initial 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 th.e.'actual permit is issued for his
Signature. ~',-?.! ..It,..;' '.--:
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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V. FOR OFF'rCE USE ONLY.'
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit appl i cant exempt from regi strati on with the Buil der' 5 Board because:
Additional Project Information:
PLANS REVIEWED BY:
nanie- L~7i'/Y~ ?E~~
Signatur~--'~__
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date
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