HomeMy WebLinkAboutPermit Building 1991-1-2
I HISPECTION' LINE
726-3769
-.
Job Address 4-\ \ '~ l\ ~ 9. )
Legal Description \ fJ()3 f~8.44
Owner '1 ~ II ~)f-nte.o D J
Address 4~~~~~ l)'\:1N.
G \ (\)},.cQCY\. -
Constructio L n r (J C\ 1\'; 1\"
Phone
Address
Ut~lliN TEAI'1
{name}
(exoiresl
(I)hone no. \
Primary
Structural
Electrical
Mechanical
CONTRACTORS I name I
Generalt t\\~ 'Ilf\rtQ
Plumbino
. (i\~dress) (lies. n.ll..).
( -1\(\ D.[) /JJ:J, \C{rrYl i ~ I \ 3~1
(exllirp",l
((/ ,.
I
fl)hflnp fin
Electrical
~1echan;cal
PLUIIBING
ELECTRICAL
MECHANICAL
NO.
FEE CHi'JIlllL jj(l
F'FF' rl:fARG.E. NO_
~~L..cliAB.G.E..
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
or 'extensions
Floor furnace
and vent
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
seoariltf'l
Stationary evap.
r("l('ll""r
Vent - fan with
sinale duct
Vent system apart from
hea t i no or A. C.
Mechanical exhaust
hnnd <tnd dud.
~Iater service
Temporary Construction
Change in existing
rp'Sjd..e.nr",
multifamily, COIl1T1. or
Industrial
Sewer
CO~1./IND. FEEDERS
Install/alter/relocate
distrib. feeders
Wood stove/heater
Of
amps.
I SSUANCE OF PFRl1lT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE LW REQUIRES that the Electrical work be done by an 'Electrical Contractor, the electrical portion of this permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true
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 UO OCCUPArKY will be made
of any structure without the permission of the Building Oivision. I further certify that my registration with the Builder's
Board is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and that
~IY subcontractors and employees who are in compliance with ORS 701.055 will b: used on this project.
\\.w. (please printl---i,4-c.IY /'/A?fiC 6e::-L... SI"IIATURE 9~h~~ OATE /- :1-9/
.~ FOP. OFFICE USE ~y
(Zone Tyoe/Const. Units Sq. Ftg.
Fi.re Zone Bedrooms Occy load Sq. Ft9.
Flood Plain Stories Occy Group Sq. Ftg.
f1ain
Access
Other
x
Value
Value
Value
x
x
TOTAL VALUATION
BUILDING PER/lIT L5 CO Plan Ck. Co"'"lInd
Charges an': -- ,->1)=&)-- 65%/Bldn Ppr Fpp
Surcharges Plan Ck. Res
30%/Blda Per Fee
PLU'1BING PERMIT Fence
Cha rges and ------------
Surcharges D~mo
ELECTRICAL PERI~IT 'Sldewal k
Cha rges and ------------
Surcha rges A/C Pavin9
MECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
Systems Development
Charae (1.5~)
Total Comb. Permit
TOTAL
1\ D.1 ~
--
.f)
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax lot 100, lane County Map Reference
17 03 43
2. exam~le- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C.. Name. etc. of owner and construction lender
O. Energy Sources
"1. example- heat/electrical ceilinq/or forced air Qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. exam~le- 1250 sq. foot house, 500 sq. foot garage
2. examole- if new project. check new - if addition,
check add, etc.
F. Building permit information:
I. exam~le - construct single family house with an
a ttached garage
2. example - remodel existing garage into family room
3. exam~le - 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 TEAM .ANO CONTRACTORS
To avoid design or construction delays, Building
~ivision Staff must be able to contact appropriate
persons regarding design information or job site
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 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
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
O. As noted on the CAP, the 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. ---
III. 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 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.
V. FOR OFFICE USE ONLY
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
j-c9- 91
# ;crCVO
)
Permit Clerk
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
J
date