HomeMy WebLinkAboutPermit Building 1990-8-14
I INSPECTION LINE
726-3769
Job Address IO<?~/
Legal De,cription I, () ~7/ 7 A'-S!;
-6
CITY UF SPRINGFIELD .
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
INFORHATlON UN,
726-3753
Sq. Ftg. Hain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Pep.
Range -Fence Demo Change/Use
Valu, of Hork: Other- -
B'?S01. ,.jn(Y7p r)t I f D .b W k(. B .ld S. 1
Ul CllnQ ernl1 n 0: escrl e or '-.e.. Ul 1ng e
Familv Residence Hith Attached GaraQe)
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(address' (lies. no.' (expires'
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Owner p Ii;jJ (1/111 (..J(fP/Y .~ II II/;} flA'h/ail/lA.
Address Z22r:v' r t' hi Ave) r'Lei Phone LI'j!,{
r::: u. 0f)0..l.: (J r7..Ji.:ZH 0 q ftith, IJoh VI 0 ~~
Construction tender.
Address
DE~ tliN I I:.Ar~
Primary t7\.9.P rl--c;1Wl~ .Qrw(JV~
Phone
{phon,- no.
lnalll~ I
.-:2,l.1? -31l77
Structural
Electrical
Mechanical
CONTRACTDRS (name)
General OJ\, GIAruvt \u.V"'-.
Plumbina
Electrical ~Lj; 1d..,ftX e:.1..tC.tM
~lechani~al rfYV1"Wlf'YL~V
{address~
22 Cfi? ('/A h, / ."'-- /'2c;/
(f
(') C,?-, VVI ,"" ,~ . /[,:'(:0
p ~ 'pxx'rDD zlJ!liinf)
not.{ I /AI ~ Sf
(1 ics. no.'
O\OW
fexoires\
"b \ 3\ IC\()
(phone no.l-
Ine;; 79t/tj,.;
o tJ.23 C
(,,737//J
IBl12!9 ()
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4'if 6 -cf1 Z:<'
3L{5. 23 7'/
PLUIIBING
ELECTRICAL
MECHANICAL
NO
FEf . rHARGF Nr
err . rH~Rr.r NO
. HI=' . r~fARG.E..
SQ. F1.
furnace/burner to
BTU' 5
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath\
Duplex (1 bath) each
SERVICES
Recessed wall
S~~rp hp~tpr ~nrl vp~t
1
amps.
Appliance vent
'if'oaratp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatinq or A,C.
Mechan i ca 1 exhaus t,
hood ilnd dLJ~t
'1"sc ·
12d
2-
Sewer
Temporary Construction
Change in existing
res. i d~.nce
multifamily, corrrn. or
Tnrlll<:.trial
Additional bath
Water servi ce
Storm Sewer
Of
COMH./IND. FEEDERS
Install/alter/relocate
di<;.trih. fppdprs.
/
Of
amps.
Wood stove/heater
2 ~toX'~--,r.; ~
,,4,;q t:fbT'<"&7S
I$. s?:>
WHERE STATE L'\\~ REQUIIH:::i tnat the Electrical work be done by an,:Electdcal Contractor, the electrical rortion of this permit
shall not be vali~ until the )abel has been signed by an Electrical Supervisor and returned to the Building Division
H..'r' .../~c. 0~'94??~A-
~'L/ ~A"/.N~ -::;;,..~~
~'?~P-.
I SSUANCF OF PFRl1lT
TOTAL CHARGES
TOTAL CHARGES
TOTAL CHARGES
I HAVE qAREFUllY EXAMINED the completed aprlication for permit. and do hereby certify tha~ all information hereon is true
and correct. and I further certify that any and all work performed 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 NO OCCUPAIKY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's I
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 this project.
BUILDING PERHIT ---q~-~~- Plan Ck. COITlll/lnd
Charges and 65%/Bld~ ~pr ~~e
Surcharges /6. bS' Plan Ck. Res
30%/Bldo Per Fee
PLUt1BING PERMIT Fence
Charges and ------------
Surcha rges DBmo
ELECTRICAL PERIHT .Sidewalk
Cha rges and ------------
Surcharges .- . A/C Pavipg
.,
HECHANICAL PERHIT ____-L~2'- Curb Cut
Charges and
Surcharges '13
.
) IGIIATU .
FOr. OFF I CE USE OIIL Y
Type/Const.~~~Units S~. Ftg. 11ain x Value
Bedrooms Dccy Load.3'L..,'" Sq. Ftg. Access x Value
Stories /;-h'7~2~Occ.v Group.1?-.2. Sq. Ftg. Other~~C: M2.....:>2lialue~.'.?O
. ,- - ,
wI7-ZO-Q() \2ec:Jt.11-&Z-- TOTAL VALUATION
24'-1.'-/.0 tL-\'vl'm;~~St~~~~lopment U.L,
- - , ~
~
DATE3-/ll90
NAHE(please print) I-:t1R-Y t5 ('.J /ftJ1/J.,i. ~
Z on e ---""= /.:'
Fire Zone
Flood Plain
-'
Total Comb. re~m;t
I
i TOTAL
, tj //. G'B
.
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax lot 100, Lane County Map Reference
]1 UJ 43
2. example- Lot 1. Block 3, 2nd Addition to
Sprlngfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
). example- heat/electrical ceilinq/or forced air Qas
'Z. examole- waterheater/electricallor solar
Eo' Square footage or valuation, etc. -
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check-nfw - if addition,
check add, etc.
/' F. Building permit information:
1. exam~le - construct single family house with an
a ttached garage
2. example - remodel existing garage into family room
3. exa~le - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Struc't!Jral Specialty Code
H. DESIGN TEAM 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.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant n~ed 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 SCHEOULES
D. 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. ---
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 the actual permit is issued for his
signa ture.
.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.
,
;1
.V. FOR OFFICE USE ONLY
tl,. qo
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Permit Clerk IWJdJ.fAMJ.-
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.. PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
.Additiona 1 Projec;t Ini'onnation:
-
.,
PLANS REVIEWED BY:
name.L09.#~- ~~~ignature.4p_- ~~-,4ate_B-&-9C:>
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