HomeMy WebLinkAboutPermit Building 1990-8-22
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I ItlSPECTION LItlE
"i 726-3769 -
Job Address
I.egal Description
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ItlFORlIATION lIN"
726-3753
Sq, Ftg, 1,Iain
~q. Ftg. Access.
Sq, Ftg, Other
flew Add A lter ~ep,
-Fence Oemo Change/Use
Other - -
CITY OF SPRltlGFIE~D
COHBIIIATION APPLlCATIDtI/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Range
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Builo;nQ Pernlit Info: Describe Work(i.e., Build Single
Familv nesidence With Attached Garaae)
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nics. no.) (exnires) (OhOM noj
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Address lD l.P ~ ~"':Il.l.JOOD
SL)0c..nO~ DD-I
Construction Lender
Address
Ul;IGN llAI1
Primary
Structural
Electrical
'1'1"6
Phone .:L~ S~
91'-N '5
(namel
Phone
(address)
Mechanical
CONTRACTORS I name 1
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------
Plumbino
Electrical
~lechan; ca 1
NO.1
faddresc;.)
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P~UI1BltlG
E~ECTRICA~
MECHANICA~
I FFF I fHARGE Nfl I
I HI=" I rl-lllRG.E. NO I
1r:.E..E.-1..c.HARG.E.
Residence of
furnace/burner to
'BTU's
Each single fixture
SQ, FT,
Relocated building
(new fix, additional)
S.F. Residence
11 bathl
Duplex (1 bath) each
Additional bath
~Ja ter servi ce
Sewer
Storm Sewer
,
New circuits alts.
or extensions
Floor furnace
and vent
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SERVICES
Recessed wall
S~~~p hp~tp~ ~nrl upnt
ITemporary Construction
IChange in existing
rp~; dJ'J1~p
Imultifamily. COrTm. or
Tnnud,r;al
10f amps,
ICO~1,/IND, FEEDERS
I Install/alter/relocate
ni<:.trih fppnpl'"<:'
10f amp~
I
Appliance vent
s!='oarrlt,p
Stationary evap.
cooler
Vent fa"n with
sinole duct
Vent system apart from I.
heatino or A.C.
Mechanical exhaust
hood rind dud
Wood stove/heater
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ISSUAtlCF OF PFRIIIT
TDTA~ CHARGES TDTA~ CHARGES TOTA~ CHARGES
WHERE STATE L\H REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this pelTolit
shall not be valij until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFU~~Y 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 Spri ng fi e 1d and the Laws of the Sta te of Ore~lOn perta i ni ng to the work descri bed herei n, and that NO OCCUPAr~CY 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 ons 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 t~ject,
IWIE(please print) .::::s-, to-..... ~~ SIGN^TURE~~~ DATE '6b;:)j&:,{;
FOr. OFF I CE USE OIjL Y
So, Ftg, 11ain\
~
Sq, Ftg, Access
Sq, Ftg. Other
Zone
Fire Zone
Flood Plain
8UI~DING PER~1lT
Charges and
Surcharges
P~U'1BING PERMIT
Charges and
Surcha rges
E~ECTRICA~ PERIIIT
Cha rges and
Surc~arges
HECHANICA~ PERMIT
Charges and
Surcharges
Type/Canst.
Bedrooms
Stories
Units
Occy ~oad
Occy Group
x
Value
Value
Value
x
x
TOTA~ VA~UATIOrl
, Plao Ck,
_ut_Z--2!?..__ 65%1Rldo
~ Plan Ck,
-'L I ..) 30%/81 do
I Fence
------------
I Demo
I Sidewalk
-----------.~I ~/C fayi.n~
I Curb Cut
____________1
COI1l11Il nd
Ppr Fe!='
R.es
Per Fee
Systems Development
Charpe (1.5~) ,
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Total Comb. Permit
I TOT A~
~'5>_tb3
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COMBINATION APPLICATION/PERMIT (CAP)
I, Applicant to furnish
A, Job Address
B, Legal Description
1. example- Tax Lot 100. Lane County Map Reference
1/ oj 43
2, exa~le- Lot 1, Block 3, 2nd Addition to
sprlngtie1d Estates
C. Name. etc. of owner and construction lender
D.. Energy Sources
1. example- heat/electrical ceil;n~/or forced air Qas
2. exa~le. waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1, exame1e- 1250 sq, foot house, 500 sq, foot garage
2. example- if new project, check new - ff addition.
check add, etc,
F. Building pennit information:
1. example - constru~t single family house with an
attached garage
2. example - remodel existing garage into family room
3. examJPle - 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 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 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
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 ~he permit is issued.
V, FOR OFFICE USE ONLY
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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7i '"2. "3-7'0
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Permi t
Clerk~~
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
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name
Lt5,?Y~jq~~
signature
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date &'-"2 ~~Z>