HomeMy WebLinkAboutPermit Building 1990-4-3
j INSPECTION LItlE . CiTY OF SPRINGFIELO
726-3769 COMBINATION APPLICATION/PERMIT
Job Address /29~ ?~' . r' ~ _ EilERGY SOURCES:
"/ -:.;> ~ .?> Heat
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Legal Description 17-~<-n~. "':1'36'~ Hater Heater
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INfORJIATlON UNt
n6-37SJ
Sq. Ftg. 1,Iain
~q. Ftg. Access.
Sg. Ftg. Other
New Add Alter Pep.
--Fence Demo Change/Use
-Other- --
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Range
ValuE. of Hork:
Owner, E if 5.b &2 '''''R:?''''''''"' , . "
Address ~-'7 ~__ /~V/L'~ Phone BUlle!nQ Permlt Info: Oescrlbe Work(l.e" BUlld Slngle
.r,../"'/,.e:;?_Y/~ ore:::. -01" ~/1 Family ~esidence Hith /I.ttached GaraQe)
a~.#C~ - "??9"y~ C:Y7~ /~?5"p.;:::..r-~~ 7~
, 5~~/n ~.;;;;g-~A-~~
J">i-cA7Tm-p~&c!,L/? r.
. (lies. no.) r",xniresl
Construction lender
Address
DESIGN TEAH (name)
;114"<.. ~""/Q<>-W~O
PrimarY6~{?~~/_~_..;~ .E"
Phone
(address)
(nhone no.)
Structural
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t/B</~</// ,E,y??2L/
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Electrical
Mechanical
-CONTRACTORS I name}
Genera I #7-R/&; ,~l!EC.:ry- G,,, :.., ~ .
PlumbinQ ~<:'4,..M/L/FR
Electrical ,&-~ E2:~"2/:
(address 1
(li~~ no.)
(p)Co;rpc:,)
(ohnnp nn )
~1echanical
PLUllBING
ELECTRICAL
MECHANICAL
.....llih
FEE CHARr;F Nn
~~L JJiAB.G.E. NO,
H~ r~
5'
Each single fixture
Residence of
?'s-? ?'250
SQ, FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
~ New circu~ts alts.
or extenslons
?.A..-=I-~~E
?Z IX:
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath)
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
each
Water service
\
1
I
Temporary Construction
Change in existing
rp<; i qe.n('~
multifamily, comm. or
lnduc:trial
/
~_/,..~ If,
Appl iance- vent
s~oarate
Stationary evap.
cool~r
Vent fan with
sinale duct
Vent system apart from
h~atino or A.C..
Mechanical exhaust
hood and durt
a~-
-2
Additional bath
Sewer ( ...
"
'-
~-
,
J ,) /::<.::'. ~
, /
/ Of./~ amps,
CO~1,/INO, FEEDERS
Install/alter/relocate
dic:trih. fppdprc:
-n, :2:>
Storm Sewer:
Wood stove/heater
/ Of 7~ amps. ?~"JjC f Z2>~LLJ"'C.""'Y"r
~ .,h-r-?/'>?/r M &-, a;.-= W'~
<&;uoA'~"," 7?o/ /;'F.3;;,?~
~"":n?A<:~. ISSUANCE OF PFRt1lT
TOTAL CHARGES ' Ji7, ~ TOTAL CHARGES ~? :50 TOTAL CHARGES /9. 5',,::>
WHERE STATE L~W REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
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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 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 UO 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 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 ~sed on this project. .
IWIE(please printl_ME'\.... DA_O-Z"""""""" m- SIGIlATURE~ o~ OnE ~/3 ho
FOr. OFFICE USE DIlLY . ,
Zone_P"::: . TYoe/Const,~ Units Sq. Ftg. t1ain 7~ x Value~~' ...
Fi re Zone Bedrooms Occy Load Sq, Fta, hAOOs. oVVg x Value
Flood Plain Stories/"'Ao?"",:>:;::> . Occ'y Group ~-2 Sq, Ftg. Other x Value
BUILDING PERfIlT __.2.d.~__ Plan Ck, Comm/Ind :2%:'3S"
Charges and 65%/Bldo ~pr Fp~
Surcharges /.f? 95' Plan Ck. Res
30%/BldQ Per Fee
PLUt~BING PERMIT '~5'.:? Fence
Charges and ----- -----
Surcharges 2.89 Dl/RIO
ELECTRICAL PERIHT ~~'_~~LZ SIdewalk
Charges and
Surcharges <..c-....,.- ~~.."..c- A/C Pavi ng
tlECHAN I CAL PERMIT __n.{~~__ Curb Cut
Charges and
Surcharges ~
, -
TOTAL VALUATION
/ ----- ~-
.Systems Oevelopment~
Charqe (l.5~) / -rL =, '--
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TOTAL
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\:J\.~V/
:~k~
,
Cf78.87
I ~'7:25: /6
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Total Comb, Pennit
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I I I.
I. Applicant to furnish
A, Job Address
B. Legal Description
1. example- Tax Lot 100, lane County Map Reference
II 03 4j
2. examele- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
0, Energy Sources .
~1.'example= heat/electrical ceilinQ/or forced air Qas
2. examyle- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. checknew - if addi,tjon,
cneck. add. etc.
F. Building permit information:
1. example - construct single family house with an
attached gar~ge
2. example - remodel existing garage into family room
3. example - 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
full schedules
C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
0, 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. ---
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:
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V, FOR OFFICE USE ONLY
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ClerK ~ jl[JDJ ,
Permit
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PROJECT CONDITIONS TO BE SATISFIED 8EFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board,because:
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Additional Project Information:
PLANS REVIEWED BY:
name
~7'rA/~ h.~~
~
signatur4~~
date "'5-/-~~