HomeMy WebLinkAboutPermit Building 1990-8-3
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Job Address 5CJo# Mil)
Legal Demiption I iii (J33 561
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~ CITY UF SPRINGFIELD
"""CDMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
lia ter Hea ter
Range_
Valu, \\H,t?\ )
BuildinQ P~nllit Info:' Oeser be Work(Le..
Familv Residence With Attached GaraQe;
.
I NFORl1ATlON Ll NE
726-3753
Sq. Ftg. I~.in
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Pep.
-Fence Demo Change/Use
Other- -
j
] INSPECTION LINE
726-3769
Oo\W
Owner', Cftt!!/.)t:'4~:.u
Addressq~~~\ \A\) ~\)\ ~ Ph~ne
construc~~\@Jf " L4.\ 41 )
Build Single
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:Rt=yJ(.Hto~ .(In{J; 70fJ /ft/A7',
ih7J'/"
Address
UESIGN IEN1
(name1
Phone
(address I
flies. no.'
(exoi res 1
{OhOM no.
Electrical
'*
Primary
Structura 1
Mechanical
CONTRACTORS
{name'
(address'
(l ies. no. \
(exnires\
(nhone no. 1
~ener~l
Plumbino
Electrical
, ~.~~~.~~ '3'~' 4/7q/
/J~<'4./~t~ 3g(jo~'././'~ :t~-I'~
PLUI1BING I' ELECTRICAL MECHANICAL
~1echanical
--1!9 ,
FFF . f:H'\Rr.F Nfl
FFI=' 'rH1RG[ NO_
furnace/burner to
LI(7f'''19O BTU's
,
Floor furnace
and vent
"F rH.1RGd
~ ().l2
Each single fixture
Residence of
SQ. FT.
Relocated building
(new fix. additional)
New circuits a1t5.
or extensions
S.F. Residence
(1 bath\
Ouplex (1 bath) each
SERVICES
Recessed wall
~n~rp op~tpr ~nd vpnt
Storm Sewer
Of
amps.
Appliance vent
c;,_~oar:at~
Stationary evap.
~oQler
Vent fan with
!!.;n~le duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and tturt,
Sewer
Temporary Construction
Change in existing
re$i(te.n~
multifamily. camm. or
'ndustri(l.l
Additional bath
Water service
CO~1./INO. FEEDERS
Install/alter/relocate
distrib. fppders
Wood stove/heater
Of
amps.
dJ//fJFe6
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TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali~ until the
TOTAL CHARGES
I SSUANCF OF PFRIHT
TOTAL CHARGES
J 5. dO
that the Electrical work be done by an..Electrical Contractor, the electrical portion of
label has been signed by an Electrical Supervisor and returned to the Building Division
thi s pemit
I HAVE CAREFULLY EXAMINED the completed aprlication 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 NO OCCUPAI~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 ORS 701.055 will be used on this project.
Zo~e
Fire Zone
Flood Plain
Units
Occy Load
Occy Group
. S I GtlATURE
FOr. OfFICE USE DIlLY
Sq. Ftg. llain
Sq. Ftg. Access
Sq. Ftg. Other
OATE
IWIE(please print)
Type/Const.
Bedrooms
Stories
x
x
Value
Value
Value
x
TOTAL VALUATlOtl
PLUI1BING PERMIT
Cha rges and
Surcha rges
, Plan Ck. Comn/lnd
____________ "ill/B) no ~er Fee
Plan Ck. Res
30%'8ldQ Per Fee
Fence
Systems. Development
CharQe O.5~ '.
BUILDING PWlIT
Charges and
Surcharges
ELECTRICAL PERmT
Charges and
Surcharges
D(j11lo '
'Sidewalk
A/C Paving
___Lfi_".::___ Curb Cut
Total Comb. Permit
MECHANICAL PERMIT
Cha rges and
Surcharges
TOTAL
/5.7)
,7,r
..
--~-~
1
.
.,
COMBINATION APPLICATION/PERMIT (CAP)
"
i PERMIT VAll DATION
, , . I
1. Applicant to furnish
A. Job Address
B. legal Description
I. example- Tax lot 100, lane County Map Reference
II 03 43
2. example- lot I. Block 3, 2nd Addition to
>prlng~ield Estates
C. Name~ etc. of owner and construction lender.
D. Energy Sources
L exam~le- heat/electrical ceiling/or forced air Qas
2;. examole- waterheater/electrical/or SOlar
E: Squar,e, footage or valuation, etc. -
I. example- 1250 sq. foot house, 500 sq. foot garage
2. : .~~- if new project, check new - if addition,
Cl1eC1add, etc.
F. Building permit information:
1. . example - construct single'family house with an
attached garage
2. -examEle - 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 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 SCHEDULES
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. ---
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 pennit ,is issued.
71
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V. FOR OFFICE USE ONLY
Permi t Clerk d )(' /J?1 ~
.~ ( ~
.
I
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
.