HomeMy WebLinkAboutPermit Building 1989-6-23
Job Address
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'CITY Uf SPRINGfIELD .... INFORlIATION LINe
, COHBIIIATION APPLICATION/PERMIT. 726-3753
E!IERGY SOURCES: Sq. Ftq. I.Iain
Heat ~q. ~tg. Access.
i-later Heater Sq. Ftg. Other
Ilew Add A Her Rep.
Range -Fence Demo Change/Use
Valu, of H"!J./;OO c"" Other--
Bul1dina Permit Info: Oeser.be Workl;,e., Build Single
Familv nesidence With Attached Garaae)
Phone
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I INSPECTION L1I1E
726-3769
Legal De5cription
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Owner -Pr=>:l-r>.r ~ \"1 j L
Addrcs~ c;3..C:; Hn(~ ~.
~nhd eld- : ()(2_
Construction lend~~
Address
OESIGI~ HAI1
(name)
'lLi7.{J3D',' 4~h/R~LT WOOD F.?h7~eZ:>
/'7?A'"~&at::c.iE ON .;c-AtL'e- /5r:
/?~0'j'('f'~ "J?~/C-.h./~
(lies. no.) (exniresl'" (ohone
Phone
(address)
no. J
Primary
i~
~
Structural
Electrical
!1echanical
CONTRACTORS Inamel
General C'< .., ",.,.- 1/ek...... J.I, J /
Plumbina
(address)
>5;'- f1a ,.....4
(lie!>. no.)
(pxoirpt;.)
(ohnnp nO,1
Electrical
~'echanical
PLUIIB I NG
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ELECTRICAL
MECHANICAL
NO.
SQ. FT.
furnace/burner to
BTlI's
rrr 1..cJJA1lliL
I
I
FEE CHARr,E.JJO
rrL..cJJA1lliL .JIJl.....
Each single fixture
Residence of
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
~nArp hp~tpr ~nrl vpnt
Sewer
I Storm Sewer
Of
amps.
Appl lance vent
~eoaratp
Stationary evap.
cooler
Vent fan with
s;nole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and duct
Hater service
Temporary Construction
Change in existing
rpc;. j tteflce
multifamily, camm. or
Innu<;tr;al
COMM./IND. FEEDERS
Install/alter/relocate
rlic;trih. fppdprc;
Wood stove/heater
Of
amps. I
I SSUANCF OF PFRIIIT
TOTAL CHARGES
WHEnE STATE L~H REQUIRES
shall not be valij until the
TOTAL CHARGES TOTAL CHARGES
that the Electrical work be done by an. Electrical Contractor, the electrical portion of this perr.lit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXMlINED the completed aprlication for permit. and do hereby certify that all infonnation hereon ;s 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 1m OCCUPAIlCY 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 ORS 701.055 will be used on this project.
IW.IE(please print)
17 c:.h v- J
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S IGIIATURE
FO~ OFFICE USE OIIL Y
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DATE b/2J/,n
tY
20ne ..c:::: L
Fire Zone
Flood Plain
Tyoe/Const. ~-/V.
Bedrooms
Stori es
Units
Occy Load
Occy Group ,1.--;3
Sq. Ftg.
Sq. Ft9.
Sq. Ftg.
t1ain ,x Value
Access x Value
Other M~a:r---B Value /':;?='. =...
TOTAL VALUATION
BUILDING PERflIT
Charges an~
Surcharges
Plan Ck.
__g~..5-"~___ 65%tBldo
/~ Plan Ck.
/. l!? 30%/BI do
Co"",1l nd
Ppr Fp~
Res
Per Fee
~ -;':?:;"
{2/~
9/_,_.---
Systems Development
Charae (1.5~)
/l-d
PLur1BING PERMIT
Char..ges and
Surcharges
Fence
ELECTRICAL PERI~IT
Charges and
Surcharges,
11ECHANICAL PERMIT
Charges and
Surcharges
D~mo
Sidewalk
A/C:Paving
Curb Cut
I
I
I
~ I. .
I
ITo~~J Comb. rermit
==5'0,6$
I
I TOTAL
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,
COMBINATION APPLICATiON/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Description
I. example- Tax Lot 100, Lane County Map Reference
II 03 4'3
2. example- Lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. Name, e"tc. of owner and' construction lender"
D. Energy SO!Jrce~ ".
1. examole- heat/electrical ceilinQ/or forced air qas
2. , examole- waterheater/electrical/or sola~.
E." Square footage or valuation, etc.' -
I. example' 1250 sq. foot house, 500 sq. foot garage,
2. exa~ple- if new project. check-new - if addition,
check add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. examDle - remodel existing garage into family room
3. examole - 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
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. BUILOING DIVISION STAFF WILL FILL OUT ALL FEES ANO
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. ---
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.
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V. FOR OFFICE USE ONLY
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's' Board because:
Additional Project Inf9rma~~on:
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PLANS REVIEWED BY:
n~ine '/J~7-'?~ !~C=:Z:;'~ signature
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