HomeMy WebLinkAboutPermit Building 1990-12-3
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INFORllATlON LINe
726-3753
Sq, Ftg, /.Iain
~q. Ftg. Access.
Sq, Ftg, Other
New Add Alter Rep,
-Fence Demo Change/Use
-Other - -
'I INSPECTION LItlE
I 726-3769
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CITY Uf SPRINGFIElD
COMBINATION APPlICATION/PERMIT
EIIERGY SOURCES:
Heat
l~ater Heater
Range
lP\5 iVJA--IN ~.
legal Dmription VI ()~ ~ ~~ ") \ N....{:yV
(Fe1=>-~ -l- ~ . e.ou 'I' ~ fu~ll\..l)
tv\:.P G-U L IVJ:l U s..f:.
Address 2>5,'S N''-w. YGaN Phone.k-?~i:
PO~t-.J"O (oou ~)
Owner
ValUE of \-Iork: ,ilfl q <1
Builriina Pennit Info: Describe Work(Le..
Familv nesidence With Attached Garaael
Build Single
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Job Address
~,---,.-r....R...l~""i"CIj::
Address
UESIGN TEAI.\
{namel
Phone
(address)
H.lnf"l =.;:::,
v.J1 ~ ~"" ,. 1=\". '-I-M M e.L-'R-&l.J:.l;'
I-lol"" ~PF80 R..oa1='I~.(<.:wG",,;>,="''''(,.-tl.:
,,,,,. M.' ,..""~._ 00.
Construction lender
Primary
Structural
Electrical
/1echanical
CONTRACTORS (name I
~ R.O'G ~Ol=--!.UCr--
(address) (1ic~. no.)
(p~n;r,:>c:l
(onnnp nn. 1
Plumbina
L'ltt)'1'-l C"~D.en ~ ICH')~
~c,..E UE: , '11'--10L
IIl-Ilo,D
3H '-l - ClJ..., '\
Electrical
t-lechanical
PlUtIB I NG
ElECTRICAl
MECHANICAl
NO.
FEF rH~ ~n
"-EL J:IJAB.GE. NO.
':.E..L J:IJAB.GE.
Each single fixture
Residence of
SQ. FT,
furnace/burner to
BTU's
Relocated building
(new fix, additional)
New circuits alts.
or extensions
Floor furnace
and vent
5.F. Residence
II hath)
Duplex (1 hath) each
Additional hath
SERVICES
Recessed wall
~o~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
COMt.I./INO. FEEDERS
Install/alter/relocate
(iic:,trih fpprlprc:.
amps.
Appliance vent
"poa ra tp
Stationary evap.
cooler
Vent fa"n with
"inale duct
Vent system apart from
hea t; no or A. C.
Mechanical exhaust
hnod and dur:t
Wood stove/heater
Sewer
Temporary Construction
Change in existing
r'P-S-jqPJlt'l'I
multifamily, COIl1T1. or
Tndlld.riil.l
~Jater serv; ce
Of
amps.
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ISSUANCf OF PFRt\1T
TOTAl CHARGES TOTAl CHARGES TOTAl CHARGES
WHERE STATE l,"/ REQUIRES that the Electrical work be done by an'-Electrical Contractor, the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
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 fm OCCUPAflCY 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 7nl.055 will be used on thi~ject.
NAI-IE(please print) ...j \ "^-' R...o s ~ SIGNATURE ~~) ~ ~ DATE
FO~ OFFICE USE mIl Y I \
Zone Type/Canst. Units Sq. Ftg. f1ainV x Value
Fire Zone Bedrooms Occy Load Sq. Ftg. Access x Value
Flood Plain Stories Occy Group Sq, Ftg, Other;.1'G:,~.......-:>x Value Y'75i'<?
TOTAl VAlUATION
BUIlDING PERfllT
Charges and
Surcharges
~ Plan Ck.
__~Q.,$~__ 65%/Bldo
". Plan Ck,
.--::? -S,;;i' 30%lBI do
I Fence
------------
I Demo
ISidewa 1 k
------------
.IA/C Pavin9
....... I Curb cu;-
------------
I
COIllll/! nd
PJ'r Fpp
Res
Per Fee
Systems Development
Charoe tl. 5%)
PlUt1BING PERMIT
Charges and
Surcharges
ElECTRICAL PERI~IT
Charges and
Sur~~arges
MECHANICAl PERMIT
Charges and
Surcharges
Total Comb. rermit
TOTAl
53.03
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATIDN
I, Applicant to furnish
A, Job Address
B, Legal Description
1, example. Tax Lot 100, Lane County Map Reference
II 03 43
2, example- Lot I, Block 3, 2nd Addition to
Sprln9field Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examJPle- heat/electrical ceilinqjor forced air qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -----
I. .examole- 1250 sq, foot house, 500 sq, foot garage
2. examole- if new project. check-new - if addition.
checlc add, etc.
F, Building permit information:
1. examele - construct single family house with an
attached garage
2. exam~le - 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 (al 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 Plumhing, 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. ---
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 permit is issued.
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V, FOR OFFICE USE ONLY
Permi t
Clerk~.s>.._ ~_?
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
. Additional Project Informati'on:
name
~~/Ve~~~signature
_/1
~.....j~date /-;;;:-f"'"3'tC>
PLANS REVIEWED BY: