HomeMy WebLinkAboutPermit Building 1990-11-6
/
I INSPECTION LINE .
, 726-3769
Job Address l Q t n ';l. \fi) if\ ~ p 0 Q F
legal Oescription I' )()3~~r 101 eX"") -
CITY Uf SPRINGfIELD
COMBIIIATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Hater Heater
Range
.
INfORlIATION UN,
726-3753
Sq. ftq. f'lain
~q. Ftg. Access.
Sq. Ftq, Other
lIew Add Alter Rep.
-Fence Demo Change/Use
Other- -
Phone
....a
g
b
Build Single ~
, ffiu-i-nn1rz -f/(I J Tdf'p p~ t nil/' fU it; !
~
Owner, ~ '~S\\9 {"~'-\iYt_Q_/ '-- ~ ~
Addres~l () \ () ~ N\~ I. 1\
~\N\ (~'
Construction \en~r -,) ;gn
Va1~ y Qor~~'l)(l 00
BulldinCl Pennit Info: Describe l4ork(Le.,
Famil y Res i dence Hith .A.ttached Garaoe)
Address
UI:.~Il;jN II:.Af1
(name)
Phone
(address 1
llies. no.)
(exo;res)
(ohane no.-)
Mechanical
CONTRACTORSJ (rare)
Genera~ 1! J C J l'
Plumbina
(address)
(1ic~. nn.)
~
I
,
l~I~7q\! (Pg~~:t64{),
Primary
Structural
Electrical
015 (!Jrh )
.?lIX70
Electrical
~ ')C()~'o Q~ ')
Hechanical
plur,1BING
ELECTRICAL
MECHANICAL
NO.
FEF CHARGF NO
~I="L...c.I::JARG.E. NO
SQ. FT.
furnace/burner to
BTU's
..E.EL .QlARliE.
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or 'extensions
Floor furnace
and vent
S.F. Residence
(] bath I
Ouplex (1 bath) each
SERVICES
Recessed wall
So~rp hp~tpr ~nrl vpnt
Of
amps.
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan with
~inole duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and duC"t.
Wood stove/heater
Additional bath
Iwater service
I Sewer
IStorm Sewer
Temporary Construction
Change in existing
rpS,id~nC"p'
multifamily, COntll. or
lnrluc;trial
COffi1./IND. FEEDERS
Install/alter/relocate
rli~t.rih, fpprlpr~
Of
amps.
'-
l-~~~~.P~~<_
TOTAL CHARGES TOTAL C G I TOTAL CHARGES
WHERE STATE lAl~ REQUIRES that the Electrical work done by an Electrical Contractor, the electrical rortion of this remit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I SSUANCE OF PFR!IIT
I HAVE CAREFUllY EXAMINED the completed apr1ication 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 Springfield and the laws of the State of Oregon pertaining to the work described herein. and that- rw OCCUPAUCY 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 subco~tractors and employees who are in compliance with OP.S 701.055 will be used on this project.
HAlIE(p1ease print) ~E"J?I'IL/) 1 L; 111-(' SIG;IATURE~~ XX/.Mt..TE 11-6-9()
FOr. OfFICE USE mIL Y
Zone Type/Const. Units Sq. Ftg. Hain
Fire Zone Bedrooms Occy load Sq, Ft!J. Access
Flood Plain Stories Occ'y Group Sq. Ftg. Other
,
x
Value
Value
Value
x
TOTAL V AlUA Tl 011
BUIlOlUG PERI.IIT I cb) ::j ) _ Pl an Ck. ConmlI nd 4rL \.0::\
Charges an~ -- 65%1B1do Per FpE'
Surcharges 2).\6 Plan Ck. Res
30%lBldo Per Fee
PlUt1BING PERMIT Fence
Charges and ------------
Surcharges D~mo
ELECTRICAL PER;~IT Sidewalk
Cha rges and ------------
Surcharges Ale Paving
11ECHANICAl PERMIT Curb Cut
Charges and ------------
Surcha rges
Systems Development
Charoe (1.5~) ,
Total Comb. rermit
TOTAL
~blo.~\P
.
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax lot 100, lane County Map Reference
II uj 43
2. example- Lot 1. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
"1. example- heat/electrical ceiling/or forced air Qas
2. examoJe- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check-new - if addition,
cneck add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. examele - 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
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 permit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
l
PERMIT VALIDATION
C\O
\\,\0'
P'rnit CT",c~uiJ
I
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
. ~
date