HomeMy WebLinkAboutPermit Building 1990-5-29
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i INSP~r.TiJN LINE
1726-3769
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CITY UF SPRINGFIELD
C0I1BIIIATION APPLICATION/PERMIT
EiIERGY SOURCES:
Heat
Hater Heater
\O\OU
(name)
Phone
(address)
INFDRlIATION liNt
726-3753 , fj'
Sq. Ftq. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other ""l
Ilew Add A I ter Pep. V
-Fence Oemo Change/Use
ValUE afro dJ Other- - ~
BU1101no rerml~escrlbe Work(l.e., Build Single -..:>
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}\\ \?b...m \
(lies. no.}
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Job ~.ddrEss
b6s 1n111i; sr
De,cription \ f")(")~ ~~ 3\
Ran~e
Legal
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Owner / sr / NT.../!. 51'./I'T'J::.
Address PO. 80Y: ~ I=?I
7>0 '27 Ul IJp (')~ ~oJ
,
f3fJtJ/C-
/_22~hon"2301
Construction Lender
Address
Ut>IliN TCAr4
(exnires)
{ohone no.
Structural ..j-c>h~ +I~rU2''c t:.. ?-{;,
Electrical 8<91.. 2. N/'$.I:TL 'i'- ..JJU J?1311/uJ
Mechanical 15/fL 2.-IJt'SE:k ..p Hut$MltJ)
CONTRACTORS Inamel (addr.s,l
General LEE g.uL.'" ~v.c7t2 70,60'1: 2/'137
{ViN
,
/,U, JI.4M~t-f'/f'
,
mck1tJly'sr EI/Gt!LJt:;
l\ Ll
"6).,'1 <;~Ov
6'0 0/'2.9
b 8''' Z Ii 7 6'
Primary
S?GO
,.
(lies. no.)
(em; ff>S)
(ohonp no.l
C'8'e- 20<./ Z-
Electrical
Scortl;ljj ~Ler..
-J..//I/lVez., ?/?lCC (0
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PLUIIBI NG
'3711 Wt IE
eUGI!:,,->t;;:
~'*~
fS6 8'10 12-
7'1'" IbZ.(
120GOJ~
PlumbiM
~1echanical
2.0 (t:;
YJu~Q~ r
, .
kI~
ELECTRICAL
MECHANICAL
NO.
FEE . CH~RGF NO
FFF rH~ NO,
n'!=' r~
SQ. FT.
i
furnace/burner to
<' 1"'~~BTU's
Floor furnace
and vent
6 CO' ::c'-l~ '
Each single fixture
Residence of
S.F. Residence
(] bath \
Duplex (1 bath) each
Additional bath
~ New circuits alts.
or extensions
? .p.q N7~ e
SERVICES
Z2.~
Relocated building -
(new fix. additional)
Storm Sewer ~
I
Temporary Construction
Change in existing
rp~ i qr,nce
multifamily, camm. or
Tndustrial
Of ?"7sr:- amps.
COffi1./IND. FEEDERS
Install/alter/relocate
distrib. feeders
5'Z.B. '
Recessed wal'
~l?<}('S' l'jf"t,:lC ~nr1 '!.ent .1
"'4"G~ .."., ex.7l!f?Y.R
~v.:::rJvP~
Appl iance. vent
Sf'!oarittp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
hea t; nq or A. C.
Mechanical exhaust
hond anri rlurt.
'6.~i>
Water service
Sewer
Wood stove/heater
L Of --:z.~&> amps. ~s< t../ d:45 L;;w-N<!ZT......".. r :2.. -
.:l.,~ ; "I::l.~I, ~~~c::T?'f/L#L. ~ "n..,.,~'
Gi\ I b ,."~~ #_/....../..v Al--:>.<:5~~
";:)'1'VlAv-nw...... -'"'-_. ~ .....-
OJ'" _ '5<I-oM<;"'",( ~ Glol.<J 7~;q~ / 77' ISSUANCf OF PFR!\IT
TOTAL CMARGES ~ TOTAL CHARGES 97,:5"'&>, TOTAL CHARGES ~2. ,17
WMERE STATE L\l~ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pemit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
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I HAVE CAREFULLY EXAUINEO 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 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 UO OCCUPAUCY will be made
8 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 used on this project.
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1lAf.IE(please print) (.:,el:!I'H....P L. ; 1/,'<:: SIGIlATURE ~ ;{,. ;t:,~
FO~ OFFICE USE OIltY
DATF~''2''1-90
Zone Cc.. Tvpe/Const. _Uni ts Sq. Ftg. Hain x Value
Fire Zone Bed rooms Occy Load Sq. Ft9. Access x Value.
Flood Plain Stories. ;? Occy Group 11'- ? Sq. Ftg. Otherf!?€~<!:>D€,,( Value~"~. -
TOTAL V ALUA TI ON
PLUt4BING PERMIT
Charges and
Surcharges
~ Plan Ck. Comm/Ind
___2'LL~___ 65%IBldo p.pr F..
Plan Ck. Res
/ &.t6S" 30%lBlda Per Fee
Fence
. ~4Q. ~~
'Systems Development
Charae (1.5~)
BUILDING PERfllT
Charges and
Surcharges
D~mo
ELECTR ICAL PERIIIT
Cha rges and
Surcha~ges
rlECHANICAL PERMIT
Charges and
Surcharges
'Sidewalk
~2 ~ Curb Cut
___-:t:__:.a_____
/. bt:J
TOTAL
'125":2 :)'
~67, 7cJ
A/C Payi ng
Total Comb. .Permi t
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COMBINATION APPLICATION/PERMIT (CAP)
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I. Appl icant to furn-ish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, lane County Map R~ference
1/ 03 43
2. exam~le- Lot 1. Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and constructiori lender
O. Energy Sources
1. example- heat/electrical ceilinqjor forced air Qas
2. examjle- waterheater/electrlcal/or ~
E. Square footage or valuation, etc.
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if a~dition,
check add, etc.
F. Building permit information: ,
1. example - construct single family house with an
, attached garage \
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 TE~I 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'.
fu 11 schedu 1 es
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. ---
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
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 OSE ONLY
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PROJECT CONDITIONS TO BE SATIS~IED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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rf)J 01" OJ Q 1J Ca ()
rLa/~ I '
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Permit Clerk /l11J.Mv1
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Permit applicant exempt from registration with the Builder's Board ,because:
Additional Project:lnfonnation:
PLANS REVIEWED BY:
:~ame'~HE R.~~ Signatur~..2-
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/-"'~ date 6--;:('0.?c:>
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