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HomeMy WebLinkAboutPermit Building 1990-4-3 CITY Of SPRINGfIELD CqMBINATION APPLICATION/PERMIT EilERGY SOURCES: Hp.at Hater Heater Ran~e . '...... , INFORllATlON LINt 7?~-,7,1 Sq. Ftg. f;ain-'. ~q. !=t!]. Access. Sq. Ftg. Other flew Add Alter P.ep. --Fence Demo Change/Use Other- - ValuEl'lf 1)1[~ ci:) <. l,r.1.-{ I Bundin\! Penn1t info: Describe \~ork( Le., Fami1 v ~esidence IH th Attached Garaae) Build Single c I~ (J Address Ul~lliN rE:.Ar~ (name) \Z~r Phone (address) I_diDO" rif? f1 ics. no.l '''O;"~'""l2f::n.l Primary r,~ ~N-3 \f?)g. 1\1.\.) O\\Of<ttN Structural Electrical Mechanical CONTRACTORS lnamel General R()~ E (,>M At.oI\H~ Plumbina \ ~ r~~es~, W {)l \/){JlI~r: ~V~t~ N1pxn4Rto9.'L (2:; ~2'y;t ,wr 8,14 jqr Electrical ~1echanical PLUlIBI NG ELECTRICAL MECHANICAL NO, FFF r:HARGF ~n eEL.tIlAIlliE. NO t:'n' ru~ Each single fixture Residence of SQ. FT, furnace/burner to BTU's Relocated building (new fix, additional) New circuits a1t5. or extensions Floor fu rnace and vent S.F. Residence (j bath I Ouplex (1 bath) each Additional bath SERVICES Recessed wall ~n~rp np~tpr ~nrl u~nt Storm Sewer Of amps. Appliance- vent ~~oaratp Stationary evap. rflfllpr Vent-fan with sinole duct. Vent system apart from I heatino or A.C. Mechanical exhaust hnnd and rtllrt Sewer Temporary Construction Change in existing I"P~ j d_p)'Irp multifamily. camm. or I nrtus tri ill ~!ater servi ce COMfl,/IND. FEEDERS Install/alter/relocate di~trih. fppdpr~ Wood stove/heater Of amps. I SSUANCf OF PFR!1lT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L~W REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit f' 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 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 OCCUPAllCY will be made of any structure without the permission of tthilding Division. I further certify that my registration with the Builder's Board is in full ill fr and effect as required y ORS 701.055, that if exempt the basis for exemption is noted hereon. and that only subcontractor an ,playees who are in om! liance with OP.S 701.055 will be used on this project. , ~ Q IlAlIE(please print. . ,A1V\1\ ~, ~IGfIATURE ~I'\ n\.. \\.'lBA~ DATE..2Lla\ q6 I FOP. OFFICE USE OiILY I Type/Canst. Units Sq. Ftg. t1ain x Value Bedrooms Occy load Sq. Ft~. Access x Value Stories I Occy Group dIl-"'3 Sq. Ftg, Other #-~/ffi'~ Value 9~,~ U ' TOTAL VALUATIOtl Zone <<:::: c.. Fire Zone Flood Plain BUILDING PERHIT __'5-~_C2!?__ Plan Ck. COIllll!l nd ::2:"5"'..0 ? Cha rges an':: 65%/Bldn Ppr Fee Surcharges ~9;3 Plan Ck. R-es 30%/Bldo Per Fee PLU>~BING PERMIT Fence Charges and ------------ Surcharges D~mo {, ELECTRICAL PERI:IT 'n~~~~ Sidewalk Cha rges and SurCharges - A/C Paving - MECHANICAL PERMIT Curb Cut Charges and ------------ Surcharges Systems Development Charo. (1.5%) #.~ . Total Comb. rermit TOTAL b;5"; Yrb . e ~,. _... .. - . -- , . COMBINATIG:i APPLICATION/PERMIT (CAP) -; I , PERMIT VAll DATION ~ I. Appl icant to furnish A. Job Address B, legal Description I, example- Tax lot 100, lane County Map Reference 17 D3 43 2. example- lot I. Block 3, 2nd Addition to Sprlngfield Estates C. Name. etc. of owner and construction lender D. Energy Sources L exam~le- heat/electrical ceilinq/or 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. example- if new project. check-new - if addition, cnecK add, etc. F. Building pennit information: 1. examole - construct single family house with an attached garage 2. exa~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 (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 -*' l (;<;tl( ~ Permit Clerk ~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Pro~ect Information: . PLANS REVI EWED BY: '.' name , , ~ /" &gnfF ?~~Signature~../1"~~~ date _ ( ;-- '-, v ;- - ?-?~ ~