HomeMy WebLinkAboutPermit Building 1989-8-21
J-V
6 'I INSPECTION LINE
726-3769
01 f IJO
CITY OF SPRINGFIELD . INFOR/IATlON LINE 'I
COMBINATION APPLICATION/PERMIT 726-3753
ElIERGY SOURCES: r Sq. Ftg. Hain
Heat ~q:Ftg. Access.
Hater Heater Sq. Ftg. Other
lIew Add Alter Rep.
Range -Fence Demo Change/Use
val/Uj oh,(fJ.'OD Other- -
Build!nQ Permit Info: Describe Workli,e.. Build Single
Familv Residence I/ith Attached GaraQel
.h6rALL. 73-rL./-'~ ?~_ -,. C:>',~
~.P:n""..v....,,~' E...h"5",~ ~7, ":.'_ J7"
1'Z$'x ,/?,t
(1 ics. no.'
I
~
Job Address qua l1a',V) S=t
Legal Description /103 ;3,t)" L/-~
Ownerb),O"+Cl11 () 4 J-YV\~ orl-eJ M.doR..S
Address 9:(() ~ met 1\'") ST Phone
'l'1'"j-? 3'7tf
00
1&
I~
Construction Lender
Address
DESI~N TEAr~
{name}
Phone
(address\
(exnires1
(ohone no.
Structural
A
~>
Primary
Electrical
Mechanical
CONTRACTORS lnamel (address'
General 8.11 SlJn..,j PICl+1..- :ll1"lt'Y.lWJL.... Q.7e. 81IJ1WJ
{lies. no.'
(exn; re~ 1
(n~onp no. ,
3-L/S-4-34-7
rJO'>O,~
7/"'-3IQO
Plumbino
Electrical
~lechanical
PLUI1B I NG
ELECTRICAL
MECHANICAL
NO,
FEE CH~RGE NO
FFF r~ NO,
rf:'F' 'rH~
SQ. FT,
furnace/burner to
BrU. s
Each Single fixture
Residence of
Relocated building
(new fix, additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
,SERVICES
Recessed wall
"n;H'p hp;>tpl" ;tnrt vpnt
Storm Sewer
---~b I/~~>
Of
amps,
Appliance vent
s.epa rate
Stationary evap.
cooler
Vent fan with
sin9le d\lct.
Vent system apart from
heatinq or A.~.
Mechanical exhaust
hood and duct
.'
Temporary Construction
Change in existing
resicirpr:p
multifamily, conn. or
'nrtuc:.trial
~Ia ter servi ce
Sewer
CO~1,/IND. FEEDERS
Install/alter/relocate
distrib. fepdprs
Wood stove/heater
Of
amps.
v-- ~~....~" _ ..___
c.:::-.A/~b_U ,---,c".;--'il~-.F/
I SSUANCf OF PFRIHT
TOTAL CHARGES /7((6" ./b-::"",qp I TOTAL CHAAGES I TOTAL CHARGES P/H _ /s: '"2>
WHERE STATE L\\/ REQUIRES that ti,e Electrical work be done by an,'Electrical Contractor, the electrical portion of this pemit
shall not be va1i1 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 NO OCCUPAI~CY will be made
of any structure without the permission of the O~i1ding 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 r exemption is not hereon, and that
only subcontractors and employees who are in compliance with OPS 701.055 will be us ~~ ~
HAI'iE(please print) H<<a f-( S ;? Cl tA V SIGNATURE DATE 9iv-tC;
FOr. OFFICF~ >" j
~ ~
Sq. Ftg. t1ain x Value
Sq. Fta. Access x Value
if'-"2....Sq, Ftg. Othe~ .n"6':#~ Value /~..........-.,.
'-?tl. g/1 If0 _k.oL/#-ltIs"7~TAL VALUATION
v' 51'; /)~ 'Systems Development '
(I). ~') Charoe (1.5~ '
Zone /.../
Type/Const. ~ ~_lJnits
Bedrooms Occy load
Stories ~ Occy Group
Fi roe Zone
Flood Plain
BUILDING PER~IIT
Charges and
Surcharges
/'/>" ~ ' Plan Ck. Comm/lnd
__ 7?~:...':!l:?__ m/B1do Pyr Fee
,/ PlanCk. Res
,,-~ 30%/B1do Per Fee
___IS:- --
_ 7~ 0_
Fence
PLUI~BING PERMIT
Charges and
Surcha rges
\ELECTRICAL PERI\IT
Cha rges and
Surcharges
~ECHANICAL PERMIT
'harges and
'I,rcharges
'Sidewa1 k
.'~ i?"r?
/V_ '
___1-:..._______
_7S-
A/C Paving
Curb Cut
Total Comb. Permit
TOTAL
/2'2. 3;3
,
.--l
.
.
"
"
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
l. Applfcant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100. Lane County Map Reference
II oj 43
2. exam~le- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
'I. exam~le- heat/electrical ceili~c/or forced air cas
2. examDle- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I, example- 1250 sq. foot house. 500 sq. foot garage
2." example- if new project, check new . if addition.
cneck add. etc.
F. Building permit information:
I. examole - construct single family house with an
attached garage
2. examole - 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
Struttural 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. ---
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.
?jf i LjI~J
'.
V. FOR OFFICE USE ONLY
Permi t Cl erk
/Jj U _____
(
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit appli,cant exempt from registration with the Builder's Board because:
Additional Project Information:
name ~R~ 12c-<<-~
signature ~~~
'// ~
date ~'2/ ,.C'-;:
PLANS REVIEWED BY: