HomeMy WebLinkAboutPermit Building 1990-5-2
Owner D tit..- CO<r'tUJY\
Address L /; 1 In I S e- maO ( e- h UI\5-r-
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Construction Lender
Phone Wi3-
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~q. Fig. .cces~._
Sq. Ftg. Other '
Ilew Add Alter ,Rep.
0_. FencLDemo_Change/Use ()
Val~2)n ~ _Other --=-- ,
Bu,'o,no Permit Info: Oescr,be Work(i.e., Build Single I" ~
J~~~_t2~~r
I
Range
I INSPECTION LINE
, 726-3769
.
CITY OF SPRINGFIELD
CDMBIIIATION APPLICATION/PERMIT
EilERr,y SOURCES:
Heat
I~ater Heater
Job Address 9;-70 VYlr.!XV\ st- _ _
Legal oescriPtion\1 \O'~~A 1)~(<f1J
Address
DESIGN IEAI1
\
Phone
(address)
(1 ics. no.)
(hnirt:s)'
(ohona- no.,
(name)
Primary
Electrical
~
(~tl\~~^iMi;;:sV() t~'Ld\Q'44.b~ k024n 34:~~qm
-, ~ -. I, llft{()S/I~fqn .
, r I I
Structural
Mechanical
CDNTRACTDRn1 ,(name)
GenerA./'K. ). _ -:LA AI Q )
Plumbina (j-
Electrical
Mechanical
PLUIIBING
ELECTRICAL
MECHANICAL
NO.
FFF CHARGF on
cF, fHABJilC-PO
~~I=' rJ:fARG.E..
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building -
(new fix. additional)
New circuits a1t5.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bathl
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~rp hp~tp~ ~nrl vpnt
Storm Sewer
Of
amps.
Appliance' vent
",PDaratp.
Stationary evap.
r:nnlpr
Vent - fan with
~in~lf:" ~l'~t:
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
~p} i dJ'J1/'p
multifamily. comm. or
Tndu...tr;~l
Water service
COMfl./IND. FEEDERS
Install/alter/relocate
di...trih. fppdprc;.
Of
amps.
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
ISSUANCE OF PFRlllT
TOTAL CHARGES TOTAL CHARGES
that the Electrical work be done by an. Electrical Contractor. the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED the completed application for permit. and de 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 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 this project.
IWIE (p I ease pri nt(/ J!h c,Jooo lAo/>oaJtt.hadlll SIGrIATUR\..~!~...r,~~~ DATE<;="2 ~O
FOr. OfFICE USE OfILY
Zone Type/Canst. Units Sq. Ftg. r-\ain x Value
Fire Zone Bedrooms O.ccy Load Sq. Ft~. Access x Value
Flood Plain Stories Occy Group Sq. Ftg. Other , Value
TOTAL VALUATIOIl
BUILDING PER~IIT -0f~2f~- Plan Ck. Conm/l nd
Charges an~ 6S%/Bldo Ppr Fpe
Surcharges Plan Ck. Res
3D%/BldQ Per Fee
PLU'~BING PERMIT Fence
Charges and ------------
Surcha rges D~mo
ELECTRICAL PERIHT Sidewalk
Charges and - --- -- --- ---
Surcharges A/C Paving
MECHANICAL PERMIT, Curb Cut
Charges and ------------
Surcharges
'Systems Development
Charpe (1.S~)
Total Comb. Permit
TOTAL
1. 4\) 1~
.
--
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
I, exampl~' Tax Lot 100, Lane County Map Reference
17 UJ 43
2. example- Lot L Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender.
D.' Energy Sources _ ! <
"1. examele. heat/electrical ceilinqlorforced air qas
2. example. 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.
check add, etc.
F. Building penllit infonnation:
'1. examole - construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3. exa~le - 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 ~ivision
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
O. 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. ' ---
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 penmit is issued.
.~':,; -
III.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
.,..--
II .' ,.
"
, PERMIT VAll DATION
(' ' J '
Sr2~qO
# \ GC2f
Pennit
Cl",eilm )
-
.
Permit appl i cant exempt from regi strati on with the Buil der 1 s Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name
signature
.
date