HomeMy WebLinkAboutPermit Building 1990-01-10I NSPECT I
726-37 69 ICOMBIL
L 726-3753
ON IINE
Job Addrpss eZ/ 4*p<LG ? 5f Hea
Ranq
EIIERGY SOURCES:
l,later HeaterLega1 Descri ption
Sq. Ftg. l'1ain_
Sq. Ftg. access]
Sq. Ftg. 0ther--
_l,lew_Addal ter_Rep.
_Fence_Demo_C han gel U se
0therVa l ue of l,lork:ffirOwner
DescrtI .e., Build Single
-Addres s //w Bez->ter G,-\
Phone
M%-asa.7 ?-92/ar -
Constructi on Lender
--7
s
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N
Addres s Phone
exo t res phone no.addres sDESIGN TEAI4 name
Primary
Structura l
Electrical
Mechanical
exnl req ohone no.a ddrps s I ics. no.nameCONTRACTORS
Genera l
Pl umbi nq
El ectrical
MECHAN I CALELECTR I CALPLUI4B I NG
i
FFF CHARGFFFFl:I.{ARGF NOCHARGFNNFEE
I
furnace/burner to
BTU' S
Residence of
FTSQEach single fixture
Floor furnace
and vent
New ci rcui ts al ts.
or extensions
Relocated building
(new fix. additional)
Recessed wal i
Soace heater and ventSERV I CESS. F. Residence(l bath)
Duplex (l bath) each
Apol iance vent
spna ra t-FTemporary Constructi onAdditional bath
Stationary evap
coo l erChange in existing
rpsi dpncp[,later servi ce
Vent fan with
sinole ductmultifamily, comm. or
I ndustri a ISewer
Vent system apart from
heatinq or A.C..amps.0fStorm Sewer Mechanical exhaust
hood and ductCOMM./IND. FEEDERS
tJood stove/heaterInstal I /a l ter/rel ocate
di st-ri b. feeders
Z6--Vrm0fs,
(
/yxltg
ISSUANCF OF PFRIlIT
,@
TOTAL CHARGES
ea2€-TOTAL CHARGESTOTAL CHARGES
I,IHERE STATE LAN REQU
shalI not be vali'l until
IRES that tlre Electrical work
the label has been signed bY
be done by an,Electrical Contractor, the electrical portion.of t
an Electrical Supervisor and returned to the Building Division
S permi t
"r)S IGNA DATEt'lAl'lE(please print ,hw-
permi t
'formed
0regon
the Bui
ngfi e
struc
t heon reon trS ueathaLncertdoandfyhereb.yatconINEEXAMDpapcomp nance s thef cwlcet0rdhe tythhabenedonccordanaaworkndatthaaDerndafucertrtherndarrecc0tfy
wl madbe enanfdtha0cNOCYCUPAHtherwodekrscbedhere
ny
of rta n toStapenganddethwsLatheoftefoSpr
B ul rde strastontthehonfucrtherertthta0'0n f di Dr's fy reg im.yerm5swlturetthouhefngofany ha tandtonnohereontedbasforsethefexemptaredORS055701tha+
pr
ff'ndfunsrdBoaforcea tec se byrequ
n0 ht s ectberojancethwl7OPS0505acrstondawhoreanonsu bcon tr 0yees c0mDemply
Flood Plain Stories Occy Group Sq. Ftg
TOTAL VALUATION
x
Ftg
st Vai uits So. Ftg. l'lainZone
Fire Zone_pedrooms 0ccY Load Val ue
Va lu
Access
0the r
Svsteris Development
charqe (t.s/)'Plan Ck.
Plan Ck. Res
30%/Bldq Per Fee
BUILDING PERMIT
Clrarges and
Surcharges
Fence
DBmo
PLUI4BING PERMiT
Charges and
Surcha rges
Sidewal k
Tota'l Comb. PermitA/C Paving
ELECTRICAL PERt,IIT
Charges and
Surcharges
Curb Cut 26;.zSTOTAL
MECHANICAL PERMIT
Charges and
Surc harges
-?_?_,4
)e l.lorkI Garao
PERMIT VALIDATION
/2ea 2
/{P4r
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal DescriPtion
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
?examol e-
Sprl ngt'l
Lot 1. Block 3, 2nd Addition to
el d Estates
C. Name , etc. of owner and construction lender
D. En air gas
2E. sq
1 ga ra9e
a 'i tion,
F. Bui lding permit information:
I. exampie - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. example - convert singie family residence into
FesTiFant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural SH. DESIGN TEAM
pecial ty Code
AND CONTRACTORS
To avoid design or construction delays' Building
Division Staff must be able to contact appropriate
persons regarding design information or iob site
corrections, etc.
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 adiacent
to the appropriate item(s) to be installed
B. Ful I 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
ful I schedu'les
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the labe] must be delivered to the
electrical contractor for signature by his electrical
supervisor. The genera) contractor is.not authorized
to sign the electrical label.
Appl icant to sign and date
Whenever possibie, 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
s i gna tu re.
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.
II
III
IV.
V. FOR OFFICE USE ONLY
permit appl'icant exempt from registration with the Builder's Board because:
Additjonal Proiect Information
PLANS REVIEWED BY:
datei gnaturname
CITY OF SPRINGFIELD
Department of Planning and Devel^nment
Building Safety Divi
225 North 5th StreetSpringfield, 0regon 97477
726-3753 (sus. ) 726-3769 (Insp. )
OCCUPANCY INSP|_
APPLICATION
'l
SPRINGFIELD
OF Y ?2
DATE:o
JOB ADDRESS:JI 2
OWNER:[)
OI,INERS ADDRESS#
At^^arj.rr.
ol
APPLICANT:b
APPLICANTS ADDRESS:
FOR ACCESS To PRoPERTY--rLEASE TNCLUDE TELErHoNE NTTMBER, ]r\g*^ r.,IL
PROPOSED USE:6t"4r
A $ 35.00 INSPECTIoN FEE IS REQUIRED AT THE TIME
OF APPLICATION
THIS APPLICATION FORM MUST BE SIGNED BY THE Otr.INER OF THE PROPERTY TO
BE INSPECTED.
IGNATURE OF TY OI,ilNER t #\1-,r4,
FOR OFFICE USE ONLY
DATE OF I}ISPECTION:
DATE OF REPORT:
la t&qb RECEIPT NI]MBER:
DATE PAID , /2- '/'2D
DATE OF CERTIFICATE OF COMPLIANCE:
COMMENTS:
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