HomeMy WebLinkAboutPermit Building 1989-3-10
I INSPECTION LINE
726- 37 69
.
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
\~ater Heater
Ranqe_
Valuf of Hork:
.
INF0R11ATION LINt
726-3753
Sq. Ftq. 1,1a i n
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter- I~ep.
--Fence Demo Change/Use
Other- -
~
~
~
Job Address '20.:;0 /77A'Rc:.4<;1L- );:-2:> .
Legal DescriPtion/7-&'~'2.~~ .7/.,;7...1' 9~
Owner ,h0L.~~X/ fr~;P~7/r5 "":/.W:
Address '7.?d XI' ~.... fic,,'-"'7'\.l)<;> Phone
;:z.=",-,,< ' L7.A> - 972/'/
Construction lender I'
BuiltiinQ Penmit Info: Oeser.be Workll.e., Build Single
Familv Residence With Attached Garaoel
~ hv5':i!1'k
~ ~ . .
~:!7.?..aoL~ <n>. ~~~~
Phone &~ ~ JJ;-/~L.Z?/~ )-!')',v> .
(address) 111cs. no.) (exnires) (ohone no.l
?'f7/ '<;)F'!P-~. ::;'6' .
PrimaryW-"'5r~.-'-~,-/N,B~/~~. ~=-___..-<>A ~:;:>";7c:::>
...
,5:',.. ._:>-A ~Lv. r/J
Adtlress
DES I GN TEAr'
(name)
;s- "g .>-- ;:;> v.?S-'
".
Structural
.~~
.q~
Oks. no.1 (~pires.)
(ohane no.)
Electrical
Hechanical
CONTRACTORS I name J (address)
General :P~TA ~-r:~R~O/( 41/L? Zl<'<5'<"/V:
7"tt:/-z~
Plumbina
Electrical
~lechanica 1
PLUllR !rIG
ELECTRICAL
MECMANICAL
....ill'
I FFF rIlARGE.J!(l
rn r~o\RG..E. un
n~ f'uo1R.G(
sq. FT.
furnace/burner to
BTO's
Each sjngle fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(j bath)
Duplex (I bath) each
Additional bath
SERVICES
Recessed wall
Soace heatpr ~nrl vpnt
~Iater service
ITempOrary Construction
IChange in existing
res i Qf'nce_
Imultifamily, conln. or
lnc1ustrial
IOf ;:!ml1s.
C0/111. /I NO, FEEDERS
Install/alter/relocate
rli~tr;h, fpprlprs
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hond ~ nd riue- t
Sewer
lStorm Sewer
Wood stove/heater
or
amps.l
I
I
I
I SSUANCF OF PFRllI T
TOTAL CHP,RGCS TOTAL CHARGES TOTAL CHARGES
WHERE STATE L.\l.J REQUIRES that tile Electrical work be done by an Electrical Contractor, the electrical portion of this perlilit
shall not be valH until the label has been signed by an Electrical Surervisor and returned to the Building Division
I HAVE CAREFULLY EXN1INED the completed ap['llication for permit. and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work nerformed shall be done in accordance with the Ordinances of the City
of Springfield and the LaviS of the State of. Orel)on pertaining to the work described herein, and that UO OCCUPAllCY will be made
of any structure without the permission of the [!uilding Division. I further certify that my registration v/ith 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 emrloyees who are in compliance with OP.S 7nl.055 will be used on this project.
1lN-IE(please print)ELkL~t;.J(-'
SlhlIATURrCl2u!/ (2;J)~'p
DATE 3-lo-'i?9
Zone 6C--
Fi re Zone
Flood Plain
Tyne/Cons t.
Bedrooms
Stories
. Units
ro~ OfFICE USE OIlLY
Sf!. Ftg. riain )(
Sq. FtQ. Access x
Sq. Ftg. Other~~4'__:-" N-&:L
~-/S-:59
REL,j":1-,zO<'/ .c..7(:
Plan Ck. Comm/lnd" ____ syste.ms Developme:Jt
65VBldo Per Fee =>~..- CharQe (J.5~l
Plan Ck. lies " "i7 :;;7-
30%lBldo Per Fee e_()FWi'!"~
Fence I ~~~.....iJ_.,
I
I~~~,t~'t"'/~P,?;~".d'r~ &~75;
I . Total Comb. Permit IL-
I l~r.(EI"7' ...L.~#?'~ I
I I TOTAL IYL~.
Value
Value
Value
.Occy Load
.Occy Group
TOTAL VALUATlOtl
BUILDING PERI,UT
Charges an~
Surcharges
"
Demo
40.. -0 \.
/&p..:r= .
'. //
PLUt1BING PERMIT
Charges and
Surcharges
----------....,..
EL[CTR I CAL PERI:I T
Cha rges and
Surcharges
;
------------
I Sidewalk
I A/C Paving
I Curb Cut
I
11ECIIAN I CAL PERM IT
Charges and
Surcharges
.
,COMBINATION APPLICATION/PERMIT (CAP)
Ie Appl icant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100, lane County Map Reference
II oj 43
2. examEle' lot 1. Block 3, 2nd Addition to
,pringtield Estates ,
C. Name. etc. of owner and construction lender
D. Energy Sources ' "
1. exam~le- heat/electrical ceilinq/or forced air qas
2. example- waterheater/electrlcal/or solar
E.,- Square footage or valuation, etc.
1. examole- 1250 sq. foot house, SOD sq. foot'garage
," 2. example- if new project. check~w - if addition,
cneck add. etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. exam~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. OESIGN TEAM ANO CONTRACTORS
To avoid design or construction delays. Building
~ivision Staff must be able to contact appropriate
persons regarding design infonmation 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 fonm 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. ---
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 penmit 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY;
,
PERMIT VALIDATIpN
~ ID,R&C1
,
~~33<sq
,
Permit Cl er
Permit applicant exempt from registration with the Builder's Board because;
Additional Project Information;,
PLANS REVIEWED BY:
. name.i.&A'#~ h~
signature /2,,~~
7// ./
date 9-9-:f5'9