HomeMy WebLinkAboutPermit Building 1990-7-5
] INSPECTION LINE
726-3769
Job Address O~~~ \\,{\~N\\O YCL
tIIIt CITY DF SPRINGFIELD
COMBIIIATlON APPLiCATION/PERMIT
EIIERGY SOURCES:
Meat
l~ater Heater
Range
.
INFOR1<IATlON LINE
726-3753
Sq. Ftg. I.;ain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
-Fence Demo ChangelUse
Other- -
"
Legal Description /7..t:>'2-"3t? .-0, /J/9~
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Constr';cti n Lender ~ Gf147,
V~J{HoTn.co
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BuilriinQJPermit Info: Describe Workli.e..
Familv Residence With Attached Garaqel
Build Single
-
J
1~
.'
-
Address
DESIGN rEAr~
(name)
Phone
(address'
~ \ .
llli\~ \ 1QY l ,.~y If\O
.!2 ' (1;5)~)) (exoJ) - (DhO~ no.'
Electrical
..
..."..,../A
~
.~
Primary
Structural
Mechanical
CONTRACTOR~ (name)
General lU.1~
(address'
(1 ie5. no.'
(exoires)
(Dhone no.'
Plumbina
Electrical
~'echanical
PLUl1BIIIG
ELECTRICAL
MECHANICAL
NO.1
Each Single fixture
FEf C!lARGF NO <rr I rHARGr NO.
Residence of furnace/burner to
SQ. FT. BTU's
J:'H rllAQr,~
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
/1 bath\
Duplex (1 bath)'each
SERVICES
Recessed wall
~n~rp hp~tp~ ~nrl vpnt
Storm Sewer
,/ U,.....N ~~P7J.
Of
amps.
Appliance vent
seD!'Irate
Stationary evap.
cooler
Vent fan with
s;n~le duct
Vent system apart from
heatiOQ or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
r~$.,id_eJ'lce
multifamily, COnIn. or
[nrluc:;trial
Additional bath
Water service
COMl-1. IIND. fEEDERS
Install/alter/relocate
rlic:;trih_ fppdprc:;
Of
amps.
I SSUANCf OF PFR/IIT
TOTAL CHARGES
WIIERE STATE L\I~ REQUIRES
shall not be vali1 until the
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 EXMlINED the completed apf"llication for permit. and do hereby certify that all infonnation hereon is true
and correct, and I further certify that any and all work oerfonned shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the. State of Ore()on rertaining to the work described herein, and that NO OCCUPAI~CY will be made
of any structure without the permission of the [luilding Division. I further certify that my registration \'lith the Builder's
Board is in full force and effect as required by Or.S 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 7nl.055 will be used on this project.
Zone I>' I
Fi re Zone
Flood Plain
Tyoe/Const. ~..~
Bedrooms
Stories /
Units
Occy Load
Occy Group
SIGIIATURf
FOP. OFFICE USE OIlLY
Sn. Ftg. liain .r7~9l'
Sq. Ftg. Access
~--~ Sq. Ftg. Other
(fkl 1J 'k1
Dm 1-.5' qv
IIAf.lE(please print)
v
x
Value.-;><;I ~--'
- #/
Value
Value
x
x
TOTAL V ALUA TI ON
BUILDING PERfIlT
Charges an~
Surcharges
A/ - Plan Ck. ConmlInd
_L)!.!?_L(7~__ 65%/Bldo P!'r rpp
Plan Ck. Res
30%/Bldo Per Fee
Systems Development
CharQe (J.5~) - - .
PLU!~BING PERMIT
Charges and
Surcha rges
A/&> z:z:.-tF
__,)5-..:.._Z:..L____
Fence
D~mo
ELECTRICAL PERtiIT
Cha rges and
Surcharges
Sidewalk
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
Total Combe Permit
<C/7"- I
TOTAL PH';yEP . ~ ~
~/4P/4~ .1
'. AIC Pavi ng
.
COMBINATION APPLICATIONIPERMIT (CAP)
I. Appl icant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
II OJ 43
2. . .example- Lot I. Block 3. 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy,: Sources
1. examole- heat/electrical ceilinqjor forced air Qas
2. exampJe- waterheater/electricalior ~
E. Squar.e footage or valuation, etc.
1. example- 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. example - construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3. exam21e - 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
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. ---
III. Applicant to sign and date
Whenever possible, the initial application will be used as
a worksheet only. Where possible, Building ~ivision 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
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
J.
PERMIT VALIDATION
'.
:.;:.'
1-5-90
1/ rer@!
Permit Clerk
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name ~l?H6 /-1 ~6R
/'i' 'n ;? .
signature~ ~~~~ .~~~
-/-~ .,----
date
//-29~
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