HomeMy WebLinkAboutPermit Building 1990-9-12
I INSPECTION LINE l' L. CITY OF SPRINGFIELO .. INFORllATION liNe I
726-3769 l1li' COM~INATION APPLICATION/PERMIT 726-3753
Job Address,-~LfCj~ ,I YJ(l/lQnU U. E~;~GY SOURCES: ~~: ;~~: ~~~~ss. J:J
Legal DescriPtion!' )rv.r 8DC[) ('ir"'\',,('Y'1ater Heater Sq. Ftg. Other D
I .Jt7\ .A ~ ) _ {an~e Ilew Add A Iter Rep.
- -Fence Demo Change/Use
I va}j{),(J(f),od, -Other- - 0
BUiloind Permit Info: Describe Work(i.e., Build Single ~
t F~l ~~d~CO I~i~~h\~ Gar~~r1 it1rJilS ~'
-
owner-n\ <l. .\.'fu VCiJ \ ~O f\\ QJ? )
Address ?{)! Y s. "'r\11 ^ rIll [)hone)
~ro ' , UV ~q1tJB
construc~~) I
Address Phone
Ut~Il.iN 1~t:N1 (name)" ~addr.ess} (lies. no.) (exo;res) '~hr:~~ "0."
primarYU\\~_~t~()'W, \~()~\(\Y~J\f\~~ r J ,Ii. rA-~-lQoloq____
StructuralU-.{~l(L\lQ n I, \~ Db('{\. "'V \~ffic)\\, _ \ ~ ~ w'\ LL
Electrical () ~ ~
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....j,~LL ~~/AY' #1
~ ~l0',w;/ ~ ~~ 1"~ .J?":' ISSUANCF OF PFRIHT
TOTAL CHARGES ~_""". TOTAL CHAR~ES TOTAL CHARGES .):O1'~""'" /<: ~
WHERE STATE LAW REQUIRES that the Electrical work be done by an, Electrical Contractor, the electrical por{ion Of'tfiis permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
11echanical
CONTRACTORS . ~ame 1 ,
General aI\ rt ~~ W ~ .
Plumbino. fr~, ) \ \ fu.b1JJt);
El~ctrical ~ Y ~~f0 ~
~1echani ca I <c:\r{\ 9--\\'
PLUll~NG
NO,
FFF CHARGE
'I
Each single fixture
?~ "3t?
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath)
each
Additional bath
,
Water service
Sewer
Storm Sewer&~~' ~
l~i~rH\n r fW('^~,b
~\t\fl If z. N\(\ t f\ J 6~ b
~NYJ \.0\1. \ \~ 0 st{Y~ l?., G
(exoirec:,\
~n~1.;51oL
, f\4V'\ ~~qCXq
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4 'fA ..Ll~'S5\
ELECTRICAL
MECHANICAL
Nn~1
Residence of
rHARGE. NO.
FEF
FEF
r"~
furnace/burner to
aTU1s
SQ. FT.
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~cp hp~h:>r ~nrl
----
~',~j
Appliance venf.
c:,eo~r~tp
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and durt
s:<<1>
~
Vj:>n!
Z1.. '77"" ~~
Temporary Construction
Change in existing
res j rl_e]lcP
multifamily, COIl1T1. or
Industri~l
/
Of
'l.mps.
CO~1,/IND. FEEDERS
Install/alter/relocate
dic:.trih. fPPdprc:.
Wood stove/heater
Of
amps.
I HAVE CAREFUllY EXM1INED 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 oerformed 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 Builder1s
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 OP.S 701.055 will be used on this project.
IlAl-IE(please print) WI ARII,i{t..J ~/.dl.vA<9-A{A") SIGII^TURE~.l~100v1A.A,,~ DATE--=t:.f;:> -90
FO~ OFFICE USE ONLY
Zone-/i-l
Fi re Zone
Flood Plain
Tyoe/Const..~~
Bedrooms
Stories /
BUILDIIIG PERI1JT
Charges and
Surcharges
-_Jl!t5=~_
/7./S-
L2?&JC?
____vv....
Z~
PLU'iBING PERMIT
Charges and
Surcha rges
ELECTRICAL PERIHT
Cha rges and
SUrl;ha rg~s
rlECHANICAL PERMIT
Charges and
Surcharges
----/~~~
,:/5
Units Sq. Ftg. r1ain x Value
Occy load Sq. Ft<1. Access x. __ ~e
Occy Group€--?_sg. Ft~. Other~ ~'f"~ue ~,c;:: _
f'f.\~~\\L.A.pA.qf) "IS I~T~VALUATlON
Plan Ck. Corrm/lnd \'}" L\ n~' ISystems Development ;"-'" ~ _
65%/Bldo Ppr Fop / --y C l\ '-'\::- '\ CharQe (1.5~) ,"" ;:> c.,.t.
Plan Ck. Res - I
30%/BldQ Per Fee
Fence I.
Demo I
Sidewalk I.
AIC Pa~i ~g _
Curb Cut
ITo_t~l. Comb. Permit
I
I TOTAL
,.......
{~
'.
. ~::?&. '7'.0
/1f7~ 7"b
..
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
2. example- Lot I. Block 3, 2nd Addition to
;' Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinQ/or forced air qas
2. examyle- waterheater/electrica(/or solar
E. Square footage or valuation, etc. - .
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition, .
check add. etc.
F. Building pennit information:
1. examele - 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. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division 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 penmit 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 SCHEOULES
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. ---
III. 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.
V. FOR OFFICE USE ONLY
PROJECT CONQITIONS TO BE SAT}SFIED BEFORE OCCUPANCY:
II
'I ,I
PERMIT VALIDATION
1-/2.--.7 ().
Gkvtv-.
~-tc.e~t* ;\:J::(' [ ~Z-7 L
Pennit Cl erk (J.A;v ~
l
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Permit appJicant exempt from registration with the Builder's Board because:
I
Add-itional' Project Infonnation:
PLANS REVIEWED BY:
-,
.' na~~ -~~~~~~~s;gnature
~?~~J:)
{' , -., .:
r
date
9-? ""!7t:J
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