HomeMy WebLinkAboutPermit Building 1990-11-20
I INSPECTION LINE
726-3769
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Legal Oescription \ i) U ~ '2)~\ ()"2JfJ(j
owner\;(j "~\'Ill\(\ ~.~ tt\
Address ~ 1 ~~ 1)f) i N b g- Phone
ce,~~tV~ \ ~~4~~1~~4
-/-/ - 1210 Z C( Q,~
(address)
CITY UF SPRINGFIELO
COMBIIlATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Na ter Hea ter
Range
INFORlIATION LINt
726-3753 .
Sq. Ftg. '.Iain r-.
~q. Ftg. Access. ~J
Sq. Ftg. Other r ~
New Add Alter Pep.. ~
-Fence Derro Change/Use ___
V I f W an -Other--
aF!<r: . _ ,CD ~_Q
BuilciinQ ~nnit Info: Descrlbe Work(i.e., Build Single r
Fauiwi;j O:~tachU;MJ? ~ J}L
u nlTht'\ "t ~ -I . ..
a
Job Address
=
Address
Ut>J(iN IEAr~
(name)
flies. no.l
(exoiresl
. (nh(lMp nn \
Primary
-~
--y~
Structural
Electrical
Meehan; ca 1 I
CONTRACTOR; i\ (~ame I
General Qjl.0~
(address)
l1ies.no.)
(pxnirps)
(ohonp nn. \
Plumbina ~. \v .
. '
Electrical'- _ ~.
~Iechani~al .; \)Q i ^C\--?n\~
. PLUlIBI NG \J
ELECTRICAL
MECHANICAL
NO.
FEF CHARr,F Nn
~~~ r~AR~~ NO
~~I=' r~.lUU~~
IS
Each single fixture
Residence of
4a-e I~
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bathl
Duplex (1 bath) each
SERVICES
Recessed wall
<:n;:lr'" hp;:lt.,... ;onrt ".,.nt
Storm Sewer
L~~UY/~~
Of
amps.,
Appliance vent
<;POfir;:ltp
Stationary evap.
cooli='r
Vi='nt fan with
sinoli=' duct
Vent system apart from
hi='atina or A.C.
Mechanical exhaust
hood and duct.
Wood stove/heater
Additional bath
Sewer
Temporary Construction
Change in existing
rp~irlJ'J1cP
multifamily, corrm. or
Tnnll"t.ri"l
Water service
/~-
COI~1./IND. FEEOERS
Install/alter/relocate
rli"t,rih_ fpprlpr"
Of amps. I ,:;
& -",...../?.#C ;.-:;;;~ ~~ ~
~~/~~..."..A7.~!Z
~~/7: I .
M~ .9> 3'~~
.ar-~E,oy .~ 3.-
.J./~ . -:>0 $S~
l/...cz.//.J/_AA . c;---o _ ':C.'_.o.c
ISSUANCE OF PFRtllT /b.:".:)'
TOTAL CHARGES
. WHERE STATE L\IJ REQUIRES
shall not be val;1 until the
/90.- TOTAL CHARGES TOTAL CHARGES 22 S-=
that the Electrical work be done by an.:Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Oregon pertaining to the work described herein, and that fW -OCCUPAUCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
Board is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and that
::III:(:~::::t:::::~S~d(~:; ~hO ar~in ~O:~~With :::II:::R::JZ ~hi;kr- omlr Od/{J
FOr. orF! CE USE DIll Y -. .
Units Sq. Ftg. t1ain x Value
Occy load~.. ~~q. Ftg. Access x Value
Occy Group "21-2 Sq. Ftg. Other~ x;>~"Value..8P~-
:U- t63 ~ DcA Uc q_ _~~1:1MATIorl .
Or I.I-l" /\.~ \ Sys te. ms Oeve I opment
\ ~~.) CharQe (1,51) .
zone~~~/'~TYOe/const.
Fire Zon~ Bedrooms
Flood Plain Stories
~-t:;>-/-Y
-:2
BUILDING PERflIT
Charges an~
Surcharges
--:277- Plan Ck.
.? 7- 65%/BI do
----/$~6? ~6~~Bi~~
____i2.t;?.=.~ Fence
"'7. S.c> D~o
Conm/lnd
Ppr ~~e
Res
Per Fee
PLUf1BING PERMIT
Charges and
Surcharges
ELECTR I CAL PERI~IT
Char.ges and
Surcha.rg~s. ."
I1ECHANI CAL . PERMIT
Charges and
Surcharges
'Sidewal k
AfC Pavi n9
____::?Z.2~_ 'Curb Cut
1.58
. .T9t~J Gomb.. .rermit .... '_...,.,,\. .
-- TOTAL 162e>. 05
.
I
I
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100. Lane County Map Reference
II oj 4j
2.exam2le- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources .
1. examDle- heat/electrical ceilinQ!or forced air oas
2. examPle- waterheater/electrical/or solar
E. Square footage or valuation, etc. -----
I, examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. checklruew - if addition,
check add. etc.
F. Building permit information:
1. examele - construct single family house with an
attached garage
2. exam~le - 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 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
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 chock 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
. p~yable when the permit is issued.
V. FOR OFFICE USE ONLY
. .
. .
P~OJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,
~
PERMI.T VALIDATION
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Permit Cl erk
,
Permit applicant exempt from registration with the Builder's Board because:
,l\dditi ona 1 Project. Informati.on.:.
PLANS REVIEWED BY:
name L...,RHcF 11:.. ~,g?\
Signatur~-,,_~
~/ /'
r
date /O~9-9C>
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