HomeMy WebLinkAboutPermit Building 1990-7-20
] INSPECTION LINE .. CITY Uf SPRINGfiELD -------iIIIL INfOW1ATION LINt
726-3769 COMBINATION APPLICATION/PERMIT ~ 726-3753
Job Addre;-; L\4f'A.' \'\'(\ i f\ ~<)t)l Qffi ~~~~GY SODRCES: ~~: ~~~: ~~~~ss,
Hater Heater Sq, Ftg, Other
--11ew__Add__Alter~ep,
Range __ _~__ Fence Demo Change/Use
valt)of':IT). cl). Other- - . D
B'~JnO Pem'it info: Oescr,be WorklLe.. Build Single .t
~~'o~e1Pni\~rh ~t~d~~t(h.
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(lies. no.) (exllires'" _.., _':'lh01l~ "'0.
legal Description
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Owner (\\'\n~ uK 0~o t'5
Address 1)...0 ~ (I . {},Q.). \) Phone
c~{\)\l ~Jn Q141'x
Construction l\nd9[)
Address
Ul:.~ltiN TEAM
lnameJ
Phone
(address)
Primary
~ -
~
V
Structura 1
Electrical
Mechanical
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(exDires~
(nhone no.'
..Pl umbi na
Electrical
~1echanlcal
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ELECTRICAL
MECHANICAL
PLDlIBING
NO.
FEE . CH^RGF Nn
:...rrL' ..clJA.CF NO
FH' 'fU
SQ, FT,
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits a1t5.
or extensions
Floor furnace
and vent
S.F. Residence
(I bath\
Duplex (I bath) each
Additional bath
SERVICES
Recessed wall
Sn~ce he~tpr and vpnt
amps.
Appliance vent
c:eDaratp
Stationary evap.
cooler
Vent fan with
sin9'e duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
re~jqeJlce
multifamily, camm. or
Industrial
Water service
Storm Sewer
Of
CO~1,/INO, FEEOERS
Install/alter/relocate
dic;trih. fppdpr<;
Of
amps.
ISSUANCf OF PFRf11T
TOTAL CHARGES
WHERE STATE LAH REQUIRES
shall not be vali1 until the
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
, TOTAL CHARGES
TOTAL CHARGES
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 NO OCCUPAUCY will be made
of any structure without the permission of the ~uilding Division. I further certify that my registration with the ~uilder'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
:~11:(::::::t:::::~S a~ ;~~~~es Wh~::~n :O;~~~:~With :Pl:II::~~:55 ?led o2:::ject, DATE 1-~o-10
FOr. OfFICE USE DIlLY
Sq, Ftg, flain
Sq, Ftg, Access
Sq. Ftg, Other
Stories
Units
Occy Load
Occy Group
x
Value
Value
Value
Zone
Fire Zone
Type/Const,
Bedrooms
x
Flood Plain
x
TOTAL VALUATIOII
PLW1BING PERMIT
Charges and
Surcha rges
. CHI 5Q Plan Ck. COIlll1/lnd
__~~. _ ~/Rldo Pj'r Fee
\ I -:2 Plan' Ck. Res
1 . 0., 30l/BldQ Per Fee
Fence
syste. r:1S. Development
CharQe ll,5~) '.
BUILOING PER~1lT
Charges anC:
Surcharges
D~mo
ELECTRICAL PERfm 'Sidewalk
Charges and ------------
Surcharges AIC Paving
Tota' Comb. Permit
TOTAL
5\\6
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
r
.
.
I
~
--.-
.-
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
J, Applicant to furnish
A, Job Address
B. Legal Oescription
I, example- Tax Lot 100, Lane County Map Reference
II oj 43
2, exa~le- Lot I, Block 3, 2nd Addition to
. . sprlngtield Estates ..
C. Name. etc. of owner and construction lender
O. Energy Sources
1. 'examole- heat/electrical ceilinQ/or forced air Qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
I,' ~xample- 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 garoge
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
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 n~ed 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, BUILOING DIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEDULES
0, 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 permit is issued.
....
V, FOR OFFICE USE ONLY
Permit' Clerk
I
~\ \ffLJ
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
I ,