HomeMy WebLinkAboutPermit Building 1990-10-29
I INSPECTION LINE . CITY Uf SPRINGFIEI.D . INFORl1ATION l.lNt
726-3769 COMBHIATION APPLICATION/PERMIT 726-3753
- E!IERGY SOURCES: Sq. Ftq. 1.lain8.-.!5"Y~ ~
Job Address L/~ 9'2 ,.x/7A"/~ 57":, Heat ~q. Ftg. Access. \,,)
I.egal Description 17-o:;;>-~2''f':;>/ &6 ~.c:> l'later Heater Sq. Ftq. Other ~
/- Range --1lewc.Add _A lter _Pep. '~' "'
Fence Demo Change/Use
Va I u€ of Hork: Other - -
Owner r;M I~/L.~A;/ 17,? 26. V?>
Address ~ 77 -" """ /" ob ~ =/ Phone Bundino Permit Info: Descr be Hork(Le.. Build Single l'i'
7 ~~~ ,~ ~~ Familv nesidence With Attached Garaoel \f
?PP,t2:::'. ~/? ?7'1"'>B ?~..e>~.ss ,lpn g&o/LJ' ~,.rnVrcF -/zjPJ?~'
Construction Lender k F/4S/'7.i<'A"> ~,rp /~/~
-5"~;i>, . //
~ (lies. no.)
Address
Ut~IGN TEAI~
(name)
Phone
(address)
(~'l(~:d res)
(nhnn~ n~. i
Primary
Mechanical
CONTRACTORS Inamel
General ;?~ .tf'c?A"A"/"S.r-c::!-_/.
(address) _ f1 ics. nn.)
,=<,~!;~,..y~ ?jlh"P>,r
."AIC'LJ'::> 6/<. / 5./':;?/3,_
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~9-'/ '7s/.,(--:v-:?-;>
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Structural
Electrical
Plumbina
Electrical J~"""'~~ ~~. 5~s7"'~.
~1echanical
PLUIlBI NG
ELECTRICAL
.MECHANICAL
NO,
FEE
CHARGE
Nn.
SQ. FT.
INO.
I
I
1
I
1
1
I
...
r"1\B.IiE.
Each Single fixture
Residence of
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits a1ts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath)
Duplex (1 bath)
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
each
Additional bath
Appliance vent
5f'lOaratp
Stationary evap.
cooler
Vent fan wi th
c:.innle duct
Vent system apart from
, heatinq or A.C.
I Mechanical exhaust
hoori tlnd duct
Install/alter/relocate I Wood stove/heater
distrib. fppdprs
Of amps. ?k-~~,..:;;;;:;.
E.:: E?;;,7';I!;>/~ <' ".-::;~ ~ ~V/C&
.y"/,, ~7'7h9' A f~~l.
~ii7~;~ . H. I
Temporary Construction
Change in existing
rps i (tp.nrp
multifamily, COITm. or
lnrlust.rial
Water servi ce
Sewer
Storm Sewer
Of
amps.
I
I
~I
k-~~.
I -
ISSUANCr OF PFRt1IT / ~ -
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES 7~ . cs-e.
WHERE STATE L'\l-l REQUIRES that the Electrical work be done by an 'Electrica1 Contractor, the electrical portion of this permit
shall not be va1iJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
COfolJ.l,/lND. FEEDERS
I HAVE CAREFUllY EXAMINED the completed aPr1ication 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 Spri ngfi e 1 d and the laws of the Sta te of Oregon perta i ni ng to the work descri bed herei n, and that. rw OCCUPArKY wi 11 be made
of any structure without the permission of the Building Division. I further certify that my registration with 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 subco~tractors and employees who are in compliance with OP.S 701.055 will be used on this project.
SI"IIATUR~ C
FOP. OrFICE USE 0I1LY
Sq, Ftg,
Sq. Ft~.
Sq. Ftg.
~(,,~
DATE I IJ--2.q-,.O
IWIE(please print)+(OV\..
lei=-..P U-4tc. l
Zone / M/
Fire Zo""ne
TYDe/Const.~~
. ,
Flood Plain
Bedrooms
Stories
/
Units
Occy load
Occy Group
u.-'t'
liain x Value
Access x Value
Othe#.l>?? ggyx ~.c.pValue/?_ ~26'.,YO
TOTAL VALUATION
,'#Fr. I-!f/~ ,~Systems Development ~.~. 4Q_
~~'::> ~"r7T.l':haroe (1.5~) ~.., T ;,Coo'
BUILDING PERfIlT
Charges and
Surcharges
-_./~!:~-
6.~
Plan Ck, Comm/lnd
65%1B1dCl P-,;or i=pp
Plan Ck. Res
30%/Bldo Per Fee
Fence
I
I
I'
ITotal Comb. rermit
I
I TOTAL
-lb/. Ie,
1'2/ ~
PLU'~B lNG PERMIT
Charges and"
Surcharges
Demo
ELECTRICAL PERI~IT .Sldewa 1 k
Charges and -------_____
Surc.ha~:g~s . .... . '-. I A/e Pav!ng ,
.jECHANICAL PERMIT ~ s: ~ '1 Curb Cut
Charges and ____""i._~____
Surcharges /. <'5" I.
~
.
.
, .
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COMBINATION APPLICATION/PERMIT (CAP)
'.J .
I. Applicant.to furnish
A. Job Address
B. Legal Description , .
1. example- Tax Lot 100. Lane"County Map Reference
17 uj 43
2. example- Lot I. Block 3, 2nd Addition to
Springtield Es.tates -, ~ ..'
.. C.. Name, etc. of owner and. construction lender '\
D. Ener.gy.Saurces ~ : ._
','1.' exam!!' e- hea't/electi-ical'"ceil ing/or forced air oas
2. examyle- waterheater/electrlcal/or sOlar-
E. Square footage or valuation, etc. -
I. example- 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. exam~le - construct single family house with an
attaChed garage
2. examele - remodel existing garage into family foom
3. exa~le - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 30~ (a). at the". ,.
StructuralSpecialty Code. ". ' . . _' - ." . .
ii,' 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 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
fu 11 schedu 1 es
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 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
payabl~~ben:the p~~it. is iss~ed.
..PERt111':V A!-WAT'! ON
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V,. JOR .OFFICE USE ONLY, '",:;,;
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. P~OJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permi t appl i cant exempt from reg i strati on wi th the 8uil del" S Board because :.
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.~d~itional Pr.C!j,~ct Information:,
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PLANS REVIEWED BY:
riame'~6~ l3' ~l!!9f"
signature. ~~. '.~ date /e?-/SO......,e;>
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