HomeMy WebLinkAboutPermit Building 1989-10-9
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I INSPECTION LINE
726-3769
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CITY OF SPRINGflELO
COMBINATION APPLICATIONfPERMIT
EIIERGY SOURCES:
Heat
Hater Heater
INFORl1ATION 1I~
726-3753
Sq. Ftg. l'lain~""""",,'"
~q. Ft!J. Access.
Sq. Ftg. Other
)01ew Add Alter Rep.
Ran!1e Fence Demo Change/Use
Va I u, of Hork: Other - -
:?~3, :;>6<> . - j;! -.. -. ,.:s
G.I;?-~"'e::::>> _'"i/7'E~
BU116ina Pernlit Info: Oeser be Work{i.e.. Build Single
Familv Residence With Attached Garaae~
.
^ddrcss
DES I GN I cAI~
(namel
Phone
(address \
5dD,pt?/'70/~?",,;pr" 2~ ./&<:>1' e>,K:-
~'SE <;~ ?...., ??A"-CE 72-us
A5'~~ S;~h~.Y6"~7":"
flics. no.l 1exn;res) (nhone no. I
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Job Address 71f?rro M{/,~#
Legal De5Cription I?-o.?-:::r~ I
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Owner l?~"R~T ~/Y?/~rz,~ .14/,.,..~534
Address \) () &'N. - K 1- Phone
~~jh f\r\~ a (\) ~ --' qi4lJ
~constru~'Lender N ') J
Primary ~.;.-4vY~Z::> ,e:;;~~;"";C~-;5/-1>.
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Structural
:~' ,
. -
CP-
Electrical
~~ t4Jf#4Y~--r '-'" y....~
~~ehanlcal J&>#/Y rpA1'5S4 _
CONTRACTORS . I name) , -
General ~I..J~
{address'
(1 ies. no.) -
(exoires'
-7q'~-?~
(Dhon~ no. \
Plumbino
,.'1loD
~~'vl -
~lectrical
~lechani ca 1
PLUIIBI NG
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE NO
FFF ~HARr,F NO.
FFF rH~Rr,F
z:;v ~S
SQ. FT.
furnace/burner to
BTlI's
7
Each single fixture
Residence of
Relocated building
(~ew fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
I
Appliance vent
seD~rate
Stationary evap.
cooler
Vent fan with ~
sinole duct ./
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood ilnd duct
Wood stove/heater
h_=t
<"~., Water service
,,;~ 1iewer
r
~ Storm Sewer
6.....
~.-
~..-
Temporary Construction
Change in existing
res j dcnct;'
multifami 1y, cornm. or
Industrial
-:z
Of
amps.
f.
CO~1.fINO. FEEDERS
Install/alter/relocate
distrih. fpprl(>rc;
05&
Of
amps.
& '~7. /p~#< '7i!7/ ~ 7b
~?/,.y -)~~~~
',~. 4 ~/ ,I1/~C ;:"G!?/.;?>. '7: ISSUANCF OF PFRrllT
TOTAL CHARGES I b 7~S?> TOTAL CHARGES TOTAL CHARGES M//y. ~ =<>
WHERE STATE L'\\~ REQUIRES that tile Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I I1AVE CAREFUllY EXAt1INED the completed app 1 i ca t i on for permit. and do hereby cert ify tha tall in forma t i on 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 og fi 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 UO OCCUPAIKY will 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 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 7~1.055 will be used on this project.
HAlIE(p1ease prin~ ~Q - Qel? 1)7
Zone / ",./
Fire Zone
Flood Plain
TypefConst. -~--~
Bedrooms /
Stories /
SIr,IIATURE
FOP. OFFICE USE OIlLY
lInits/~~T So. Ftg. 11ain=2~,,,/~P x.,t~/~ Value~,"'/<i::ll:""",
Oeey Load Sq. Ft~.~, <"de> x -::J'9..?OVa1ue /'f<2SZ?......
Oeey GrouD.R.,?~~-2Sq_ Ftg. Other"";;;/?2!'" ~A.S. Value 40.~.-""
~ \!\C'\ (\'( ~ (('\. \UlA \ C\._~\A:EAUATIorI31'J. ?--,....,-'
~....,. _6 Plan Ck. CO,mmfI,n,d ,... -, \ ~ste, ms Development _I q J!2 _
=7.-<;. 65%/B1do Ppr Fpp ::;, ./?.~ Charoe (1.5~) v/ ~. /CJ
-- ---~y~:;- ~b~~B~~~ ~:~ Fee
___!~2.~_~_ Fence
d!':) ~~ D~mo
=. -'=>
DATE
BUILDING PERfIlT
Charges and
Surcha"rges
PLUtIBING PERMIT
Charges and
Surcharges
ELECTRICAL PERIIIT
Charges and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
~-
,
Sidewalk -;<-;;:7
o/'t/-~
'7 g.s. ~
Total Comb. Permit
(t/1t/."<8
_ ___,;.--z_":"'_ ___
AfC Paving
- -- /"""' <7.? I Curb Cut
- -- -;'~./~;-:7?-1',
TOTAL
6-557/$
..
.
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 ceili~Q/or forced air qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation. etc. -
I. example- 12S0 sq. foot house, 500 sq. foot garage
2. example- if new project. check-nfw - if addition,
check add. ete.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. example - 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.
It. Abbreviated Plumbing, Mechanical. to Electrical Schedules
A. [xcept 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 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
I.
PROJECT CQNDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
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PERMIT VALIDATION
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Permi t Cl erk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
'name ~;yc: n~~signature
~~
", ./
date
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