HomeMy WebLinkAboutPermit Building 1990-7-18
'1 INSPECTION LINE
1726-3769
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Job Address
q 9 '?&>
//74/4 ~
CITY Uf SPRINGFIElD
COMBINATION APPLICATION/PERMIT
I EIIERGY SOURCES:
Heat
t'later Heater
Ranqe
INFDRlIATlON LINe
726-3753
Sq. Ftg, l'lain_ ~?_
~q. Ftg. Access.
Sq. Ftg, Other
Ilew Add Alter Pep.
-Fence Demo Change/Use
Other- -
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legal De<cription /:?-P2 -?:2-Y/, ~t5-.::>
ValUE of Hork:
Owner ':z?.a..eC?'lT ~/L~__ 7'1< !:"t6t!. f:,e>
Address !-;;~ '""'z::> ~~ Phone Bufldlnq Permit Info: Describe \~ork(i-.e.. Build Single
TG c.../- /..-?e:::>X e::..-> ~ Familv ~esidence Hith Attached Garaoel
5'?PL-D, or~. 5l.?o/..?? 7jtG-SS~7 /107.) 6C/X/2?,;/1)/N'-;P/~.c.. A1..C'
Construction lend.,(' /e; X laa /'r.~7/--A/ , M ~"Sl7;
Address Phone (R'~~", c."'" 3t::>/'-..2>~.J'./-=
UI::.~HiN TE.AH (name) (address) . (lies. 1'10.) - ,~(eX_irps) (nhone no.,
f/J .~.e>'-: 4I;:>4f W.r~~ '. h _'_'--.__~_,;;
Primary /Th>~7"/cr} ,..-~. RAi::~ -=- ~1ry ___,. _
I /_
Structural
~
~
Electrical
Mechanical
CONTRACTORS
(name I
(address)
(1 ic~ no,)
(pxnirps\
(ohonp no.
Genera 1 ~ Jfr,.,~;q
Plumbina
Electrical
~1echanical
PlUl,lBI NG
ElECTRICAl
MECHANICAl
NO,
FFF rHAR(;F NO
~~~ r~ARr,~ NO
~~~ rI-lAIU~~
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTUts
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S. F. Res i dence
(I bath)
Ouplex (1 bath) each
SERVICES
Recessed wall
SI);l,-". np;ltpl" ;In,i I/ont
I/~J Storm Sewer
Of
COMH,/IND, FEEDERS
Install/alter/relocate
di,trih_ fppdpr,
amps.
Appl iance. vent
seo~ ra tp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood ilnd durt
Wood stove/heater
Additional bath
~Ia ter servi ce
Temporary Construction
Change in existing
resjdf'ncp
multifamily, comm. or
Tndustriill
Sewer
Of
amps.
~ .s=.7/'l/~c. 4~ -:;;r~ ~
;S;.4~<C.~/.NA ~~$~
h,~ft;/7". .
I SSUANC, OF PFRIHT
TOTAL CHARGES ? 5:- e> TOTAL CHARGES
WHERE STATE Ul~ REQUIRES that the Electrical work be done by an
shall not be valid until the label has been signed by an Electrical
TOTAL CHARGES
Electrical Contractor, the electrical portion"of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAnINED 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 Derformed 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 HO OCCUPAHCY 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 ORS 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.
1lAJ.1E(please print) SIGI1J'J/JL/~ _
FO~ OFFICE Ut'E DillY
in, Ftg, 110in A':i'_9I'
, '
Sq, FtD,
Sq, Ftg,
c .c:;
Type/Const, ~~'"
7-j~~'ltJ
D~.TE
(
Zone
Fire Zone
Flood Plain
Bed rooms
Stories
/
Units
Occy load
Occy Group ~~
Access
Otherav/~
x //.'''Y2Value 9:;2,A'<.rA"::~
x Value
t:.7'Z/?f' Value'::;, 7::70.--
TOTAl VALUATION ~ .-;~ /' /'>
BUIlOING PERfl1T
Charges an':
Surcharges
Ll'L .d'" PI an Ck.
___7.. Z,_____ 65%/Bldo
PI an Ck.
';;!e;, era 30%fBldo
~5 a<tl> Fence
____.L_~____
/ ,;?,.~ Oemo
Conm/Ind
Ppr Fee
Res
Per Fee
p -"-". .'f'-f? 5S6
~':I..~ Systems Development
,,"7...2> Charoe (I.5~)
/4'9'8. '5'~
PlUI~BING PERMIT
Charges and
Surcha rges
5": - '"
A/e Paving
C2. _5'0
Total Comb. Permit
--I
~gb.g5
ElECTRIC~,l PERI~IT
Cha rges and
Surcha rges
Sidewalk
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
I
I TOTAL
'"20,?o. ?S
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
, A., Job Address
B. Legal Description
1. example- Tax Lot 100, lane County Map Reference
17 U3 43 . '
2, example- Lot I, Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender ~,
D. Energy Sources
"1. examole. heat/electrical ceilinQ/or forced air Qas
2. examyle- waterheater/electrica(/or solar
E. Square footage or valuation, etc. -----
'1. 'examo 1 e- 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. example - construct single family house with an
attached garage
2. example - 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 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 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
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PERMIT VAll DATION
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7 ~/& -9C)
:# /1139
P,noit Cl"~ ~
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
0~~ ~r~ P~~t"oP~cF_~ K..~_v7-?E..-:;;?~__~ A/67~
/~ 7,6Z) --7.N' _C;;~ 7t~~ .
Permit applicant exempt from registration with the Builder's Board because:
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Additional Project Information:
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PLANS REVIEWED BY:
name -Lb/?~ ~~~Signatur~.......~...-"? date 7yB-~
, , .,/ ,7A/,