HomeMy WebLinkAboutPermit Building 1989-8-3
1 IIisPECTIDN YINE
726-3769
.' CITY UF SPRINGfiELD'. INFORl1ATlON LINE ,I
COMBINATION APPLICATlON/PERMIT 726-3753'. 1../
" EIIERGY SOURCES:'~ Sq. Ftq. l1ain ' [L~ gs
Job Address <j 2ttP7J' /,??#a" ~ Heat ~ J ~q: Ftg. Acces,s,
Legal Description 10{)~ 1:J.6~)()/q{Y) ~ater ~rt-/6L/" Sqile~tqAd~th~~ter Rep,
- V:::~IO;:-~' u-<(X) , ,I' 6~~~~_DemO_Chanqe/Use Q
Owner R~~jttl<$iQw.Ji1.JIJ::-)' 'l: II -:::-...J
Addres'... Dn JJ.jJ)L 8/(3/ I d~~-~,=VO BuildinQ ptril1i nfo: Describe Work(i',e.. Build Single 2S
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Mechanical
CONTRACTORSt)
Genera~~ 0
-,-
Address Phone
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Structural J ' - ~ ~ ,.., 344..()4~~
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Electrical
Plumbinq ~
Electrical~)C f\.lo ~ ~
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~lechanical
PLUI1B I NG
ELECTRICAL
MECHANICAL
NO.
FFF: CHARGF ~In
FFF 'rH',RliE, NO_
f:'r~ .tliARGL
SQ, FT,
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
~'New circuits alts.
orextlW$;ons, "
'2 &>f'5 ~
SERVICES
Floor furnace
and vent
:Z2~'
S.F. Residence
fl bath\
Duplex (1 bath) each
Additional bath
Recessed wall
Snac~ hp~tpr ~nd vpnt
~-'-
Storm Sewer
,
Of <. /.0.0
amps.
?:?r~
Appliance vent
spoarate
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
'hnnrl and rlurt
Sewer
Temporary Construction
Change in existing
resirlence
muYti-f"amily. corm!. or
Tndustrial
Water serv; ce
COMM./IND, FEEDERS
Install/alter/relocate
~i~tr;b. feeders
Wood stove/heater
Of
amps.
ISSUANCE OF PFRltIT
TOTAL CHARGES TOTAL CHARGES ~-t>- . TOTAL CHARGES
WHERE STATE L\\/ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valid until the 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 oerformed 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 UO OCCUPAllCY 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
only subcontractors and employees who are in compliance with OP.S ]01.055 will be used on 'this project.
IWIE(please print) C:.t=I?/'t'C--/J 1. [//':e SIf,tlATURE _~...ff / /dtc;. DATE J%3'Pl.
FOr. OFFICE USE miL Y
Sq. Ftg,
Sq, Ft~,
Sq, Ftg,
Zone c::: ~
Type/Const.
Bedrooms
Stories
<-,A/
Units
Value
Value
Value
TOTAL VALUATION
I no (1'...!.. (\(uJ...'sterns Development I
rJn :t < ) \" A"'ctarQe (1,5%) ,
f1ain
Access
Other
x
Fire Zone
Flood Plain
/
Dccy Load
Occy Group
"';<7',0
x
.yb=~-'-
~
x
BUILDING PERflIT
Charges ant:
Surcharges
, //{/ <;;r) 'Plan Ck, ConmlInd
____~L~~__ 65%/Rldo p.pr J:'pp
-::< :2"'" Plan Ck, Res
~ -' 30%lBl do Per Fee
Fence
M ~ c:so
PLU'~B ING PERMIT
Charges and
Surcha rges
Demo'
ELECTRICAL PERIHT
Cha rges and
Surcharges
_ n__tp5;., ~_S1dewalk
2'. -?S- . A/C Pavi ng
Tota' Comb, Permit
'1-:5. "78
.
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTAL
jS3',/"B
.
.
-10
"
"
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
{Lfbb -3
I. Applicant to furnish
A. Job Address
B, Legal Description
1, examele- Tax Lot 100, Lane County Map Reference
I! UJ 43
2, exam~le- Lot I, Block 3, 2nd Addition to
springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
I, exam~le- heat/electrical ceilinG/or forced air Gas
2. examole. waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
I. examDle- 1250 sq, foot house, 500 sq, foot garage
2. examp'le- if new project, check-new - if addition,
check add, etc.
F. Building permit information:
I. examDle - 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.
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
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 b~ 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
P''''t Cl"~
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I
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
I>
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
I
PLANS REV IEWED BY:
name . 'L~;~,7t~~ signature _~~~,"'? date ;52-/-,87