HomeMy WebLinkAboutPermit Building 1990-12-5
IItlSPECTIOtl LItlE
726-3769
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CIn UF SPRINGFIELO . INFOR/IATION LINt I
COMBItlATION APPLICATION/PERMIT - 726-3753
ElIERGY SOURCES: Sq. Ftg. I.la i n ~ ~
Heat :q. Ftg. Access. ~
Water Heater Sq. Ftg. Other "
!lew Add Alter Pep. .........
Range --Fence Oemo ChangelUse
ValUE of Work: Other- - :-t~
/~-~~-
BallG~nQ Permit Info: Descrlbe Work(i.e., Build Single
Familv nesidence With Attached Garaae)
#'~"Ye:-~p,-~ ~.~ ")~
<)~ f"{/7(~ D'" I
A'e-~~~ W/ &~,.z:>. &"'7~~.'
(lies. rfo.) (exoires) (ohane no. ~
Phone
Job Address -::?~"7 \~.h" _ ~7 .
Legal Description \ i"1t)'o.6 ~ r'f\ ~ ll,) \
/j'b (? Bf.l-T 5~e.-.-"
Address /?~ ~~~
-'5P~ -4? .::;?":>s.- ~ ~
Construction Lender?
Owner
Address
Ut~J{;!l rtAH
(name)
Phone
(address)
Primary
Mechanical
CONTRACTORS lnamel
Genera 1 -5""7.)C>VC ~ '
/
!addr~ss)
%4/"7' ~~V~ c,..y.
."c::;;i :J~V'~~.
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(lies. no.)
_ Ii
~
(pxnirp~' , (Q~nnp nn
Structura 1
Electrical
4'~~.vc> _
..
5'-9/.
..
~ 2': .=<~ A:::'
Plumbina
Electrical
,
~1echanical
PLUIIBI NG
ELECTRI CAL
MECHANICAL
NO.
FEE CHARGF Nn
FFF r"ARGL NO
~~L..cHARG.E..
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
11 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~rp hp~t~r ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
seoarat~
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and durt,
Wood stove/heater
Sewer
Temporary Construction
Change in existing
rp<;; (Le}lce
multifamily. comm. or
Tnrluc;tr;a 1
~Jater service
CO~1./IND. FEEDERS
Install/alter/relocate
rl;c;trih. fppdprc;
Of
amps.
, -
ISSUANCE OF PFRIIIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'I/ REQUIRES that tile Electrical work be done by an..nectrical Contractor, the electrical portion of this perr.Jit
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 oerfonmed 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 un 'OCCUPA[~CY 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 7~1.055 will be used on this project.
Zone
Fire Zone
Flood Plain
Type/Canst.
Bedrooms
Stories
Units
Occy Load
Occy Group
SIGIlATURE~'u:JL~ , DATE/':L-5-<jo
FO~ OFFICE USE Ollt
Sq. Ftg. Hain x Value
Sq. Ftg. Access x Value
Sq. Ftg. Othe~,)?..:--$' Value/q__...._-c
TOTAL VALUATION
rWIE(please print~T"\ "" e, M.a..++ ~
BUILDIrlG PERNIT
Charges an~
Surcharges
__ ~~:s-c>
9.b3
Plan Ck. Comm/lnd
65t:/Bldo Ppr Fpp
Plan Ck. Res
30%/61 do Per Fee
Fence
Syste,msDevelopment
Charqe (I. 5~)
PLur1BING PERMIT
Charges and
Surcha rges
I
ELECTRICAL PERlm
Cha rges and
Surc.harges
11ECHANICAL PERMIT
Charges and
Surcharges
Oemo
Sidewalk
._AlC Paving
. I Curb C~t
____________1
'rotal Comb. ~ermit ..
'1
.
TOTAL ?t'- s:5
.
-
COMBINATION APPLICATION/PERMIT (CAP)
"
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. lan~:Cot~tY-Map'~Ret:erence
II uj 43
2. examole- Lot 1. Block 3, 2nd Addition to
springtield Estates " .. .......
,-. 'C:~~"Name, etc'"':: o'f 'owner 'aniJ:const~uc'fiori-leri'der" '. ,
~
D. EI!~rgy .Sourc~s . :.:~ " . ..', .. ...... ~_"... .
1. ',examQle~'heat/electrical'ceilinq/or forced air Qas
,,_ ,. 2.... example-..Y1~terheater/electr.lcal/o!.:.:solar r
. ,-. . 'E. Square footage or v"aluation, etc. ' ~ ..
1. examole- 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. exam~le - 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 ;he '", ,
.... 4. .~Structural Sp~cia1ty 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
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. ---
Ill. 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
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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.~#71f
Permit
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Permit applicant exempt;from registration with the Builder's.Board because:.
-"Ac!d.) t.i ona 1 Proj ect .I,n:f;o.nnati qn:
.........."';...
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PLANS REVIEWED BY:
name / &;~h~)'" Signatur~.? ~ _-? date /'7-5'-5e>
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