HomeMy WebLinkAboutPermit Building 1990-9-10
IIMSPECTlOM LIME
726-3769
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CITY u, SPRIMGFIELO
COMBIIIATlON APPLICATION/PERMIT
EliERGY SOURCES:
Meat
Hater Heater
Range
ValuE of Hark:
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Builciino Pennit Info: Describe Work(Le.,
Family nesidence With Attached Garaop)
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INFORJIATlON UNE
726-3753
Sq. Ftg. l'lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Pep.
--Fence Demo Change/Use
-Other- -
Owner.l.~iVY -Ift?/RP##'A-7 ~/~_.-:,
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Address 9'"? ~/ ~,~,~_ ~ Phone
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Construction Lender
Build Single
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rv
q)
Job Address
1./0/5'" ~UV ~7o
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Lega 1 Oescription 17-t?';/ -"3')'-9'/
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Address
DESIGN TEAl1
(namel
Phone
(address)
(lies. no.)
(exnires)
(onone no _ ')
Primary
. A
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Structural
Electrical
Mechanical
CONTRACTORS Inamel
Genera 1 ,:k.,I/O ~~--efL .
Plumbino
(address)
(l ics. no.)
(pxoirps) (n~nnp nn \
Electrical
~lechanical
PLUllBHIG
ELECTRICAL
MECHANICAL
NO.
FFF rHARGF "~
~~L...cHARG.E. NO
'IL.cJiARllE..'
-:z..
Each single fixture
Residence of
1~~ '/S-s: .
SQ. FT.
furnace/burner to
BTU1s
Relocated building
(new fix. additional)
New circuits alts.
or'extens;ons
Floor furnace
and vent
S.F. Residence
(] bath 1
Duplex (I bath) each
Additional bath
SERVICES
Recessed wa 11
SnA/"p nPAtpr And vpnt
Sewer
ITemporary Construction
IChange in existing
residence
Imultifamily, camm. or
Inrlustri<tl
Storm Sewer
IOf
ICOMM./IND. FEEDERS
I Install/alter/relocate
dic;trib. fppdprc;
IOf
I
I
I
amps.
Appliance vent
,\poaratp
Stationary evap.
cooler
Vent fan wi th
sino 1 educt
Vent system apart
heatino or A.C.
Mechanical exhaust
honrl and durt
from
Water service
I
I
I
I
I
TOTAL CHARGES /.5:"-e TOTAL CHARGES
WHERE STATE L.\I~ REQUIRES that the Electrical work be done by an
shall not be vali~ until the label has been signed by an Electrical
Wood stove/heater
amps.
ISSUANCE OF PFR!IIT
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINEO the completed aprlication for rermit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work performed 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'IW OCCUPAllCY will be made
of any structure without the permission of the BUilding Division. I further certify that my registration with the Builder's
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only subcontractors and employees who are in comoliance with OP.S 7nl.055 wi be used on this project.
11A!,IE(please print) Mir'~l1'Vl. JDnr5 SIGIIATURE ~~ DATE q - /0 JiO
FO~ OFFICE USE'lmLV I /
Zone Type/Const. Units Sq. Ftg. r1ain V x Value
Fire Zone Bedrooms Occy load Sq. Ftg. Access x Value
Flood Plain Stories Occy Group Sq. Ftg. Other x Value
TOTAL VALUATION
BUILOI!IG PERflIT
Charges an':
Surcharges
s: --- Plan Ck.
_____L__o____ ~/Bldo
.;$' ~6~~B~~~
____,?:_~_ Fence
..?S' Demo
'Side';, 1 k
Co""'/I nd
PF>r' ~pp
Res
Per Fee
Systems Development
Charqe (1.5~)
PLU'1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERlm
Cha rges and
Surcharges
A/e Pavi ng
Curb Cut
,'.
T9ta} Comb. rermi.t.. _ '? ) _/C:--tC>
TOTAL I '""3/-SC>
MECHANICAL PERMIT
Charges and
Surcharges
?
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description ..:. '. _"- ,
1. example- Tax Lot 100, lane County Map R~ference
II 03 43
2. exa~le- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates _ .'. . '. " ",
. C~ Name. etc. of owner and ,construction lender. \
O. Energy Sources _ . '.
1. ."-examl!le: hea't/e'lectrical ceil.inq/or' forced air Qas
2. examole- waterheater/electrical/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:
I. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. examJPle - 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
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
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
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PERMIT VALIDATION
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Permit
Clerk ~.
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Permit applicant exempt from ,registration with the Builder's'Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
z.~#~~C'~~
Signatur~~'
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date 9-4t:>-"5f~