HomeMy WebLinkAboutPermit Building 1989-10-10 (2)
......
I INSPECTION LINE
, 726-3769
Job Address /? /tP /0.#/~ 9""
.......
IIIIIIII CITY UF SPRINGFIELD
~OMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
liater lIeater
Range
ValUE of liork:
8~~
Bui]o;no Permit Info: Oeser be Work(i,e., Build Single
Familv nesidence With Attach.d Garaoel
?r~/~ ~=",/..M;~ 4:r-
..~ ~~.r;1 f}r~/~Y
-
l"fOR/IATlON Lint
726-3753
,Sq. Ftg. Hain
~q. Ftg. Access.
Sq. Ftg. Other
Uew Add Alter Pep.
-Fence Oemo Change/Use
Other- -
I
~'
~
I
I~
legal Description
Owner /N7~#/P'/7e?~A'C r;:.A'~ ~ /~
Address p&>X A::/~.s- Phone
CO'-:;:'~/YC.r~ ~V.::::::s-/
Construction lender
. Address
DESIGN TEN4
{name]
Phone
(addressl
"
(lies. no. 1 l exni res 1 ( ahoM no. J
A
*
.~.
(1;C'!;,. no. \ (pxnirpc;.l (ohonp no. 1
Pri ma ry
Structural
Electrical
Hechanical
CONTRACTORS [name J (addr.ss 1
Genera1/~"""'A'r.#__",.. .a;~~..>;'..2:l~~
"3~~ "5?~~C:; ~..~ ~~
/
Plumbina
Electrical
~'p.chanfcal
PLUllBlNG
ELECTRICAL
MECIlANICAL
ND.
FEE cll~.l'n
rrr r"~ JNP.
rrLJ:lJAJlliE.
Each single fixture
Residence of
SQ. FT.
furnace/burner to
DTU's
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Ouplex (1 bath) each
Additional bath
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
~n~~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
c;.roar",tp
Stationary evap.
['ooler
Vent fan wi th
~fnale duct
Vent system apart from
heattno or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
r~s14e.nc~
mUltifamily. comm. or
Industrial
\lla ter servi ce
COMfl./lND. FEEDERS
Install/alter/relocate
di~trib. fppdpr~
Of
amps.
TOTAL CIlARGES
WIIERE STATE L\li REQUIRES
shall not be va1iJ until the
I SSUANCF OF PFR!IIT
TOTAL CHMGES TOTAL CIlARGES
that the Electrical work be done by an.-[lectrical Contractor, the electrical Ilortion of this pemtt
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXM1INED the completed application for permit, and do hereby certify that all information hereon is true
and correct, and 1 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 Orel]on pertaining to the work described herein. and that UO OCCUPAUCY will be made
of any structure without the permission of the Building Division. 1 further certify that my registration with the Builder's
Board 1s 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 701.055 ~ used on this project.
1lN-IE(please prin{2^ 7Iv 'v S/'../I {, a.. ~ d SIr.IIATUR( d70~ .f2I..u.!-A,fl OATE..LO //d/t'T
FOr. OFFICE USE'-lltlLY J. / I'
SO. Ftg. flain ,Value
Sq. Ft~. Access x Value
Sq. Ftg. Othe~~ ~~/....?~Value
/ TOTAL VALUATIml
Zone
Fire Zon.
Fl ood PI a i n
Type/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
~.=-
BUILDING PER/lIT
Charges an~
Surcharges
/~<:>_ Plan Ck.
_ _ ./-;2- '- -..:; <-- _ _ ~~~~B~~~
. ~,/,....... , 30%/Blda
Fence
Comm/l nd
Ppr fpp
lies
Per Fee
syste.ms Development
Charoe (1. S~
PLur~BING PERMIT
Charges and
Surcharges
0_
ELECTRICAL PERfIlT Sidewal k
Charges and - --- -- --- ---
Surcharges A/C Paving
Total Comb. Permit
MECIIANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTAL
/5:75..
~
--
Ii
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
I. examole- Tax Lot 100, Lane County Map Reference
II OJ 43
2. examele- Lot I. Block 3, 2nd Addition to
~prlngrield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
I. examele- heat/electrical ceilinq/or forced air oas
2. examole- waterheater/electrlcalJor solar
E. Square footage or valuation, etc, ------
I. example- 1250 sq. foot house, 500 sq. foot garage
2. examole- if new project, check new - if addition,
check add, etc.
F. Building permit information:
I. examele - construct single family house with an
attached garage
2. examele - remodel existing garage into family room
3. examyle - 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 ANO 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 TME SCHEDULES
D. As noted on the CAP, the label must be delivered to thc----c
electrical contractor for Signature by his electrical I
supervisor. The general contractor is not authorized
to sign the electrical label. ---
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 penmit 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 ~hen the permit is issued.
III.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
n
, ,
9\TY OF SPRINGFIELD
. ' City Han
'- Sprlngftald. Oragon
. Development Services
OFFICIAL RECEIPT
...
15086
Date fY-r;. /~ _ 1989
I Rec'd From C~~C~ ;... .~_",.))
'3~~E~
Address /":'vr~C#~'
i . _
Received For~~8E,e?S7 k~ ~
/ '
7?,l>.
~O
/I?'" C>'i?
,,~-
- .:::::s-
-I
-
{i'r
I
I
'i
j
/5>-7 >
~#--
Amount Received
~
/,7; 7~_
.!!L
~~~~~~~
J-
Frontier BUSINESS fORMS. l/'fe,
I~JI~2.11.'
...,
.
Permi t Cl erk
J
Perinit appl.icant. exe'11pt from registration with the Builder's Board because:
Additional Project. Infonnation:
PLANS REVIEWED BY:
.
name ~ .6t6?'~.,c;?
signature ~~)2:>~-......-->date
6'V' C"""" ...
/ ~ -".0-, -,8'5