HomeMy WebLinkAboutPermit Building 1990-1-10
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legal Oescription/7.t'3.3/;;'~3/_ .?/e:'..?<>
__ CITY UF SPKINGFlELO
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Ilater Heater
.
INFORllATlON LINE
726-3753
Sq. Ftg. I~ain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add A Her Rep.
-Fence Demo Change/Use
Other - -
~
i INSPECTION LINE
726-3769
,
~
Owner ;;?~_'_ /</cZ;:1EotC-<""
. ".
AddreSS /4!d/ ~
/ .
?7?'="0 ~R
Construction lender
Phone
Range
Valu€. of Hork:
'2'.~. -
BuiltiinQ Permit Info: Describe Work{i~e"
Family nesidence With Attached GaraQe~
Build Single
Address
DESIGN TEAl1
(namel
~6 #r~~ ~/.a;.</ ~~ ~..:;;.~.
. .'(~~~ ",. kf5;;;;'~ ~/,"~~-,;
r~~/?? ~/f St/~7-/ ~~ .
(lies. no. \ (exoires' (ohane no.
Phone
(address'
Primary
Structural .~.r- ~//~7).
Electrical
~
~"
Mechanical
CONTRACTORS name
laddres$'
C1 its. no. \
lexoires) lohonp no. \
Genera 1
Plumbino
Electrical
Ij"r V
::. 7v-
~1echanical
PLUIIBING
ELECTRICAL
MECHANICAL
NO. '
FFF CH~Rr,F Nn~
~~~ r~ NO_
. FFF r"~
SQ. FT.
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(J bathl
Duplex (1 bath) each
Add I t I onal ba th
, SERVICES'
Recessed wall
~n~cp ~p~tpr ~n~ vpnt
Storm Sewer
Of
amps.
Appliance vent
seoari\tl~
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
1
Sewer
Temporary Construction
Change in existing
r~s.i dr.nee
multifamily, comm. or
Industrial
Water service
COMfl./INO. FEEDERS
Install/alter/relocate
di~trih. fe'ders
,Of
amps.
1
I SSUANCf nF P[RIIIT
TOTAL CHARGES ~ TOTAL CHARGES c TOTAL CHARGES
WHERE STATE L\W REQUIRES that the Electrical work bo done by an, Electrical Contractor, the electrical rortion of this rernit
shall not be vali~ 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 performed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of OreCJon pertaining to the work described herein, and that NO OCCUPAllCY 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 ons 701.055, that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with ORS 7nl.055 ~ be used on this project. '.
1lAf.1E(please print) ?At..l L 1? I ~ <2.. LL SIGIIATURE \J{.. JL ~ / -/() -90
FOr. OFFICE USE OIIL y
Units Sq. Ftq.
Occy Load Sq. Ftq.
Occy Group A-"- -:2-.. Sq, Ftg.
r
Zone ,...- C
Fire Zone
Flood Plain
Type/Const,
Bedrooms
Stories
Ha;n x Value
Access ,x Value
Othe~~,J'5"~ Value
TOTAL VALUATlOII
:2.,..'") ~_ c:=--
BUILDING PERMIT
Charges and '"""
Surcharges r
~~ Plan Ck. COIll11/lnd .
__~_'<::'.:::..___ m/Rldo P.l'r Fee
Plan Ck. Res
/ 77 30%'Bldo Per Fee
r"
~
'syste. ms Develop~ent ~
Charqe rl,5~ .
75': tP3
PLur~BING PERMIT
Charges and
Surcharges
Fence
Of/mo
ELECTRICAL PERIHT
Cha rges and
Surcha rges
'Sidewalk
A/C Pavl ng
Curb Cut
Total Comb. Permit
11ECHANICAL PERMIT
Charges and
Surcharges
TOTAL
i 65.'1b
1
.
.
.
.\
.
, COMBINATION APPLICATION/PERMIT (CAP)
,PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100, Lane County Map Reference
'17 oj 4'3
2. examele- Lot 1. Block 3, 2nd Addition to
Spnngtield Estates . ..
C. Name, etc. of owner and construction lender
O. Energy Sources .
1. example- heat/electrical ceilinQ/or forced air Qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check-new - if addition.
cneek add. etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. exam~le - 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 ip 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 ins ta 11 ed a re 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
O. 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
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit'applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date