HomeMy WebLinkAboutPermit Building 1990-1-10 (2)
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. CITY OF SPRINGFIELO
COMBINATION APPLICATION/PERMIT
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EIIERGY SOURCES:
Heat
l~ater Ileater
Ranqe
ValuE of Hork:
-:?5~, - l:\.
BuiloinQ Permit Info: Describe Work.(he., Build Single I"'\..K
Family nesidence llith Attached Garaoel I .......
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lics'. no. x ir ,.,
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N RJ1AT ON
726-3753
Sq. Ftg. I~ain
~q. Ftg. Access.
Sq. Ftg. Other
flew Add A Iter P.ep.
--Fence Oemo Change/Use
Other- --
~
NSPECTlON LINE
26-3769
, Job Address /7"'::; CJ j<n#/ ~/ ~r_
Legal Description/7.t:'3.~~'3/_ "/e:'PZ>
,
. Owner' ~ ~/C/::lE,tC.<-
Address /Z/<?/ ffl.IhI'VA'.-F/
~7f:~.' -15/;- .
Construction Lender
Phone
Address
Ut";)Il:iN 1t.i\l1
Phone
address
'ohonp no.
Primary
Structural ,~.r- (4,//_n,
Electrical
Mechanical
CONTRACTORS
(name'
(addrp"c;.'
f1 ;"C nl" l
I"p,.'~\
(nhnnp nn. ,_____
Genera 1
Plumbino
Electrical
~1echanical
PLUrmING'
-ELECTRICAL
FEE CH'IBGL JI{l FFF 'CHARliE. NO,
Res idence of furnace/burner to
SQ. FT. BTU's
MECHANICAL
Each single fixture
I FF~'.QlARliE.
NO. .
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath\
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sr'lu'p hp1'lt.pr anel vpnt
Storm Sewer
Of
amps.
App I lance vent
_ _ ..ll.o~r.,tp
Stationary eyap.
coo h~r
Vent fan with
~tn~l~ ~ur:t
Vent system apart from
heB~inq Dr A.~.
Mechanical exhaust
hnod and duct
Wood stove/heater
, '
Sewer
Temporary Construction
Change in existing
rpc; jdYJ1C'e
multifamily. comm. or
Tnduc;t.rial
,',
r:
Water servi ce
CO~1./IND. FEEDERS
Install/alter/relocate
rlic;trih_ fppdpr~
Of
amps.
TOTAL CHARGES
WHERE STATE L.\ll REQUI RES
shall not be vali1 until the
ISSUANCE OF PFRJIIT
TOTAL CIIARGES TOTAL CHARGES l'
that tile Electrical work be done by an.{lectrical Contractor, the electrical Ilortion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXN11NED the completed aprlication for permtt. and do hereby certify that all tnfonmation hereon is true
and correct. and I further certify that any and all work perfonmed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Ore~lOn pertatning to the work. described herein. and that 1m OCCUPAI~CY will be made
of any structure without the penmission of the Butlding Dtvision. I further "certtfy that my registration with the Builder's
Doard 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, co~plianCe with OP.S lrn.055~. ill be used o~ ,this project. ~,
~. "D -:> '. ^O.A __F/-/()-90
rWIE(please printl...::t:=.Ltt.l L f.. I 2-d Q.. LL SIGNATURE .~ f- ' - "............ DI'W
FOP. OFF I CE USE DIlLY
Units Sq. Ftq. l1ain x Value
Occy Load Sq. Ftg. Access x Value
Occy Group J"--L.. Sq. Ftg. Othe~~,)"]~ Value ':2..-,_=--
TOTAL VALUATlml
Zone ".- C
Fire Zone
Flood Plain
Type/Canst.
Bedrooms
Stories
BUILDING PERfllT
Charges an~
Surcharges .
~ . Plan Ck. Comm/lnd
__.irlF.?_;;;;>.!'::::"-__ 65%/Bldo P.rr Fpp .
/. -;;r Plan Ck. Res
. . '7'/ 30%/Bldo Per Fee
7'""r. t!!>3
syste.li1s Development .
Charae t!.5t'. ' ,
PLUI~BING PERMIT Fence
Charges and ------------
Surcharges D~O
.to' .".
ELCCTRICAL PERIHTSldewalk
Charges and ------------
Surcharges AlC Paving
Total Comb. rermit
/lECHANICAL PERMIT
Charges "and
Surcharges
Curb Cut
TOTAL
I
I 65. '1b
,
III.
I. Applicant to furnish
A. Job Address
B. Legal Description
1. exome1e- Tax Lot 100, Lane County Map Reference
II UJ 43
2. exa~le- Lot 1. Block 3, 2nd Addition to
~prlngtie1d Estotes '
C. Name. etc. of owner and construction lender
D. Energy Sources
'1. examel.- heat/electrical ceilinqlor forced air (
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation. etc.
I. exame1e- 1250 sq. foot house, 500 sq. foot gara\
2. example- if new project. check new - if additior
check add. etc.
F. Building pennit information:
1. examele - construct single family house with an
attached garage
2. examo1e - remodel existing garage into family ro
3. example - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (al 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 in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjace,
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 schedull
have been abbreviated
2. If the item(s) to be installed are not covered 0'
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 t
electrical contractor. for Signature by his electrical
supervisor. The general contractor is.not authorizec
to sign the electrical label. -
Applicant to sign and date
Whenever possible. the initial application will b~ used as----
a worksheet only. Where possible, Building ~ivision 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.
\
City Hall
Sprlngftold, Oregon
Development Services
OFFICIAL RECEIPT
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CITY OF SPRINGFIELD
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, COMBINATION APPLICATION/PERMIT (CAP)
15740
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Rec'd Fro~~?f ~~A'<7',,:'c::r
Address I~~/;, ....?
Received For" W~?K,/-;'J, ~
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'2,.5',~3'
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~S' 96'
c;~~?~//53
Amount Received
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/' ~ :UTHORlZED SlGIqATURE
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f. ....,.. BUSINESS FORMS. INC. 1!o031:M2",40
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V. FOR OFFICE USE ONLY
Permit Cl erk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit'applicant'exempt from registration with the Builder's Board because:
'Additional Project'Information:
PLANS REVI EWED'BY';
. \
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1'/ _. name
signature
date
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