HomeMy WebLinkAboutPermit Building 1990-1-31
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INSPECTION LINE
726-3769
. CITY UF SPRINGFIELD
CO/mIllATlON APPLlCATlON,PERMIT
EIIERGY SOURCES:
Heat
I~a ter Ilea tcr
.
INFORltATlON LINE
726-3753
Sq. Ftg. '.'ain
:q. Ftn. Access.
Sq. Ftg. Other
New Add Alter Pep.
--Fence Demo Change/Use
Other- -
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Job Address /f?~tJ )1/1/;; sf.
Legal Description J1/ o3~/G/;J 3 '
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Ranfle
Owner f~u I X,'", rI f" / /
Address Skn>'J- /-10/ jrt,J'kt'!.f sf,
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Construction lender
Phone
Va~ of Hork: 00
.,If' 35'00 -
BUll<iino Pennlt Info: Describe Work(Le., Build Single
Familv ~esidence With Attached GaraQe~
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72(,-M:'/ ~
Address
UESI GN llAH
{namel
Phone
(address 1
!lies.no.\
(exnires)
(ohone no. I
Primary
Structural
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1:175 JJ. G"'Avp" E"'I'
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'Eupt"-
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t, '87-0 t/35
Electrical
Hechanical
CDNIRACTORS lnamel
General EUfera IJ.
A'.IJ/'I/~
(address)
,')A A
(1 ics. no.'
LQ,QC\D ')
,
(pxnJrps1lr I Jphone nt'.)
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Plumbino
Electrical
~lechanical
PLUlm ING
ELECTRICAL
MECHANICAL
Each single fixture
FEE CllARGE NO _ 1 en:' rHAJH;~ NO.
Res idence of furnace/burner to
SQ. FT. BTlI's
rFF CHARGE..
NO.
Relocated building
(new fix. additional)
New circuits alts.
or extcns ions
Floor furnace
and vent
S.F. Residence
11 bath!
Duplex (1 bath) each
Additional bath
SERVICES
Recessed willl
Sn~~p hp~tpr ~nrl vprt
Storm Sewer
Of
COM/.I.IIND. FEEDERS
Install/alter/relocate
flistrib. fppders
amps,
Appliance vent
sel)a ra te
Stationary evap.
cooler
I Vent fan wi th
sinale duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
res j deJ'lce
mUltifamily. COITlT1. or
Industrial
~Iater service
Of
amps.
I SSIJANCF OF PFRPIIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WIlERE STATE L'H REQUIRES that the Electrical work be done by an Electric.1l Contractor. the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I IIAVE CAREFUllY EXArllNED the completed application for flermit. and do herehy certify that all information hereon is true
and correct. and I further certify that any and all work nerformed shall be done in accordance with the Ordinances of the City
of Spri ng fi e 1 d and the laws of the S ta te of Orel]on perta i n i ng to the work descri bed here; n. and tha t 1m OCCUPAUCY wi 11 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 re~uired by ons 701.055. that if exempt the basis for exemption is noted hereon. and that
on ly subcontractors and employees who are in comp 1 i ance wi th ons 7()1. 055 \'Ii 11 be used on th i s projec t.
IlAI-1E(please print)~'wt. ru", r'1If1( SIr.il^TURE_k~4 4dt1'~V!-
V FO~ OrFICE USE oln)!' 17
~
Type/Cons~/~ Units S~. Ftg.
Bedrooms Occy load Sq. Ft~.
Stories / Occ,V Group ~-2. Sq. Ftg.
Dm/- 3/-$_
Zone CG
Fire Zone
Flood Plain
f1ain x
Access x
Other ;-41A'/V/~~X
TOTAL
Value
Value
Val ue -:?,5' ~ eo-c
V^LUATION
BUILDING PER/lIT
Charges an~
Surcharges
LI Plan Ck.
___~1..-:.f2~__ ~'Blde
Plan Ck.
7_'2.. 3 30%/BldQ
Conmll nd
Ppr Fpp
Res
Per Fee
'J.r. q:?
Systems Development
Charoe (1.5~)
PLUIIBING PERMIT
Charges and
Surcha rges
Fence
ELECTRICAL PERI\IT
Charges and
Surcharges
Dlll110
_ ___ _ _ ___ __ J 'Sidewal k
I.A/C Paving
_ _ _ _ _ _ _ _ _ _ _ _I Curb Cut
I
Total Comb. Permit
tf6. 73
liECHAN I CAL PERMIT
Charges and
Surchar!Jes
TOTAL
I
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COMBINAIION APPLICATIONIPERMIT (CAP)
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I. Applicant to furnish
A. Job Add ress
B. legal Description
1. example~ Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot I. Block 3, 2nd Addition to
springtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam~le. heat/electrical ceilinq/or forced air qas
2. examyle~ 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~ew - if addition,
check add. etc.
F. Building pennit information:
1. exam~le - construct single family house with an
attached garage
2. examDle'- 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 TEN1 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 work~heet 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 penmit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
I. '
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PERMIT VALIDATION
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Penni t Cl erk
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Permit applicant exempt from registration with the Builder's Board because:
Addit.i ona 1 Project Information:
PLANS REVIEWED BY:
name. / ..6>29,N'...r ?~~
Signature~~ date ?~<9--"9i::>
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