HomeMy WebLinkAboutPermit Building 1990-3-30
I INSPECTION LItlE
)726-3769
, -' V, .tIn
Job Address (JI(~. .
Legal Deseri pt i on I ()()
.II&... CITY UF SPRINGFIELD
,....., COMBINATION APPLICATION/PERMIT
mn 1 n ..$[1--PPT ~~;~GY SOURCES:
63Lo4"d Il f:JSCI )Hater Heater
n ~ Range
OwnJ\\)jr\'{~\~YY?1'WO tli~ I valu:E,U-W.CO
Address "2. s:?' r v-t .#-'\.\11)[ (j l>< Phone BU11tilncf P~nnit Info: Describe Work(Le.,
_ \.. )l,~1 'L.:\\^- .... l Far:nlv ReSldence 1'l1th Attached Garaoel
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Construction Lender 1
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INFORllATlON LINt
726-3753
Sq. F,tg. '.Iain
~q. 'Ftg. Access.
Sq. Ftg. Other
New Add Alter Pep.
-Fence Demo Change/Use
Other- -
Build Single
-D
3
~
Address
DtSI!;'. ItAI1
(name)
Phone
(address)
I) 0 ~. NI'r/i
CXYU' .i'W 00
(l ics.
!r~AO~~Q+nA(M~f1t -
nn,l ) (exn~ 'ohnne no.,
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,
Primary
Structura 1
Electrical
Mechanical
CONTRACTCR*---ff ~ name) - H.)
Gener/!..; \ A l{ .l. JYl 0 K-/
PlumbinQ
(addrdSS 1
(lir~ nn. )______(pxnirp~l
fohnnp nn_ ,_____
Electrical
flechanical
PLUllB I NG
ELECTRICAL
MECHANICAL
NO,
FEE CHARGE ~n
FFF r"l\RliE. .J<<l
~~L !HAB.G.l
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~o~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
App 1 i ance' vent
Sp.Dar~t~
S.tationary evap.
cooler
V"ent fan with
sinole duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hond and durt
Sewer
Temporary Construction
Change in existing
re5 i de,nee
multifamily. comm. or
Tnl'llJc:trial
Water servi ce
CO~1,/IND, FEEDERS
Install/alter/relocate
distrib. feeders
Wood stove/heater
Of
amps.
ISSUANCE OF PFRrlIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\I/ REQUIRES that the Electrical work be done by an Electrical 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 HAVE CAREFULLY EXAMINED the completed aprlication for permit, and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work oerformed 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 fW OCCUPAfKY 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 ORS 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 7n1.055 will be used on this project.
SIGrlATURESf k_ a~
FOR OFFICE USE '(Jllry
Sq. Fig. 11ain
Sq. Ftg. Access
Sq. Ftg. Other
Ld.es
DATE 3~/fu..
IWIE(please print) J//JJt.M
Zone
Type/Const.
Bedrooms
Units
Occy load
Occy Group
x
Value
Value
Value
Fire Zone
Flood Plain
x
Stories
x
TOTAL V ALUA TI ON
BUILDIIlG PERHIT n()~.~__ Plan Ck. Conm/Ind
Charges an::: 6S%lBldo Ppr Fpp
Surcharges Plan Ck. R'es
30%/Bldo Per Fee
PLUllBING PERMIT Fence
Charges and ------------
Surcharges D~mo
ELECTRICAL PERr:IT Sidewalk
Cha rges and ------------
Surcharges A/C Paving
I1ECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
'Systems Development
Charoe (J.S~)
Total Comb. Permit
TOTAL
i~~J
--
p
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
II U3 43
2. exam~le- Lot 1. Block 3, 2nd Addition to
,prlngtield Estates
C. Name, etc. of owner and construction lender
o. Energy Sources
1. exa"!ple- heat/electrical ceilinqlor forced air Qas
2. examDle~ waterheaterjelectrlcal/or solar
E. Square footage or valuation, etc. -
I. examDle- 1250 sq. foot house, 500 sq, foot garage
2. example- if new project, check-new - if addition,
check add, etc.
F. Building permit information:
1. 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 TEM1 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
fu 11 schedu 1 es
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:
-
"
_"' ~ _.. 0.,_'_ _ .",
PERMIT VALIDATION
, '
\lo60G-
-- ~L
/30 ~ Q..O
Permit Cler
voU
, .
Permit appl icant exempt from registrati on with the Buil der' s Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date