HomeMy WebLinkAboutPermit Building 1990-3-23
'J IrlSPECTIOrl L1r1E
726-3769
Job Address IOolIVlAJ.A/
Legal Description 17 03
-
Phone
INFORlIATION liNt
726-3753
Sq. Ftg. ',Ia i n
~q. Ftg. Access.
Sq. Ftg. Other
-1lew_AddXAI ter _Pep.
Fence Demo Change/Use
ValuE of 7:21000 Other--
Builriino Pennit info: Describe Work.(Le., Build Single
Familv nesidence \~ith .A.ttached Garaae) D
RUlLO AA/J:A1Ct..QSfD 5TCJRI'/{;EAR.#l 8>, _
/lDDJA/6- e IAJAJ.LS Tn Ex l"iTING- 'TRiAcl( e
,
S TORt9GE f?U/i.f?/A/G
flies. no.' (f!xoires)
.
SI
35 L/ /
...
LoT S,(r?n
CITY OF SPRlrloFIELO
COMBINATIOrl APPLICATION/PERMIT
EilERGY SOURCES:
Meat A/OA/LF
Hater Heater~~~
Range ~~
-C
3
Q)
Owner SPR/A/Gr/ELO
Address 250 AI' A
UTi/.- /T'/
sT
80A/?O
Construction Lender /V'l)A/'~
~i7~
~- ~"'S/. '39.P
,
Address
Ut:)ll:ir~ I EAr~ (name)
Primary S et.j::
Structural SELF
Electrical A/ rwl1
Mechanical A/OAIe
CONTRACTORS (name)
General SELF
Phone
(address)
(ahone no.
(suRI
iSUR1
~
(address)
flic<:;.no.1
(PXr:li,..pc,'
flJJ,nnp nn,)
(SUR)
Plumbino
Electrical
~1echanical
riO,
PLUMBING ~t'AV'~
FEE rHARr.F Nn
ELECTRICAL ~t'A/~
MECHANICAL /l/OA/E
~~~ ru~ NO
SQ. FT.
furnace/burner to
BTU's
E:'E:'E:' Q!ARGE..
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(l bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Sewer
Temporary Construction
Change in existing
rps i d_PJ'l"P
multifamily, comm. or
IndlJc;:tri~l
Of amps.1
!COMM./IND. FEEDERS
l'Install/alter/relocate
distrib. fppdpr"
10f amps.1
I
I
I
Appliance. vent
~Pl'\i'I ra tp
Stationary evap.
cooler
Vent fan with
sinnl~ rtllCt
Vent system apart from-
heatina or A.L
Mechanical exhaust
hood and durt,
Water service
Storm Sewer
Wood stove/heater
ISSUANCE OF PFRillT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L'H REQUIRES that the Electrical work be done by an, Electrical Contractor, the electrical portion of this pen:tit
shall not be valid 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 Derformed 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 UO OCCUPAIKY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builderls
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 7Ql.055 will be used on this project.
rWIE(please print)
~',--( &,<; r/
SIGIIATURE ~ ~.3L
FOR OFF I CE USE OIlL Y
Sq. Ftg. riain
Sq. Ftg. Access
Sq, Ftg. Other&Lr~.e'"
OATE~-2,)- <JO
Zone_-r.' c.. .
Fire Zone
Flood Plain
Tyoe/Const.
Bedrooms
Stories
57\/
Uni ts
Occy load
Occy Group ~.1
x Value
x Value
~~elalue
TOTAL VALUATION
~ ~.-.:--.
/
BUILOIrlG PERmT
Charges an~
Surcharges
'2.r- Plan Ck, ConrnlInd
___d'_:;C='2~__ 65%/Rldo P-"r Fpp
/ 3 Plan Ck. Res
.6 30%/Bl dQ Per Fee
I Fence
------------1
. D~mo
I Sidewalk
I A/C Paving
I Curb Cut
I
";Z /. /3
Systems Development
Charoe (I.5~)
//.4 ,
.. ,
PLUllBIrlG PERMIT
Charges and
Surcha rges
ELECTRICAL PERi~IT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL
'3~j3
6"5: '2.6
..
Total Comb. rermit
.
- "
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. examole- Tax Lot 100. L~ne County Map Reference
"1/ oj 43
2. examole- Lot 1. Block 3, 2nd Addition to
springtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinqjor forced air OdS
2. examDle- 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-nfw - if addition.
check add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. exam~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. OESIGN TEAM 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. ---
Ill. 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 CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
-
\
PERMIT VALIDATION
103-<;,7
~..
Permit Cl erk
Ov
Permit applicant exempt from registration with the Builder's Board because:
"Additional Pro~ect Information:
..
PLANS REVIEWED BY:
name L&>//#E ~ C:<;,tF~
Signatur~-"" --
//
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",
date '""5-'9-9C:>