HomeMy WebLinkAboutPermit Building 1988-2-24 (2)
I INSPECTION LINE
726-3769
Job Address
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1/)10 M,Alto....l
oescriptionl '70 ~ 3S
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Legal
Owner
tit
CITY Uf SPRINGfiELD INfOrolATION LINe
COMBINATION APPLICATION/PERMIT 726-3753
EilERGY SOURCES: Sq. Ftg. 1.lain
Heat ~q. Ftg. Access.
Water Heater Sq. Ftg. Other
flew Add Alter Pep,
Range --Fence Demo Change/Use
ValUE of Hork~S rfJl)f),. Other- -
BUlloinQ Permit Info: Describe Work(i.e., Build Single
Familv n&sidence With Attached Garaael
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Address
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Phone
Construction lender ~
Address
Ue>IGN leM
(name)
Primary ~"t' ~.:.5-
Structural t:',1L,L 6J~""v
Electrical ~r
Mechanical ~JF=;
CONTRACTORS Inamel
General r-",,>I..lp"-1U~ Il y~
Plumbino ~~'pVA/1e'(
Electrical ~Vll... ~o-, t:::/ ~
flechanical &A~ ttth
PLUI,IB I NG
ND.I
Each single fixture
I Fff" I r:HARGF
Relocated building
'1>' (new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
~Ia ter serv; ce
Sewer
Storm Sewer
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Phone
f address)
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(1;('<:'.110.) (pxniresl Cohon!" nn
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MECHANICAL
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(address'
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4:VY(JV r;il+
ELECTRICAL
Nn I
Residence of
t ~n.
I rl-lARG.E. NO. I
I HI=' I rl-l.;&G[
furnace/burner to
BrU1s
SQ. FT.
tl.. _
<~"
Recessed wall
So~rp hp~tpr ~nrl vpnt
~
~-New circuits alts.
", or extensions ~
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SERVICES
<'2 sz:
Floor furnace
and vent
Temporary Construction
Change in existing
rps i dJ'nr:p
multifamily. camm. or
Tnrlu,t.r;;tl
Appliance vent
"poa ra te
Stationary evap.
con'~r
Vent fan with
sino 1 educt
Vent system apart from
heatina or A.C.
Mechanical exhaust
hnnc1 find rllJrt.
Wood stove/heater
..- ,f.t,TQ<i' D~ €.xn<'WO />~
n~.JL.7'v../~AN'" .s?..w. /7 ,-
Of
amps.
CO~1./IND. FEEDERS
Install/alter/relocate
didrih_ fppnprc;,
Of
amps.
ISSUANCE OF PFRr1IT
TOTAL CHARGES 3&. "! ~ TOTAL CHARGES "2 :?' Sc:> TOTAL CHARGES ;""'':>0
WHERE STATE LA1~ 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 application 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 NO OCCUPANCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 ORS 701.055 will b ed on this project.
NAI.IE(please pr;nt)JA~~
Zone
cr:.
Fi re Zone
Flood Plain
BUILDING PERHIT
Charges and
Surcharges
PLUt1BING PERMIT
Charges and
SurCharges
ELECTRICAL PERI~IT
Charges and
Surch~r~es .
MECHANICAL PERMIT
Charges and
Surcharges
':::?~4' ",,0 Plan Ck. Conm/lnd
~~~ 65%/Rlda Ppr Fpe
--- ----- Plan Ck. Res
.;~. ~~ 30%/Bldo Per Fee
"'3,a "'.!"'. I Fence
____-'~~.l..I.:.;___
/. 5" I DeRlO
2-:? $0 ISidewalk
------/..-;.3hl.,A/C Paving.
____f.:r;_~__ Curb Cut
.?S
tqr"cA
Type/Const.
Bedrooms
Stories
,<;':'R
/
DATE~h~jM
- (
Units
Occy load
Occy Group
SIGtI URE
FOr. OFFICE ii:SE 011 Y \
Sq. Ftg. t1ainx Value
Sq. Ft9. Access x Value
B-2 Sq. Ftg. otherk7.!!="A''''''''fi~/~alue&T--''--'.:''"'''
TOTAL VALUATION
.Q. -12-~ i;
(0'133
syste.ms .Development
CharQe (1.5%)
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ITota'
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I TOTAL
7178. Z8
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Comb. Permit. I
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COMBINATION APPlICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. legal Oescription
1. example- Tax Lot 100. Lane County Map Reference
II 03 43
2. example- lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. exam~le- heat/~lectrical ceilinq/or forced air Qas
2. examyle- waterheaterjelectrical/or solar
E. Square footage or valuation, etc.
1. example- 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. example - construct single family house with an
attached garllge
2. example - remodel existing garage into family room
3. example - 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 TE~l 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 ~ou 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 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.
/099/
V, FOR OFFICE USE ONLY
~-2<1-B-~
Permit Cl erk /"//,..: ,_ _, _
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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 L~RNG 'A.G~
signature ~~........, date -;2-2 Y-$S5,
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