HomeMy WebLinkAboutPermit Building 1990-5-29
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J~b Address I{)! of)<=>l.lrJ-I Co 1m 1 n 11" ~~;~GY SOURCES: ~~: ~~~: ~~~;ss. ~
Legal D..cripticn r 1'\" '? ':jc!..?\ \ (~l t"\r--.. I;ater Heater Sq. Ftg. Other @
. 1f}:J I<.JI: 1 \'-'\\ J\ ) Ilew Add Alter Rep.
- _\ 1'"'\,1\1 '{:'I," ' Range Fence_Demo_Change/Use
own~~' to1 \''(\1 ~\'\ f>~~~'rli~~ ValuE.~Jk6~?_gJ, _Other
Address \ i'\. n "'180' -l f\ d"...:L Pho:)e. Buildino P~~it Info: Descr,be Work(Le., Build Single -
_ ~,))' I N ~ \ ;:tvl1-. _ Fam,ly nes,dence \;,th Attached Garaoel ::J
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construc\io)'Vnder I ( ;:-' /~n"l to \ 3 \ ~ C\ \) 0 t ~.\\ ,")'"le\ \ \ \{\t;s. \' X\~ .. '-
Address \JC\ ~ n ....010J\g. _ t\\.rN. ()\ \ !--"ifx'V"\ l\"':'--.~-+"; d ,,~
UI::::dl:iN 1l:.Ar-1 lnamel (address) - -l\ 'T('ics. no.) (exoires) \ (ahone no.'
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Primary Fi:>~/) L .hPFr-7'r
,
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Structural
Electrical
Mechanical
CONTRACTORS. (name I (address 1
Genera l~. HlJv!...\) 6) A ~, V1- i, .., ,}......
Plumbin ..Qcj~u-~ MV\...!! ')
\ '--
Electrical
(lies. no.'
(exnireos.)
(ohnn~ nn. ,
l
~1echanical
PLUlIBING
ELECTRICAL
MECHANICAL
-...llih
FEE 'CHARGE 'ill......
FFF rH~ NO.
':fL'
SQ. FT.
furnace/burner to
BTU's
Each single fixtu~e
Residence of
Relocated building .
(new fix. additional)
S.F, Residence
(1 bath)
Duplex (1 bath)
~ New circuits alts.
Y or extensions
1/ -::!_"'~~R6E"
SERVICES
:2 (7.;9<'
Floor furnace
and vent
Recessed wall
SD~rp hp~t~r ~nrl vpnt
{
ea,ch
Storm Sewer
Of
amps.
Appliance vent
S~DaratE'
Stati onary evap.
cooler
/.'/ Vent fan with =,~
t:;;J sinol~ duct ~ ~&.
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood and dur:t.
Wood stove/heater
Additional bath
Sewer
Temporary Construction
Change in existing
rE'S i Qf!J1Ce
multifamily~ comm. or
Tndustrial
Water service
COMfI./IND. FEEDERS
Install/alter/relocate
(Ii <:.tri h. f~~d~rs
Of
amps.
~ ?~r-=' ,EcGC; ~/""?-C
~~/T ~..&. ? ~ ~ e:;Z:
& B' c-L.r..../~c ':::::;'A~..J,~ ISSUANCE OF PFRIIlT
TOTAL CHARGES TOTAL CHARGES~Y7.~'" ,-?~~<;i.I~ . TOTAL CHARGES 41 ,R. ao
WHERE STATE L,'H REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this permit
shall not be valij 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 performed 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 here;n~ 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 Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption ;s noted hereon, and that
only subcontractors and employees who are in compliance with ORS 7~1.055 will be used on this project.
cJ:
IWIE(please print)'~ V-,1 VI Caz r' / );V SIGrlATURE -;./~
'-l FOR OFF I CE USE OIII'Y (
Tyoe/Const. ,~~# Units Sq. .ltg. 11ain, Value
Bedrooms O~cy Load Sq. Ftg. Access x Value
Stories / Occy Group P- / Sq. Ftg. Other x Value
. - - . . ~Q'n Q.t-.-{J:)-0..q()~11JCf?Ar~lOrI
'qs' UJ ' Plan Ck. COIllTI/lnd ' ~/\ '/ \ 'syste, ms Development' II 4'
. 65%/Blda P.r F.. '-- n . CharQe O.5~)' oR- ,
- -'0-- Plan Ck. Res I' . '
. 30%/BldQ Per Fee
Zone
cc.
Fi re Zone
Flood Plain
BUILDING PERflIT
Charges and
Surcharges
I
PLUt1BING PERMIT
Charges and
Surcharges
Fence
ELECTRICAL PERf~IT
Cha rges and
Surcharges
MECHANICAL PERMIT,
Cha rge sand
Surcharges
Demo
Sidewalk
\J V:. . ~ 'l\oAJ t,
-,..()~ ~U
- I
~~Jl(D ~
AIC Paving
Total Comb. Permit
____1'"8--'--~~u
-:z. Yo
Curb Cut
-- TOTAL
~
,
. - " I."" ..,__ 0_
./"
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
J. Appl icant to furnish
A. Job Address
B. legal Description ' ", If
1. example~ Tax lot 100, lane County Map Reference
17 oj 43
2. example- Lot I. Block 3, 2nd Addition to
spr,ngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
'I. example- heat/electrical ceiling/or forced 'air qas
2. exa~le- waterheater/electrlcal/or ~
E. Square footage or valuation, etc.
I. example- 1250 sq. foot house, 500 sq. foot garage
2. examole- if new project. check-nfw - if addition,
. cneckadd, etc. - .
F. Building permit information:
1. example - construct single family house with an
attached garage
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 TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or jab 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 Oivision 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.
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(l\<64
V. FOR OFFICE USE ONLY
"" Penni t
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.........
PROJECT CONDITIONS TO BE SATISFIED B'EFORE' OCCUPANCY:
.. . ~ .
Permit applicant exempt from registration with the 8uilder's Board because:
..J
Additional Project Infonnation:
.
PLANS REVIEWED BY:
name
signature
date