HomeMy WebLinkAboutPermit Building 1990-2-15
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I INSPECTION LINE . CITY U, SPRING,IElD . INFORl1ATlON LINE
726-3769 COMBINATION APPLICATION/PERMIT 726-3753
Job Addre~s \ \1 \~, ~ r{y~ Y\ ~~o Dr) ~~;~GY SOURCES: ~~: ~~~: ~~~~ss.
Legal Description \ C\ n 3354. \ ()~ m-) Nater Heater Sqile~tgAd~th~~ter Pep.
. - Range -Fence Demo Change/Use
L. - ,,-. \.,. ~ 1\ Valu' of f10rK:/1j\.'I\ ,ro -Other--
Owne'-A 1). 'ff\~~ ~ \}.,"" \ \ ~'yt'fx1\\('<~__ ~ BUlldinQ permi~~~}: Describe WorKll.e.. Build Single
Address _)l:J~~\\. f\ \.. A ~ l\ Phone Family nesidence Hith Attached GaraQe:
?f)f-\r\ 8? / Cf14l~ ~~l \:\J\),J\rn., ~O~>
constr~C;1\~ \ender J \J
I
Address
Ul~IGN IlAI4
Phone
(address'
(lics.no.'
lnamel
Primary
Structural
Electrical
Mechanical
CONTRACTOjlS
Genera ( l)
----
V
l1ir.s.no.'
_ (add~"
~..
(namel
~)\\()Oy
PlumbiM
Electrical\\A S f\)o~).(')
~le~, rWr7'). ~~4 ?L~
- "\<..-/;L~lBING - - /
ELECTRICAL
-1J!h1
~ Each single fixture
Relocated building
(new fix, additional)
I FFF I CH~Rr.E
J:'H 'r~ARr"l=' NO
"D
Residence of
)g). I~!>>
SQ. FT.
New circuits a1t5.
or extensions
S.F. Residence
II bath]
Duplex (1 bath) each
Additional bath
SERVICES
Temporary Construction
Change in existing
res5 de.nee
multifamily.
Industrial
Water service
Sewer
corrm. or I
amps.
Storm Sewer
Of
CO~4./IND. FEEDERS
Install/alter/relocate
distrib. feeders .
Of
amps.
(exoires)
I
(ohone no.'
J1f
(exoires'
(ohonP no. \
MECHANICAL
furnace/burner to
aru's
Floor furnace
and vent
Recessed wall
Sr.~p~tpr ~nrl VP"t
Appliance vent
seOilrate
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
TOTAL CHARGES
WIlERE STATE L,\l~ Rl~UlI(l~
shall not be vali1 until the
ISSUANCf OF PFRlIIT
TOTAL CHARGES \~.()~,rrs TOTAL CHARGES
that the Electrical work be done by' an,'Electrical Contractor. the electrical portion of this
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 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 ons 701.055. that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in.compliance with ORS 7n1.055 will be used on this project:
IWIE(PleaSeprint)_S~~ .~ SIGIlATURE &I- A-- If -Q
FOr. OFFICE USE OlILY
Sq. Ftg. rlain
Sq, Ftg. Access
Sq. Ftg. Other
Zo~e
Fire Zone
Flood Plain
Type/Const.
Bedrooms
Star; es
Units
Occ.y Load
Occ'y Group
BUILDING PER~IIT
Charges and
Surcharges
II _ 0) .. Plan CK, COlllTl/lnd
__l~~__' _'-_ 65%/RJdo p.pr Fpp
(f n' Plan CK. Res
. C\. ~ 30%/BIdQ Per Fee
__\5.:.QQ__ Fence
.'l~ D~o
_J~:.._o..~___ .Sidewalk
,15 A/C Paving
Curb Cut
PLUr~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERIIIT
Charges and
Surcharges
MECMANICAL PERMIT
Charges and
Surcharges
,~
~
'.,S)
-
t
FF<
. r".1RGE
I
permit
DATE '2 -/<=90
x
Value
Value'
Value
x
x
TOTAL VALUATION
Systems. Development
Char~e (1. 5~ ..
Total Comb. Permit
TOTAL
tj-Y.3o
.
-----..--
COMBINATION APPLICATION/PERMIT (CAP)
I.. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, lane County Map Reference
17 03 43
2. exam~le- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
q. Energy Sources
I, exam~le- heat/electrical ceilinq/or forced air qas
2. exa~le- waterheater/electrlcal/or solar
E'.. Square footage or valuation, etc.
I. example- 1250 sq. foot house, 500 sq. foot garage
2. '.example- if new project. checkMw - if addition,
.' cneck add, etc.
F. Building permit information:
1; example - construct single family house with an
attached garage
2, example - remodel existing garage into family room
3. examJPle - 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 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 n~ed 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 CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
J-
PERMIT VALIDATION
,
-~
1Flu03/
Permit. Clerk ~
.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date