HomeMy WebLinkAboutPermit Miscellaneous 1990-10-24
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Address V() ~ q n']( )
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Construction ~g
I INSPECTION L1I1E
726-376~
Job AddH OO( )
Legal Description
Owner
Address
DESIGN ItAr~
Primary
Structural
Electrical
'"'
':&.. CITY UF SPRINGFIELD .. INFORlIATlON liNt
- --W' COMBIIIATION APPLICATION/PERMIT 726-3753
EIIERGY SOURCES: Sq. Ftg. 1.lain
Heat ~q. Ftg. Access.
I~ater Heater Sq. Ftg. Other
flew Add Alter Rep.
Range Fence_Demo_Change/Use
v~~nn ,ex) , _Other
BUild\nQ Permit Info: Describe Work(i.e.t Build Single
Fam~ nesidence With Attached Garaael
-
Q.:)
C)
{Nfl AV
~
Phone
\
It b llJ 0hR Ji'iJLLJ
(name}
Phone
(address)
(ohone no.
flies. no.)
(pxn;r~c:)
Mechanical
CONTRACTORS (name J
General b0 ro ~ I ffiY\uJlO
- (
Plumbino
Electrical
Mechanical
....llih.1
Each single fixture
" ~d~ress)
UID '
flies. nn.\
'~0np nil' \
48'S. 7q1~J
(PYl)irp<\\
PLUllBING
ELECTRICAL
MECHANICAL
FFF rHARr,F NO <<< 1..cJiAlli ~
Residence of furnace/burner to
SQ. FT. BTU's
~~~ r~11RGL
Relocated building
(new fix. additional)
S.F. Residence
(] bath 1
Duplex (1 bath) each
Additional bath
~Iater service
Sewer
Storm Sewer
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~rp hp~tpr ~nrl vpnt
Temporary Construction
Change in existing
rps i ciPJH'P
multifamily, comm. or
Industr;al
Appliance vent
seoaratp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and dUl".t
Wood stove/heater
Of
amps.
COMfI./lND. FEEDERS
Install/alter/relocate
d; str; h. fpprlprs
Of
amps.
ISSUANCE OF PFR!lIT
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali~ until the
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" rw OCCUPAHCY 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 subco~t c and employees who are in compliance with ORS 701.055 will be used on this project.
IWIE(please pri .'/O/.JTEOkER'-f SIGII^~f2. J,.. ~_.LA-O-
){ FOr. OFFICE USE Q;lLY () ___............
/ Type/Canst. Units Sq. Ftg. t1ain x ~
/ Bedrooms Occy Load Sq. Ftg. Access x
Stories Occy Group Sq. Ftg. Other x
Zone
Fire Zone
Flood Plain
BUILDING PER~IIT
Charges and
Surcharges
PLU11BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Charges and
Surcha rges
rlECHANICAL PERMIT
Charges and
Surcharges
TOTAL CHARGES
TOTAL CHARGES
that tile Electrical work be done by an Electrical Contractor. the electrical portion of this perIilit
label has been signed by an Electrical Supervisor and returned to the Building Division
DATE II.) - V-l-"lo
TOTAL
Value
Value
Value
VALUATION ':.J..... ,;(']U
/
A~ . ='" Plan Ck. Conm/lnd
__~ .__~ 65%/Blrlo Ppr Fpp
...,<"'J:: Plan Ck. Res
. oL -- 30%/81 do Per Fee
Fence
Systems Development
Charoe t1.5~l
Demo
___________J Sidewalk
I A/C Pavi ng
I Curb Cut
------------
I
Total Comb. rermit
TOTAL
~_.
i 4f rl.73
I
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATIDN
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. lane County Map Reference
17 oj 43
2. example- Lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinqjor forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. - .
I. example- 1250 sq. foot house, 5DD sq. foot garage
2. example- if new project. check-new - if addition,
check add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. examole - 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 3D3 (aJ 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 infonmation 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 fonm 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. ---
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 penmit 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.
D" ;j4q{)
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V. FOR OFFICE USE ONLY
Pennit Clerk
.
PROJECT CONDITIDNS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
date
signature
name
.
( .
\.
.
)
r
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,
I
SITE DATA
. :BUS STOP HO:- ,5? _
. -. ;\MENIT"..::r'5Im.'ER O'BEN<;]{-O PAD '0
lOCATION EVALUATION: : GOOD j FAIR 0 POOR
CONFLICT W/ BUILDING: : YES NO
SIDEWALK: : YES NO \JVE.5T
RELOCATE: SIGN: .. YES HOZ~FT._(N. OF' EX. SIGN
REPLACE SIGN/POST: = YES NO TYPE
PAD REQUIREO: _ YES NO
PAD SIZE: ~ .t F'T ..J;;LIN. X 2..2.!...n .-S;L:IN.
,R~ 81-.a~n~~~ 0._
tr 'ES 0 NO
SHEL TrR TYPE:
5:<o..TEJl OfE. To.:.
LEASE .rauIREO:
PROPERTY ADDRESS:
OWNER ADDRESS:
SITE STATUS:
NOTES
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BUS PASSENGER \IA'[T1NG AMEN! TI ES
LOCATION:
.. DE Os OW SIDE or MAIN STQ:E.E.."'l
. !.ZSL-FT . ON DE . Os .w or
THE CENTERLINE OF: ...!.!e.....h 5"TD.E...r..,.
JUR I SO I CTi oN:
OATE:
I NT.
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P.O. SO:t 2"'0 El.cene. OtI!'gCn 97402
REVISIONS:
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