HomeMy WebLinkAboutPermit Building 1990-10-23
I INSPECTION LINE
. 726-3769
Job Address /97t::>
legal Description
.
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
I~ater Heater
Range
ValuE of Work:
.
INFOR/IATlDN LINt
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
flew Add A Iter Pep.
--Fence Demo Change/Use
-Other - -
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/5C 1/?',,47 7>""-':::::'
~cn/ rp/"f !b-YHC /#/~~ ~
Address ~/~7~z,
J
plene
BuilriinQ Permit Info: Describe Work(i,e" Build Single
Familv nesidence With Attached Garaoe)
~f/.~dCr~~ ___ff'{.'{:AE' I
,.fZ6 ,/L' ~~ ?~","--",-
/AI ~kt. fr~hr~.
(lies. no.l fexoiresl (ohone no.
~#,A;:.
'7L&:-/'5'~7
Construction. Leryler ,.,..... ~......:/."...c ?lo'";) - ~'7" ~
Address .z;;";:#~#A:'- 'I8~p:?:~6 c;>
UI:.~lbN fi.{r'f- (name) ,/ (addressl
Primary
Structura 1
Electrical
Mechanical
CONTRACTORS
General ~ ~
Plumbina
(name)
~LvA'7~C7f'C,
(address)
(1ir:~_ nn.)
(pxoirp<:ol
(ohnl'lp nn ,
Electrical
~'echanical
PLUI1BING
ELECTRICAL
MECHANICAL
NO.
FEF r:HARhF NO
~~~ r~~ NO
~~~ rl-l~
Each single fixture
Residence of
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
~n~rp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appliance vent
c;.poa ra tp
Stationary evap.
coolar
Vent fan with
sinole duct
Vant system apart from
heatino or A.C.
Mechanical exhaust
hood and durt
Sewer
Temporary Construction
Change in existing
res i ~~.nce
multifamily. COn11l. or
Industrial
Water service
CO~~./IND. FEEDERS
Install/alter/relocate
dic;.trih. fppdprc;.
Wood stove/heater
Of
amps.
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be valid until the
TOTAL CHARGES
ISSUANCE OF PFR!lIT
TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit
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 IIOOCCUPAllCY 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 subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
oC>ps (
SIGII^TUR~Ko~I"'" L. 14 I c.1<.""l> N
FOR OFFICE USE Q;lLY
Sq. Ftg. tiain
Sq. Ftg. Access
Sq. Ftg. Other
Print)/?~ -----/..~~.1
Dm/O-.:n-90
NAI.1E (p 1 ease
Zone
Type/Const.
Bedrooms
Units
Occy load
Occy Group
x
Value
Value
Value
Fi re Zone
x
Flood Plain
Stories
,
TOT^L VALUATION
PLUHBING PERMIT
Charges and
Surcharges
Plan Ck. Comm/Ind
65$/Bldo P~r Fpp
------------ Plan Ck. Res
30%/BldQ Per Fee
Fence
Systems Development
CharQe (!.5~)
BUILDIrIG PER/lIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Charges and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
Demo
'Sidewalk
A/C Paving
Total Comb. rermit~
Curb Cut
TOTAL
I;YO fre-
.
I.
.
~
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example~ Tax Lot 100, Lane County Map Reference -'\ ,-
II oj 43
2. example- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates .
C. Name. etc. of owner and construction lender
D. Energy, Sources .' - ...
1.' examole- heat/electrical ceilinq/or forced'air Qas.
2. .~examOle- waterheater/electncalJor solar,
E. Square 'footage or valuation, etc. ~
I. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check new - if addition,
cned:. add. etc.
F. Building pennit information:
1. exame'e - 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. 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 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. ---
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.
'"
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...
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V. FOR OFFICE USE ONLY
Pennit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~ennit applic~nt exempt from registration with the Builder's Board because:
Additional Project Infonnation:
PLANS REVIEWED BY:
name / o;~/,:r--:<&"'?tsignature~~~ ;date
,vr - , ,; ,
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