HomeMy WebLinkAboutPermit Building 1989-9-20
'l'iNSPECTlON LINE .
716-3769
Job Address 14 d f) lUV I ~~ i#> 3~
I.egal Description \1) ():=).!{ I?)~\ I (')0 'l(,()
CITY Of SPRINGfIELD
COMBINATION APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
Ha ter Ilea tcr
.
INFORI1ATION LINt
726-3753
Sq. Ftg. Hain
~q. Ft~. Access.
Sq. Ftg. Other
flew Add Alter Pep.
-Fence Demo Change/Use
-Other- -
))
e
..CJ
JJ
CJl
Ranne
ValU(~rto~
Buihiinoi5ermit Info: Oeser be l4ork(i-.e.. Build Single
F~~l~Ctr/t A;tauh~dM~: ,~O
Address
UES I GN ltAf1
(name)
Phone
{address I
!lies. no.l
(exo; res)
(ohone no. j
Primary
Structura 1
Electrical
l1echani ca 1
CONTRACTORS tnamel {address' (lip- "9.) (p.xnire!i.)
Generalr~('~. 15Lo{p {~~f(J\Cff)4D1
Plumbina '\::ct:$.~ \?~~ IOn C/)t-Lt n, Ei cDO-RP6
Electrieal~\,{\r.f\, ~b~, .
rlechani~al f~~)~(\. -1'C\lp(o 0f\ht.Lll.Q f::'~Wo
~~oo llirn~ U
314:2q~
843"5401
MECHANICAL
7:?tt/ 3:;:?..e.
SQ. FT.
furnace/burner to
BTlI's
I
1
Each Single fixture
FFF CHARGF Nr,-
Residence of
"r
'J!AllG.E..lIJl.
NO.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
II bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sn~~p he~tpr nnrl vpnt
amps,
Appliance vent
sel}aratp
Stationary evap.
cooler
Vent fan wi th
single duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hOl"\rl nnd rlurt
Sewer
Temporary Construction
Change in existing
res j rlJ'nr:~
multifamily, con1l1. or
Inrlustrial
~/ater service
Storm Sewer
Of
COMfI./IND. FEEDERS
Install/alter/relocate
distrib. fppders
Wood stove/heater
Of
amps.
TOTAL CHARGES
WIIEnE STATE L'II REQUIRES
shall not be vali:.! until the
u~/:~/~~r 6;....;....~ ~
~ /A-f/.;<j'/N' .~c-.=7.
K~ff-/' ...-7:>.....": (7lEl .~. ISSUANCF OF PFRim
( .~.
~. -'" TOTAL CHARGES I TOTAL CIIARGES
that tile Electrical work be done by an Electric,'ll Contractor. the electrical portion of this permit
label has been signed by an Electrical 5upervisor and returned to the Building Division
I HAVE CAREFUllY DAmNED the completed app 1 i ca t i on for permit. i\Od do hereby cert ify tha t a 11 informa t i on 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 Spri ngfi e 1 d and the Laws of the Sta te of Oreqon perta i n i ng to the work descri bed herei n. and tha t rw OCCUPAI~CY wi 11 be made
of any structure without the permission of the Building Oivision. I further certify that my re8istration 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 SUbconty\ractors and employees who are in eomolianee with OP.S 701.Q55 will be used on thi~Ojeet.
IWIE(please pr ) l')AvloC> H-oLMt'::. SIGil^TURE~) DATE ')p.o/J'J _,
I FOr. OFFICE USELOII\. Y ,
Zone C'- c.J TYDe/Const. :7--A/ Units So. Ft~. 11ain x Value
Fire Zone / Bedrooms Ocey load Sq. FtI1. Access x Value
Flood Plain' Stories / Occy Group 8-2. Sq. Ft;. Othe~1vr..~6>/<<",'.-c-~ Value q...;.::-~--
TOTAL VALOATlOtI
BUILDING PERfIIT
Charges and
Surcha rges
V' / a:-: Plan Ck.
_ _ __ _L'l-_~~ _ 65%/Bldo
/7 -:? Plan Ck.
-< - -;:;(...J 30%/Blda
~& -=:0 Fenee
____~t.:J____
1_ Sc:s D~mo
Sidewalk
Conm/Ind
Per Fpp
R-es
Per Fee
:::;>&9'3
Systems Development
Charae (1.5~)
#-4
PLUI~B I NG PERMIT
Charges and
Surcharges
~'l'tK~~-:-6S-.00
8~.c.ey~ '7,k.., 9'5'
ELECTRICAL PERI:IT
Charges and
Surcharges
------,------
A/C Paving
Tot~l Comb. rermit
11WIANICAL PERMIT
Charges and
Surcharges
Curb Cut
,
jLJ7/b
TOTAL
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
n. legal Description
1. ~xarnple- Tax Lot 100. lane County "lap Reference
17 03 4J
2. exa~le- lot I. Block 3, 2nd Addition to
SprIngfield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceili~Q/or forced air qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, checklnew - if addition.
check. add. etc.
F. Building penn it information:
1. example - construct Single family house with an
attached gartlge
2. exam~le - remodel existing garage into family room
3. exarT.!Ple - 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 TEAfI AND CONTRACTOIlS
To avoid design or conslt'uction d(~lays. Building
Division Staff must be able to contact appropriate
persons regarding design infonnation or job site
corrections. etc.
II. Abbreviated Plumbing, Mechanical. & Electrical Schedules
A. Except ~Ihere blank spaces occur in the description
portion of the r~echanical 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 ~ 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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
~.
~
~-W,<6~
4Cf3t-
Pennit
Clerk_~ffJ1 ')
.
Permit applicant exempt from registration with the Builder's Board because:
Additi ona 1 Project Infonnation:
PLANS REVIEWED BY:
name
~~ ;7}._-, .:...,..,.signature
c
~~~ate
/' p/ ..; //' '/'
r, r
~/"5 &. ?