HomeMy WebLinkAboutPermit Building 1990-6-13
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'I' INSPECTION LINE
726-3769
Job Address0J( )G() l )\lj,N\PI(' P~7A
Legal Omription \'1C)CQ~\ \DIIrx:J
CITY UF SPRINGFIELD
COMBIIIATlON APPLICATION/PERMIT
ElIERGY SOURCES:
Heat
I'later Heater
4~dr\\m~5s~:~ I~ii~_'la[; (ohnnp no 1
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3377<.,
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owner...lD'u0r\40 \01 \'N\ Qv
Address c9r\~ ~ '\ \ ((Y\.() \ t' Phone
~C'\~~ \ (~\ Critl!
~~Le\+
L.-" (J~\.l ~f\I(Of~ 141-\~
~t"bN 1EAI1 :j,?ta~ej (address)
v
Primary
Structural
Electrical
I~echanical
CONTRACTORS (name)
Genera 1 1!ZL/ ~ N'7/f' .Ate }7:Fh~
Plumbina IJ1,LI
Electrical 'cll'b 1 ')(\\:'....&:f' ~ ;,''-.7 D
CA-..P er.
~'echanlcal
PLUl1BING
NO.
FEF CHARr.F Nn
Each single fixture
Residence of
Relocated building
(new fix. additional)
/\ New circuits alts.
~ ~exte~sions
S.F. Residence
(] bath)
Duplex (1 bath) each
IAdditional bath
I ~Jater service
jSewer
Istorm Sewer
SERVICES
INFORllATlON UNt
726-37,3
Sq. Ftg. /.Iain
~q. !='tg. Accpss.
Sq. Ftg. Other
flew Add Alter Rep.
Range -Fence Demo Change/Use
valu~ ~CI) Other--
BulldinaJPermit Info: Describe \~ork(Le.. Build Single
riarre~ ~AQQ~~r.a~
~ Q ){\S,-\-1 (\~V~ Q 0 f'\ .D<L . ~Q.
..t)
~
.......,
s---
JJ
(jJ
flics.no.)
(~x[)ires)
fohoneno.J
/0-"11
"72(,.7040
ELECTRICAL
MECHANICAL
~~r rH~ NO
rrr r~
SQ. FT.
furnace/burner to
BTU's
'22Sl$
Floor furnace
and vent
Recessed wall
Soac~ hpatpr ann vpnt
ITempOrary Construction
IChange in existing
rps i ctPJ1r:P
ImultifamilY. camm. or
In<iustri(tl
10f
COMfl./INO. FEEDERS
amps.
Appliance vent
spoa ra te
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and dud
Install/alter/relocate
rlidrih fppnp",,,
10f
Wood stove/heater
amps.
ISSUANCf OF PFR!HT
TOTAL CHARGES TOTAL CHARGES <.2-:5"D TOTAL CHARGES
WHERE STATE L'\~ REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this pemit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed aprlication 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 fW OCCUPAr~CY 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, ~nd that
only subcontractors and employees who are in compliance with ORS 701.05<:ft..pv} ""1";; ~;-\:;'::;e~~. -
IlAl.IE(please print) L. ;S.IA ,+ SIGilATURE ~av~, OATE~/9D
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Zone r-.M 7<
Fire Zone
Flood Plain
TYOe/Const.~~ Units
Bedrooms Occy load
Stories / Occy Group. B~2..
FO~ OFFICE USE miL Y
Sq. Ftg.
Sq. Ftg.
Sq, Ftg.
t1ain x Value
Access x Va 1 ue
Other $.r--.>>o?'-<5'oP@ L~~e
TOTAL VALUATION
'<"" ~-">
BUILDING PER~I!T
Charges anC::
Surcha rges
-:<"& L:": Plan Ck. Corml/Ind
___~.=.i:?E__ 65%1Bldo Ppr ~pe
Plan Ck. Res
/. '9"7 30%/Bldo Per Fee
_u.,..{?::"~__ Fence
. 75' 0/1ll10
____3<-5.::> Sidewalk
1-/3' A/C Paving
PLU'~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERr:1T
Cha rges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
~l'i'. .q() \lIDlP
l)~ ^~M Syste. ms Development
~. ~~ Charoe (1.5%)
#-1--
Total Comb. Permit
TOTAL
7'7. 8 (
'(;ill
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COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
1. Applicant to furnish
A. Job Address
B. Legal Description
1. example. Tax Lot -lOa, lane County Map Reference
17 03 43
2. exam~le- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceiling/or forced air Qas
2. examyle- waterheater/electr;cal/or solar
E. Square footage or valuation. etc.
1. exam~le- 1250 sq. foot house, SOD sq. foot garage
2. example- if new project, check new - if addition,
,cneck add. etc.
F. Building pennit information:
1. example - construct single family house with an
attached gar~ge
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 TE~I 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 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 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.
QtJ
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0-/3-CJO
V. FOR OFFICE USE ONLY
Cl.,)lffn )
Permit
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from. registration with the Builder's Board because:
Additional Pro~~ct Information:
PLANS REVIEWED BY:
name
L.c;/7....s/c ~ ~67f
signature
~~~.--:> date t::-//-9C>
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