HomeMy WebLinkAboutPermit Signage 1989-8-28
Job Address;'/.~ 'f1;Hef!!Y' f/k 1/ F.
Legal Description f,oC::;(>A.de OlLt~:~",,,,,,
. CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EIIERGY SOURCES:
Heat
Nater Heater
.
INFORJIATION LINE
726-3753
Sq, Ftg. '.Iain
~Cl. FtlJ. Access.
Sq. Ftg, Other
Ilew Add Alter Pep,
-Fence Demo Change/Use
Other- -
INSPECTION LINE
726-3769
owner'RaltJ" s.;.......cL
Address 17~ IJ)e:st ~ sr
,).tJI";uaf,~fJ jot C17~77
Construcfion len"er
Phone
Ranqe
Valu, of Hork:#~ 79$!!!:.
,I
BuiltiinQ Pennit Info: Describe Work(Le..
Familv nes;dence With ^ttached GaraQe\
Build Single
~
()
IX:
C.
~
'\)<.
AJdrcss
OESIGN TEAM \namel
Primary ,( l4f.r2 ra IUI.dH ;UO ,jo 13(1 I1.lA e.. ('
CJ
Structural
1~-v,i4L:.( :g" ~"'~~XO"" ~~/~,~;.
pbVG' ~/ / -"': ~CF ,7>->
Phone "P~.#~~.
(address' ..... (lies. no.l {exnires}
I 1 flrJ - n - C" ' "
~()7~w.5' ~e I t'rJ' i:'t"Ke - ~ ,&u5
{ohone no.
Electrical
t
11echanical
CONTRACTORS lnamel
General F'HA P YO<'1/d ,4119"': lAG
laddre$$'
(1 ies. no. \
(PllO; rpt;. \
(ohnn!' Of' )
Electrical
,11I"Cl b b UA.
'-.J
fleeTY" 'c...
Plumbinl1
"lechani ca 1
PLUIIBIIIG
ELECTRICAL
MECHANICAL
SQ.
Ieee
FT.
fJJARr:1=' NO,
ecc
fPARf...E.
NO.
FEE
rHARr,E
Nn
Each single fixture
Residence of
furnace/burner to
BTlI's
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(I bath)
Ouplex (1 bath) each
Additional bath
SERVICES
Recessed wall
I Sn~rp hPiltpr- ilnri Vf.nt
Storm Sewer
Of
amps.
Appl iance vent
seoa ra te
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent syste~ apart from
heatina or A.C.
Mechanical exhaust
hood <1nd duct
Sewer
Temporary Construction
Change in existing
residpnc~
multiiami-ly. COrJ111. or
Industrial
~la ter servi ce
CO~1./INO. FEEOERS
Install/alter/relocate
d;~trih_ fppdpr~
Wood stove/heater
1
Of
amps.
/1h~" cCFC)';;"/4:~A/
:"5 ""-1'L: ( "?;!S"T.A'/A/
/ rn'/7/ //:
TOTAL CHARGES TOTAL CHARGES
WHERE STATE LMI REQUIRES that the Electrical work be done by an
shall not be vali~ until the label has been signed by an Electrical
&'l~
I
I SSUANCF OF PFRiIl T
I TOTAL CHARGES
Electricnl Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXMlINED the completed application for permit. and do hereby certify that all infonnation hereon is true
and correct. and I further certify that any and all work oerfonned shall be done in accordance with the Ordinances of the City
of Spri ng fi e 1 d and the Laws of the Sta te of Orel)on perta; n i ng to the work descr i bed herei n. and tha t IlO OCCUPAUCY wi 11 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 OP.S 701.055 will be used on his project.
Zone
Fire Zone
Flood Plain
Units
Occy Load
Occy Group
S IGIIATURE
FOr. OrFICE USE LY
V.
Sq. Ftg.
SQ. Ft~,
Sq. Ftg,
/
OATE~- 23'-%91
IWIE(please print)
'x:n 'fMJV'OM..
Tvpe/Const.
Bedrooms
Stories
Hain x Value
Access x Value
othej4~;....:..?x Value::::2?9.~
TOTAL VALUATION
.,....
BUILOING PERfllT
Charges and
Surcharges
~ &"'0 ~~a~B~~~
-----_..._----~
Plan Ck,
I. '?3 30%/Bldo
Co"",/I nd
Ppr Fpp
Res
Per Fee
25:&3
'Systems Development
CharQe (1. 5t)
A/,,/
PLurmING PERMIT
Charges and
Surcha rges
Fence
eLeCTRICAl. PERIHT
Cha rges and
Surcharges
t1ECHANICAL PERMIT
Charges and
Surcharges
O~o
Sidewalk
Ale Paving
Total Comb. Permit
Curb Cut
TOTAL
65". Yb
.
.
.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A, Job Address
B. Legal Oescription
1. example- Tax Lot 100. Lane County Map Reference
11 oj 4)
2, example- Lot 1, Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction Tender
D. Energy Sources
1. example. heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electrlcal/or solar
E. Square footage: or valuation. etc. -
I. example- 1250 sq. foot house. 500 sq, foot garage
2. example- ~,f new project. check-new - if addition.
check add, etc.
F, Building pennit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
J. 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 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 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
0, 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.
/ ~/ d-O
V. FOR OFFICE USE ONLY
Permit Cler~~
fe11HJ7
r-.
.
I
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name ~?f~E n~~ignatur~.--~--=-> date 979 2'7
. ,