HomeMy WebLinkAboutPermit Building 1990-10-16
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1 INSPECTION LINE
726-3769
.
~ITY Of SPRINGFIELD
CO~aIiIATlON APPLICATION/PERMIT
EtlERGY SOURCES:
Heat
(.Jater Heater
Ran!le
ValuE of Hark:
/7#0
Builri;na Permit Info: Describe Work(i~e.. Build Single
Family Residence With Attached Garaae)
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.
INFORttATlON LINe
726-3753
Sq. Ftq. I"ain
~q. Ftg. Access,
Sq. Ftg. Other
Ilew Add Alter Pep.
--Fence Demo Change/Use
Other- -
~
IS
~
'j
Job Address /805"~ ~/~9 L",/>/
,
Legal De,cription /7~6-;S."2.~-'2? 02C)OC:>
;
Owner _7?(I.~.h'?-:?f .~-;.-.....-,~//~
Address 9~ A/ 7.bh?.Ao/~ Z>::?, Phone
?~~T~.-n /.t9P_
Construction Lender
Address
OESIGfl TEAI1
lname)
Phone
(add"ess I
{lies. no.)
(exn;res)
(ohone no:'
Primary
Structural /~~7/f/ 1~ -'5/~~
Electrical
Mechanical
CONTRACTORS Inamel
General~~r/~15~. ~
Plumbina
.faddr~C;5\ _ ll;~~_ no.
?e2~C~~~~~:2
(pynirp<,\
~np on ,_
~ L{-zd.7~9
Electrical
/I
n
..-,
20- ?'?C<( ::S
-qn-/7G9
~1echanical
PLOI.1BING
ELECTRICAL
MECHANICAL
NO.1
I FFF \ f.HARGF Nn I
~ nr I r'1JAB.G.E. Nn I
Irrl=' lrf.t~
SQ, FT,
furnace/burner to
BTU's
Each single fixture
Residence of
Relocated building ,
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(1 bath 1
Duplex (1 bath) each
Additional bath
SERVICES
I Recessed wall
~n~~p hp~tpr ~~rl vpnt
Storm Sewer
Of
CO~1./IND. FEEDERS
Install/alter/relocate
d;~tr;h fppdpr~
amps.
Appliance vent
~e!Daratp
S-tationary evap.
cooler
Vent fan with
sinala duct
Vant system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Sewer
Temporary Construction
Change in existing
r@s5 q~JH:e.
multifamily. comm. or
Industrial
~Jater service
Of
amps.
/' - J,'- 1
I'~?'L.(~~ f<</I'7A
?~.K/ 7ft:-RM.' r-
I SSUANCf OF PFR'lIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE LA\/ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valid until the 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 UO OCCUPAllCY 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.
Units
Occy Load
Occy Group
SIGII^TURE ./2/ ~ -:?;:7-}. t1t~
FOP. OFFICE USE ONLY
Sq. Ftg.
Sq. Ftg.
;/- '3' Sq. Ftg.
DATr/O..../::>-- 90
1lAJ.IE(please print)
NAL. {V."CJ2():>5
Zone /: r
Fire Zone
Flood Plain
Type/Canst .5"-rV
Bedrooms
Stories' I
t1ain x Value
Access x Value.
Other~//~~"~ Value
TOTAL VALUATION
,-
i 1". .....-.
-0>
BUILDING PERfIIT
Charges and
Surcharges
--::? /.-p Plan Ck. Conm/lnd
..,,!.~~ 65~/Bldo Per Fep
--- -I-~-- Plan Ck. lies
- ./.;J 30%lBlda Per Fee
Fence
-:70../5
Systems Development
Charae (1.5~)
AI /-1'.
;
PLU11BING PERMIT
Charges and
Surcharges
Demo
ELECTRICAL PERI~IT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Sidewalk
A/C Paving
Total Comb. Permit
'5'2.6'5
TOTAL
~2.?o
,
Curb Cut
.
.
..,
.
-
. 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
1/ 03 43
2. e"amEle- Lot I. Block 3. 2nd Addition to
>pr,ngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examEle-" heat/electrical ceilinq/or forced air qas
2. example- waterheater/electrlcallor solar
E. Square footage or valuation. etc. -
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. exa~le- if new project, check-new - if addition,
cneck. add, etc.
F. Building permit information:
1. examyle - construct single family house with an
attached garage .
2. exam~le - 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 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
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. ---
Ill. Applicant tu 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.
s28
CjG
[OJ 16-QO
V. FOR OFFICE USE ONLY
Permit C1 erk
LO ".
(J)()J Ov
.
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
'Permit applicant exempt from registration with the Builder's Board becaus€:
Additional Project Information:
PLANS REVIEWED BY:
name L~;q N',,3 /;: ~ """..?'f"
signature ~_____ ~
r . r ( ,,;;
date 41-2o-9d?>