HomeMy WebLinkAboutPermit Building 1989-11-13
\ INSPECTION LINE
726-3769
~ CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
Address
DES I GNI EAr1
(name)
Phone
(address 1
INFOR/lATlON liNt
726-3753
E!lERGY SOURCES: Sq, Ft%...I'I~Jf.:S'"/8.""~
Heat ~q. Ftg. '1(c s'.:??~,
I~ater Heater Sq. Ftg. Other ~
<l0Iew . Add Alter P.ep. ~ <"<
Ran~e _Fence_Demo_Change/Use '0
V'\I' of \'loff:2~~= _Other ~
'I.A.....- -:i . ~__ L I~
Bull(iinQ Permit Info: Describe Horkl Le.. Build Single ~
Familv ~esidence With Attached Garaae'
uV~...r~.r ~.;J; ~t--~~
k;;;_......~,-...:;..~ ?....~~~69,;. t:D
: S;~ ~/>~,~~/... .
(lies. no.) (exnires1 (ohone no.
Iffi'Z. ,^hllAMC.I~~ tD,P;3.-414~.
.
Job Address PION~1e PLA-ZA
\BOS P P. E.
e~-~"2'3r ~~&
~O~\ E."f ~l 1 .,. ~
AdJress
Legal De~cr;ption
Phone
Construction lender
Primary
~uc..E. 'b1"-l~E;Y .~c!-\..
Structural
Electrical
11echanical
CONTRACTORS
Genera 1
(name) (address) (lics~ ,";.:t-:....'~n~~~""'.o.n~8no.')1l
P.<V:.u=.r. r~, 4 DF=\ls::.1 rlP.....~ ____~' T
PlumbinQ
Electrical
~1echanical
PLUrlBING
ELECTRICAL
MECHANICAL
7.~/IJ!l-"
SQ. FT.
furnace/burner to
BTlI's
I "FF I rHARr.F
NO. '
I FEE 'CHARGF
NO '
I ~FF I rHdRr.F NO_
7/.1
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
f1 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
Sn~ce hp~tp~ ~nrl vpnt
~'Storm Sewer
Of
amps,
Appliance vent
c;eoa ra te
Stationary evap.
cooler
Vent fan wi th
sing:le duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and dud
Wood stove/heater
~56 "Water service
,
<~ Sewer
/-'5: -e;>
~."""
~5:~
Temporary Construction
Change in existing
rps i rjenq'
multifamily, conm. or
Tnrlustrial
COMM./INO. FEEDERS
llnstall/alter/relocate
di~trih. fppdpr~
Of amps.
6~7;;;'.K,#t: ~/9/-:?.A:<;:;"'/'?' ~~A"...,.../C'#c. ,r,;;~~~~ 1"
~'/ /
d W"'c. /.2?7#/A7 Jc--;::;;~,.1!;" /~~w.< <: ,,(;/I<J/__4v .~~ 7?.#?< ~
hrr.r""/.7":' ~M"/7IssumicF OF PFRtHT
TOTAL CHARGES ':<:"~ - TOTAL CHARGES I TOTAL CHARGES
WHERE STATE L'\H REQUIRES that tile Electrical work be done by an Electrical Contractor, the electrical rortion of this pemit
shall not be vali~ until the label has been signed by an Electrical Surervisor and returned to the Building Division
I HAVE CAREFUllY EXAMINED the completed app 1 i ca t i on for permit, and do hereby certify tha t a 11 infonna t1 on 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 Spri ng fi e 1 d and the Laws of the S ta te of Orel]on perta i n i n9 to the work. descr i bed herei n, and tha t 1m OCCUPAUCY wi 11 be made
of any structure without the permission of the ~uilding Division. I further certify that my registrat' 'th the ~uilder's
~oard is in full force and effect as required by ons 701.055. that if exempt the b is for exempt' is note eon, and that
only subcontractors and employees who are in como1iance with OP.S 7nl.055 will be ed on this oject.
. ~ ~
NAI.IE(please print) ~c>.s L, WI'pe;-<fr. SIr.IIA . "/'/..?/ ~/./
FOr. OfFICE lJSEIllfL Y- ~
Zone.tCc:.. Type/Const..":;'?' Units So. Fl~. r1ain~g, ~~ x Value ?o/"::>..o-~
Fire Zone Bedrooms Occy Load-LL/ Sq. Ft~. Acces""~ ~1~ Value
Flood Plain Stories / Occ,Y Group.!!.:! S~. Ftg. Othe6rEk~~.........".....a1ue -=<;t!)~
-n -::>_ .:::; ~ H_, ,,;:?!!!ft?6.'2C> I.l.:t11~(\",....( ) TOTAL VALUATIOII:?~~
r?H"v /1E:Y,E4>.::.J~'C> ~.E<",..="Y (rlV' l( f.J:'Y ,
BUILDING PER~IIT 7tJG. d?::> Plan Ck. COIIIII/lnd' ...r- -"!> '\J Systems Development '/AS-~ c=>'C
Charges and ____I-~____ 65%/BldoP~erFe. -:?/"J' Charq.(1.5~) '7&' c...r.
Surcharges ....7 ...1' Plan Ck. Res
v . r~ 30%/Bldo Per Fee
"'Z ~ -=- Fence
----~""::=----
/If,--O
PLUl1BING PERMIT
Charges and
Surcharges
Demo
~TG'__L ;~/<<'
ff:--Wt!:W ~E ///./,>
ELECTRICP.L PERr:1T Sidewalk
Charges and - --- -- --- ---
Surcharges ~/C Paving
/-;72 coe
Total Comb. Permit
/Z7.z. ,/'$"0
rlECflANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTAL
5Y~"3- ~~
.
I,
.
.
,
,
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
1. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax lot 100. Lane County Hap Reference
17 uj 43
2. exam~le- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources .
1. example- heat/electrical ceil inq/or' forced air qas
2. examyle~ waterheater/electrical/or solar
E. Square footage or valuation, etc.
I. examele- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check new - if addition,
check add. etc.
F. Building pennit information:
1. example - construct single family house with an
a ttached garage
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 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
O. 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. ~Ihere 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.
\\~ 3- 80
\~33
V. FOR OFFICE USE ONLY
Permit Cl erk
~t[)CL
,I
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
/!/t:? ?C~/??/T /'75V'#A/CG- /"/...4"'7/<::"
~:?YCEz=:/'??E"'7r- ~C=-/'V=-I?
/ ~
~-:.,,;:;;;:> .l5ct/c:=r. 0 ~"'~.?-
~P//T#Ti':'F 1/W'/7;V ~;?7-5.
W1/ / I ~/f'-.;;;;:-;.- ')
\.. . 'T' ---
//7" .
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name !..on~/c:-"G~
'. -/;/~ ""---..~
Slgnatur~~ _~h_
? date /&-,/9
.....
"'-.