HomeMy WebLinkAboutPermit Building 1990-9-19
CITY OF SPRWGFIELD
COIIBIilATION APPLICATION/PERMIT
i ErIERGY SOURCES:
Hea t ,elf:;: 7,///(/ ./?JI'5..
Water Heater ~EL-JlZ/C/
RanQe -..-f:li];.17Z/IL
ValuE of Work: )
Id CO IX
Buil~ina Penmit Info: Describe Work{i~e..
F amil v nes i dence IH th A.ttached f;a raoe 1
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'1 IrISPECTIOII LIIIE
1726-3769
Job Address (,PR Fr=J:;.) k'H'I/
Legal Description ('i3 -0,';2 - 1'1 S- - /.1.
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Owner '11. fJ. 77!/')(),[J
Address 144."5 //) JI
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Phone
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Construction Lender
Address
DES I GIl I cAI1
Phone
(address)
(lies. no.)
(name)
Primary iJ:/171'/f7:f. - A/'" J1.fP's<:;81
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)145 tJ, )/"'- Rt;f70r::
Structural
1<
El ectri ca 1 "-
-I
t1echanical
CONTRACTORS
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.(name)
(addressl
(1its. no.)
Genera 1
OW,{..t::V
r)W/Vf7z..
Ow AJDV
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Plumbina
Electrical
t.lechan i Cd 1
PLUlIB IIIG
ELECTRICAL
ita.
FFF CHARGF NO_
~FF CHAPr,F NO.
Each single fixture
Residence of
So' FT.
Relocated building
(new fix. additional)
,
New circuits alts.
or extensions
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.../'~
S.F. Residence
(1 bath)
Duplex (1 bath) each
SERVICES
"
(\ ~ Additional bath
~Jater servi ce
/?.k.l .::CJ_c;"]
Temporary Construction
Change in existing
re5 i df;.nr~
multifamily, comm. or
Industrial
Sewer
Storm Sewer
Of
amps
CDMM./IND. FEEDERS
Install/alter/relocate
di~trih. fppders
Of
amps.
TOTAL CHARGES ,.1,'23') TOTAL CHARGES
\'JHEnE STATE L1\/ REQUIRES that ti,e Electrical work be done by an
shall not be vali~ until the label has been signed by an Electrical
\'\I"\.N\ Q .-<
ItlFORllATION LINe
726-3753
Sq. Ftq. 1,Iain <:;;;-7. S'
:q. ~t9. Access.
Sq, Ftq. Other
Uel'l'i,Add Alter R.ep.
--Fence Demo Change/Use
Other - -
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'CD
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J
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:0
(Y
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Build Single
(exnires)
(phone no. \
683' '1>0'.9
Jqj -U6C{
(exoi res)
(phone no.'
MECHANICAL
I=FF rHARGF
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wa 11
Soace heater and vpnt
~/
Appliance vent
seoarate
Stationarv evao.
cooler ~ .
Vent fan wi th
sinole duct ~..:.tJ ..~.C~
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
ISSUANCE OF PFR'1lT
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":';;:;.J TOTAL CHARGES
Electrical Contractor, the electrical rortioo of
Supervisor and returned to the Building Division
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thi s pemit
. I HAVE CAREFULLY EXAMINED the completed apr1ication for permit, and do hereby certify that all information 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 Springfield and the laws of the State of Oregon pertaining to the work described herein, and that 110 OCCUPAUCY 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. and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
HAHE(please print) J3.(jl!3flesc:::.0J
Zone F- - i
Fire Zone
Flood P1 a in i..:;'j
~-'~/./
Units
Occy Load
Occy Group
S IGilATURE ..~ r-=:-..
FOr. OFFICE USE ONLY
," L...IC/,rW" ,.."
Sq. Ftg. Hain _
Sq. Ft9. Access
,.:2'- _~. Sq. Ftg. Other
Tyoe/Cons t.
Bedrooms
Stories
;;
-,
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DATE!:l9/,(O/&')
I,
,
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x dtf. &Zi
x
x
Value /4!1~;j::;:1.:::0
Val ue
Value
BUILDING PERI,IIT
Charges and
Surcharges
_.., Plan Ck. COrmJlInd
l", -CO 65%/Blda Ppr Fpe
------------ Plan Ck. Res
~7 - .~:g 30%/BldQ Per Fee
TOTAL VALUATIml !L(,::;::JX'.<;Q
In,...,. "t., Systems Development
1.' ,'. ~ "\ -\\)"0. Charoe (1.5~)
c. r~ ,Cfo ,1
I :)~<;;~( 10 Qod I ,Yr1lf.J!...,
PLU'1B IrIG PERMIT
Charges and
Surcharges
_ _ _ _ _ _ _':la:...o..rL
Fence
ELECTRIC~,L PERI~IT
Charges and
Surcharges
/ ;: () Demo
/~<DrJ I'Sidewalk
--------~:;-I Ale Paving
______~2.,E[}_ Curb Cut
/ -r[(
/7.7(; ME
, r!} ()
/.'!- ,.f'oI''''U'' ,r-
._-~ ..,. -
l7. 70
Total Comb. Permit
1~"/,/0
I1ECHAN I CAL PERi1IT
Charges and
Surcharges
,cz/
/'7- J __ /
~.,
..., /
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TOTAL 10:;),00
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COMB IlMTI 0:1 AP?LIC..;no.'UPH_'''Hi 'G~;t)
I. Applicant to furnlsh
A. Job Address
B. Legal OescriPtion
1. examole- Tax Lot 100. Lane Co~nt1 1-~"'D ~c~erC!"\ce
11 03 43
2. examole- Lot 1. Block 3. 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lemler
D. Energy Sources
1. example- heat/electrical ceil ing/or forced air oas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, 500 sq. foot oarace
2. examole- if new project. check~~ - if additio~,
check add. etc.
F. Building permit information:
1. examole - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. 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 TEA~ 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.
11. Abbreviated Plurr.bing, I'lechanical, & Electrical Schedules
A. Except \'Ihere 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. l'lechani(:al. 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. BUILDIIiG 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
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ITY
OF
SPRINGFIELD
<I
City Hall
Springfield. Oregan
Department of Public Works
OFFICIAL RECEIPT
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No; B 5 4 81 0 <t
\)('~ i. t n 199::{)
'From~\Jf )~! \'0<' .
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ed For~~t,\7'\ T'L \7..-.00
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Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAtlCY:
ii)\-o...;. '), -,H:<--, 4 JL~."~~~-(::..; A c_.
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Permit applicant exempt from registration'with the Builder's Board because:
Additional Project Information:
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PLANS REVIEWED BY:
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name
signature
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date
.9-/7 - "vd
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