HomeMy WebLinkAboutPermit Building 1988-4-28 (4)
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11$PECTION LINE
1'26-3769
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Job Address //~l/ 6A7?FWA-"- (....- p
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Phone r '\
(address) l1ics. no.) (exoires) (ohone no.
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CITY Ur SPRINGFIELD
COMBINATION APPLICATION/PERMIT
EilERGY SOURCES,
Heat
l~ater Heater
Range
ValuE of Hark,
: j'6(!J(!:>. a-c:. .
Builoino Permit Info: Describe Work(i.e.,
Familv nesidence With Attached Garaael
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INFORlIATION L1No
726-3753
Sq. Ftg. I.'ain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
--Fence Demo Change/Use
Other- -
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Owner' OREC:;;;08 ;lfA.~
Address q5/~ <oW: A?~.zl~
&7Z..4-wZ) . z::;zr. 9 7:?~
Construction lender ~
Phone
Build Single
Address
Ul:.~ tliN TEAr~ {name J
Primary '&<.Jct!! A
'2~-7r;Z';::;
Structural
Electrical
<"J~ <..,00
. I
Mechanical
CONTRACTORS (name) (address) f1ic~. no. \
GeneraIM",,;J?--< A/~C.TY ~/ ~E /E~~~
,
(exoi rp,)
(ohonp nn.)
({;R?-2 2&?
Plumbina
Electrical
f>1echani ca 1
PLUIIBING
ElECTRICAL
MECHANICAL
NO.1
Each single fixture
I FE!: I r.HARr;F r-m I I ITL 1....cHAR.GI Nn _ I
Residence of furnace/burner to
SQ. FT. BTU's
I ~~LI...cli8.RG.E.
Relocated building
(new fix. additional)
S.F. Residence
(J both'
Duplex (I bath) each
Additional bath
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~rp hp~tp~ ~nrl upnt
Storm Sewer
Of
amps.
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sinn 1 f3, duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hnnrl "Jnd duct
~Ia ter servi ce
Temporary Construction
Change in existing
rps j dJ'~nr:p
multifamily, COIml. or
Tndu,t.rial
Sewer
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COffi1./IND. FEEDERS
Install/alter/relocate
(iic:.tdh fpprt"'rc:.
Wood stove/heater
Of
amps.
ISSUANCf OF PFRIIIT
TOTAL CHARGES
WHERE STATE L~H REQUIRES
shall not be valid until the
TOTAL CHARGES
TOTAL CHARGES
that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAr1INED 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, nd that NO OCCUPAllCY will be made
of any structure without the permission of the Building Div' 'VII. ~ ~her certify that my 'stration \'/ith the Builder's
Board is in full force and effect as required by ORS 701.0 ,that if ex pt the basi or exe ion is noted hereon, and that
only subcontractors and employees who are in comoliance wi ORS 7n1.055 ill be us on- 's p jectjJ
, _ f
IW'IE(PleaSepr;nt).f1/lrf-;lf. k/""21;,,~s~~,~M- .0 'DATEU-;2~-~~1'
OR OFFICE USE DIlLY t/
Zone C~ Tyoe/Const. "--/#.k> .Units Sq. Ftg. 11ain x Value
Fire Zone Bedrooms Occy load Sq. Ft~. Access x Value
Flood Plain Stories "2.. Occ.v Group ;:?~2. Sq. Ftg. Other~>>"" ~l!f"~/.?? Value ~~~,-
,/) TOT^L VALUATION
L:: Plan Ck. Comm/tiid- ~,~"'"t/ ;!!#!S'", Systems Development .4/.A
__~C'-,-.5:~___ 65%1Bldo P.l'r Fee R.S~ .".';l~~"Charqe (J.5~) , /ytI'"T
.., r-=> Plan Ck. Res
.c - '" .;;;;> 30%/Bldq Per Fee
I Fence
I D~RIO
IS1dewalk
I A/C Paving
I Curb C~t
I
BUILDING PERflIT
Charges and "
Surcharges r
PLUI1B ING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Cha rges and
Surch~ rg~s. ..
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JTotal
I
I TOTAL
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~ S"3c:?5
I
Comb.~ Permj t
MECHANICAL PERMIT
Charges and
Surcharges
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COMBINATION APPLICATION/PERMtT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. lane County Map Reference
II oj 43
2. example- Lot t. Block 3, 2nd Addition to
sprlngfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. 'examDle- heat/electrical'ceilinq/or forced air Qas
2. example- waterheater/electricaf'tor solar
E. Square footage or valuation, etc. .
I. example- 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
attached garage
2. examyle - 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. ---
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.
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V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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',PERMIT VALIDATION
PLANS REVIEWED BY:
name L.:?;;;;;'A/tfF ?c~~ Signature~..-...... ~--.
~a> Elf',
Permit Clerk
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Permit applicant ~xempt from registration with the Builder's Board because:
date r-<.>~-~~
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Additional Project Information:
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