HomeMy WebLinkAboutPermit Building 1990-4-12
1. INSPECTION LINE
7<6-3769
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CITY Uf SPRINGFIELD
COMBIIIATION APPLICATION/PERMIT
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INFOR/1ATION UNt
726-3753
Sq. Ftq. 1.lain
~q. Ftg. Access.
Sq. Ft9. Other
Ilew Add A Her Rep.
Range --Fence Demo Change/Use
ValuE of Hark: Other- --
I,I~~ ~
Buii(ina Permit Info: Describe Work(i.e.. Build Single
Fa~ilv nesidence With Attached Garaael
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Job Address 1/'1'7' ~7?C~;{~L.o~(f. )
Legal Description \ I) ( )O~ ~m {)'r{-:::z.rf
EilERGY SOURCES:
Heat
Hater Heater
Owner J(;.J&>Al-Ph' /:, N..J7)iC"R
Address~~:)7 _<("=N~ ~c:'~~, Phone
Z>.Atdl//-cl':L'j- a. '$.,.::> "".:;:. (W.5'}~~:?y~
Construction lender _
~,.....,.,...,.. ..",.....~<frI
JES$ 1-r~NEY
Ut"uN T<M1 lnamel ,
Primary --S~-'D7 ~T~..... ~l/~LJ?
.. __. l--IfLI"",
Structural
~"'-75'6'6
-Phone
(addre~~~
/1/~r,4~c:'. h'C/f=~/c-"".-:: /A/
~.;-,;t~#t~~~~ I
(lies. ~0.) (exrfiresl (phone no.
3Se.~#~.
...c?-~ ~r'''>- .-
V~<-~Bs
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Electrical
Mechanical
CONTRACTORS (name,J raddress 1
'-r:~~~ff-
General.J...Hh 7.)0.<2:>O......~4A".... :A ~?/:?__- /"/,.--
Plumbino Eh'7~O ~r~?cz;t::; _
Electrical ~,"5 &=--=::,..
(l ir,,_ no.)
(pxoirpe,'
(ohonp nn.)
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'77<T-.4" ,:; 2..
~1echanical
PLUllB I NG
ELECTRICAL
MECHANICAL
NO.
FEE r.HAJH~F Nn
~~r r~ARr.~ NO.
rrr r~ARr.r
?
Each single fixture
Residence of
?~ -:a.S.:P
SQ. FT.
/
furnace/burner to
_ BTU's
;j",...~...~;;;r~
Floor furnace
and vent
??
Relocated building
(new fix. additional)
New circuits alts.
or extensions
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additional bath
SERVICES
Recessed wall
So~~p hp~tpr ~nrl ~~nt
/ ~Q ~A''''''
7.5L>
Of
COMM./INo. FEEDERS
Install/alter/relocate
rl;~tr;h_ fpprlpr~
amps.
~~ft~'7"~. ,.:;
Appl iance- vent
seoarat.p
Stationary evap.
c.onlpr
Vent fan wi th
siflOle duct.
Vent system apart from I
heatina or A.C.
Mechanical exhaust '
hood and durt
Hood stove/heater
Sewer
Temporary Construction
Change in existing
rps i d..pnrp
multifamily, comm. or
Tnr1l1~trial
Water servi ce
Storm Sewer
Of
amps.
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valiJ until the
~-/-"""h//:.PL ~.y7.-"..
~~~L ~r.;tI7/~-:~
?k__~~....-.:s-". (:.:.::7A~fi. ISSUANCf OF PFRtllT
~ _~ TOTAL CHARGES TOTAL CHARGES ~_ _ ./S:"'-
that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
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 fW OCCUPAflCY 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 u on this project.
Zone C c...
Fire Zone
Flood Plain
Tvoe/Const. ~~/'
Bedrooms
J ;., \,.,~) T. VIA O~_SIGrl^TURE
(FOr. OFFICE USE
Sq.
Sq.
;1>..::2_ Sq.
~
DATE '11/2- f10
IIA!-1E(please print)
v
OIl
FL"ain ) , Value
Ftg. Access x Value
Ftg. Other6~#~f~$U";",,v.,ue 9'~~--~
TOT^L VALUATION
Stories
?
Units
Occy Load
Occy Group
BUILolIIG PER~lIT
Charges an~
Surcharges
Plan Ck.
6S'VBldo
Plan Ck.
30%lBl do
~~..,e> I Fence
------------1
/.:>.0 o~mo
I S1dewa 1 k
---------:~-I A/e paving.
____L~~_J Curb Cut
,?5" I
_ _ _':? ~.J2...rP
I~.o~
ConmlI nd
P~r Fee
Res
Per Fee
/69. 5J
Systems Development
Charqe (1. 5~)
PLUt1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERI~IT
Cha r:ges and
Surchqrges ... .,
ITotal Comb. Permit '?'~_?.s:s
I
I TOTAL r;9~//
I
/1ECHANICAL PERMIT
Charges and .
Surcharges
.
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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
17 03 43
2. exa~le- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. I Energy Sources .
1. examole- heat/electrical ceilinq/or forced air qas
2..... examole- waterheater/eJectr;caf'/or 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 garllge
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.--~1-~lumbing, Mechanical. and Electrical Schedules
are avaTlable at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the';tem(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. ---
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.
4~\~~qD
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V. FOR OFFICE USE ONLY
Permit Cl erk
rJx
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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
~#<!? ~EZ; 67f>
signature ~
f/"JP"
-.~
,/
date
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