HomeMy WebLinkAboutPermit Building 1990-10-8
I I~ISPECTI\1N LINE
726- 37 69
Job Address Various (see attached)
Legal Description N/A
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ErlERGY 'sOURCES:
Heat ~Ol.ar
Hater Heater N/ A
N/A
Range
iNFORi1~TrON LINt.
726-3753
Sq. F tg. r'la i n
:q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
--Other -- -- '
Owner' Lane Transit District
Address P.O. Box 7070
Eugene, OR 97401
Construction Lender,
Phone
ValUE of Hark: '
52,500
BuHc:inq Permit Info: Describe \~ork(Le;,
Family Residence,With Attached Garaqe) ,
Build Single
c~
\GI
S"Z),
'-....:
<2;
if
741-6100
Construct Cone. Pads for Bus PassPTIo-prq
" -.-.".-d. ~
and Bus She 1 ters
Address
-DESIGN TEAM (name)
Primary Branch Engineering "
Phone
(address), (lfcs. no.)
212 "Qt, Street, Springfield; ;OR
(exoires)
(ohone no.'\
746-0637
Structural
Electrical
r~echani ca 1
CONTRACTORS
(name)
(address)
(lics. no.)
(exoires)
(ohone no. ,)
General
Sr.h~ll/T1hl1r~ Enterorises. Ine. 165 C) ('.()1 mrv "f".q,.,;, Rrl;. Eugene. OR
485-7970
Plumbinq
Electrical
~'echani ca 1
)
NO.
pLUt,1B ING
I
f
J
/ ,
Each si ngl e fixtur;,e
/ /. / .
,
"N/A
ELECTRICALN/ A
MECHANICAL
N/A
FEE
CHARBE
NO.
F'I-J;HAR(';F NO.
FFF
I CHARGE
Residence of
SQ. FT.
furnace/burner to
BTlI's
Relocated building
(new fix. additional) i,
New circuits alts.
orextensiorls
Floor fu rnace
and vent
S.F.Residence
(l bath)
Duplex (1 bath) each
SERVICES
.ReCessed wall
Soace heater and vpnt
Sewer
I
I
I
I
Temporary Construction
Change in existing
residence
Imultifamily, comm. or
Industrial
IOf amps.I,
ICOMM./IND. FEEDERS I
IInstall/alter/relocate I
distrib. feeders
Of amp~1
Apoliance vent
seoarate
Stationarv evao.
cooler - "
I Vent fan wi th
sinale duct
I Vent system apa rt from I
heating or A.C.
I Mechan i ca 1 exhaust I
hood and duct
I I-Jood stove/heater I
I
I
I
I
I
I'
I
I
I
Additional bath
Hater service
Storm Sewer
ISSUANCE OF PFRmT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L"H REQUIRES that the Elect'rical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be val i:J 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 oertaining to the work described herein, and that NO OCCUPAIKY will be made
of any structure without the permi:ssion of the Building Division. I further 'certify that my registration ~Iith 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 ~nd employees who are in comoliance with ORS 701.055 will be used on this project. ~
fW1E(please prin;) (l.kJ1o^-'\6C;:>~,-( , SIGN^~J-~ DATE i()-8-~a
FOR OFFICE USE Oi~L Y -/ ( "\ ___ ~ ~ L.I J:.:...f'.I'\
Zone Tyoe/Const. Units So. Ftg. t1ain ~ts x 3,50(r"'~ue ~
Fi re Zone Bedrooms Qccy Load Sq. Ftl]; Access x Va 1 ue
Flood Plain Stories Occy Group Sq. Ftg. Other, x' Value
TOTAL VALUATION
BUILDING PER~1IT
Charges and
Surcha rges
, [1'Ose Pl an Ck,
___~ t.:.....:.._ 65%/Bldo
, '.~O '8~~ Plan, Ck.
L'+.U '. 30%/Bldq
N/A . I Fence
---~---:----- -Iri~mo'
_ ___ IYb___ __JSidewalk
. A/C Paving
Comm/lnd
Ppr Fpp
Res - -
Per Fee
?O..DO F::Br
Systems Development
Charge (1.5ro)
N/A
PLur~BING PERMIT
Charges and
Surcharges
I '
I,
ELECTRICAL PERMIT
Cha rges'and,
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
To~al Comb. Permit
____Wb=_____ Curb Cut
I TOTAL
$~
\c;C\.OO
I
1...
;;,.
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. exam~le- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Springfield Estates _
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced air qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check"'ilew - .if addition,'
check add, etc. ' ' '
F. Building permit information: '
1. example - construct single family house with an
attached 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 ~esign or construction delays, Building
Divi'sion 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
fu 11 schedu 1 es
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.
\~& .
~" ~ ~(J
D'S
~ ~V}
V. FOR OFFICE USE ONLY
Cl erk ~ (IYU
Permit
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
signature
date
CITY OF SPRINGFIELD
,Date
City Hall
Sprlnglleld, Oregon
Development Services
OFFICIAL RECEIPT
/-
?)
I
Received For:
" , ~:;'
:'..;" '-"7}'
Amount Received . (' () b 4 II'A -=<... OC- _
~ t/{; /V) -J
- AUTHOR~~
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