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HomeMy WebLinkAboutPermit Building 1989-8-2 ~ - INSPECTION LINE ;}26-3769 . s;,,,,,, TN .)t! :5/ R~. CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat t~a ter Hea ter Range ValuE of Hark.: ~ C'_-~. -=iP BuiltiinQ Pernlit Info: Describe Work(i.e.. Build Single Family nesidence With Attached GaraQel ,1?E77~F p-/",=""""f,&.7?A'"7~z::, l~[;;P 5 ;f?-:-r-- ~A#?7i7~~ . IHFORllATlON L1Nl 726-3753 SQ. FtQ. I~ain ~q: Ftg. Access. SQ. Ftg. Other New Add Alter Rep. -Fence Demo Change/Use Other- - !~ ~ ~ 1"-. .: Job Address /19'0 legal De5cription ~;i3??~~:r-~ ~.-o~/.'? Ow~er /fiLk( L?7#/E"' . Address 19~/. n~?,A2- Z)2? , yPL-D. .//'K Construction Lender / I , ? '1:::>-:7"-<Y.3 Phone Address DI:.~ H:iN lI:.Ar~ lname) Phone (address) (lies. no.~ {exoires1 (ohone no. Primary Structural Electrical Meehan; ca 1 CONTRACTORS {name~ (address' (lies. no. 1 (~~nirps1 (ohonp no.' General #/??E ~?5"V/C/2C/P~'1 U:~MCC~I'!'N"f ~2:,,)~::?-9~. Y'A"'-::?Y~ Plumbina Electrical ~1echanical PlUI1BING ELECTRICAL MECHANICAL NO. FEE r.HARGF: ~n_ FFF r.H~Rr,F Nn_ FH rHQ.RGF SQ. FT. furnace/burner to BTU's Each single fixture Residence of Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (l bath) Duplex (1 bath) each SERVICES Recessed wall Sn~rp hp~tpr ~nrl vpnt Storm Sewer Of amps. App 1 i ance vent seoarate Stationary evap. cooler Vent fan with sinole !flirt Vent system apart from heatina or A.C. Mechanical exhaust hood and duct. ~Ia ter servi ce Temporary Construction Change in existing resiqr,nce multifamily, comm. or Inc1uc;triill Additional bath Sewer COW1./IND. FEEDERS Install/alter/relocate distrib. fpeders Wood stove/heater Of amps. TOTAL CHARGES TOTAL CHARGES WHERE STATE L,\l~ REQUIRES that tile Electrical work be done by an shall not be vali1 until the label has been signed by an Electrical I SSUANCF OF PFRIIIT TOTAL CHARGES Electrical Contractor. the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFULLY EXMlINED the completed application for permit. and do hereby certify that all infonnation hereon is true and correct, and I further certify that any and all work perfonned 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 rm OCCUPA[{CY 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 O~S 701.055, that if exempt the basis for exemption is noted hereon. and that only subcontractors and employees who are in compliance with ORS 701.055 will be lJsed on 'this project. NAHE(please print) \\rH\C~ ~(''''V1cl<Q.vy~\s SIGN^TURE ~ CllMU, ~VlCM'lce,.., FOr. OFFICE USE OULY I Sq. Ftg. t1ain Sq. FtO. Access SQ. Ftg. Other DATE Bh;/r~q Stories Units Occy Load Occy Group x Value Value Zone Tvpe/Const. Bed rooms x Fi re Zone Flood Plain x Value TOT^l VALUATlml BUILDING PERfllT Charges and Surcharges I --::? e:2? c::-'..-" I Plan Ck. COllll1!1nd ~_,:.)~~......d~_ ~/Blc1o P.l'!r Fpp Plan Ck. Res /. 9::::3 30%/BldQ Per Fee Fence syste.ms Development CharQe O.5~ ., PlU'~BING PERMIT Charges and Surcharges I D~mo .Sidewa 1 k ELECTRICAL PERlHT Charges and Surcharges flECHANICAl PERMIT Charges and Surcharges I AIC Paving Total Comb. Permit Curb Cut TOTAL 7"~ y 3 . . . 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 II OJ 43 2. examEle- lot 1. Block 3, 2nd Addition to Sprlngfield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceiling/or forced air Qas 2. examole- waterheater/electrlcal/or solar E. Square footage or va1uation, etc. ------ 1. example- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project. check new - if addition, cneck add. ete. F. Building pennit information: 1. examole - construct single family house with an attached garage 2. example - remodel existing garage into family room 3. exa~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 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 SCHEOULES 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. --- Ill. 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 penmit 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 I payable 'when the permit is issued. ' V. FOR OFFICE OSE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: . PLANS REVIEWED BY: ~,7~~ n~gnatu~_~__--'? C-/d/ "'" . date g-2 .;;;;-;: name .'