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HomeMy WebLinkAboutPermit Building 1989-8-2 (2) I INSPECTION LINE 726-3769 OW~/;;~~&:;~44~ Address ~/: ~"",,7)fi- "0-<. , 9PLD. ./?/<<' Construction Lender / ~. CITY OF SPRINGFIElO COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat Hater Iieater Range_ ValuE. of Hark: ~ ~~ ~~,6:> . BuiltiinQ Pernlit Info: Descr,be Work{i.e.. Build Single Familv nesidence With Attached r.araQel =' I 7'3'-<'>'.3 '77 7:! nE7}-~E.,t .#-/~'&7".A'7~z:, {r/?/K 5 .~-r-:- 4:"#?;z?7.--?~~ .l (11c5. no. \ (exp;re51 (ohone no. INFORl1ATION. LINl 726-3753 Sq. Ftg. '.Iain ~q.~ Ftg. Access. Sq. Ftg. Other flew Add Alter Pep. -Fence Demo Change/Use Other- -- ~ ~ " Job Address 1/9"0 ~?'7'.4 )1-! 5/ legal Oe5cription Phone Address OE.~ I {iN TEAf.., (name) Phone (address\ Electrical 1 Primary Structural Mechanical CONTRACTORS (namel (addrp.o;.~) (lics.. no. \ (pxnirf's\ General,7/??E ,/f~/C/:>="/P ~.I ,eqc;-h#c".4'a;~//--': ~-=~2f)- :7-9"G? Plumbino (ohoop nn_ , Y'-""''''-",," '/S""'; Electrical ~'echanical PlUIIBING ELECTRICAL MECHANICAL SQ. I rrr FT. \r~r.~ NO I ~ ~~r InJ..ARG.E. NO. . FEE CH~Rr,F NO Each single fixture Residence of furnace/burner to BTU' 5 Relocated building (new fix. additional) S.F. Residence 11 bat.h\ Duplex (1 bath) each New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall Sn~~p ~p~tpr and vpnt Storm Sewer Of amps. Appl iance vent Sf"Oarate Stationary evap. cooler Vent fan wi th sin91e duct Vent system apart from hea t i no or A. C. Mechanical exhaust hood and dur.t Sewer Temporary Construction Change in existing reo;. i d~JH'P multifamily. camm. or Industrial Additional bath Water service COMfl./IND. FEEDERS Install/alter/relocate clio:.trih. fppder.. Wood stove/heater Of amps. TOTAL CHARGES WIIERE STATE l,\l/ REQUIRES shall not be vali1 until the ISSUANCE OF PFRlIIT l 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 EXMllNEO the completed aprlication for nermit, and do hereby certify that all infonnation hereon is true 1 and correct. and I further certify that any and all work Derfonned 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 OCCUPAUCY will be made of any structure without the permission of the Building Division. J further certify that my registration with the Builder1s Ooard 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 \'1111 be used on this project. lIAf.lE(please print) (\(J Y\l.~ '\3(CI nc\<Q.V1\f.\) SIr,rlATUREk~V\lYlc&v- DATE B/dRCf FOP. OfF I CE USE OIll Y I Zone Type/Canst. Units Sq. Ftq. t1ain x Value Fire Zone Bedrooms Occy Load Sq. Ft9. Access x Value Flood Plain Stories Occy Group Sq. Ftg. Other x Value TOTAL VALUATION BUILDING PERrllT Charges an~ Surcharges --;;?.a' C"""'...r> Plan Ck. COlll11lInd __~....t:2:::~...d~_ ~/~ldo p.PI'" Fpj!> Plan Ck. Res /. 9:::3 30%'Bldo Per Fee Systems Development Charoe (1.5% . PlU!~BING PERMIT Charges and Surcharges Fence D~mo ELECTRICAL PERIIIT Charges and Surcharges .Sidewalk AIC Paving Total Comb. Permit ." -; '\ ~~Y3' MECHANICAL PERMIT Charges and Surcharges ---------. Curb Cut ~TOTAl ~ e, COMBINATION APPLICATION/PERMIT (CAP) 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 I. Block 3. 2nd Addition to ~prln9tield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. exam~le- heat/electrical ceilinq/or forced air Q 2. examDle- waterheater/electrical/or solar E. Square footage or valuation, etc. ------ I. example- 1250 sq. foot house. 500 sq. foot garag 2. examp.le- if new project. check-new - if addition eneck add. etc. F. Building permit information: 1. examDle - construct single family house with an a ttached garage 2. example - remodel existing garage into family rOt 3. exam~Je - 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 adjacen 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 schedule 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 tl 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 a! a worksheet only. Where possible, Building Division Staf1 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 palable 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 . .. I 'l nl.nUTT \1/11 TI'"\/lTTf'\" CITY OF SPRINGFIELD City Hell Springfield, Oregon Office 01 Community and Economic Development OFFICIAL RECEIPT 14547 Date ~/.c;. ::2, 19&"7" . . , Rec'd From .1~"!:'".c"i<'" .~:P'j0<;7Z>F/Y/".FL"5 ?t. ~~.n'.Dy/'6"=-> ~ Address D':::"<='5 c/',/'z:-, 67? 97.;/c6 , Received For ~/T?#:?7o 77' /' /~.~ (/. ///' gp I-G~ Z3'$ SO /.9;3' --- 7;;-/ <<0, ~::> cd';fC'?/// Amount Received ~ O. r~ BY - /'/'~-?-Pr:"'~ :/---. I- I t::: ~UTHORlZEO SIGNATURE ./' r ,. , BUSINESS FORMS. INC. ($03IJ.11'" Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: PLANS REVIEWED BY: ~,7'/Ii!~' h'~~gnatu~_~___:-, c.....----- V"" C/' . Additional Project Information: name . date J?-? ~.-;: