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HomeMy WebLinkAboutPermit Signage 1980-12-31 llllSPECTION LINE 726- 37 69 Job Address,~;<) Legal De5cription . J4 <-f:> C1t/L CITY UF SPRINGfIELD COIIBIIIATJON APPLIc~nDN/p~RMIT ErlERGY SOURCES: Heat \~ater Heater Range . INFORllATION liNt 726-3753 Sq, Ftg, l'lain 'IJO'Q .:q. Ftg. Access. SQ, Ftg. Other 'rlel< . AdlN Alter Rep, --Fence Demo Change/Use ~Other -- -- ~ ~ Owner_ -f-JJ7 OM.-/~OrYJ/1 Addres~1S7_GS HQlU~~' ~!:r~t~e~ () 0 C\ f ~l Phone Valu€-9f Work: ~ 1'J 00, LA-' Buildino Permit Info: Describe Workl;~e.. Build Single Far.1i1v P..esidence Hith JI..ttached Garaqe) & f m(l)(J .J1 r1. ./ J ffO 0 0 -P U. ) ()()n Address UESIGN TENI (name) Phone (address) (lies. no.) (exoi res) (ohane no.') Primary Structural Electrical 11echan; Cd 1 CONTRACTORS (name) (address) (1 ir:s. no.) (pxnirpc;) (ohonf> nn.) General r<n~lJy7_0 V'" Plumbino Electrical H~chanical PlUI'1BIflG ELECTRICAL MECHANICAL ':0, FFF rHARr,F Nn_ SQ, FL FFF rHAR(:;F NO. I FFF rHARr,F furnace/burner to ; I BTU's . Floor furnace :,,1 and vent _ Each single fixture Residence of Relocated building (new fix. additional) New circuits alts. or extensions S.F. Residence (l hath) Duplex (1 bath) each SERVICES Recessed I'Jall Sna~e h~ater ann vent Sewer Temporary Construction Change in existing rf>sirlflnr:p Imultifamily, comm. or Industrial IOf amps. ICOMM,/INO, FEEDERS Install/alter/relocate distrih_ fperlprs Appliance vent seoar<l.te Stationary evap. cooler Vent fan with sinole duct I Vent system apart heatina or A.C. I Mechanical exhaust hood and dud Wood stove/heater from Additional bath ~Jater service Storm Sewer Of amps. ISSUANCF OF PFRI1IT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L'\\'l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be vali) until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAmNED the completed apf'llication for permit. and do hereby certify that all information hereon is true and correct. and I further certify that any and all work performed 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 riC OCCUPAIKY 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 comnliance with OP.S 7nl.055 \.Jill be used on this project. IJAI.IE{please print) J?~/P/?./,dl AAIJ.ed SIOIIATURE OL_~.t/ ~rC FOR OFFICE USE OITLY Sq. Ftg. t1ain Sq. FtQ. Access 5q, Ftg, Other om 1:78/lxe? - - - I I Zone Fire Zon€' Type/Canst. Bedrooms Units Occy Load Occy Group x Value Value Value x Flood Plain Stories . x BUILDING PERMIT Charges and Surcharges ~J-~()D I _ .:.J.._______ TOTAL VALUATION PLUI~BING PERMIT Charges and Surcharges Plan Ck. 65%1BI do Plan Ck, 30%/81da Fence COJllll!lnd Per Fee Res Per Fee ISystems Development Cha rqe (I. 5%) Demo ELECTRICAL PERliIT Charges and Surcharges Sidewalk A/C Pavi n9 Total Comb. rermit 11ECHAN I CAL PERMIT Charges and Surcharges TOTAL I J5,cD Curb Cut . i "\ COMBINATION APPLICATION/PERMIT (CAP) I II I. Applicant to furnish A. Job Address B. Legal Description 1. example-' Tax Lot 100. Lane County Map Reference II 03 43 2. example- Lot 1. Block 3. 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilingjor forced air QdS 2. examp]e- waterheater/electrlcal/or solar E. Square rootage or valuation, etc. ------ 1. examole- 1250 sq. foot house, 500 sq. foot garage 2. examole- if new project. check-new - if addition, check add, etc. F. Building permit inform.tion: 1. examole - construct single family house with an attached garage 2. example - remodel existing garage into family room 3.- examole - 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 Mecha~ical 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. BUILDIriG DIVISION STAFF HILL 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 signa ture. IV. Fees and Charges Plan check fees are due and payable at the time of the application, and no plans \.,.111 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 ,,,' ~..' . _ .1, ;.... ,,,..1 I. PROJECT CONDITIONS TO, BE SATISFIED BEFORE OCCUPANCY: , ' . . PERMIT VALIDATION Permi t Cl erk Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date 1'-.;. ,_I ..."