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HomeMy WebLinkAboutPermit Building 1984-2-24 1 INSPECTION LINE 726-3769 . CITY Uf SPRINGfIELD COHBIIIATION APPLICATION/PERMIT EIIERGY SOURCES: Heat Ha ter Hea ter Address lJt~IGtl TEAr., (name) Phone (address 1 INfORlIATION liNe 726-3753 Sq. ftg. 1.lain ~q. Ftg. Access. Sq. ftg. Other New Add Alter Rep. Ranqe --Fence Demo Change/Use ValuE of wo~~.lJC) Other---- Buildinq Permit Info: Describe Work(i.e.. Build Single Familv nesidence With Attached Garaae} ~ ~ :... wd/ ~rYI- ~ ~qA~ l.<Jl-Ad~.,I ~". /L.,'.. -6, (\0 a>fl4 c...7b V (lies. no.l (exoires) . Job Address I ~ Legal Description ~ ~ ~S'f... ~ \\ . &sA\ f)~~ Owner /J....kv....,,_ ~lIJ"fw-f.e..r )l/M<-(o$J-,.g",-<r. Address J:2 /7 _ <:, /hI;tL A' <:;'1 .) 't Pl"::''''-''' ~ 11'1 J - Construction Lender (ohaM no. Primary Structura 1 Electrical -,. , .. . r t1echanical CONTRACTORS (name) (address) 2~".5 Rc....~... """ L... f1 ice;. no.' (exo; res) (nhone no.) Genera 1 <::, ~4-o{' t:-v...<.-h . :; 'II. ~ ~ 't- 28 - 8 it .;< ,,-,-So9)7 Plumbina Electrical "/1,..,.,;::t" "'- PI-ed., \... (,., M' ;::: 31-t{ "R"1. ./t.:l. P ~'echani ca 1 PLUIIBING ELECTRICAL MECHANICAL NO. Each single fixture FFF I f.HAR(;E NO I \ I H~ rHAR~~ Nn_ I Residence of furnace/burner to SQ. fT. BTU's New circuits alts. Floor furnace or extensions \()-:- \0.- - and vent S::~~ rHARr.~ Relocated building (new'fix. additional) S.F. Residence (l bath) Duplex (1 bath) each Additional bath Iwater service I Sewer \storm Sewer SERVICES Recessed wall $OnCP hPntpr nnrl vpnt Of amps. I' Appl iance vent Sf'!Dnrntp I S'tationary evap. cooler I Vent fan with sinole duct Vent system apart heatino or A.L Mechanical exhaust hood nnd duet I ~/ood stove/heater I I I from !remporary Construction Change in existing rf'S j (tenet". multifamily. COIl1!l. or Industrinl COMM./IND. fEEDERS Install/alter/relocate distrih. fpedF!rs Of I I I I \ (') .-, TOTAL CHARGES 'Electrical Contractor. the electrical portion -of this permit Supervisor and returned to the Building Division amps.1 I I I I SSUANCE OF PERil IT TOTAL CHARGES I TOTAL CHARGES WHEnE STATE L\H REQUlnES that tile Electrical work be done by an shall not be valiJ until the label has been signed by an Electrical I HAVE CAREFULLY EXAMINED the completed aprlication for permit. and do hereby certify that all information hereon is true and correct, and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Ore!]on pertaining to the work described herein, and that NO OCCUPAUCY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Board is in full force_and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and that only SUbcontractors!;:. employees who are ~~omPliance with ons 701.055 '("\1 be used on this projec . NA/IE(please print)~}d S (">.A 1!5 .....~{a.~SIGrIATURE \)~ . OATE.:2 -~ v"ll'-} Fori OFfICE USE DilLY/ Sa. 4<1. rIain. Zone Fire Zone /Type/Const. Bedrooms Stories Units Occy LoaL- Occy Grou~~~_ x Value Val ue Value X1J 0:) flood Plain Sq. Fta. Access Sq. ftg. Other x x TOTAL VALUATION BUILDING PERflIT ' \r, --- . Plan Ck. Comm/Ind Charges an': _____~_--__~/Bldo Pj:!.\" I=p~ SUrCharges.,,\~ :::mA-- LID Plan Ck. Res "I II \ ::1<r11 \ l'" 30%lBldq Per Fee PLUMBING PERMIT fence Charges and ------------ Surcharges D~mo ~~;~;:;C;~ PERI:IT L__D<--=-=-__J Sidewalk SUrCharges~\.\J~ ,L\O I AlC Paving IIECHANICAL PERMIT I Curb Cut Charges and ____________ Surcharges I 'Systems Development ' Charqe (1.5~) . I I I I Irotal Comb. rermit I I Of-'-.. I TOTAL ?~O. O-J . COMBINATION APPLICATION/PERMIT (CAP) l. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, lane County Map Reference II uj 43 2. example- lot 1. Block 3. 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceiling/or forced air qas 2. exampJe- waterheater/electrical/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project. check-new - 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 res.idence 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. 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 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 7thorized to sign the electrical label. 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. 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. II. III. IV. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . PERMIT VALIDATION Permit Clerk ~ \f{ '1.; ~\.9 ~. cP VJY /ju Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: ,;g"'t",$;~)Lr\ ~\ d~;' 'G -?CJ J:~ '-1 name ~