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HomeMy WebLinkAboutPermit Building 1983-9-12 Ll TV 01- SPRliH.iF I ELD C0I1BHIATION APPLICATION/PERMIT E!IERGY SOURCES: Heat ~' . Hater Heater /fJ.d r] Ranqe - IItISPECTIOII LlllE 726-3769 Job Address 'J} .' ~ 1s'17 legal Description /111AP. lAy., L,.,T "" n-03-3C, -'3d..- ~II ,7~ /llL,.~olJ .<;"1'), '.<:I " 57 So. 0)1001 Owner Address Phone )'/)_~~? J r"J , Construction lender A/lfJ./C Address Ut~lliN Tl:.Nl (name) Phone (addressl Primary , / ~ (}?, ~~(fA~ jl-J J Q OI..!ST. Structural Electrical f1echanical CONTRACTORS (namel (.) .! 'I k.'.\J.~' I:~, '\J:.-IJClIH,Hn" ,~.J,". If)d.()E OAU€ K ; 01) ne.T. NoiJ t; (addrpss) t. ?If? <:" Sf. qgJ ;;J General Plumbina I INFORf1ATION Ul'1t 726-3753 Sq. Ftg. 1,Iain ,/.:JOO ~q. Ftg. Access. Sq. Ftg. Other ~lew__Add__Alter~~ep. Fence Demo Change/Use Other- - ~ ~ ~ 1<::> IUJ I~ va;, of Hark: /0.000 BuilGinQ Permit Info: Descr be Work{ Le., FamilY nesidence With Attached Garaoe) ~~- ... /.:;, 0-0 a;;; /1 flics.no.l (1ir:s.no.) Electrical ~rt( s: ?f"T"'...-r t.lechani ca 1 PLU1IB ItIG NO. ELECTRICAL Build Single /'-I'/.b<A;f~ ""~ Otl {/ (exoiresl (ohone 00.\ (p)(oirpc;) (ohnnp nn_) ~_ -/.P:f?<I '/y}-,]'P'lc, ?<()-3'I'l ., MECHANICAL Each single fixture FEE CHARr.r: NO H~ rI-lARC:::~ NO Residence of furnace/burner to SQ. FT. BTU's ~~~ rI-lAQr.1=' / I I I I I I I Install/alter/relocate I c Il"-Il~ OQ ni,'rih. feener, \;)" " ~ I I I I II I I I TOTAL CHARGES Electrical Contractor, the electrical portion of this pe~it Supervisor and returned to the Building Oiv;s;on Temporary Construction Change in existing rp<;id~ncE' multifamily. comm. or lnrlllc;tri<ll 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 pertaining to the work described herein. and that NO OCCUPArKY 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 compliance with ORS 701.055 will be used on this project. SIGIIATURE~ C JrM- ~.LOATE_2:./.'2 -Pj FO~ OFFICE USE Q;IL Y So. Ftg. Hain Sg. Ftg. Access \ ?.c-t:) Sq. Ft9. Other Relocated building (new fix. additional) INew circuits alts. or extensions ISERVICES I S.F. Residence (1 bath 1 I Duplex (1 bath) IAdditional bath ~Ia ter servi ce each Sewer Storm Sewer Of COffi1./IND. FEEDERS IOf I TOTAL CHARGES TOTAL CHARGES WHERE STATE L,\I/ REQUIRES that the Electrical work be done by an sha1l not be valii until the label has been signed by an Electrical IWIE(please print)~1ff CaNsT Zone_c.C . Tyoe/Cons L\l' ~ Bedrooms ------- Stories \ Units \ Occy Load Occy GroupQ..- \ Fire Zone - Flood Plain - BUILDING PERfIIT Charges anc Surcharges __.5.2,-~__u_ :~~;B~~~ ? 08 Plan Ck, , 30%/Bl do Fence CommlI nd Per Fpp Res Per Fee PLUI1BING PERMIT Charges and Surcharges I Demo I Sidewalk I A/e Paving Curb Cut ELECTRIC~,l PERI~IT Cha rges and Surcharges - -- ]:!;),'-~- --- \. '2.0 11ECHANICAL PERMIT Charges and Surcharges 1.'Zt/~-d'5 <01(j)7~Syste. os Development I , =>,?\ s::>.r, -,Charae (1.51,) . '1 l Ui9" tlnrm I I I I I I I I I t~'" \S~ I I I amps.1 amps.l Floor fu rnace and vent Recessed wall Sn<l~p hp<ltpr <lnrl vpnt I App 1 i ance vent seoarate Stationary evap. cooler Vent fan with <;,inole rluct Vent system apart heatina or A.C. Mechanical exhaust hood and duct I Hood stove/heater I I I from I I I I ISSUANCE OF PFRlllT x Value _ Value [().(W ,." x x Value TOTAL VALUATION I~().OO ITotal I I TOTAL Comb. rermit 85.2'l> 235. 2e I - .. II . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION II. t. Applicant to furnish A. Job Address 8. legal Description 1. example- Tax lot 100. Lane County Map Reference 1/ 63 43 2, .xa~l.- Lot 1. Block 3. 2nd Addition to ~prlngtjeld Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. exam~le- heat/elec!~ical ceilinq/or forced air QdS 2. example- waterheaterjelectrlcal/or ~ E. Square footage or valuation. etc. 1. example- 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 a ttached garage 2. example - remodel existing garage into family raam 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. OESIGN TEM1 ANO CONTRACTORS To avoid design or construction delays, Building Oivision 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. BUILOING OIVISION 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. --- 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 pay~ble 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. (9c~. ~ /qB3 '- lo llCK) ~ jOJIL ~ III. IV. ""'- V. FOR OFFICE USE ONLY Permi t Cl erk0ARLYJ.J ., . PROJECT CONDITIONS TO 8E SATISFIED BEFORE OCCUPANCY: ,. I , Permit applicant exempt 'from registration with the Builder's 80ard because: J _ Additional Project Information: PLANS REVIEWED BY: name~)\\)~ \?\')F"-1\ ~\ " signatur~ \, )lA-C'- ") "-<')':-A.J'r 1 date a. ,. ?~l. Ch.~