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HomeMy WebLinkAboutPermit Building 1985-9-6 INSPECTION LINE 1726-3769 ~ CITY UF SPRINGfIELD CO/tBINATION APPLICATION/PERMIT ." I NFORlIATION UNt 726-3753 Sq. Ftq. '.Iain 5q. Ftg. Access. Sq. Ftg, Other New Add Alter Pep. -Fence Demo Change/Use Other- - Owner.<)?A'/~~Z:;> ~c.../ TY Z?e...+;"-;-_ ~ Addres-;- 2S'O Alt:il fi' 57: ?,,~j,R'~"/ Build Single I ~ \1 00 W '. Job Address :2 5'0' PlS1: A' $r. E/IERGY SOURCES: Heat Hater Heater Ranqe__ ValuE of l'lark: /1 04:>. -0. BU1~;inQ Penmit Info: Describe Work(i.e.. Family nes;dence With Attached GaraQel Legal Oesc'ription 17.~.=J'S'.32. <!:)Z'/e>O r Construction lender h" ~A'/6/f ;?6'-..,.-v t!!!'C:. ~ G-6.~" r:-n.....e:.~ ,l/f!n/bAN _ O/">~/C ~~ . ... . .. Address DESIGN IE:.Ar~ (name) Phone (address) (lies. no.) (expires) (phone no. Primary OJVHGX Structural Electrical t1echan; ca 1 CONTRACTORS Inamel General ~h 7? g::;;z><;: (addrpss) {l ir'c;. no. J (exoirpc; ) (ohnnp no.) Plumbina Electrical b',-",c..~"') E~.7: Ilechanical -~/?;~""T rcc::> PLU/IBI NG ELECTRICAL MECHANICAL NO. FFF CHARGE NO FH" rl-lAflr.F NO_ FFF r,",AIH::~ Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) ,.".--'New circuits alts. oJ: extensions ~ -J- a;tl,.~-=- SERVICES IS- Floor furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each Recessed wall So~r.P hp~tpr ~nd vpnt Of amps. I I I I I I ........ ~n::?'f ~A 6>...., Appliance vent seoarate Stationary evap. cooler Vent fan wi th sinole duct Vent system apart heatina or A.C. Mechanical exhaust hond ~nd duct from Additional bath ~Ja ter servi ce Temporary Construction Change in existing res.i d_ence multifamily, COtml. or Tndustriill Sewer Storm Sewer Of amps. COMM./INO. FEEDERS Install/alter/relocate di..trih. fppders Wood stove/heater TOTAL CHARGES TOTAL CHARGES WHERE STATE L'H REQUIRES that the Electrical work be done by an. shall not be valiJ until the label has been signed by an Electrical ISSUANCE OF PFR!lIT IS: - rOTAL CHARGES A/At , /cP.-'" Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFUllY EXMlINED the comp 1 eted app 1 i cat; on for permit, and do hereby cert ify tha t a 11 in format i on 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 rw OCCUPAIKY will be made of any structure without the permission of the Ouilding 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 and employees who are in compliance with OP.S 7nl.055 will be used on this project. IlAI.IE(please print) ..5T€.mtv 1'Y\, Ri:A--D SIGNATURE ~7L /:. 0 FOR OFFICE USE DIlLY Sq. Ftg. Sq. Fta. ??~ :2 Sq. Ftg. DATE 9-.5 - 1.5 Zone c:c. TYDe/Const.~hI~ Bedrooms Stories Units Occy load Occy Group riain x Value Access x Value Other 11't!!S1-^-"-'-"''-- Value..../.?~. ..... TOTAL VALUATION Fire Zone Flood Plain BUILDING PERIlIT Charges and Surcharges 5l . Plan Ck. ______~,_~_ 65%/Rlda <.J Plan Ck. :<. '2 / 30%/B1dQ COllll1!1nd Ppr Fp~ R"es Per Fee 3&:. '70 .Systems Development . Charqe (1.5%) #4 PLUt~BING PERMIT Charges and Surcharges Fence ELECTRICP.L PER/lIT Charges and Surcharges D~l!1o ____.15 --- Sidewalk ~ A/C Paving '0 &- Curb Cut ____JJ.__.____ _ ~t:> Total Comb. Permit ItECHANICAL PERMIT Charges and Surcharges TOTAL ~~<Y /225:'6- Y J COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. legal Description 1. examp.'e- Tax lot 100, lane County Map Reference 17 03 43 2. exarnple- Lot 1. Block 3. 2nd Addition to spr1ngtleld Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. . exam~le- heat/electrical ceilinq/or forced air qas 2. examyle- waterheater/electricalfor solar 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 attached garage 2. example - remodel existing garage into family room 3. example - 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 TEAM 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. 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 OIVISION 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 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 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 payable when the penmit is issued. .~ 105 ;)-Sif q-G -'/~ ffD V. FOR OFFICE USE ONLY Permit Cl erk cfY 4 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLA~S REVIEWED BY: .. name Lo8./G 1".( ~ E.?? . Signature~,~~ date_9~,,"-~