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HomeMy WebLinkAboutPermit Building 1988-8-15 (2) . i IrISPECTlON LINE CITY UF SPRINGFIElO ,726-3769 COMBINATION APPllCATION/PERHIT , / ; I EilERGY SOURCES: Job Address ~~ AY~ )I ?/...,-~.... " Heat legal Description /7~3.3S-3/. ~2/0C> Hater Heater Range ValuE of Hark.: f?, 5"9~ (/6 Bullriina Permit Info: Describe Work(Le., Build Single Familv ~esidence W;t~ Attached Garaael J?E~""72_~_ l/~ttJc:>F/2:;e .~h7~ ..,-'""""~~ ";;a::>~~' &<<:~ ~-'1?T' Qh'1"~~ f1 ics. no.) . INFORltATlON liNe 726-37S3 Sq. Ftg. Hain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. F eoce _Demo )s.thange/Use _Other ~ I~ I~ Owner t"'::/To/ c7.1"'" <;z;;q~/'9c:=z.z> Address ~2~ hi.e '>>'_~ ".-- '= => rr-L//. L?r>. -r7Y7? Construction ~nder I Phone 72v1-:?G~~ .h.Jf,t17 2'....,"/~/4< Address Uk.::ll1.iN ll:.Ar.' lname) Phone I address) (expires) (ohane no.) Primary Structural 'cJ;)~. (~ill') Electrical Mechanical CONTRACTORS Inamel General.Q'&I~#.::.4;r~/""'r' U,(,/~C:;. Plumbina (addre~,,) (lie". no.) (exnire,,) (ohnne nn X...,y ~y~ .4'R7- q<=,/~ Electrical 0../'6 Hechanical PlUltBI NG ElECTRI CAl MECHANICAl NO_I FFF ~ Each single fixture / "17> ~;ti'ffI?;pY,E2 , Relocated building (new fix. additional) S.F. Residence 11 bath) Duplex (1 bath) each rHAR(;F NO '" rI-lAIU~~ NO. '" nIARr.:~ ~ Residence of SQ. FT. furnace/burner to BTU's ~ New circuits alts. or extensions 2 dSl ~~~ ZZ-5'o Floor furnace and vent Stann Sewer Of amps. Recessed wa 11 Sn~rp hp~tpr ~nrl vpnt - /h r&.ti' 72r~..t#r '(p~iance vent I' c;p.Drlrrlte Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from heatino or A.C. Mechanical exhaust hood and dllct [WOOd stove/heater I SERVICES Additional bath Sewer Temporary Construction Change in existing rp~idpn("p multifamily, COI111l. or Induc;trial Water service CO~1./IND. FEEDERS Install/alter/relocate di<:.trih. fpprlpr<; .Co- ,~ ~ _41 Y Of amps. ..- - -'~'_. ,'_ ISSUANCE-.OF. .PFR/+1T- _.~ =-_"~.- TOTAl CHARGES ...-?p/~. 6: -~ TOTAl CHARGES WHERE STATE l_'\~ REQUIRES that the Electrical work be done by an shall not be vali~ until the label has been signed by an Electrical :;::;;'::<'-:5'<==> TOTAl CHARGES ~#. /-5.- Electrical Contractor, the electrical portion of this per~it Supervisor and returned to the Building Division 1 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 Ore(]on pertaining to the 'Work described hereln, 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 ORS 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 7~1.OSS will be used on this pro~~ ~ IWlE(please print) CITY ()!= SR/t)GrF'r(E:.L1) SIGNATUREbq! dMUf!L.. Ii ~DATE FQr OFFICE USE Oilt:'Y I f~ Sq. Ftg. riain x Value Sq. Ftl). Access. x Value Sq. Ftg. Otherd~~ x Value1=? ~~. ~O TOTAl V ALUA TI Or! Zone Pt'.. Flood Plain TYDeIConst.,";::.,y. .$?-? Bedrooms Stories Units Occy Load Occy Group ~-2 Fire Zone n---, BUIlDING PERNIT Plan Ck. ConmlI nd I~Y'A Shstems Development //#. Charges ant:: d- __~-2~___ 65%1Rlda Ppr Fpp C aroe (1.5~) Surcharges Pl an Ck. Res I /:2. :>8 30%/Bldo Per Fee PlU'1BING PERMIT /5-~ I Fence I Charges and S ------------ I Dell10 I Surcha rges .7S- ElECTRICP.L PERr:IT ____?32__ Sidewalk Charges and y Surcharges /./'3 A/C Paving Total Comb. rermit f1ECHANICAL PERMn ____/5:"-~__ Curb Cut 07"yOW'~ 160 Tee Charges and ltJ I TOTAla..~~ Surcharges 7,) I - . , COMBINATION APPLICATION/PERMIT (CAP) , , , ( I . ~ .. PERMIT VALIDATION IV. I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax lot 100, Lane County Map 11 03 43 2. examole- lot 1. Block 3, 2nd Addition to Springfield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. exam~le- heat/electrical ceilinq/or forced air Qas 2. example- waterheater/electrlcal/or ~ E. Square footage or va1uation. 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. examyle - convert single family residence into restaurant (change of use) G. Value qf work as defined in Section 303 (al of the Structural Specialty Code H. OESIGN TEAM ANO 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 8. 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 1 abe 1 must be de 1 ivered 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 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. / Reference II. III. V: FOR OFFICE USE ONLY Permit Clerk .'"T' .......,..,...-...::-._.;. ::. PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name ~7?'/V~ ~?2L'J.~Signature~~ r/ /k~~ date g7"'S-&'8 .,..' ~