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HomeMy WebLinkAboutPermit Building 1990-6-5 C)jl!1l CITY Uf SPRINGfiELD CDMBlIIATlON APPLICATION/PERMIT -- EilERGY SOURCES: Heat Hater Heater Ranqe ValuE. of Hork: b !-j ) <i1(JO BuildinQ Pennit Info: Oeser be \~ork(Le" Famjlv ~esidence With Attached Garaae' '<We_vr)(')\2 B\dJ . INFORf1ATION liNt 726-3) 53 Sq. Ftg. r.lain- ~q. Ftg. AcceS5. Sq, Ftg. Other New Add Alter ~ep. -Fence Demo Change/Use -Other - - jINSPECTION LINE 726-3769 .. . Address ~ AYL ~H(JI""" , } ')( (' ../(7 -e<.. .J- So C \('Ji n P.. Phone Build Single -S> C) a ~ . Job Address L.j I J /\}, A S,-t Legal Description 1/0").,'.:<, c;.:l., I - n CSl./(')r) Owner . Construction Lender Address UCS lliN n:.M1 {name) Phone {address 1 (lies. no.) (exoires) I (ohane no.l Electrical LA IIV'.r~1A A . 4< rvJ-; he> \'::,1\ II) t=! S 10{~S- lOJ&lqn ~\A)d 00 1\). G.IAJ- \ ) LL ~.7::J.OL Primary Structural f1echanical CONTRACTORS Inamel Uvv--c,qlA'" (Otl(,i..'~~ r.O .. 0 (address' (lies. no. \ (pxn;rec;\ (ohonp nn. , General Plumbina C/)....\ ,S~DO Electrical ~lechanical PLUI1BING ELECTRICAL MECHANICAL NO. HE '[HAR!;F Nt" FFF rH~Rr.F NO. . FCF rHARr.F SQ. FT. furnace/burner to BTU's Each single fixture Residence of Relocated building . (new fix. additional) S.F. Residence (] bath 1 Duplex (1 bath) each Additional bath New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall ~n~~p heater nnd vent Storm Sewer Of amps. Appl iance- vent seoarate Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from heatina or A.C. Mechanical exhaust hond and dll~t Wood stove/heater ~Iater servi ce Temporary Construction Change in existing re$ i cl~.nce multifamily, carom. or Industriill Sewer COMM./IND. FEEDERS Install/alter/relocate distrih. fppdprc; tp Of amps. TOTAL CHARGES WHERE STATE I.'W REQUIRES shall not be valiJ until the ISSUANCE OF PFRt11T TOTAL CHARGES TOTAL CHARGES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pernit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed apnl;cation for.permit. and do hereby certify th3t all information hereon is true and correct, and I further certify that any and all work Derformed 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 IJO OCCUPAHCY will be made of any structure without the permission of the Builrling 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 a~e in compliance with OP.S 701.055,wi be used on this oject. Zone Fire Zone Flood Plain Type/Canst. Bedrooms Stories' Units Occy load Occy Group SIr,' ,/ I FOP. OFFlC~ USE OJIIV Sq. Ftg. Hain Sq. FtlJ. Access Sq. Ftg. Other DmUd9D IJAJ.tE(please print)&r)A.IA-e.D~JenP-fJ x x x Vafue Value. Value TOTAL VALUATION PLU'1BING PERMIT Charges and Surcha rges I. t P1an Ck. Comm/lnd __51l,-SD___ 65%1"1~n ppr Fpp Plan Ck. R'es 'd. .S ~ 3D%/Bldq Per Fee Fence ISystems Development Charqe (1.5%) BUILDING PERMIT Charges an~ Surcharges ~ Demo EI.ECTRICA.L PERI11T Cha rges and Surcharges Sidewalk A/C Paving Total Comb. Permit tlECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL .1bS3,03 1 . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example~ Tax Lot 100, Lane County Map Reference 17 03 43 2. exam~le- Lot I. Block 3. 2nd Addition to Springtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinQ/or forced air qas 2. examole- waterheaterjelectrical/or solar E. Square footage or valuation. etc. ----- 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project, check-nfw - if addition, check add, etc. F. Building permit information: 1. examole - construct single family house with an attached garage 2. examole - 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. 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 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 {tem(s) to be installed are not covered on the abbreviated schedules you should consult the full schedules C. BUILOING DIVISION STAFF WILL FILL OUT ALL FEES ANO CHARGES ON THE SCHEOULES O. As noted on the CAP, the label must be delivered to the electrical contractor for signature by his electrical supervisor. The general contractor is.BQ1 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 permit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . PERMIT VALIDATION ~ ct:.- ~J. ci. ~ \1~~L/ ? Permit Cl erk .~ Permit applicant,exempt, from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date ." ~.~.'