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HomeMy WebLinkAboutPermit Building 1986-4-2 __._______.____.... -;.._t::,:. ~. _.- ,'. ........ '-~ ,'-,. "'~.-----.'-"'--'-----'--"-..-._.____.." . . I IrISPECTlON LINE 726-3769 . CI TV Uf SPRiNGfiELD.. INfORltATION LINt COMBINATION APPLICATION/PERMIT 726-3753 EIIERGY SOURCES: Sq. F tg. 1.1a i n Heat Sq. Ftg. Access. V YG-' Water Heater Sq. Ftg. Other _ , tlew){Add Alter Pep. Banq~-,. --;-. _ ~-=-- -Fence Demo Change/Use f -ValuE of Work' ~I -Other- - , . t:1'O ""-.- ..... '"2~ 7/7. . Phone ('\41 Bunci-;n~nnit Info: Describe .Jork.( i-.e., Build Single . 1 K' \~:nW-Att::Ga\j~ ~t\.~ ( 110 b;.U '.'1 '- J 0'7200 ~ S" a --- ~ Job Address "'5= r---- -' \ - ~ ~ ~ >,o.1m n Legal Description \ 7 03 ~C; 3d-" Owner I ps:, .YJ.( JLlC;;:P..a ;;11 Address271()leJ1n~ /)iIJuJ ~ c r",.JL O.c::. '2$1.J.f)" Construction Le'~der O"JlZ 7t1;'~g. Address Ut.~ll.i" H.Al1 tname) Phone (address} (lies. no.) (exoires) (ohone no.. Primary Structural Electrical Mechanical CONTRACTOp5 (name) General \ Zd 0 ~L i~. ,- (\ (address) erA J '1AI1J) ~ 11 ks. no. l tfG gg I (pmi rp,.c;) / '2 - 2.t: - ffi (ohone nn.l Plumbina E1 ectri ca 1 Mechanical PLUtlB I NG ELECTRICAL MECHANICAL NO. ' , F~~ 'rIjIlQr.F Ill" . ~~t" . ru~ NO 'FF~ '..t!IAB!i.E. SQ. FT. furnace/burner to BTU's Each single fixture Residence of Relocated building (new fix. additional) ~ New circuits alts. ~ ~~s~~~ SERVICES 'Z2,~) Floor furnace and vent S.F. Residence (1 bathl Duplex (1 bath) each Additional bath Recessed wall ~n~rp hp~tpr ~nrl vpnt Storm Sewer Of il.mps. I Appliance vent s~parat~ Stationary evap. cooler Vent fan wi th ~inole duct Vent system apart from heatino or A,C- Mechanical exhaust hond i'lnd durt Sewer Temporary Construction Change in existing res j ~.nce multifamily, comm. or Tnrltlc:trial Water service COffi1./IND. FEEDERS Install/alter/relocate rlic:trih. fpprlprc: Wood stove/heater Of amps. TOTAL CHARGES WHERE STATE LAW REQUIRES shall not be vali1 until the ISSUANC, OF PFRI1IT TOTAL CHARGES ~<-5Z> TOTAL CHARGES ~N. /-r)':-o that the Electrical work. be done by an 'Electrical Contractor. the electrical portion of this pelT.lit label has been signed by an Electrical Supervisor and returned to the Building Division 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 UO 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 :~::(::::::t:::::~J;;:OY~;: :: {i~\C:l;~ith :::II:::~7i!I'~~;;;;;;;Z~TE~t? ~ FOP. OfFICE 'f5~' VI Zone c:: C Tyoe/Const.5" -AI Units S<(. Ftg. llain x Value Fire Zone Bedrooms Occy Load Sq. Ftg. Access.i::Y'09" x/O. - Value ~'I~.'- Flood Plain Stories I Occy Group.-l/'Z Sq. Ftg. Other~'N x value.R3'17.- TOTAL VALUATIOrd27L?- BUILDING PERHlT , ___"7~:2~_ PI an Ck. Conm/Ind Charges anC: 65%/Blda Ppr F'pe Surcharges ,?p ~€/ Plan Ck. R-es 30%/Blda Per Fee PLUP1BING PERMIT Fence Charges and ------------ Surcharges 0_ ELECTRICAL PERrm ----~~:..~~- 'Sldewalk Charges and Surcharges .'9~ A/C Paving MECHANICAL PERMIT /5._~_ Curb Cut Charges and Surcharges .(;0 ~</.~3 Systems Development CharQe tl.5%l . /~o. 7b TOTAL It//. ~q' ~6. ::z '"3 Total Comb. Permit . . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION 1. Applicant to furnish A. Job Address B. legal Description 1. example- Tax Lot 100. lane County Map Reference II 03 43 2. examyle- Lot I. Block 3. 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. exa~ple. heat/electrical ceilinqjor forced air Qas 2. example- waterheater/electrlcal/or solar E. Square footage or valuation. etc. 1. example- 1250 sq. foot house. 500 sq. foot garage 2. examRle- 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. 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. 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. & Electrica1 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 itern(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 itern(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 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 payab~e when the permit is issued. 01cb)q~ y~ L)_~-b~ V. FOR OFFICE USE ONLY P'noit Cl"k ~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: n~me Lt71<';~ ?t~~signature 4-..';~ ........., date t./-I-~b .r" -" I .