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HomeMy WebLinkAboutPermit Building 1984-10-30 -~ fiTlSPECTION LINE CITY OF SPRINGFIELD 1726-3769 - COMBInATION APPLICATION/PERMIT Job Address ., ~_ ~ .....4. / ../I EIIERGY..50UIJ.CE~.;,.- '"" "" ^ . ,rA.. rr ,__.~ Heat cU::;C, Legal Description _~_ '5';" J?1---1:::;'iS~':'~n!1 !~ater Heater- Ranqe - I? -"'( lA./' u/ """ LOT Owner s:.e ,/ -+ IA " " ,; P A-t' "f Ie , Address - -' INFORf1ATION 111'tt 726-3753 Sq. Ftq. f.lain /(. (~) ~q. ~tg. Access. ---- Sa~tg. Other ----- ~ew 'Add Alter ~ep. --Fence Oemo Change/Use Other - - ., = I? P. Va~H("rk:\- ;;nfr7n- I Builaina Permit Info: Describe Work{i.e.. Familv nesidence With Attached Garaqe) Build Single ':J \)... f'.. ~ 00 Phone Construction Lender A/('j) "f/~ /'FlhrtJ rJ5:Gh n...('f-rc..C;;; f'. fI-~ lname) Phone (address) /!CJO ~ (lies. no.) (exoir~ #. Address Ul:.SHirl I tAr., , (ohane no. J ... Primary / .,tf-/.7J?y Structural 4LL6/f/ /.r<t.. <:' ,'AldL fLlTl.&IkA7.=nJ> .J"<.r'J- <./ ~L ,_ Electrical f1echanical CONTRACTORS (name) (address) gf!:: r<?() .puv;rGItJUL~ {1 ir.",. no. (e)::n;r~c;.) (phone no.) General D f"/ /J1 ~ T ui,if-'= Plumb;na Electrical PAt ~ _1/ c3ZC('7~Lr 15<:; A/ ./ f/"vt , "/''''~/f ,t,!;Zr.5./J/) <f-:l v -Y'; 5SS0 -,=/?-y, <Sf'7 -'2P4 / ~lechan; ca 1 PLUIIBING "'J.~ FEE CHARGF ELECTRICAL MECHANICAL (j~ IlU. NO FFF f:HARr,F NO. FFF rHARGF SQ. FT. furnace/burner to BTU's Each single fixture Residence of Relocated building (new fix. additional) S.F. Residence [l bath) Duplex (1 bath) each Additional bath New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall SOnce he~tpr ~nd vpnt Storm Sewer Of amps. Appliance vent c;eoarate Stationary evap. cooler Vent fan with sinole duct Vent system apart from I heatina or A.c. Mechanical exhaust hood <'Inct duct Sewer Temporary Construction Change in existing res; denc!' multifamily, camm. or Tndu..trial \o-Jater serv; ce COI1f1. /I NO. FEEDERS Install/alter/relocate d;<;.trih. fpprlerc; Wood stove/heater I I I I I \ ofi ;.::'; \( l{) amps. I()~ IO,<A. ISSUANC, OF PFRIIIT TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be valij until the . TOTAL CHARGES that tile Electrical work be done by an label has been signed by an Electrical TOTAL CHARGES Electrical Contractor. the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFUllY EXAMINED the completed ap~lication 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 OrelJon pertaining to the work described herein. and that tiC OCCUPAr~cY will be made of any structure without the permission of the Building Oivision. 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 cornoliance with OP.S 7nl.055 will be used on this project. NAME(pIease print) DI'1-I11 t11 qu IV~.F SIGUATURE4 7JJz.~ FO~ OFFICE USE DULY ." /.~ Units \ So. Ftg. Ilain 'rC'~,-" '; Occy Load_ Sq. Ftg. Access Occy Group~-'~ Sq. Ftg. Other ... IJ4f \3 c;, S1~ Z. Comn/lnd 1.11 por Foe If' /3.0{) Res I Per Fee I DA TEl tJ - ,5U - ~<I Zone (_ t~ Fire Zone - Flood Plain _ Tyoe/Const~ \..) . - , ~() ...-1- LLL Bedrooms Stories x Value \." Value Value \ x TOTAL VALUATION BUILDING PERMIT Charges and Surcharges I ~/"'_ _ I Plan Ck. __'..!~________ 65%/Bldo \ q 1.\ Plan Ck. , 30%lBl do \" \'. N\~ ------------ IO~~o,-f<.{ syste. r:1S Development I rP~Q Charoe (1.5~) C\O.M . ., DeRlO \ C~"\ )~FIl ~ ~V ?'":l., '-lC>_ \~ cD ~_. :). \0.'-\0 PLU'1BING PERMIT Charges and Surcharges Fence ELECTRICAL PERf:IT Charges and SiJ.r~harges \(), . -' Sidewalk -----~~\U-- A/C Paving _..-:_\.;ll...~____ Curb Cut Total Comb. Permit "ECHANICAL PERMIT Charges and Surcharges I I TOTAL ,\ l\C6:V4___ . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax lot 100. Lane County Map Reference II 03 43 2. example- Lot 1. Block 3, 2nd Addition to ~prlngt;eld Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. exam~le- heat/electrical ceilin~/or forced air Qas 2. exa~le- waterheater/electrlcal/or solar E. Square footage or valuation, etc. ----- 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. examplea 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. examole - 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 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 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 payable when the permit is issued. ,\ '. " 1 V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAnCY: t:.'/..\~\ Lj G S\\;_~JC"\:\.) Q\.::: n.\C-Y~\ ,_(? \ ,'--'\.\ 0. \C', \:?:.E' \2'.r::'-\O\.. ~Fa '- . \:'-,(-:V,R..F r.....cc''' \~?!;...\..\C'\ ()~ Di">-I....L) \. \\.\\~ Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: nam-;QN._)\~\:.: \ p., \\ signaturelJrl-o. _A:V~_\r- date \ \ -'2.- \.\- ~q . 1 .