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HomeMy WebLinkAboutPermit Building 1986-4-1 .- .,.;. ;... . .--. ...-.----...-.--~-----.-'--.-..'l~<1f) - -.-------- ---.'.- -.._~ 'I Job Address . Q 55 Legal Description \ 'J7 <;:::Ol,-th H- -=':>5-3-" 0.":> ,). 0-.. . C I TV OF SPRIIIGfTI'ID COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat 0'72.00 l/ater Heater Ranqe_ INFORllATlO~ L,Nt I 726-3753 Sq. Ftq. Main I ~q. Ftg. Access. yrO Sq. Ftq. Other .-tlewgAdd _A 1 ter .....:~ep. I \'ill Fence Demo, Change/Use '-"'\ Other - - I f)'. a I I HlSPEC 10rl LINE 726-376, .' Address DESIGN IEAI1 (name) Pl,one (a~ddress ) ValUE of Work: ~ ./"2" ?/7. BuiltiinQ. Pennit Info: Describe Work(i~e.. Build Single Familv nesidence With Attachpd Garaae\ \~o rL 0 ~ \ ..\~,~~ ~/'\~ l/lQ\Q/;,.li\ J - CXJ 0\J Owner I Cc::. .~.f III C C ull T Address ,-~7f!') -TP; ~~& i )/n" ') CC.oc O.v-.lL Of---.. nL-P.=; Construction Le'~der ~fZ 7t11-~~ Phone ,\y b (lies. no.) (exo;res) (ohone no. Primary Structural Electrical Mechanical CONTRACTORS (name) General \ Zd 0 <::::'t. t ~. ___ () (address) 9:1/ f! All]) , b (lirs nn,1 (~y~irps\ (l1hn"", I'l:n, 1 ~Gg~1 /~-gt,-R,0 Plumbino I El ectri ca 1 Hechanical PlUIIBlIlG ELECTRICAL MECHANICAL rIO. HF (HARl;F Nn.- <:EL J:liARIiE. ..l!Q.... n. ~ r~>1IDiL Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) ~ New circu~ts alts. or extgos10nS ,2D "2~)c" ~~,.,.~ SERVICES "22. f!j ) Floor furnace and vent S.F. Residence (J bath 1 Duplex (1 bath) each Recessed wall ~n~~p hp~tpr ~nrl vpnt Storm Sewer Of amps. / Appliance vent ~p1)ari'ltp Stationary evap. cooler Vent fan with sinole duct Vent system apart from I hp~tino or Ar_ Mechanical exhaust hood ~nd durt Additional bath Water service Temporary Construction Change in existing rps i rlJ>n~p multifamily. comm. or T",(ipo:.tri"l Sewer CO~1./IND. FEEOERS Install/alter/relocate rHct..ih fpp(ip..o:. Wood stove/heater Of amps. TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be vali1 until the ISSUANcr OF PFRllIT TOTAL CHARGES 2-;?~:X:> TOTAL CHARGES ~#. k'/): e>O that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFUllY EXAMINED the completed aprlicat;on 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 exemDtion is noted hereon, and that only subcontractors and employees who are in com?liance with OPOS 7nl.055 will ~ used on this project. IIAI.IE(please print) SIGNATURE FOr. OFFICE USE om y DATE Zone C C Fire Zone Flood Plain Tyoe/Const.~-/\I Bedrooms Stories / Units Occy load Occy Group~'<2: Sq. Ftg. t1ain Sq. Ftg. Access "'/0" Sq. Ftg. Other~2"~ x Value x./t:/.06 Value ~'ICJO.'-' x Value$8J7,- TOTAL VAlUATIOll/27(?-'>-6 BUILDING PERfHT Charges ant:: Surcharges . a.o~..... Plan Ck. ___LJ!2~L':::_ 65%1Bldo "'7 ~L / Plan Ck. .;1 ~ r '7 30%lB1 do I Fence Conm/lnd Ppr Fpp Res Per Fee ~Y,03 Systems Development Charoe tL5~) /~o. 7tb PLUI1BING PERMIT Charges and Surcharges DfjRlO ___33.'_~c:?.._S1d.walk . "7(!) A/C Paving ___../..s;_~_J Curb Cut -be; I Total Comb. Perm; t / t.j /. qq- I TOTAL I ~6. :z. 3'_ ELECTRICAL PERIHT Charges and Surcharges 11ECHANICAL PERMIT Charges and Surcharges I . . :.. .. ~. COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION II. t. Applicant to furnish A. Job Address B. legal Description 1. example- Tax lot 100. Lane County Map Reference II 03 43 2. examole- lot 1. Block 3, 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. examole- heat/electrical ceilinQ/or forced air Qas 2. examp\e- waterheater/electrlcal/or solar E. Square footage or valuation, etc. ------ 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project. check-new.- if addition. check add, etc. F. Building pennit information: . 1. example - construct single family house with an attached gaT'age 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. 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 Z. 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. --- 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. , " 01cb)q~ V~ ~-?--<;~. , III. IV. V. FOR OFFICE USE ONLY Permi t Clerk ~ ~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: I PLANS REVIEWED BY: name . -z;, ./"?' '--:7"> - L.t>7<'H~ rC~~signature ~~-C_ _.~ ,~ ,r date v-/ -2?t;;