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HomeMy WebLinkAboutPermit Building 1984-4-12 I INSPECTION LItlE 726-3769 e CITY OF SPRINGFIELD COHBlrlATlON APPLICATION/PERMIT EnERGY SOURCES: Heat Hater Heater . INFORt1ATION UNt. 726-3753 Sq. Ftg. 1.lain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter ~ep. --Fence Demo Change/Use -Other - - I~ --to ~ ~ G' I~ Job Address q,I]' ;/}/. A. Legal oescriP;ion iiJffi~l. oLrLrtJ ghJy~/Jff Address f{ z...':l' u/;"jj;C.lJL? '" C' J Ph~57_?"'34 cons~JE~~- \ ~ J QM \\ \\ ~ Address Ut::>ltiN HN1 7%#fi ~1d Range ValuE of Work: I' .;4l/ 6'tJ 0Z.- . BuildinQ Pennit Info: Describe Work.{i..e., Build Single Familv ~esidence With Attached Garaoe) .st:.Y~ T#' "~U5 tJ?/',c r;f- ;?E/fZJ~r k////-I C21l4'?~ ~fi% R 5/".Il4/#/.&.5> Owner ~..f'<? . (name) Phone (address) (lies. no.) fexoires) (ohone no. ') Primary Structural Electrical Hechanical CONTRACTORS (name! General 7J?.Jf'ftt/ 5#.e.-l l?4# r (address) .;<.$ 21./"'7 1I,1lV R'i/t3:? nics. no. (pxnirpc;.) (ohonf> nn.) ~2.5'5'6 J/)-IZ-- B'tJ "/{{l-/- 'Z'-"37"-7 Plumbina Electrical ~1echanical PLUlIBIIIG ELECTRICAL MECHANICAL NO. FFF . r.HARr.F NO ~~~ r~AQ~~ NO_ ~~~ r~ADr.r: Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) S.F. Residence (] bath) Duplex (1 bath) each Additional bath New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall Sn~rp hp~tpr ~nrl vpnt TOTAL CHARGES WHERE STATE LAW REQUIRES shall not be valij until the I I I I ISSUANCF OF PERIHT I TOTAL CHARGES I TOTAL CHARGES tha t the El ectrica 1 work be done by an, 'El ectri ca 1 Contractor, the e 1 ectri ca 1 port i on of thi s permit label has been signed by an Electrical Supervisor and returned to the Building Division ITemporary Construction IChange in existing rp$.i dJ'nrp Imultifamily, COnln. or Inrlllc;t.ri~l 10f ICOMM./INO. FEEDERS I Install/alter/relocate . didrih_ fppdprc; 10f amp~1 I amps.1 App 1 i ance vent saoar<i.tp Stationary evap. cooler Vent fan with sinole duct. Vent system apart from I heatina or A.C. Mechanical exhaust hood i1nd dur.t Wood stove/heater \oIater service Sewer Storm Sewer I HAVE CAREFULLY EXM1INED 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 performed 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 NO OCCUPAr~CY 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 7Ql.055 will be used on this pr~~~ ~ HAI.IE(please print)-r;:;A/fy 5'//,e"'i?#/?- SI"IIATURE~ ____~ATE;-I2--%<,I FOr. OfFICE USE DIlLY ./_____ // Sq. Ftg. riain Sq. Ftg. Access Sq. Ftg. Other Zone Fire Zone Tyoe/Const. Bedrooms Stories Units Occy Load Occy Group x Value Value Value x Flood Plain x TOTAL VALUATION BUILDING PERMIT Charges and Surcharges ,.,~I 'Plan Ck. Comm/lnd -/-rt..~__ 65%/Bld(l Ppr Fpp - ,., 7- Plan Ck. Res . -, ~ 30%/Bldo Per Fee Fence 'Systems Development ' Charge (I.5~) PLU'~BING PERMIT Charges and Surcharges D~o ELECTRICP.L PERr:rT Charges and Surcharges Sidewalk 11ECHAN I CAL PERM IT Charges and Surcharges AIC Paving ____________1 Curb Cut I Total Comb. Permit TOTAL;( q. 0/ f.R . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax Lot 100. lane County Map Reference II 03 43 2. exam~le- lot 1. Block 3. 2nd Addition to sprlngtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. example- heat/electrical ce;l;n~/or forced air Qas 2. example- waterheater/electrical/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 permit information: 1. examole - construct single family house with an attached garlJge 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. OESIGN 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 2. If the item(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 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.~ 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. , II. I I I. IV. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: e PERMIT VALIDATION 13 &,;;;. -? 3- b 2/-,)~f Permit Cler~ t7 . Permit applicant exempt from registration with the Builder's Board because': Additional Project Information: PLANS REVIEWED BY: name signature . date