Loading...
HomeMy WebLinkAboutPermit Building 1987-11-4 #>\'i) - 11 .....:. ~ I INSPECTION LINE 726-3769 . JI~t--LJ CITY UF SPRINGFIE~D U INFDR11ATION LINt COMBINATION APPLICATION/PERMIT 726-3753 EIIERGY SOURCES: Sq. Ftg. 11ai n Heat ~q. Ftg. Access. Water Heater Sq. Ftg. Other New Add Alter Rep. Range --Fence Demo Change/Use / _ ;alUE of l'lork: 1$1$ ~ ~ ~ Other- - Phon~ 3.."-\1...- BU'ilciinQ Pennit Info: Deser.be Work.(Leq Build Single I f-.=tq.l F.amilv Ilesidence ~~ith Attached Garaae' _ /Tl::::.~ oPF u, \ c:rt"J ~. ~\: R!""/.,F / '\, 0' f:l.10O 'Rr::.'R1-y)f2. I U\l\-"'\ \:.J\.A::x:, F\ D1C-. '-l. f:>l--H ( ~ \ ~ ,e...., ,) (l ics. no.) ()fL ,rA~ Job Address LP'Y~ N. "Au sr-. Legal Description Address k.\ k.E \<'!\Jt')G,LL- \3L 1;-. ~'R.Of-\JOWA'i ts\.)C:,-'G: \01:::;- ) ( \ + ~ a l""-' 00 Owner' Construction Lender Address UlSIG" rEAI1 (name) Phone (address 1 (exoires) (ohane no. J Primary Structural ~r() ii r 9;;, 6'0 .(';'q, L.// \:J IP ~ Electrical Mechanical CONTRACTORS (name) ~General ') Y:;>,--t.~ Ql"""f"'P., C'\.\(_ (addr~ss) (lir.c;. no.) (plmires) ..a..\C\Cl~ 111'-1/'6/ (nhone nn_) Plumbina t '><.014 ('~W RJO_ E:DC...,;t;:, uo:; , '" f "\ () L 3H4-()'l..loQ Electrical "lechanical PLUllB I NG ELECTRICAL MECHANICAL Each Single fixture FFF ~HARr,F Nn~1 '-EELIJ:IJAJlGL NO, I Residence of furnace/burner to SQ. FT. BTU's New circuits alts. Floor furnace or extensions and vent i="H. fl-lM.G.E. ~ Relocated building (new fix. additional) S.F. Residence (1 bath) Duplex (l bath) each SERVICES Recessed wall SD~CP hpatpr and vpnt q '1 ITempOrary Construction IChange in existing res.; d{mce Imultifamily. conm. or Tndustri~l IOf amps. !COMM./IND. FEEDERS I Install/alter/relocate dic:.trih. fppdprc; IOf amps. I I I Appliance vent c:;poa r~ tp Stationary evap. cooler Vent fan wi th ~inale duct I Vent system apart from heatina or A.C. I Mechanical exhaust. hood and dud. I \-load stove/heater I I I Additional bath ~Iater service Sewer Storm Sewer ISSUANCF OF PFRrllT TOTAL CHARGES I TOTAL CHARGES , TOTAL CHARGES WHERE STATEl:'U~ REQUIRES that tile Electrical work be done by an, 'Electrical Contractor. the ,electrical portion of this permit shall not be vali~ until the 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 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 OCCUPAIKY 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 ons 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 701.055 will be used on this project. NAt.IE(please print) ':3"'\ t--\" R.xJ::-,s-, SIGIIATURE ~ _ ~ ~ FO~ OFFICE USE OIII.YI~\ Sq. Ftg. riain Sq. Ftg. Access Sq. Ftg. Other DATEi:ll-\4-0l.lo"\ Zone Tvpe/Const. Bedrooms Stories Units Occy Load Occy Group x Value Value Value Fire ZonE" x Flood Plain x TOTAL VALUATION BUILDING PERNIT Charges and , Surcharges 01- , . , I Pl an Ck. ____~:1.~b_~9__ 65%/Rldo Plan Ck. ,3. 73 30%/Blda Call1l1llnd Pf!r Ff!e Res Per Fee ISystems Development ' Charoe tl.5~) , PLUllBING PERMIT Charges and Surcharges Fence Demo ELECTRICAL PERIHI Cha rges and Surcharges Sidewalk A/C Paving 11ECHANICAL PERMIT Charges and Surcharges Curb Cut Total Comb. rermit I I TOTAL 1 ~ ;1.3 . 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. examp.le- Lot 1. Block 3. 2nd Addition to Springfield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. exam~le- heat/electrical cei1inqjor forced air qas 2. example- waterheater/electrical/or solar E. Square footage or valuation, etc. ----- 1. example- 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. example - construct single family house with an attached garage 2. exa~le - 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 item{s} to be installed are not covered on the abbreviated schedules you should consult the full schedules C. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEOUI.ES 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . .-~' PERMIT VALIDATION '\2"C 0 . 'r'\" :#' I Permit Clerk ID07'-f i1J'L- . Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY; name signature . . date