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HomeMy WebLinkAboutPermit Building 1984-6-14 1 INSPECTION LINE. 726-3769 -- CITY OF SPRINGF'IELD CDr1BlilATION APPLICATION/PERMIT EilERGY SOURCES: Heat t.Jater Heater e INFORI1ATION li"t 726-3753 Sq. Ftg. 1.lain :q. Ftg. Access. Sq. Ftg. Other Ilew Add A 1ter P.ep. -Fence Demo Change/Use Other- - I OJ (} -C.. IqJ - Job Address (~c:,'; ~\" 'A J Legal Description \,C)~ ',~S:5\ f)4Q{)) Owner () C l.&W-a. e1dg.. Address r/)~c- A) _ 'Ail' .<..}- construct~ d OX..J Phone Range vall of flork: CO I?_nO. Buildintl Pennit Info: Family nes;dence With Describe Work(;.e.. Build Single Attached Garaae' (' .nf'l\.\llliJU' io.-D Q(lNilJj Qo.lY\OCU QJ 11}f1 fJ fJ ...- Address DESIGf~ TEN1 (name) Phone (address\ (l ;C5. no.) {exnires1 {ohane no. I Primary Structura 1 Electrical f1echan;cal CONTRACTORS (namel General ?Y.f e j {\ nil.. "\& . (address' roO(IJID W.S'f/")-f (lies. no.) (exo;rps) ,~'74v;3 .Jul'J Rtf JOhone nn. Plumbina Electrical ~1~c;han; ca 1 PLUI1BING ELECTRICAL MECHANICAL NO. FEF . CHARGE Nn F~F rHAR(;F Nn_ FFF rHARr,F SQ. FT. furnace/burner to BTU' 5 Each single fixture Residence of Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (j bath) Duplex (1 bath) each SERVICES Recessed wall Snacp heater ann vent Storm Sewer Of amps. Appliance vent seoarate Stationary evap. cooler Vent fan wi th sinale duct Vent system apart from heatina or A.C. Mechanical exhaust hood and duct Sewer Temporary Construction Change in existing rps i (tf-nre multifamily, camm. or Tndustr;;:>.l Additional bath ~Ia ter serv; ce CDMH./IND. FEEDERS Install/alter/relocate distrih_ fpeders Wood stove/heater Of amps. move.. <..f.DMf lSdJ TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be valiJ until the ISSUANCE OF PFRt1IT TOTAL CHARGES I~.{)() TOTAL CHARGES that tile 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 EXMllNED 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;wi1l 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 em~]oYees who are in comoliance wlth ORS 7nl.055 will be used on this pro;;r~ IWIE(please printt! E )! L~ L Lo,dSb/';/ wk.4IGIIATURE~ ~DATEX 6/;tIi.- FOR OFFICE USE 0111. y Zone Tyoe/Const. Units Fire Zone Bedrooms Occy Load Flood Plain Stories Occy Group <"D~ LPo " 071. I3/. BUILDING PERflIT () ~ _'Yl 00 Plan Ck. Charges anc _____~_g-. 65't/Blrlo Surcharges 0 Plan Ck. . 30%/Bl do PLUMBING PERMIT Fence Charges and ------------ Surcharges Sq. Ftg. f1ain Sq. Ftg. Access Sq. Ftg. Other x Value Value Value x x TOTAL VALUATION Conm/l nd Ppr Fpp Res Per Fee Systems Development Charoe (1.57,) Demo EI.ECTRIC~.L PERI:IT Charges and Surcharges 11ECHAN I CAL PERMIT Charges and Surcharges _____./_5.fPO Sidewalk 1-0 A/C Paving . LO Total Comb. Permit TOTAL ! 3(,.L/O Curb Cut e COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. examFle- Tax Lot lOa. Lane County Map Reference II 03 43 2. examele- lot 1. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner 'and construction lender D. Energy Sources 1. example- heat/electrical ceiling/or forced air qas 2. examole- 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-nfw - 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. examjle - 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 CONTRACTDRS 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, & E1ectrical 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 TME 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: e PERMIT VALIDATION (o3U-I1 h-/Lfff ~ ry Permit C1 erk ~ . Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature -- . date ....,..-....