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HomeMy WebLinkAboutPermit Building 1988-1-11 --7- ~----,-~- ~~ ----~ Job Address 1 ;2 '5 WI'>y- \--L Ll [) :; o>S Lj,.(' ~ A-- CITY Of SPRINGFIELD COMBINATIDN APPLICATION/PERMIT EnERGY SOURCES: Heat t~ater Heater Range ." INF0R11ATION liNt 726-3753 Sq. Ftg. f.1ain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. -Fence Demo Change/Use -Other- - oQ eN o cJ1 1.-0 - I INSPECTION LINE 726-3769 '.' .' Legal Description o I..PiOe) Owner K..e.c T;3, O-.-.L Address) I '15, :.-\ l,u.h \\ood WD~!I:?l.<.--v'M r\~ o Phone 1.{.~L/-a5,~ VaIUE)l! Hork: b?l '1, ('){)() ?' Buildirla Permit Info: Familv Residence With Describe Work(i.e.. Build Single Attached Garaoe) Construction Lender ~ ":"--j. T-\~ I ^ ,..J, (l CO~u..,().<...>,~ Address Ut~ HiN TEAt., (nameJ Phone {address 1 (l ics. no.) (exoires) (ohone no. I Primary Electrical ~).'-1 I ~ S-0 () Structural Mechanical CDNTRACTORS Genera 1 ( n....l f:G.4\ 'I ~~'..~ C () (address) 13.;1,:l- \....). ?;e)r:S- (lies. no.' (pxoirps) (ohonE> no.' C\'1J. TI &,OO.Y)D lh) 09 II ../J ./[ / Plumbina Electrical ~lechanical Ptlll!lBlIlG ELECTRICAL MECHANICAL NO. fTL- ..t.H1l.1?f;~ IIln t:'t:'t:' rl-l~ Nn t:'t:'t:' rl-l~ SQ. FT. furnace/burner to BTU's Each slngle fi~ture Residence of Relocated bullding (new fix. additional) S.F. Residence (1 bathl Duplex (I bath' each Additional batll New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall Sn~~p hp~tpr ~"rl vpnt Storm Sewer Of amps. Appliance vent seoar~te Stationary evap. cooler Vent fan with sinole duct Vent system apart from heatina or A.C. Mechanical exhaust hoor! and r1Uc.t Wood stove/heater ~Iater service Temporary Construction Change in existing rpc;J qrnc.p, multifamily. COIl11l. or Industrial Sewer CDMM./IND. FEEDERS Install/alter/relocate r!; <;t.ri h. fppr!prs '-J \0.. Df amps. TOTAL CHAllIGES WHERE STATE t~~ REQUIRES sha 11 not be v,aH'1 ,l.mti 1 the TOTAL CHARGES that the Electrical work be done by an, label has been signed by an Electrical ISSUANCE OF PFR!IIT TOTAL CHARGES Electrical Contractor, the electrical portion of this permit 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 1 further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City of Springfiield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAHCY 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 th -basis for exemption is noted hereon. and that only subcontractors and employees who are in com~l~ance with ORS. 7nl.055 will e used on ~~,t~pr:j;ct. IWIE(please print)Y "'::;;;)?1~.5 .p u./;,tJl'l1 l""K SICIIATVRE'X. 'ne{) ft!.2I~DATE V / /-.f'p FOR OFFICE U!!t"DiIL Y I S6. Ftn. 11Jin S~. Ft~~cess -- Sq. Ftg. Other Zone Fi re Zone Tyoe/Const. Bedrooms Stories Units x Value Occy Load Occy Group x Val ue Flood Plain ~ \J x Value q OQO ".::- TOTAL VALUATIDN BOILDING PERMIT _____7_{~__ ' Plan Ck. CommlInd Charges anc /'" 6S%/Rldo PPr Fpp Surcharges 6. 13 Plan Ck. Res 3D%/Bldo Per Fee PLU!lBING PERMIT Fence Charges and ------------ Surcharges D!1ffiO ELECTRICAL PERIHT Sidewalk Charges and ------------ Surcharges A/C Paving 11ECHANICAL PERMIT Curb Cut Charges and ------------ Surcharges 'Systems Development Charqe (1.5%) ft1CXtJac.t.k~ .:J3 j;;;,-,OO FU2-.- ~<-K- ~__(_. I ITotal Comb. Permit 1 I TOTAL 93~ J .. COMBINATIDN APPLICATION/PERMIT (CAP) I~ Applicant to furnish A. Job Address B. legal Description 1. ~xample- Tax Lot 100. Lane County Map Reference ]7 03 43 2. example- Lot 1. Block 3, 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. exam~le- heat/electrical ceilinqjor forced air qas 2. example- waterheaterjelectrical/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. 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. 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: .. PERMIT VALIDATION ~~ Permit Cl erk ,~ {/~o ct. ~--'~ 1)-/1 --~ Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature . date