Loading...
HomeMy WebLinkAboutPermit Building 1986-11-12 Job Address 725 Nt A L) \;)"I) c"rWO CITY 0, SPRINGfIE~D COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat \~ater Heater Range. ValuE of Hork: l I :s.f-S. ot) BuilcilnQ Pennit Info: Descr.be Workli-.e.~ Familv nesidence With Attached Garaoe) ~~4 "/ ''1 I I INSPECTION LINE 726-3769 . INFORt1ATION LWt 726-3753 Sq. Ftq. 1.lain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. --Fence Demo Change/Use Other- - Owner' t---h.-iJAb Address '72 S IU I~g~t A- Phone Build Single ~ J:;; - ~ legal Description (name) Phone {address} ~f' Construction Lender Address DESIGN TEAI~ (lies. no.) (exoires) (ohone no. I Primary Structural Electrical Mechani ca 1 CONTRACTORS (name) Genera 1 fA.) lU/t.%n -oifF Plumbina ( addn'55l ~~ / c,- (l ice;. no.' (pxnirpc;) (ohone no.) Electrical r\."IC1 ~1echani ca 1 PLUI.IBI NG ELECTRICAL MECHANICAL NO. HF rHARGF NI"l ~~~ r~ARr.~ Nn ~r~ r~ARr.~ 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 (1 bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall Snnrp hPntpr nnrl vpnt Storm Sewer Of amps. Appliance vent seoa ra te Stationary evap. cooler Vent fan with 5 i na 1 educt Vent system apart fram heatina or A.C. Mechanical exhaust hood and dlJ(:t Wood stove/heater ~Iater service Temporary Construction Change in existing re<;..i (Lence multifamily, comm. or Tnrludrinl Sewer COMM./IND. FEEDERS Install/alter/relocate di<;.trih_ fpprlprc; Of amps. ISSOANCE OF PFR'lIT TOTAL CHARGES I TOTAL CHARGES , TOTAL CHARGES WHERE STATE L'\W REQUIRES that tile Electrical work be done by an- Electrical Contractor, the electrical portion of this perTilit""-- shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXA~1INED 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 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 rw 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 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 project. IWIE(please print) D uo..wC\..LArBl tL.{'+ SIGNATURE ~~~ DATE \\-\L-~ FOr. OFFICE USE GIlLY Sq. Ftg. liain Sq. Ftl]. Access Sq. Ftg. Dther Zone F1 re Zone Tyoe/Const. Bedrooms Units Occy Load Occy Group x Value Value Value x Flood Plain Stories x TOTAL VALUATION BUILDING PER~IIT Charges and Surcharges , ,., -0' Plan Ck. _____<2'_3_o..:?__ 65%/Rldo qd Plan Ck. ., 3D%/Bldo Fence ConrnlI nd Ppr Fpf=! Res Per F~e 'Systems Development ' Charqe (1. 5~) PLOt~B ING PERMIT Charges and Surcharges D~mo 'Sidewa 1 k ELECTRICAL PERlilT Charges and Surcharges A/C Paving Total Comb. Permit I TOTAL ,~111 MECHANICAL PERMIT Charges and Surcharges Curb Cut ~ . " COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION 1. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, lane County Map Reference 1/ 03 43 2. examr.le- lot 1. Block 3. 2nd Addition to springtield Estates C. Name. etc. of owner and construction 1ender D. Energy Sources 1. example- heat/electrical ceilinQ/or forced air Qas 2. example- waterheater/electrlcal/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. 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 apprapriate 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. BOILDING 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. 6~ 1) 1{ ( 0_rffo {(r ~ V. FOR OFFICE USE ONLY Permit Clerk Y;--- .. PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: .. PLANS REVIEWED BY: name signature date .. .. 725 North "A" Street 'f-:r:' _;'!;;:.:'~;.1l,,~:~l,i:J~~iT-;-;(i ':(J .;'" t;. h. J"i?,i:f:!'-,' >.( ., .. ,., ~ :,':1{'. "i~ "1 ':.,\ ,.:gii,fi,";"M'; - ' '~!f:!:<#'i~l~ , ,,:":~".. 'I '.