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HomeMy WebLinkAboutPermit Building 1983-7-23 . . Job Address J YO <; r-..<;(,....(/ j j, 'Ii' A~ ,uJ Legal Description /7-tP'3-U-Yz. . ()~7t::>t::> CITY OF SPRlIIGFIELD CmlBlilATION APPLICATION/PERMIT EtlERGY SOURCES: Heat Hater Heater Ranqe__ INFORl1ATIDN liNt 726-3753 Sq. Ftq. 1.lain ~2,"-.p ~q. Ftg. Access. Sq. Ftg. Other -1lewXAdd_Al ter -,~ep. Fence Demo Change/Use Other - - ~ 0- 'l"" - rf) 00 11IISPECTIml LIlIE 726-3769 , Address a J va}tt of Work: Y)II/1M.n,{~.J k.1t ,(~LU: ) X \ (;H) () )/'0./:"7, (J (j),,:,,~'(J}Ch.Jl phone')'//,..".. Builciino Permit Info: Describe Work(i.e.. BU.ild Single L) '+~ un 'So.. ,y ..,~ ?.Farnilv flesidence I~ith JI..ttrl.r:hpn GitrilQp.) (>>vL~ r2dd~~ ~ ~'~ Owner ~tJ"~, Construc~n lender Address UI:.;'Jli1{ ItAft (name) Phone (addressl (lies. no.) (exnires) ; (ohane no. 1 Primary Structural Electrical Mechanical CONTRACTORS (namel QQQJ.. ~ Jaddress) Arr~ rO (1 ;r:<::. no.) (exoirp<;.) (ohane no.) Genera 1 933- ;;;;7;>7 Plumbino Electrical ~'echani ca 1 PLUIIBIIIG ELECTRICAL MECHANICAL -1lQ...1 lEach single fixture IRelocated building (new fix. additional) I S.F. Residence (I bath) 10uPlex (1 bath) each IAdditional bath Iwater service lsewer Storm Sewer 1 FFt I l"H^Rr.r NO , Residence of , CEL'-'liA&liI: "0 , _1_1=1='1=' Irl-l~ SQ. FT. furnace/burner to BTU's / y New circuits alts. or extensions "2 OR;y,C~~ SERVICES 6:.(>> Floor furnace and vent Recessed wall ~n~rp hp~tpr ~nrl vpnt ITempOrary Construction Change in existing rp'l i (tencp . multifamily, comm. or lnrluc;trial TOTAL CHARGES that the Electrical work be done by an. label has been signed by an Electrical I I I /,!;:c>e> Appl iance vent seoarate Stationary evap. cooler Vent fan with s;nole duct I Vent system apart from I hea t i no or A. C. I'Mechanical exhaust hnnd and rlurt I \iood stove/heater I I I Of ICO~1./INO. FEEDERS I Install/alter/relocate rlidrib. feerlerc; 10f amp~l I I i amps.l TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be vali~ until the ISSUANC, OF PFRtHT TOTAL CHARGES Electrical Contractor, the electrical portion of this pe~it Supervisor and returned to the Building Division I HAVE CAREFULLY EXN1INED 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 Springfielti and the Laws of the State of Oregon pertaining to the work described herein, and that rw OCCUPArKY 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 comoliance with OP.S 701.055 will be used on this project. IlAIlE(please print) 4114-.A/60/0 ((I)" f7i?..,(A,(~";lATURE~ D~ /~I FO~ OrF I CE USE OIIL Y .b' So. Ftg, 11ain" ~ 2S' fP. x Value /~~6<!l. tlO Sq. Ft~. Access x Value Sq. Ftg. Other x Value ~ ~OTAL VALUATIOll & tl rJ.J'l5br~ r) . '/.,t-Jj J~/ SYStems Development .~ I.,. _<:"</..,n Charqe (1.51,) '. DATE ~ , 7~ l.)/d; - . Zone C. C Fire Zone Flood Plain Ty!>e/Const..:, Bedrooms S'"N Units Occy Load '7/6"0- Occy Group"'. :i' Stories , BUILDIIlG PERIIlT Charges an~ Surcharges ~u..... Plan Ck. COIlVll/lnd ~ 7 . 65%/Rldo Per Fee ------------""""i5'Tan Ck. Res :;>.::r~ 30%/Bldo Per Fee -;Z7~. ...co PLUI1BING PERMIT Charges and Surcharges Fence ELECTRICAL PERI:IT eha rges and Surcharges I Demo IS.."'" 1 Sidewalk -------.-60--1 A/C Paving I Curb Cut I Total Comb. rermit jC'<. % -1 MECHANICAL PERMIT Charges and Surcharges TOTAL '3 ?:?% . . . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VAll DATION I. Applicant to furnish A. Job P.ddress B. Legal Description 1. example- Tax Lot 100. Lane County Map Reference 17 OJ 43 2. example- Lot I. Block 3. 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources . 1. examele- heat/~lectrical ceilin~/or forced air aas 2. examole- waterheater/electr1cal/or:solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project. checknew - :if addition, enee'" add. etc. F. Building permit information: 1. example ~ construct single family house with an attached garage 2. examole - 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 CON1RAC10RS 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 S1AFF WILL FILL OU1 ALL FEES AND CHARGES ON THE SCHEDULES O. 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. ~. f~ f}-c9~-~ Co \4'65 i , V. FOR OFFICE USE ONLY I Cler~UJ()J Permit .I PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: /'9-/;? c;,...H--1?/ r/~h'./~ ~ -;:VC #-"""/..../#c, h..::."", WaIF?;> /- APPrr./ONA- ( ?L.#~<;. ?~.kU7' ." /,y$"~ C7'A::l A;:.- ~ , . rdk' Mt!:<::-HA-;w<:'A-<:" //E""7?~" YG,NT/L.,.09r/~ C5~ ~ . "&/~fi? 7e:. /#57All.A7/0N_- oN Jv~7" c:?;~ c:s~ .?CJ/c:...p/~ ??E4>c..J./fi?~ . Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: !,?U/<'7.?/~ ~A'-Rn a~ ~~~LS c;:J?#h~ ~&>"'T ~~;>::> ~~ VA;q.,w..A:/cE- ~=e>F .,' . - r ~;qC:AI-V~ V &rRc...J5/........../ /N'7'l:> /<t!:>~7: .r-~_.r Y:A-~b ~r .M'~M' ,,4/!~4-. PLANS REVIEWED BY: name.L~~ R.~~ ~ c-_ 5ignatura-/'/ ~......~~......... ,. or 't.- p. date 7-/~-g3 I,