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HomeMy WebLinkAboutPermit Building 1984-3-27 f Job Address 3~ I .!ill. ro +. - L J ......'0 111/.1 Le V\ I'e..", "" Q. ~'v. Legal Description Sc..ho~L CD'" \"'1'\ \1 D~.Q~O~_ (jC&Q) Owner', c;.?~,V\~'~ \J C;::L~a.L 'i\,~\..'\c.T Address 52. S \rn~ \\ ~,""--.,. Phone CITY DF SPRINGFIELD Cm1BINATION APPLICATION/PERMIT ENERGY SOURCES: Heat Hater Heater Range INFORllATION UNt 726-3753 Sq. Ftg. r.1a in ~q. Ftg.Access. Sq. Ftg. Other ._ --1~ew__Add__Alter)(Rep. Fence Demo Ch~ge/Use Val~ 'irJOl --Other-- -- Builclinq ~ermit Inft: Describe Hork(i.e., Build Single Family Residence With Attached Garaae) J ~ INSPECTION LINE 1726-3769 Construction Lender G. V91 'Reo C' \ "" - ~ '00 ~ T^.e& o~@. ~, o - N o ~ roo Address DESIGN TEAI~ (name) Phone (address) (lies. no.) (exoires) (phone no.) Pri ma ry Structural l,i. Electrical ,Mechanical . CONTRACTORS (name) (address) /~t"ld ,10.: {,) c --'-. - , (lies. no.) (exoires) (ohone no. ) General (h~_- - Plumbina Electrical " ~lechanical PLUflBING ELECTRICAL MECHANICAL NO. FEE CHARGE NO FFF rHARr,F NO. , FFF rHARC:F. Each single fixture Residence of SQ. FT. furnace/burner to BTU's -' Relocated building (new fix~ additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (l bath) Duplex (1 bath) each ISERVICES I I I I I I Recessed wall Soace heat.er and 'I vent. ITempOrary Construction IChange in existing residence I multifamily, comm. or Industrial 10f ICOMM./IND. FbEDERS I Install/alter/relocate distrib. feeders 10f amps.1 I I I I I J . TOTAL CHARGES I TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be done by an Electrical Contractor, 'the electrical portion of 'this permit shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division I Sewer Istorm Sewer I I I I I I amps. Appliance vent seoarate Stationary evap. cooler Vent fan with s i na'l educt Vent system apart heating or A.C. Mechani~al exhaust hood and duct llood stove/heater from Additional bath ~jater service I ISSUANCE OF PFRt1IT TOTAL CHARGES I HAVE CAREFULLY EXA~lINED 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 oertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without the permission of the 8uilding 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 ORS 701.055 will be used on this project. Zone Fire Zone FloodPlain Type/Const. Bedrooms Stori es Units Occy Load Occy Group SIGNATURE ,~o.J\J\.U k- V\'\. , FOR OFFI~E USE DNLY : ' Sq. Ftg . ria i n Sq. Ftg. Access Sq. Ftg. Other Dim ~-27~8l.f rW1E(please print) '-A~~'< \<.\~G. x x Val ue Value Value x TOTAL VALUATION BUILDING PER~1IT Charges and Surcharges 0.. 0 Plan Ck. __~~.:;.g-:____ 65%/Blda , eJ Plan Ck. j.l b 30%/Bldq 'I Fence ------------, Dt;mo Sidewalk Comm!Ind Per Fee Res Per Fee Systems Development Cha rge (1. 5%) , PLU/~BING PERMIT Charges 'and Surcharges ELECTRICAL PERMIT Cha rges and Surcharges A/C Paving I Curb Cut I 1 I I ITotal Comb. Permit I TOTAL 3~,2~ I MECHANICAL PERMIT Charges and Surcharges .~~,1I11 .MlIioJolI~1 h~... \ COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION IV. I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 1703 43 2. example~ Lot 1. Block 3, 2nd Addition to Springfield Estates ,C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinq/or forced air gas 2. example- waterheater/electrical/or solar E. Square {ootage or valuation, etc. ~. 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 hou'se 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, Buil~ing 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 appli~ant 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 el~ctri~al contractor for signature by his el~ctrical supervisor. The general contractor is not authorized to sian the electrical l~bel. ApplicantJto'sign and date Wheneve~ possible, the initial application will be used as a worksheet only. Where possible, Building Division Staff wil;l prepa re a type ,wri tten copy and return it to the applicant at the time the actual permit is issued for his signature. 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. :' \ t\ j V Z~, ff g;; ') ~. Ji w1 ~1Y ? ; , Ill. 1 V. FOR OFFICE USE ONLY Permit Clerk Yv , ~ J Ii '. !~ :] i PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ., " Permit appl icant exempt from registration with the Builder' s Board because: 'Additional Project Information: PLANS REVIEWED BY: name signat~re .- date