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HomeMy WebLinkAboutPermit Building 1984-12-3 (2) . . I IrlSPECTIQlI LlIIE 726-376g l (')L\ 'Sin I I \.Jater Heater Ranqe Valu( of l-jark: INFORlIATION UN' , 726-3753 Sq. Ftg. 1'1ain ~q. Ftg. Access. Sq. Ftg. Other r~ew Add A Iter Rep. --Fence Demo Change/Use Other- - I ^ VI ~ , \ V I Job Address 8C7 ~c'Rn./'A" 57 S~"n=:]) Legal DmriPtion\"l ()~ ~'S 1.\2- Owner --:J, /l /1, ~, kiruA;:<o L.... (7tlKI'Vl.""11V Address ;::0'::- <" ~d /cc,-l..h'--:-J, ......, I.,J ,-.x-,~, n (cc,;. rla.(.F' Phone 7?1._.:::tA"t Builr;inq Permit Info: Describe WorK(Le" Build Single Familv n~sid~nce IHth .a~.t.ac;h~d Gi'f~o~1 S?R,,.:;,,",ocIt=-L.7), t)~ Construction Lender Address DESIGfI TEAfl (name) Phone (address) (llcs. no.) (exoiresl (ohane no. Primary Structural Electrical Mechanical CONT RACTORS PlumbinQ (namel ---r;+c: WI'''''' /Iil~U-IA";T f1,< S TO(V/ -H,'-<rv? 13 II.) M JK t2.0"K.e-';~c"'<"c.1? (a(lrlrpc;c;) (lice;;. no. \ (~xt);rpc;;l (ahanf! nn.) Genera 1 ~l'07 ;J,';m-J A <),,, n--- /) ~I oD s..- Electrical ~1echani ca 1 'NO.1 "~IEach single fixture I Relocated building (new fix. additional) Is.F. Residence (J bath) IDuplex (1 bath) each jAdditional bath I Water service I Sewer I Storm Sewer FEE CHAR(;E Nn "CC MECHANICAL \::J.~ rlJARlil NO mc__ Ll:IARG.E. furnace/burner to BTU's PLUI1BI NG ELECTRICAL s.- \O~) Residence of SQ. FT. \ New circuits alts. or extensions , \6' (")cr:; Floor furnace and vent SERVICES Recessed wall So~rp hp~tpr ~nrl vpnt Of amps. Appliance vent spn~r~tp Stationary evap. cooler Vent fan with sinale duct Vent system apart from heatina or A.C. Mechanical exhaust hood and rlu(",t Temporary Construction Change in existing rp'S-irlenl"'p multifamily, comm. or lnrluc;tr;~' COffi1./IND. FEEDERS Install/alter/relocate rli<:;,trih_ fpprlpr<:;, Wood stove/heater Of amps. ISSUANC, OF PFRlln TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L'\14 REQUIRES that tile Electrical work be done by an. "Electrical Contractor. the electrical portion of this pernit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the BUilding Division I HAVE CAREFULLY EXAtllNED 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 NO OCCUPAHCY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s Board is in full force and effect as required by ons 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 701.055 will be used on this project. IWIE(please print) JAMeS 1<. C...c<<c, J.,,- SI-G:I^TURE~"""'<J /?ceJ D~,TE 12- J.l?4 Zone c..t::- Fire ZonE' - Flood Plain ---- Tvoe/const\)- ,,,\.\:)_ _Units Bedrooms Occy Load Stories ? Occy Group~?_ FOr. orFICE USE ~flLY V Sq. Ftg. riain Sq. Ftg. Access Sq, Ftg. Other v x x Value Value Value x TOTAL VALUATION BUILDING PERmT Charges an~ Surcharges \~ CO Plan Ck. I I. 65%/Bl do -i:..-\O---""Plan Ck. . 30%/B1 do \ r') .c:o -~C'O- Demo ___\D.OO L\O A/C Paving Conm/Ind Ppr Fpp R"es Per Fee \\b.. Systems Development Charae (1.5%) \-..). ~ PLD'~BING PERMIT Charges and Surcharges Fence ELECTRIU,L PERI:IT Cha rges and Surcharges Sidewalk Total Comb. rermit TOTAL ~w MECHANICAL PERMIT Charges and Surcharges Curb Cut . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Description 1. examole- Tax Lot 100. Lane County Map Reference 1I OJ 4j 2. example~ lot 1. Block 3, 2nd Addition to ~prlngrield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinQ/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-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. OESIGN TEM1 ANO 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. BUILOING OIVISION STAFF WILL FILL OUT ALL FEES ANO 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 wi11 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: . II PERMIT VALIDATION fl. .::II- 6 3 9</ <( (j d ta//iN I Permit Clerk iJ;J CmQD\\... \~\. C=, '\PC-~\:''\('')''--) C")\=- \=-\. O(=; E. ~,,\. '6U\<t-..~F.? b.. ,\ C',,-'-, ~\\)R 'M. ~QR\.~~\~ Permit appl icant exempt from registration with the Buil der I 5 Board because: Additional Project Infonnation: PLANS REVIEWED BY: nam~~~~e)J~ Signat~~' ~da~e\7~~-~ u.... 'V" -._" -