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HomeMy WebLinkAboutPermit Building 1988-12-23 or Jo5 Address "'5~,) ~r# , / .4 C;r .' CITY Uf SPRINGFIELD COMBINATION APPLICATION/PERMIT -.- EIIERGY SOURCES: Heat \~a ter Hea ter . INFORl1ATION liNt 726-3753 Sq, Ftq, 1'la;n ~q. Ftg. Access. Sq, Ftg, Other flew Add Alter Pep, -Fence Demo Change/Use Other- - Legal Description /?-O"3-'3S-OCJ ~;r-L>P 2== /" i Range ValuE of Hark: ":7..........:...., -- Bull(;inQ Permit Info: Oeser be \~ork(;-.e.. Family nes;dence With Attached Garaoe) Build Single I ~ ~ .0, 1(;1.1 I NSPW.CT:JO N LINE 726-:y.>~ .. :;, Owner / S ,...- f _F_ "::>l,.v~""",/? r- Address ":2 ~ 5'P-.;:r S-r ~1;.o~&"o;;;: ~.;"'-""'?D. r::>/?, Construction Lender / Address DESIGN TEA" (name) Phone (address 1 L""'~7?i:GrC.r--- ~&/O'P ~~.~_~ 1/' ~.H'nc_. ~ h~ fk-.#./.c~___ ~S"&>~~ (lies. no.l (exo~res) (ohone no. \ Primary Structura 1 Electrical 1()"1 ') ,>0(/ t1echanical CONTRACTORS (name 1 (addrf'ss) (1 les. no.' (pxoirf's) (ohonp no.) Genera 1 Plumbina () _ tV I: V Electrical ~lechanical PLUIIBIrIG ELECTRICAL MECHAN I CAL Each single fixture FEE C:HARr,F NO I I Residence of sq, FT, INew c;rcu~ts alts. or extenslons I SERVICES I ITemporary Construction Change in existing rpsidpncp multifamily, camm. or Tnrlustrial ~FF fHARGF NO_ J:"FF fHARGF NO, furnace/burner to BTlI's Relocated building (new fix. additional) Floor furnace and vent S.F. Residence (j bath\ Duplex (1 bath) each Recessed wall Sn~ce hPrttpf rtnrl vpnt Storm Sewer Of amfls. Appl iance vent SPOil ra te Stationary evap. cooler Vent fan with sinole duct Vent system apart from heatino or A.C. Mechanical exhaust hood ilnd duct Wood stove/heater Additional bath ~Ia ter serv; ce Sewer C0I1H, /I ND, FEEDERS Install/alter/relocate dic;trih. feeders Of amps. TOTAL CHft.RGES WHERE STATE l~W REQUIRES shall not be vali1 until the TOTAL CHARGES ISSUANCf Of PFR!lIT I TOTAL CHARGES that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXMlINED the completed apfl1ication for permit. and do hereby certify that all information hereon is true and correct. and I further certify that any and all work Derformed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Orel'.lOn pertaining to the work described herein. and that lW OCCUPAr~cY 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 Or.S 7nl.055 will be used on this project. I Zone_CC Fire Zone Flood Plain Type/Const. Bedrooms Stari es SIr,II.~TURE&A""(;' d./ FO~ OFfICE USE DilLY ~-N Units Sf]. rtg. f1ain Occy Load Sq, Ft~, Access ~~J<7 Occ'y Group 7$-/ Sq, Ftg, Other ;- 12./1-1-1 aa (D ' /"Q pr "H"'t- 12-"1 t\C) ~ p, j,~ I I Plan Ck. CommlIrtd Systems Development ___2~S:c:?__ fi5%1Rldo P,er Fee ~V3 Charqe (1.5%) Plan Ck. Res "? '7.5 3D%/Bl do Per fee r!~ OftTE h-2J-'i;f; r~Af.1E(please print) x Value Value Value 9~,- x I x TOTAL VALUATION ;~ BUILDING PERMIT Charges ane Surcharges ). PLUt~BING PERMIT Charges and Surcha rges /~. ....... ?J- Fence D~mo ElECTRICft,L PERf~IT Charges and Surcharges Sidewalk A/e Paving Total Comb. Permit 7'8. "23 I1ECHANICAl PERMIT Charges and Surcharges Curb Cut TOTAL 2/3.73 J . ., , r r , , ~ :. COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATIDN I. Applicant to furnish A. Job Address B'f legal Description 1. example~ Tax Lot 100. Lane County Map Reference II 03 43 2. example- lot 1. Block 3, 2nd Addition to sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinqjor forced air qas 2. examp)e- waterheater/electrical/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. examole ~ construct single family house with an attached garllge 2. example - remodel existing garage into family room 3. exam~le - 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 OIVISION 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 ~ivision 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. " ( 2- q cf~ 12--23-V( I I \ V, FOR OFFICE USE ONLY Permit Clerk Q() PRDJECT CDNDITIDNS TD BE SATISFIED BEFDRE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name ~ ~~~--F r:- ~~ signature 4~'f:!:~r~ date/::?'-=<7-g~ ]