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HomeMy WebLinkAboutPermit Building 1983-12-5 '~ .-'. . . .j. '~ ' .t -,I' INspECTION LINE CITY OF SPRINGFIELD ' INFORI1ATION UNt , 726-3769 f COMBINATION APPlICATION/PERMIT 726-3753 , \ \ ~ 1[) l \ \--,. ~ I \ . ENERGY SOURCES: Sq. Ftg. r'1~'n, 'Job Address \O'--~. ,-Q.A\)..\)\'\f\\.~ Heat ~ ~q. Ftg. A ess ' I 1 D . t' I .r': V .A~a- Water ate ~ Sq. Ftg. Ot e _ega escrlp Ion ,?...t)y.<~ -"5 7 A V'~ ~o .. New Add Alter Rep. , Range' -Fence Demo Change/Use Valu~ of Work: .....r-, vether-' --=- :.J t , 55 r(D~ r__\Offi.CO.O\L----' Buildinq Pe~l1it Info: Descr,be Work(Le., Build Single Family Residence With Attached Garaqe) \.,\.9J'\\WA ,_0 I{J m- · 'A\'1. j6kAf2()- , CP ~ ;p ok)' b Owner~\'('l""l-tr--> _ Address \ \o~l~ U ffi ~ f\ f\ "- c\VhOne , ~Q N.\ \CUC) constructton\Le~~, J - - . ~ Address Phone DESIGN TEAM (name) (address)' Primary uJJill~. ,~_cr*' _ '_ ~~~"~d',o_~"_f\ - Structural , Electrical J' (lics. no,) (expires) (phone no.) ~O ~).\ f) _ \ N, .J\.\:f. 1~()(tlll'lf'f1 9~lo-D\i)~~ . Mechanical CONTRACTORS (name) General ~\t' L \ k.)t 9.bt ) 13S"." I I I I I I I , TOTAL CHARGES 17tP. _0 TOTAL CHARGES IS':':-" TOTAl: 'cHARGES 7Cf. 0" , WHERE STATE Ul~ REQUIRES that the Electrical work be dane by an, Electrical Contractor, the electrical portion of this permit shall not be val i1 until the label has been, signed by an Electrical Supervisor and returned to'the Building Division,,' . I HAVE Cjl.REFULLY EXNlINED the campleted application for permit, and do' hereby certify .that'all. information hereon is'true-'-' and correct" and I further certi'fy that any and a 11 work performed sha 11 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 OCCUPANCY will be made ,of any structure without the permission of the Building Division. I further certify that my registration ~Iith 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 ooly '"'CO"',""". ,"d ,mpl,y", wh, 'co " com,l1,"" wHh .ORS. 701:055/:ill ''/rd_ ~i"i'P"j,,'.. ... / L NAf-1E(please print):[J/Ck ,W pSI '. SIGN^TURF~ 1f~ DATE/:2./JIlEL FOR OFFICE USE ONLY Sa. Ftg. Sq. Ftg. Sq. Ftg. NO. .27 Each single fixture ~/N'-I-~~'~/JtlT; Relacated building (new fix. additional) S.F. Residence (l bath) I Duplex (l bath) IAdditional bath IHater service '4'-'1 Sewer I Storm Sewer' I I each I I I I I I I I I 'Zone cC. /fII.R ' ,- (address). (1 i~~1 no.)' ,(expires) (phone no.) " 20~ \:)r) ~I l~ ,,~\-J.\\Jrxt\~rl~ c4P8-RD1"L: MECHANICAL FEE CHARGE NO, ~FF rHARGF NO. FFF rHARGF Residence of furnace/burner to BTU's :/ . s:-c:oo ,., s:-- ~ New circuits alts. 2' ~~e=L;' SQ. FT. Floor furnace and vent . ;s-. I I I I I 6.-C~ ~ERVICES I Recessed wall I Soace heater and vent -I~t}"~ .zt,c~ I App 1 i ance vent I seoarate , I Stationary evap. I cooler I'vent fan with I sinale duct I Vent system apart from heating or A.t. ' Mechanical exhaust hood and duct Wood stove/heater ITempOrary Construction !Change in existing residence Imultifamily, comm. or Industrial 10f ICOMM~/IND. F[EDERS I Install/alter/relocate distrib. feeders 10f amp~1 , . amps.1 I I I I I I I I I '114CClM;M6S5CtR ~ \~)b 1'<)<ClII: '1 ~mE.1~ 3~?: I st~--' I ' I I ~~~UI-\I\Lt. \If PFRt1IT c' Fire Zone Type/Const~J1f ~~.Unit~ Bedrooms . Occy Load~St::J.J!: Stories Occy Group, .15'- 2, ~1ain x .Value Access x Value Other Xit=~Di:~ x Value ~S':t::Jt!>O... , TOTAL VALUATION ~"8e;;= ~,,: 1\'\' 'BUILDING PER~1IT "/2fl!f~~:9.~..:,1 Pl?n Ck. CommlInd Charges and _ _ :'~''-''''-'7''?''3.-''--,:''',- 65%fBl do Per Fee Surcharges "1'/' '~~'- Plan Ck. Res " _ .!..'" ." 30%/Bl dq Per Fee 170. -- Fence ------6-:,iO-' D6mo'. _ _':,. _ .I L ~~ _3; dewal k , ~CJ A/C Paving' 7 ~ ...." I Curb Cut ------~-.~~-I, Flood Plain PLur~BING PERMIT Charges and Surcharges' ELECTRICJl.LPERrm Cha rges and Surcharges MECHANICAL ,PERMIT Charges and Surcharges \ f/./!. ITatal Comb. I ' I TOTAL Permit $~~"?~- ,I .""1111...........1. ...... ...,_....\..: I' /A. - ,i~ '\ &, COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. examole- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot 1. Black 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 qas 2. example- waterheater/electrical/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 raom 3. example - convert single family residence into restaurant (chan'ge af 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 canstruction delays, Building Divisian Staff must be able to contact appropriate persons regarding design information or job site corrections, etc. 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 an the abbreviated schedules yau should consult the full schedul es C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES D. As rioted on th~ CAP, the label must be delivered to the electrical contractor for signature by his electrical supervisar. The general cantractor is not ,authorized to. sign the electrical label. Applicant to. sign and date Whenever passible, the initial application will be used as a worksheet only. Where possible, Building Divisinn Staff will prepare a type written capy 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 af the application, and no plans will be processed until these fees, are. paid. All other fees and charges are due and payable'when the-perinit is issued. :' II. III. IV. , V. FOR OFFI'CE USE. ONLY . . , \ " , , ' ,PERMIT VAL~DAJION ~ 6)1q55 t\= lD ~ () fl ,~ "", - ~ ."~ I ..~ ~ ~- '. ~ ~;; It;: '1' -;;; -~ 1 .... '. .t ~ i .' . ~ ~ .- -i i '1 f: ., i~ . ~ '. l~ I, : j -- -- . .. i- Permit Clerk~~ , I PROJECT CONDITIONS TO BE SATISfIED BEFORE OCCUPANCY: ZJ" AJV.~AL c::;. S ;/ 6 <:::4 r ~ W4JPAt' ,/4) ~ ~~,," -.."=;J!:;> S~8M/r ~py ~r: ~.s ~~ #-'p/N~ p,.", $/C5t1'iL Fu/<.r kr/IV~N Permit appl i cant exempt from regi strati on with the Buil der I s Board because: :.- ... ; ,AQditional Project Informa~Jor: PLANS REVIEWED BY: -" ~ I; .. :,.. ~.-da~e , ..,..,-? name ~~ ~..,.............5 i gna ture ~r .....,.' , . , /~.. $'-8 ~ '