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HomeMy WebLinkAboutPermit Building 1983-3-29 (II '\ UI\'\.!}1 { '. ( fI..-{( (1,\ t / j INSPECTION LIIIE 726-3769 Job Address /~ C.<!f'/JITS/JI/JIli(' legal De'cnptlon I'-t:>~ -":i:S-~<,I/ n c: -J, tI-_/ ...J-(.\.-0C(..-" t1)37~O '-L1TY OF SPRI,IGFIELD COIIBldATlON APPLICATION/PERMIT E'IERrV SOORCES Heat '/ater Heater Ranlle So Ftq IId1n ~C] Ftg Access Sq Ft9 Other r~ew Add Alter oep -Fence Demo Change/Use Other - - Valu, of 1I0rk cO I <; DOn BUllclnQ Pen111t Info Oescnbe Hork{l e . BUlld Slngle Farnlv nesldence \l1th Jl.ttached Garaqe) i) o 11,\()r.! tL r.tm'\ NY\ N.L.~( (J Uv Owner /) ) L{) U )/1 j I I/'/I'/ldtu/L:J MfeJ / Phone U Address Constructlon lender I NFORIIATlON U Nt 726-3753 ~ ~ ~ \13 ~ I Add res 5 Phone UcSHiH TEAfl {namel (address) (llCS no) (exolr~$l Pnmary M.A>I?/S-iPeDP€AI "!' ~~C. /'3/<!> c,..,~~ h. ELr,~~ Structura 1 E1 ectrl ca 1 Mechanlcal CONTRACTORS (name) (.Ai1/J I, , (ltrfI <::-I (address) {ohane no 1 '3 $I 2. ~,f"// (l,cs no) (PXOlres) (ohonp nn , /p VA", 'J0R~;v1 C'-'~ENE ELECTRICAL , MECHANICAL Nn "" I njAQ~~ Nn "" PlO IU:: [ Resldence of I furnace/burner to SO FT BTU's X INew ClrCUlts alts ~s. 01 Floor furnace or extenS10ns ~ and vent 2 DR Mt>A I SERVICES I Recessed wall Sn~rp hp~tpr Ann vpnt I I I I I I I I I I I~""J TOTAL CHARGES Electrlcal Contractor, the electr1cal port1on of thlS per~1t Superv1sor and returned to the BU1ld1ng D1vls1on Genera 1 Plumblno E1 ectn ca 1 tlechanlcal PLUllBING NO FFF CHARr,E Each slngle flxture Relocated bu,ld1ng (new flX addlt1onal) Is F Pes 1 dence (] bath) Duplex (1 bath) each Addltlonal bath I ~Jater serVl ce Sewer ITempOrary Constructlon IChange 1n eX1stlng rpc;, npnr:p Imultlfam11y, COI11Tl or Tnnuc;trli'll Storm Sewer Of amps COI~ll /IND FEEDERS I Install/alter/relocate rl,c;tr,h fpprlprs IOf I amps TOTAL CHARCES TOTAL CHARGES WHERE STATE L ~Ij REQUIRES that tile Electncal work be done by an shall not be vallJ untll the label has been slgned by an Electr1cal It El'5"'- 1'1/:/ Apol1ance vent seoa ra tp Stat10nary evao cooler Vent fan Wltl-J c::,,,,,1,,, rI",:t I Vent systerl apart from I heatlno or A C I Mechan1cal exhaust hood and duct Uood stove/heater ISSUM'Ct OF PFR'llT I HAVE CAREFUllY EXMlINED t1e completed apnllcat10n for lJer'Tllt, and do hereby certlfy that all lnfomatlon hereon lS true and correct, and I further certlfy that any and all work oerformed shall be done 1n accordance wlth the Ord1nances of the C1ty of Spnngfle1d and the laws of the State of Oregon oertalOlng to the work descrlbed hereln. and that IW OCCUPAfKY wl11 be made of any structure w1thout the permlss10n of the BUlldlng Dlvls10n I further cert1fy that my reqlstratlon ~Ilth the BUllderls Board 1S 1n full force and effect as requlred by ORS 701 055. that 1f exempt the basls for exemptlon 1S noted hereon. and that on ly subcontrac tors and eMp 1 oyees who are 1 n como 11 ance Wl th OPS tnl 055 \1111 be used on th 1 S proJec t I~Ar1E(please pnn~ .n -r ,..,J , /'1'e., (, SIr"I~TURFC<:' - Fon OfF1CE USE orlLV So Fto Sq Ft0 Sq Ftg C..J Zone G c::. Fl re Zone Flood Pla1n Tyoe/Const 5.//,I-)f(>. Unlts Bedrooms Stan es Occy Load OcCY Group_ B-2 BUILDING PERMIT Charges ane Surcharges 72 00 Plan Ck . 65%/Blda ----2:Z8.--- ~6~~Bi~0 I Fence I Dt;lmo , Sldewalk I A/C Pavlng I Curb Cut I Comm/lnd Per Fpp Res Per Fee c..J ~-rd. omJ"-..:2 '1~ ~.:' r1a1n x Value Access x Value Otherff~4"-x Value TOTAL VAlUATlON /5'" &IIPO. - ;. 1ii"6";1"'S 1.~u..r.oISystens Development I "':1. VO<<t' . "~ICharqe (J 5') /Y.;/- . PlU'~B1NG PERMIT Charges and Surcha rges ELECTRIUL PERI'IT Charges and Surcharges _ ___'-'5", -. .If,C /1ECHANICAl PEPMlT Cha rges and Surcharges fLAN ~~C"( /7s.. ~;V>~".P '~sr r.E"e - /S.6(:) Total Comb rermlt TOT"" 7$'. 8.8 i r (- \ ;' COMBINATION APPLICATION/PE~~IT (CAP) Appllcant to furnlsh A Job Address B legal Oescrlptlon 1 examole- Tax Lot 100. Lane County Map Reference 17 03 43 2 examole- Lot 1 Block 3. 2nd Addltlon to Sprlngfleld Estates C Name, ete of owner and constructlon lender o Energy Sources 1 examDle- heat/electrlcal celllnq!or forced 31r oas 2 examole- waterheater/electrlca(/or solar E Square footage or valuatlon, ete ------ 1 examole- 1250 sq foot house. 500 sq foot garage 2 example- If new proJect. check new - ,f addltlon, check add. ete F BUlldlng permlt lnformatlon 1 example - construct slngle famlly house wlth an attached garage 2 example - remodel eXlstlng garage lnto famlly room 3 exa~le - convert 51ngle famlly res,dence lnto restaurant (change of use) G Value of work as deflned ln Sectlon 303 (a) of the Structural Speclalty Code H DESIGN TEAll ANO CONTRACTORS To aVOld deslgn or constructlon delays, BUlldlng Olvls1on Staff must be able to contact approprlate persons regardlng deslgn lnformatlon or Job slte correctlons. etc II Abbrevlated Plumblng, Mechanlca', & Electrlcal Schedules A Except where blank spaces occur 10 the descrlptlon portlon of the Mechanlcal and Electrlcal Schedules, the appl1cant need flll~ln only the No Boxes adJacent to the approprlate ltem(s) to be 1"stalled B Full Plumblng, Mechanlcal, and Electrlcal Schedules are avallable at the BUlldlng Dlvlslon 1 To conserve space on the permlt form the schedules have been abbrevlated 2 If the ltem(s) to be lnstal1ed are not covered on the abbrevlated schedules you should consult the full schedules C BUILDING OIVISION STAFF WILL FILL OUT ALL FEES ANO CHARGES ON THE SCHEDULES o As noted on the CAP, the label must be del1vered to the electr1cal contractor for slgnature by h1S electr1cal superv1sor The general contractor 15 not authorlzed to 51gn the electr1cal label - III Appllcant to 51g" and date Whenever posslble, the 1n1t1al appl1cat1on wlll be used as a worksheet only Where poss1ble, BUlld1ng Olv1s1on Staff wlll prepare a type wrltten copy and return lt to the appllcant at the tlme the actual permlt 1S lssued for h15 slgnature IV Fees and Charges Plan check fees are due and payable at the t1me of the ,~ appl1cat1on, and no plans w1ll be processed untll these, fees are pald All other fees and charges are due and payable when the perm1t 1S lssued V FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY ,- 'l7.r !J:- <'i- .. ..:f e PERMIT VALIDATION uO-ul )t [yow3Q Jl~ ~1gJI / ~. . [m~ Perml t C1 erk Permlt app11cant exempt from reglstratlon wlth the BU11der's Board because Addltlona1 Project Informatlon PLANS REVIEWED BY ~ ; '1 name Lc~/Y€ R. E'~ F,e. Slgnatur~...-.........~ , date 3.2S.~3