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HomeMy WebLinkAboutPermit Building 1988-4-28 -:;...... ':" ,. 7. 11$PECTION LINE 1'26-3769 . ./ Job Address //~l/ 6A7?F'WA"- (....- p Legal Oe<cription /7'~3'~ ~2'S"'GPO /. ~ I0<l '<0 W '-.I 7JRo/ ~T ))CI'*'J'Y//I ,AIr E~y 9-> 70 6#TEW"A'"Y' t::)/'F/CE jP~?,p. I Phone r '\ (address) l1ics. no.) (exoires) (ohone no. oIt!!: ~ / d 3.:5 /'y'.e. /7':.~<: /~6'~~;\;'A<./_ 7.:P;~""4 ~'q-M~'; CITY Ur SPRINGFIELD COMBINATION APPLICATION/PERMIT EilERGY SOURCES: Heat l~ater Heater Range ValuE of \oIork: :j'6(!J(!:>.C>""C:> . Builoino Permit Info: Describe Work(i.e., Familv nesidence With Attached Garaael . INFORlIATION L1No 726-3753 Sq, Ftg, I.'ain ~q. Ftg. Access. Sq, Ftg. Other Ilew Add Alter Rep, --Fence Demo Change/Use Other- - r, . \ '. .\ , Owner' ORE<:;;;08 ;lfA.~ Address q5/~ <.w: A?~.zl~ &7Z..4-wZ) . z::;;zr. 9 7:?~ Construction lender ~ Phone Build Single Address Ul:.~ tliN TEAr~ {name J Primary '&<.Jct!! A 7~-7r;Z';::; Structural Electrical <"J~ <..,00 . I Mechanical CONTRACTORS (name) (address) f1ic~. no. \ GeneraIM",,;J?--< A/~C.TY ~/ ~E /E~~~ , (exoi rp,) (ohonp nn.) ({;R'/-2 2&? Plumbina Electrical f>1echani ca 1 PLUIIBING ElECTRICAL MECHANICAL NO, I Each single fixture I FE!: I r.HARr;F r-m I I ITL 1....cHAR.GI Nn _ I Residence of furnace/burner to SQ. FT. BTU's I ~~LI...cli8.RG.E. Relocated building (new fix. additional) S.F. Residence (J both' Duplex (I bath) each Additional bath New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall Sn~rp hp~tp~ ~nrl upnt Storm Sewer Of amps. Appliance vent seoaratp Stationary evap. cooler Vent fan wi th sinn 1 f3, duct Vent system apart from heatina or A.C. Mechanical exhaust hnnrl "Jnd duct ~Ia ter servi ce Temporary Construction Change in existing rps j dJ'~nr:p multifamily, COIml. or Tndu,t.rial Sewer I I I I I I COffi1./IND, FEEDERS Install/alter/relocate (iic:.tdh fpprt"'rc:. Wood stove/heater Of amps. ISSUANCf OF PFRIIIT TOTAL CHARGES WHERE STATE L~\oI REQUIRES shall not be valid until the TOTAL CHARGES TOTAL CHARGES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this pernit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAr1INED the completed aprlication 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, nd that NO OCCUPAllCY will be made of any structure without the permission of the Building Div' 'VII. ~ ~her certify that my 'stration \'/ith the Builder's Board is in full force and effect as required by ORS 701.0 ,that if ex pt the basi or exe ion is noted hereon, and that only subcontractors and employees who are in comoliance wi ORS 7n1.055 ill be us on- 's p jectjJ . _ f IW'IE(PleaSepr;nt).f1/lt'f-;lf. k/""21;"~S~~_~M- .0 'DATEU-;2~-~~1' OR OFFICE USE DIlLY t/ Zone C~ Tyoe/Const. .,.-/#....?> .Units Sq. Ftg, 11ain x Value Fire Zone Bedrooms Occy load Sq. Ft~. Access x Value Flood Plain Stories -:2. Occy Group ;:?~2. Sq. Ftg. Other~>>"" ~l!f'"~/.?? Value ~~~.- ,/) TOT^L VALUATION L:: Plan Ck, Comm/tiid- ~,~"""t/ ;!!#!S'". Systems Development o4/.A __~C'....5:~___ 65%1Bldo P.l'r Fee R.S~ .".';l~~"Charqe (J.5~) . /Y,I"T .., r-=> Plan Ck. Res .c - '" .;;;;> 30%/Bldq Per Fee I Fence I D~RIO IS1dewalk I A/C Paving I Curb C~t I BUILDING PERflIT Charges and " Surcharges r PLUI1B ING PERMIT Charges and Surcharges ELECTRICAL PERI~IT Cha rges and Surch~ rg~s. .. I .> JTotal I I TOTAL I ~ S"3c:?5 I Comb.~ Permj t MECHANICAL PERMIT Charges and Surcharges . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100. lane County Map Reference II oj 43 2. example- Lot 1. Block 3, 2nd Addition to sprlngfield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. 'examDle- heat/electrical'ceilinq/or forced air Qas 2. example- waterheater/electricaf'tor 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 pennit information: 1. example - construct single family house with an attached garage 2. examyle - 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, 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 DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES 0, 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. --- Applicant to sign and date Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Division 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. - " " III. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ~ . .., ~ " , . ') ',PERMIT VALIDATION PLANS REVIEWED BY: name L.:?;;;;;'A/tfF ?c~~ Signature~______ ~--. ~a> Elf', Permit Clerk ~ I / '-/-1 8 Q. C1.J~~ Permit applicant ~xempt from registration with the Builder's Board because: date r-<.>~-~~ I Additional Project Information: .' .. . ~