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HomeMy WebLinkAboutPermit Building 1988-4-28 (2) . .. x . CITY Uf SPRINGFIElD COMBINATION APPlICATION/PERMIT EliERGY SOURCES: Meat l~ater Heater RanQe ValuE of Hark: ~~~. c:<e BuilrilnQ Permit Info: Describe Work(i-.e.. Familv nesidence With Attached Garaae) . ./ l I INSPECTION lINE 726-3769 INFORlIATION LINt 726-3753 SQ. FtQ, I.lain ' ~q. Ftg. Access. SQ. Ftg, Other New Add Alter Rep, --Fence Demo Change/Use Other- -- Owner' ORP':;:;O/S( _1?1'~ Address ~~ < W M~..4.b~ .7i,ri'TL~k7/ ~: 97<'~ Construction lender ~ Phone Build Single ~ \S 11 ~ ~ Job Address //~(j 6A7i!F'W4'r L~p legal Description /7'C>3'~ .t?:?'S""c::'O , .7JR'7' ~~T ~~./A' .#7- E~s--" 7;;, 6#TESoY;'r' OrF./CE ?~7A6. Address Ut~lGN TtAM (name) Primary '&Ut:.!! # Phone (address) !lies. no.) .tt:: ." / d .'?5~&. /:?T.:LAv~ /~8~~~A<./Ji' 7.7?"KTZr"""'1 &>~' ~~_?..: (exo;res) (ohone no.. "7 "3j9-7r;'Zb Structural Electrical Mechanical CONTRACTDRS I name) Caddresd (1 ics. no.1 (pxoirp,,) (ohnnp nn ) General~""~~~ /(/~c.r",: ~/ ~E,~E~~~ Plomhioo ~:Z2g? Electrical t..lechan; ea 1 PlUI.IBING ElECTRICAl rHAOO.! NO MECHANICAl ND. FEF rHARr.F NO I I ~~~ Residence of l HF I rHAIU:;F Each single fixture SQ, FT, furnace/burner to BTU's Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (] bathl Duplex (1 bath) each Additional bath SERVICES Recessed wall ~n~rp hp~tpr ~nrl vpnt Storm Sewer Of amps_ App 1 i ance vent 'il:'oaratp Stationary evap. cooler Vent fan wi th sino 1 educt Vent system apart from I heatina or A.C. Mechanical exhaust hood and durt Sewer Temporary Construction Change in existing rPi- j dJ,t1rp multifamily, comm. or Tnrlllc:trial Water service CO~1./IND. FEEDERS Install/alter/relocate rli,trih_ fppdpl", Hood stove/heater Of amps. TOTAl CHARGES TOTAl CMARGES WHERE STATE L\H REQUIRES that the Electrical work bo done by an shall not be valid until the label has been signed by an Electrical I SSUANC, OF PFR/IIT TOTAl CHARGES Electrical Contractor, the electrical portion of this penmit Supervisor and returned to the Building Division I HAVE CAREFULLY EXN1INED 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 Derformed 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 OCCUPAUCY will be made of any structure without the permission of the Building Div~;v". : ;~her certify that my .stration with the Builder's Board is in full force and effect as required by ORS 701.0~~,^!~at if ex pt the basi or exe ion is noted hereon, and that only subcontractors and employees who are in comoliance wi~ 7nl.055 . ill b~S on's p ject.~.J1. IWIE(please print).J1 /)1:'(-; ~(f t< /.., "/ /../ ~SC~~,),M. .? U DATE U--::2~-~J' - . nDR OFFICE USE mil. Y t / Tyoe/Const. "'-/#.k" .Units Sq. Ft~. Ila;n x Value Bedrooms Occy Load Sq. Ftn. Access x Value Stories '2.. Occy Group f?~2 Sq. Ft~. OtherQy7H"" n~~......?? Value ..y,,;:"~. <rl> TOTAl V AlUA TI ON ";\./1 .....! u'?/I!5'~. Systems Development A / A ".? ~~ <,I.:l~~'Ij Charoe (J,5~) /Y r? Zone Ct": Fire Zone Flood Plain ; ~ Plan Ck. Comm/Ind __.:;zt:'..r5:c;2___ 65%/Rldo P.pr <pp Plan Ck. Res , 30%/Bl do Per Fee I Fence I Demo I S1dewalk I A/C Paving I Curb Cut I '2 - S3' BUIlDING PER~1lT Charges and Surcharges PlUl~BING PERMIT Charges and Surcha rges ElECTRICAl PERfllT Cha rges and Surcharges MECHANICAl PERMIT Charges and Surcharges .ITotal I I TOTAl 5""3.' c9 3' Comb. Permit . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax Lot 100. Lane County Map Reference 1/ oj 43 2, examele- Lot 1, Block 3. 2nd Addition to sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical'ceilinq/or forced air Qas 2. examyle- waterheater/electrlcal/or solar E. Square footage or valuation. etc. ------ 1, examele- 1250 sq, foot house, 500 sq. foot garage 2. example- if new project, check new - if addition. cneck add. etc. F. Building pennit information: 1. example - construct single family house with an attached gar~ge 2. example - remodel existing garage into family raam 3. examale - 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 TEAM 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. 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. --- Ill. Applicant to sign and date Whenever possible. the initial application will ba 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. V, FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: " . " ., PERMIT VALIDATION '!?s=7't=IP/ 1/'-1-18 . Permit Clerk~, ~.....u-.. . l Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name L~:R/'/lF ~~~ Signature~....... . / ' , ~. ~. date Y-2C-~