Loading...
HomeMy WebLinkAboutPermit Building 1988-11-18 . INFORllATlON LINE 726-3753 Sq. Ftq. 1,lain ~q. Fta. Access. Sq, Ftq. Other lIe" Add Alter Rep. -Fence Demo Change/Use -Other - - '1 INSPECTION LINE 726-3769 //S/t./ C;;#r~//V~o/' ~;~ . CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT Ran~e ValuE of Hark: /3'. 700, ere Builci1nQ Pernlit Info: Describe Work(;~e.. Build Single Family nesidence With Attached Garaqe' 1,<'::;<;h?H/5?/'IA/E~k' G;,""'/V7. . m.::- . ". . /E#A..,qr" ftPV.?~/"""h':S" 6.n'r~vvA"r ~/9'=- H42.&, (address) flies. no.) (exn;res) (ohone no.) 3;)'.-Y..::!:": //T,b,4.Ii~ .4//.1. ~rLAA./Z:>. &><? 97:Z~::z. ?-=?9-7.-)''2t:;; - Job Address Legal Description 17.,0-:;; 2Z-t:)O O'Z~OO - / Owner O;;t? FC;;OA/ 1f' .a.A:,V AddreSs ~"'3i~ --s: W /7JAc4z:14/7'? Phone ~rrTZHJ4n /pK. '9?-:Z<PB Const;uction lender ) Address DESIGN TEAM {namel Primary l5J?vcc4. -::S?/:>7~r-L ~N ; Phone . , Structural Electrical r~echan; ca 1 CONTRACTORS (name) General, ~--'1.J:7/c, #.=L r~ Plumb;nq {address' Electrical ~1echanica' PLUIIBING NO. FEE CHARGF ~n Each single fixture Residence of IRelocated building (new fix. additional) Is.F. Residence .f1 bath) Duplex (1 bath) each Additional bath I ~Ja ter servi ce I Sewer I Storm Sewer New circuits alts. or extensions I SERVICES I ~ IS ~ ~ E!IERGY SOURCES: Heat Hater Heater , (l ies. no.' (exnires) (ohone no.) 6:E?-:;: ~ I?..? ELECTRICAL MECHANICAL I-EEL J:IlARG.E. Nn ~H rH~ SQ. FT, furnace/burner to BTlI's Floor furnace and vent Recessed wall Sn~rp hp~tpr ~nrl vp~t amps. Appliance vent seoarate Stationarv evao. cooler" . Vent fan wi th sinole duct Vent system apart from heatino or A.C. Mechanical exhaust hood ilnd duct. Temporary Construction Change in existing residf'ncp' [multifamily. comm. or Inrlll<;trirll Of C0I11-1. (I NO. FEEDERS IInstall/alter/relocate ,di<;trih. fppdprs Wood stove/heater TOTAL CHARGES TOTAL CHARGES WHERE STATE L.\H REQUIRES that tl,e Electrical work be done by an shall not be vali~ until the label has been signed by an Electrica1 ISSIIANCF nF PFRl1iT TOTAL CHARGES Electrical Contractor. the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAR~FUlLY EXAMINED 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 oerformed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Ore~lOn pertaining to the work described herein, and that tlO OCCUPAHCY will be made of any structure without the permission of the ~uilding Division. I further certify that my registration with the ~uilder'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 compliance with OP.S 7nl.055 will be used on this project. SIGilATURE FOP. OFFICE USE OIIL Y S~. Ftg. riain x Value Sq. Ft9. Access x Value Sq, Ftg. Other 7-?~DCC x Value. TOTAL VALUATION IIAI,IE(please print) Zone ~/: Fire Zone Flood Plain "P/AtR. Tyoe/Const, Bed rooms Stories Units Occy load Occy Group "2. ;??-.::z CD Conrn(l nd Ppr Fpp Res Per Fee BUILDING PWIIT Charges an'::: Surcharges :1- .~ <-; Plan Ck. __.l~L-.v.:.q__ 65%1Blda ~"23 Plan Ck. ...., . 30%/Bl do I Fence I Demo I Sidewalk I A!.C Paving PlUl1BING PERMIT Charges and Surcha rges ELCCTRICAl PERI:JT Charges and Surcharges I1ECHANICAl PERMIT Cha rges and Surcharges Curb Cut DATE /'::?:~.= ~'7- #/ '2 7'V2 Q-9-8'8 A'~7.9"'3 I [ I I Syste~s Development Charoe (1.5%) Total Comb. rermit I TOTAL 1C)9. 73 ~ . . I' .- ... ," .' COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION 1. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, lane County Map Reference 17 03 43 2, example- lot I. Block 3, 2nd Addition to springtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examj>le- heat/electrical ceilin9/or fo"rced air qas 2. example- waterheater/electrlcal/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. exam~le - 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 AIIO 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 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. Ill. 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 ;s issued. /2J9 g Permit Clerk V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: rl.a.J~ //-)/ f) - <<;-1(" Permit applicant exempt from registration with the Builder's Board because: Additi ona 1 Project Informati on: PLANS REVIEWED BY: name / /'JRHt;o 71: ~ ~ .<?~~ ~... " signature ,. , date //-/&? -88