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HomeMy WebLinkAboutPermit Building 1985-10-29 " ,,. ; ., i INSPECTION LINE 726-3769 CITY OF SPRINGFIE~D COMBINATION APP~ICATION/PERHIT I E!IERGY SOURCES: Heat Nater Heater Range ValuE of \.Jnrk: I.fz.~~ --', BuilofhCl Pennft Info: Describe Wor~:.(Le., Familv nesidence With Attached Garaoel - Job Address "2./.&; 7 t?~N ?~;:>~P"" Legal Description I 7 0 3 ;).7 ,;J 'f ''S'O 0 I i~ Build Single ';;::. ~. '--~~;;~/, ~:j :f::ry ~ ~~ ~"I"r \ flies. no,) (exoires'f (ohone no, Owner J(,~ l-11.1'L JJ.P/ltl.IU\.J Address I I{ ~~ C' ~ 6 '1 " ., Q.q ,.. ~'-",-,,<> v.. . - ~O~ Construction lender -~ Pc.-oh-"" r~~' Q.I<::, )-! 't'~ ~ II Address Ul~lGN T<A11 Primary OWN~R Structural Electrical f1echani ca 1 CONTRACTORS Genera 1 Plumbina Electrical ~'echanical NO. Each single fixture Phone '6'1' ' 'l9l(tf {name} Phone (address) (namel (address) PlUlIB ING ELECTRICAL FFF r"IlBliL -"0 Residence of SQ. FT. Relocated building (new fix. additional) S.F. Residence II bath) Duplex (I bath) each I I I ~" ~torm Sewer I I ~.1Jli'/#A'(S':l.5~ I I I I I I HAVE CAREFULLY EXAMINED the completed apr1ication 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. and that 1m OCCUPAr~CY will be made of any structure without the permission of the Building Division. I further certify that my registration with 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 only subcontractors and employees who are in compliance with OP.S 7Ql.055 will be used on this project. IWIE(please printt.&Y'\"t\f'th...F r.;.~~_IGNATURE ~ ~ ,xt~tI~t) DATE 1(J;".:J9~~' FlXt OFF I CE USE DIlL Y I' Zone.....1Y1JI.tIJ Type/Const. ;)'-A' Units Sa. Ftg.~ /:e~x~""':"Value ' Fire Zone Bedrooms Occy Load.....LS Sq. Ft~.~6!~(,I5'E ~$'''' ~',-,' valuea~3- Flood Plain Stories:Z Occy Group 8~2. Sq. Ftg. Other ~I'H~ x9~ Value ?:~.- Fe:JUN/?~7"/OH ?.6'1~l'r /S~&.>~l> ~~ 9'~- ~T~~ALUATlON~~,. ?d?:"'!II BUILDING PERIIIT .".::,,_ "4> Plan Ck. Co","/lnd ">QJO'~ Systems"Development /-::.<<Y ...-_ Charges ant: ___-L.,.':01J~__ 6S2:/Rlda p.pr Fpp . ~~ Charqe (1.5~) .. 4J '"'7'....I-J Surcharaes. ~ ~J' Plan Ck. Res . """'-~ ~- ''i. iJ', c;t-., 30%/Blda Per Fee ____a~dC> Fence =1. Sf 0 Dgmo ,___3~:.~JSrdewalk I'I?" /. ~ I AIC Paving It;:;? ai> 1 Curb Cut __~u -~'ici-I Additional bath 7Z' Ilater service , //4 Sewer / PLUI1BlNG PERMIT Charges and Surcha rges ELECTRICAL ,PERIHT Charges and.... SurCharges /lECHAN I CAL PERMIT Charges and Surcharges New circuits alts. or extensions SERVICES / Temporary Construction Change in existing rpc;j4p'nr:~ multifamily, COrml. or Inrlllc:trial 2r:J. - 2~- 'JS"" I 05- Of "Z~ amps.1 COMM./IND. FEEDERS Install/alter/relocate rlic:trih. fpprlprc:; IOf I I I amps. i!3' , INFORllATlDN lINl "1 726-3753 Sq. Ftq. 1,la;n :2'c;I~'L.. ~q. Ftg. Access. .S~: Ftg. Other )(Jlew_ Add _A Iter -Yep. Fence Demo ChangelUse -Other - - . (lics. no.) (pxoi rpc:) (ohnnp nn. , "'8S~~~g , MECHANICAL ""LJ:I!ARliE: ..llil.... ~J:."~ nH~.RG.E. ~ furnace/burner to BTU's Floor furnace and vent Recessed wall ~o~rp hp~tpr ~nrl vpnt /&- I I I~'" I I I I I I Appliance vent seoa ra tp Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from I heatina or A.C. Mechanical exhaust hood and rlurt. 2 ~- 6,.OC' Wood stove/heater ~ '/7.Cl/ ~B. c:o::> /5:~ '> Total Comb. Permit .3t,/.~ I /~j~~:~'G \ I TOTAL ,. \ . - ." ^ , " COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. legal Description . ~. ,< :. , ~ . I. example. Tax lot 100, lane'County Map Reference II oj 43 2. example' lot I. Block 3, 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources "I. exam~le- heat/electrical ceiling/or forced air Qas 2. examole~ waterheater/electrical/or solar E. Square footage or valuation. etc. ------ I. 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. exam~le - construct single family house with an attached garage 2. exam~le - remodel existing garage into family room 3. exa~le - 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,;n 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. --- III. Applicant to sign and date Whenever possible, the initial application will b~ 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. '. f , ~rr ~qcJ ~D~ \\) ;6. ~ \11 \ 0 ( d \ , , , '. f. . " , ". .' . . . , " . , V. FOR OFFICE USE ONLY Permit Cl erk w PROJECT,~ONpITIONS TO BE SATISFIED BEFORE OCCUPANCY: '\ '.'Permit appli cant, exempt fr~m regi strati on wi\th, the' B~il der I s';Board 'because: .). ".,' ": 'j .' , , . ;' . . . ~ ,< , , ,~ , '...Addi.tional Project Information: " : .}~ .'~ '-\ ,- ~ ~ ~ ..' " .. , '\ ~ ~ . \ ' '.. '. ' " ..; ...., . PLANS REVIEWEO BY: ~ , ," ,.' 'na~e~ R~~ '\~~:~a~ure#U~~; date /1).2~~3S' ,0