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HomeMy WebLinkAboutPermit Building 1990-7-19 ~ - -.---- ~ -; I,;;PECTION LINE ~6-376~. \.Io~~'^.r. ,-,"tU\<d.S , Job Address '''''\ ' \ ,. I" I I ~ t ......Y"I'lo.)']'-~~....~' Leg.] Description ~-.!'2.~-/~_ dY~~ . CITY UF SPRINGFIELD CDMBIIIATION APPLICATION/PERMIT tI_ INFORftATlON LINE 726-3753 So' Ftg, I,lain qf,o;:, ~q. Ftg. Acce~ So' Ftg, Other New Add Alter Rep, -Fence Demo Change/Use Other- - {name} Phone {address 1 EilERGY SOURC!;.S: I Heatl?lec... ~.'LL""''' Hater Heater .,yJ It- Range y.j I ",. ValUE of I-lark: " '-(.::> L' <:) 0.... eo'" BU11riina Permit Info: Descr,be Work(i.e.. Family Residence With Attached Garaae~ P\>").L", \ p(>~~~a..y b......; I ~ Li I' "N~"''''~~~ c...l,>~~ ;t...;-. flies. no. \ Build Single I . ~ ~ ~ 6"'~O ..,...., \ ~~LA~A.'~. Own,r cSf'oL>:'" I.-~''; II Add"css 62..r IAA', II .d ~\'L,:.v" ~', Od \ ~ OVl- ..r , Constructlon Lender J;: LL... ( [),'~ ~ Phone7zl,) 1.7J ' ~ "11"/'11 Dn, Tc:r'-o..-:=J~""'t...J ..; Address UI:.~i(iN ltAH (exoires) (ohone no.) Electrical ?'l~~~... ~""~,I,_C~I"\-':~,r '-'':;'10(... II '?O ~.::>X" ::r"3S II S . \ -.J .,.....i~.v 61'\.. q, Jg I - OJ.JS ~ (namel (address1 (lir:s,. no.) (exoires) (phone np_) _ _ t:>G.;~ :lti'H I-~<>'" I:::: I no.!:'i2- Ia'Q.......: 0""""""" l _~",..> ,-v ~ J......c.. ,,>--/6'-~. ~.,.....?S.,/ I ( I -:? S< I .., 1U.1:!: , ,C:;;Q....J... ([?I tJO ' 11 ' {~lill ~ ~ l?.~..:-~\ .. ~- :j~'~:'- .=>=f.-LIJu.,ut&:l~ I. ' _ f:S7 JJS :1 -'-( ~q . 6''''J'-/t):3.:1 E>lJ f'i"i;;;ary Structura 1 Electrical Mechanical CONTRACTORS Genera 1 PlumbinQ ~1echanical PLUI1BING ELECTRICAL MECHANICAL NO, FFE 'CHARGE Nn . ~FF r.H~F NO_ ~FF . rHJ1RG.E.. SQ, FT, furnace/burner to BTU's Each single fixture Residence of Relocated building - (new fix, additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence 11 bath \ Duplex (1 bath) each Additional bath SERVICES Recessed wall Snac~ hpatpr nnd vent amps. App 1 i ance. vent seoaratp Stationary evap. cooler Vent fan with sinole duct Vent system apart from hea t i no or A. c. Mechanical exhaust hood ilnd r1ur:t Wood stove/heater Sewer Temporary Construction Change in existing res i (leflce mUltifamily. comm. or Industrii'll ~Iater service Storm Sewer Of COffi1,/IND, FEEDERS Install/alter/relocate dic:trib. fppdprs Of amps. TOTAL CHARGES TOTAL CHARGES WHERE STATE LAlJ REQUIRES that the Electrical work be done by an shall not be valid until the label has been signed by an Electrical I ;Yh~~ ~<.';p:)'. """'~Y/~& ,~- I L~ - TOTAL CHARGES Electrical Contractor. the electrical portion of this permit Supervisor and returned to the Building Division ISSUANCE OF PFRIHT I HAVE CAREFULLY EXAMINED the completed application for permit. and do hereby certify that all information hereon is ~rue 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 rm OCCUPAUCY 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 ons 701.055. that if exempt the basis for ex em i n is noted hereon, and that only subcontractors and employees who a~e in compliance with ORS 7nl.055 will be used on thi r ect. 1lAf.IE(please print) t....>~O e- c>...ra.C~IUe:r om 7-19-91 Fi re Zone Flood Plain FOr. OFFICE USE miL Y Type/Const. ~A7 Units Sq. Ftg. Bedrooms Occy Load ~15 Sg, FtlJ. Stories. I Occy Group ~? _So' Ftg, __I2-S~n .BS Plan Ck, 65%/Bldo Plan Ck, 30%JBldo Fence ConmlI nd Per Fee ROes Per Fee "ain.~x?w"7"Valu. Yd/:;' ~ Access x Value. Other /"2Jv~~N'...>9 Value /~ cS>--<:> .:i4. TOTAL VALUAJIOrl >'6-' g~~<!> I't\ //'7~ Systems Development ///''- .... Charoe (I,5~) ~, ;:>. ~ Zone Z? l. . BUILDING PERHIT Charges anc Surcharges /I_~B PLUt1BING PERMIT Charges and Surcha rges ,""~."<I?r"~ ~-= '2f~_~ /'30.-- ELECTRICAL PERIIIT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges Demo ..... -- __LL-C;:-" Sidewalk ( . .. //~:) A/C Pa~!~g ~. ,z.~~/?95::> TOTAL /~g,78 - .L4:f.iid.;", . Total Comb... Permit Curb Cut ~~ ..;.....0...-......--::-______- . " II, COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A, Job Address B, Legal Description 1. example- Tax Lot 100. Lane County Map Re~erence 11 U3 4j 2, exam~le- Lot ], 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. examele- waterheater/electrical/or solar E. Square footage or valuation, etc. ], examole- ]250 sq, foot house, 500 sq, foot garage 2. example. i\ new project, check-new - if addition, check add. etc. F. ,Building permit information: 1. example - construct single family house with an attached garage 2. example - remodel existing garage into family room 3. examyle - 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,mus't be able to ,ontact.appropriate \ 'persons 'regarding design information or jo~ site correct ions, 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 8. Full Plumbing. Mechanical. and Electrical Schedules are available at the Building Division 1. To conserve space on the permit form the schedules have bee~ abbreviated 2, .. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the fu 11 schedu 1 es 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 e 1 ectrica 1 contractor for signa ture by hi s e 1 ectri ca 1 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 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 SATISF,IED BEFORE OCCUPANCY: " , . : J PERMIT.VALIDATION . ' , ).- ~ r;q 1 ~ ../ . "Permit . , 'Permit applicantexempf'from registra,tion with the Builder's Board because: ...... .' " '-, Additional Project I,nformation: . ' \ -, . \- ,. , PLANS REVIEWED BY: . " . ......, ....., / '-nam~'~Rk<E?L~~ signature d~ " , ,. .' date -?-?J/-.~