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HomeMy WebLinkAboutPermit Building 1988-8-1 (2) " I INSPECTION LINE 726-376g . 7le;F/ PF&'7'C~. . CITY UF SPRINGFIELD COMBINATION APPLICATION/PERMIT Job Address ~~'"2.. iA-~.x7;=..A/ Lo-z;P. ; EIiERGY SOURCES: Meat \~ater Heater Ranqe INFORllATION L1NL 726-3753 Sq. Ftq, I.tain ~q. Ftg. Access. Sq, Ftq, Other -1lew_Add_Alter-Yep, Fence Demo Change/Use Other - - " Address ~/7r:~- , , Phone -- - -:r-/''-'" /-<0 ~ / "'"- ValUE of Hork: ?jOo.--- , Builriina Permit Info: Describe Work(i.e.. .Familv nesidence With Attached Garaoe) Build Single ~ ~ 1"1) ~ , Legal De<eription /?-"'::?-::;>')-2~ a<":<=--= ;. Owner ;?ce;:~x #r7.';Z?05 &- C-...,.,=- '/) .7" -'P/~- . ,,,r:;?/ ~. Construction Lender / ~-<:' /L~_",,_~ Pc/<? ~---<. 0p",;:Z>/",-""7'~~ Address Ut>JGN ItAI1 (name) Phone (address) (lies. no.) (exo;res1 (ahoM no.l Primary ~ Structural Electrical Mechanical CONTRACTORS {name} (address) llir:<;. nn.) (p)(nirp,,) (ohnllP fln. , General f') I/'#"A~ Plumbina Electrical ~'echan;cal PLUI1BING ELECTRICAL I -EEL I J:IiARliE.' NO_ MECHANICAL NO.1 Each single fixture I FEE I CHARGE NO. I Residence of SQ, FT, furnace/burner to BTU's I ~~~ I fHAIlliE. Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent .- " , S.F. Residence f1 bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall ~o~rp hp~tpr ~n~ u~nt Storm Sewer Of CO~1./IND. FEEDERS Install/alter/relocate rli,trin_ fpprlpr, amps. Appliance vent seoaratl? Stationary evap. cooler Vent fan with sinol@ duet Vent system apart from I heatino or A.C. Mechanical exhaust hood il.nd duct r Water service Temporary Construction Change in existing r@sjd..e.nee multifamily, comm. or Industrial ). Sewer Wood stove/heater Of amps. ISSUANCE OF PFR!llT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L,\l~ REQUIRES that the Electrical work be done by an.'Electrical Contractor, the electrical portion of this permit shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY 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 Spri ngfi e 1 d and the laws of the State of Oregon pertai ni ng to the work descri bed herei n, and that IlO 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 ons 701.055, that if exempt the basis for exemption is noted hereon. and that only subcontractors and employees who are in compliance with ,ORS 701.055 will be used on this project. HM1E(please print) k e,Ce e... d.. r>lr.Uf>r- SIGNATURE ~ siL~ OATE 19. /-t1g FO~ OFFICE USE O!IL Y Zone---L,7) ~ Type/Const. L;'- ~, Units Sq. Ftg. t1ain x Value Fire Zone Bed rooms Occy Load Sq, Ftg. Access </87 x Value "/=..~ Flood Plain Stories Occy Group J0-L-sq, Ftg. Other x Value BUILDING PERfllT LO, "'""" Plan Ck, COIl1l1/l nd Charges and ___ ._.1::______ 65%/Bldn Ppr Fp@ Surcharges ; ,e;-D Plan Ck. Res ". 30%/Blda Per Fee PLU'~BING PERMIT Fence Charges and....... ------------ Surcharges Deo>o ELECTRICAL PERfllT 'Sidewalk Charges and ------------ Surcharges A/C, Paving j MECHANICAL PERMIT Curb Cut Charges and ------------ Surcharges . TOTAL VALUATION rt::>",.? ,g-/--8ir /" c-; Systems Development _n,oO Charae (1.5~) I I "'1 1 TOTAL /0..50. /7.-=>-~ i'i; , Total Comb. Permit r CITY OF SPRINGFIELD . City Hili Sprlngeelel, Oregon OlIIce 01 Community and Economic Development ,'.. . '. .......t'l,o;.. OFFICIAL RECEIPT " " . ,.C..,..,.,. ( . 'I-,h.; .. COMBINATION APPLICATION/PERMIT (CAP) ( Date Au.::. /(_ 1~ $'8 Rec'd From _??~~ ~p;J ~ Addres~ ~~b'~~-;;?-~..~' "/- Received For: tk-i7a80 ~ ;-~Z &5'- . p~ :::rel>f",-~ ' 1Jz3. ~6 12007 ~. .,- '.. 1. Applicant to furnish A, Job Address B. Legal Description I. example- Tax Lot 100, Lane County Map Refer ~' 17 03 43 2. examole- Lot I, Block 3, 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examEle- heat/electrical ceili~q/or forced. 2. example- waterheater/electrical/or solar E. Square footage or valuation, etc. - .(~ I. examole- 1250 sq, foot house. 500 sq, foot, 2, example- if new project, check-nEw - if add check add. etc. F. Building permit information: C I. example - construct single family house witl attached garage 2. exam~le - remodel existing garage into fam;" 3. exam~le - convert single family residence il (.' restaurant (change of use) G, Value of work as defined in Section 303 (a) of ' Structural SpeCialty Code H. DESIGN TE~t AND CONTRACTORS (', To avoid design or construction delays. Buildinl Division Staff must be able to contact approprii persons regarding design information or job sitl corrections. etc. (." II. Abbreviated Plumbing, Mechanical, &. Electrical Schel A. Except where blank spaces occur in the descript. portion of the Mechanical and Electrical Schedui the applicant need fill-in only the No. Boxes ac" -t,e,.' to the appropriate item(s) to be installed \ B, Full Plumbing, Mechanical, and Electrical Schedl ,J are available at the Building Division 1. To conserve space on the permit' fonn the sct 11,,' have been" abbreviated \. 2, If the item(s) to be installed are not cover' . BY ()' the abbreviated schedules you should consult ~ full schedules (' C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES! ." , ".,' ,I,. 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, - ".111:' 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 v" 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. << ( ~ ~ 6SC=> / tP . c:>;?) _5D ( ( ar~ /7---'" 'i' << r/"~#'7:?72. << " ,,, Amount Received /?cr--e> << ':1_ ~~,~v./~ /" POTHORlZEDSlGNATURE /' . ( : .'.,....- . r , 8USINESS FOAMS. tNC. 15ll31W,,141 ' ..- ~ _.\i ~ ...,,(. ;, .~ ", " V, FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: \ \ .! Additional Project Information: \ .... ~, ....,,:-'.. ,.,:, ~':"" .' ..... '. ,.' '.' "., ". ,. '. PLANS REVIEWED BY: . ?), ./"7._~' name /'P?F#F' /- t:""~b? signature /' /'7~~/'P-- ~'n-'7- . 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