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HomeMy WebLinkAboutPermit Building 1989-9-19 I INSPECTION LINE 726.3769 J~,2) ~ COMBlllm~NOKp~rmm~~~ERMIT . Job Address 2~7 <) L.4?-/1~?7' ~~~~GYir~fu0:wnL Legal Dmription /1IJ 3 ;;J.;:)'cL-'-I- 07706 lIater lleater..EIf'I'.. \" Range ~/~I!, 0~~V INFORllATlON LINE 726-3753 Sq, Ftq. 1,Iain /loom ~q, Ftg, Access, So' Ftg, Other.!1o Ilew Add A 1ter Pep, -Fence Demo Change/Use 70ther ..J1LaJO.r' Owner Cnl'l.swuj CteiJf'j/t ~ A.JJrcss 1.:311 I'(j" r;{}f;~ Valu,S~~ 'j .'tc/."",Buil(i;no Permit Info: Describe Work{Le" rhoncZ2ro'/~Fi\milv flesidence Hith'Attached Garaoe' Build Single ~ ~ ~ ~ Construction Lender QSe/~ v Phone -e- (address \ (1 ics. no.1 (exoires) (ohane no. I Address r:{)(}JrJe, DESIGN rEAM (name) Primary ClJV{;;,ti ne. /..aV-SOVV (I!4Aa) , 13rt "6" -0- -c,- ~7S0 Structural Electrical ~ro0Q.m f';kctn'(j 11cchanical CONTRACTORS [name) (address' (1 ics. no.' (exo; reo" 1 (ahOM no.) Genera 1 ~1f Plumbino Electrical &'a.bhaWl f=leC!., ~lechanical PLUIIB ItIG ELECTRICAL MECHANICAL */1. f!;.di.- SQ. FT, furnace/burner to BT(1' s ml~ ..BQ..,.I I Each single fixture Relocated building (new fix, additional) FEE CHARr,E.NO ELL .GliAOr" Nn Residence of New circuits a1t5. or extensions Floor furnace and vent S.F. Residence II bath I Duplex (I bath) each Add it i ona1 ba th SERVICES Recessed wall SJ~~P he~tpr ~n~ vent Storm Sewer Of amps. Appl iance vent seoarilte Stationary evap. cooler Vent fan wi th sin91e duct Vent system apart from heatino or A.C. Mechanical exhaust hond ilnd rlur:t Sewer Temporary Construction Change in existing resJ Qcnce multifamily. COnIn. or Indudrial ~Ia tar serv; ce COMl'I.I1 NO, FEEDERS Install/alter/relocate distrih. fperlerc; Wood stove/heater Of amps. TOTAL CHARGES WIlEnE STATE L.\\~ REQUI RES shall not be vali1 until the ISSUANCF nF PFR!llT / <<);t:n? TOTAL CHARGES , TOTAL CIlARGES that tfte Electrical work be done by an Electrical Contractor. the electrical portion of this pe~it label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFUllY EXM11NED the completed application for permit, and do hereby certify that all information hereon is true and correct. and 1 further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of OreC]on pertaining to the work described herein, and that UO OCCUPAUCY will be made of any structure without the permission of the Building Division. 1 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 7nl.055 will be used on this project. Zone Fire Zone Flood Plain Units Occy load Occy Group SIr,II^T~~ eJJI-Sc:>I'V FQr. OrF'~F l,isrnlll.Y Sf!. Ft~. f1ain x Sq. Ft~. Access x S~, Ftg, Other x DATE 9/f91'l9' I 1lN-IE(please print) (ht'i sf, nc C;. lai"9J1IV Type/Cons t. Bedrooms Stories Value Value Value TOTAL VALUATlDII PLUI1BING PERMIT Charges and Surcharges :;;- t?C> Plan Ck, .___1___"____ 65X/Bldo c::- Plan Ck, . :/ ~ 30t/Blde _n-/5~:~- Fence -7S D~mo Conm/l nd Ppr Fpp' lies Per Fee Systems Development Charoe (J.5~) BUILDING PERflIT Charges and Surcharges [L[CTR 1 CAL PERIHT Cha rges and Surcharges I1ECtlANICAL PERMIT Charges and Surcharges Sidewalk AIC Paving Total Comb. Permit '., Curb Cut TOTAL :;?/. SO .' . . ~ ...... " '''..- ...\. ~ PERMIT VALIDATION COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax lot 100. Lane County Nap Reference 17 03 43 2. example- Lot I. Block 3, 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinq/or forced air QdS 2. examyle~ watcrheater/electrical/or solar E. Square footage or valuation, etc. - 1. example- 12S0 sq. foot house, SOO 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 gar.ge 2. example - remodel existing garage into family room 3. examjle - 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 TEA/1 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-in only the No. Boxes adjacent to the appropriate item{s) to be installed B. Full Plumbing, Mechanic.l, 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 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. . /qt1/1 V. FOR OFFICE USE ONLY P,mit c~ \ \/,\ t <tj . PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name LoRge: >>~~signature ~~~~_ ?late '- r '/ " . ~/9.,.'-8"'7 . ,