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HomeMy WebLinkAboutPermit Building 1988-2-16 r' ,L . / 'I ;~:PECTION LINE . CITY OF SPRINGFIELD 726-3769 COMBINATION APPLICATION/PERMIT Job Address LtGo LtMd'ak.- (5ep,L(P/a /lpts J ~~;~r,y SOURCES: Legal Description /1{ 0'3,,) 710 0 l(q ~ <) l~ater Heater Range . INFDRlIATION UNt 726-3753 Sq. Ftg. ',lain ~q. Ftg. Access. Sq. FIg. Other New Add Alter Rep. -Fence Demo Change/Use Other - - Owner.J'a.-e-s T. 'Bt-<clde'f Address PO 80x .3 t.8 ft/oss ~ C!4J. '1'*'3fJ I ( J/l,-rJ ~-q?P~ ValuE of Work: ~ /Ct:>r 135(:). - BuiloinQ Penuit Info: Describe Work(Le., Familv nesidence With Attached Garaae) Build Single ~ D -- (\J ~ Address UtSIGN IlAI-I (name) Phone (address) ~ ~~~ ~~d:70A..o ~.<.or -/;f/~ ~ Zo e,e.:u- ~i .:- '-:' ..ja~ 64/Nt1/~_ V' (lies. no.~ (exo;res) " (ohane no.) Construction Lender Primary Structural LA(""l 112, ~ 1001 p' u Electrical Me'chan i ca 1 .CONTRACTORS Inamel General AU-~F? IV. W. XIJc.. (address) (1 ;ts. 00.) (pxoirpo:;.) (ohnnp nn_ Plumbina ?fl83 ~ toteS! j)P -='~ C7K. 97 Yo5 "5~ztrl < 9-2-88 fi>87-zqp6 .3<fZ -ff/7 7 ~ MECHANICAL " Electrical ~'echani ca 1 PLUIIBING ELECTRICAL NO. Each single fixture FEE rHAReF 1:10....- I FFF I rlJAB.liE. NO I Residence of furnace/burner to SQ. FT. BTU's I HI=' Irl-ll1RG..E.. Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (] bath\ Duplex (1 bath) each Additional bath SERVICES Recessed wall So~rp hp~tp~ ~nrl vpnt Sewer Temporary Construction Change in existing res j qence Imultifamily, COl1lTl. or Industrial 10f ICOMM./IND. FEEDERS I Install/alter/relocate .dic;trih. fppdprc; amps, Appliance vent c;eoa ra te Stationaryevap. cooler Vent fan with sinole duct Vent system apart from " heating or A.C. Mechanical exhaust I hood and rlllrt. \10od stove/heater I I I I ~Ia ter servi ce Storm Sewer IOf I I I amps. ISSUANCE OF PFRIIIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L,\li REQUIRES that the Electrical work be done by an"Electrical Contractor, the electrical portion of this permit shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFUllY EXAmNED the completed aprlication 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 NO OCCUPAI~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. IlAI-lE(please print) 'R/~ p. PV/PMeili!..... SI(,IIATUREh f? ,~~ FOr. OFFICE USE orlLY Sq. Ftg. t1ain x Sq. Ft~. Access x Sq. Ftg. Other x 2-/6-88 DATE Zone Fire Zone Flood Plain Tyoe/Const. Bedrooms Stories Units Occy Load Occy Group Value Value Value TOTAL VALUATION BUILDING PERmT Charges anc ~ Surcharges tJ ,"7"" U'7'\ Plan Ck. Conm/lnd ~~ '-'LI 65%/R1~o PPf ~pp ------------PTan Ck. Res - (" ,\3 30%lBldo Per Fee syste,ms Development Charoe (1.5~) , PLU'1BING PERMIT Charges and Surcharges Fence I I I I I I !Tota, Comb. Permit I I TOTAL (ZK(03 ELECTRICAL PERIHT Cha rges and Surcharges DetIlo _ ___ __ ___ __-,"Sidewalk I A/C Pavi ng ____________1 Curb Cut I MECHANICAL PERMIT Charges and Surcharges ~-~ -. , . \ \: I ~J"-.-" . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION 1. Appl icant to furnish A. Job Address B. Legal Description 1. example- Tax Lot lOa, Lane County Map Reference Ii 03 43 2. examele- Lot I. Block 3, 2nd Additio~ to ~prlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources . 1. example- heat/electrical ceilinQ/or forced air Qas 2. example- waterh~ater/electr;cal/or ~ 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 permit information: 1. example - construct single family house with an attached garage 2. example - 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., DES I GN 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-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 O. 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. '. .. : \ 10 1 L(~ ;)-I&-i( V. FOR OFFICE USE ONLY Permit Clerk cv . . PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . Permit applicant exempt 'from registration with the'Bui1der's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date