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HomeMy WebLinkAboutPermit Building 1989-10-19 J~l0l "-~ ~ jINSPECTION LINE 726-3769 ,. Job Address I.!.? I') Lf...A,)f)/h.J" 1).e, Legal Dmription \ fJ n3;l 71 'd 0(")3IJ.-J CtTY U~ SPKINGflELD COMBINATION APPLICATION/PERMIT, EIIERGY SOURCES: Heat l4ater Heater . INFOR/lATlON LINt 726-3753 Sq, Ftg. Main -A ~q. Ftg. Access.~~"'" Sq. Ftg. Other ..Jlew,t:Add_Al ter 'yep. Fence Demo Change/Use -Other- - lS - Owner 5 F. 0 tJ () J It ;:; PI'S _ .^ddress J.j/'I'l -L/NtJAI.J: ??.e, Phone 7 <{ 7- .t"'? ,,"? Range Valu' of Hork: ", C. 550,tJQ Bull(iinQ Pennit Info: Descrjbe Work(i~e.. Familv nesidpnce With Atta~h~d Garaae\ Build Single ~ ..p.- I Construction lender' S7DR./fb E .#01)/ /lbN - /.:;) '.",.,:v; I J:O/? An. JIYl h;e . Address Dt~ HiN n.m" lname) Phone (addressl nies.rio.' -tJ39('1/ (exn; res) (ohane no. J Primary ORE. /....$13K', p/,t< 6, rAY. ~/ vtJ w, )/ 'Jtf!. 3i75-f?177 Structural " Electrical Mechanical CONTRACTORS General c>f< E . (name) (address) Cl ics. no.' {exniresl (l)hone no.) '/118/2. ~K6, 7/JC) 91Yb u),II'#o- *396/1 3sc"r-Sj"} 7 ~ Plumbina Flprt,rirl'Jl - --. .. ~lechanical PLUIIB I NG ELECTRICAL MECHANICAL ....lli', FFF r~^Rr,F Nn ~ < < < .CliAllG.l...llil rt'r: r~~ SQ. FT. furnace/burner to BTU's Each single fixture Residence of Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall Sn~rp hPntpr nod vpnt Storm Sewer Of amps. Appl iallce vent sp.oarate Stationary evap. cooler Vent fan with sinole duct Vent system apart from heatinq or A.C. Mechanical exhaust hood and dur:t Wood stove/heater Sewer Temporary Construction Change- in existing rp$i4e:nr.p multifamily, COIlJI1. or Tnriuc;.triil.l Water serv; ce CO~1./INO. FEEDERS Install/alter/relocate distrib. fpeders Of amps. ISSIIANCF OF PFRrlIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L'\\~ 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 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 Springfield and the Laws of the State of OreCJon pertaining to the work described herein. and that un OCCUPAllCY 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 7n1.055 will be used on this project. SIGII^TUR//~7 ~ Fan orFICE USE ~"'"7 , , Sq. Ftg. r1ain x Value Sq. Ft~. Access-2.../,fpoft' x Value~:L::>D'-::"- 7- L Sq. Ftg. Other x Value \A (\rC~ N, \1,.4 ~~To,~f)~11 /'? .c,." Plan Ck. Conm/I,n,d A) \ ::l - Systems Development ~.b -?__ ___~_""i=-~"::"_~/Bldo p.pr Fpp .~. n:-, Charqe (L5~). -/)5.....-:::> ";;> r::? Plan Ck. Res .)- t --' 30%/Blda Per Fee HAI,IE(please print) ':J:eR1'lYf c.. CtJn<-e. DATE/a> -r?-~~ Zone Fi re Zone Flood Plain Type/Const. Bedrooms ~-N.units Occy Load' Occy Group_ Stories / BUILDING PER~IIT Charges and Surcharges PLU!~BING PERMIT Fence Charges and ------------ I Surcharges Demo ELECTRICAL PERil IT 'Sidewalk I Charges and ------------ Surcharges .A/C Pavi ng I Total Comb. Permit hS:~"5 MECHANICAL PERMIT Curb Cut I,. I'" . Charges and ------------ I TOTAL :/b"3.~ Surcharges - COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Oescription 1. examole- Tax Lot 100, lane County Map Reference 1/ 03 43 2. example- Lot I. Block 3. 2nd Addition to sprlllgtield Estates .... C. Name. etc. of owner and construction lender D. Energy Sources - 1. exa~le- heat/electrical ceilin~/or forced air Q3S 2. exa~le- waterheater/electrlcal/or solar E. Square footage or valuation, etc. 1. __ example- 1250 sq. foot house._500 sq. foot garage 2: example- if new project, check-new - if addition, enee I< add. ete. F. Building permit information: 1. exam~le - construct single family house with an attached garllge 2. exam~le - remodel existing garage into family room 3. examele - 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 TEM4 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. BOILOING 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 signa ture. . 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 SATISFIED BEFORE OCCUPANCY: . ) PERMIT VALIDATION \S\~1 .....-\ . " ~\U \ Permit Clerk ~~ '-'" ' ..;, . "'Permit appl i cant- e'xe,mpt from' .regi ~tr:ati on wi th the Buil de'r'\ s'Board 'becatiie:. Additional Project Information: PLANS REVI EWED BY: , ' 'name ~~'?~ Signature~_- -// ,~~ ( ",' date /t!P 71ti' -~ g.-,.", ,-