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HomeMy WebLinkAboutPermit Building 1986-10-2 /f6f? <$', \ INSPECTION LINE 726-3769 - JA~Kv\o~ ({>>., Job Address 1\\ tJ\ 'A \ t-.) .S\. CITY UF SPRINGFIELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat liater Heater Range ~~ ~ ~ J I~'::~~~ION LINt 726-3753 Sq. Ftg. "'ain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. I -Fence Demo Change/Use ,/ -Other- - ~ 10 --J -- ~ rtQ,l legal Description y~~/S T\ RJG Sk:-~ Qk ValUE of f10rk:1! 1 () 01 ~ Owner, 'Yt::~}J ~ ) r=. /U ~ (\ d \P -\ I-.J .., ''-P BuilciinQ Pennit Info: Describe Work(Le.. Build Single , Address 10'-\ ':) IV. 0\-0 Si'Ar....r.: R.O, Phone'1."_~I"4 Familv Residence liith Attached Garaoel MT. '51.l-f->..'S,R ,c.-A. ., lo[)r~'1 ~ oFf' ':"..\ I.Ol!:t ROOFlt0C..- .... RP ~ Construction Lender '".)\'1'\"\ QIlJ~~ -t'iI'@_AlH\& ::'-Pl--'l' ~p ':O\.l-c~T. (;,'l..A) uJ.~.) c-\.A""~ ~ 1'\" (lies. no.l (axo;r~s) (ohone ~ [1,1 Address Ut,IGN I EAr~ (namel Phone (address) Primary Structural Electrical Mechanical CONTRACTORS ~eneral) .\ tnamel (address) (1;~c;,. M. (pxnirpc:,) (ohonp no. ) ~ L1\D'll-\ (')fQ'')loJ R}('j, E\)~",l=: nee. . en >-i () 1.. "I"l (,.... \\1 '-1\ ~I^ -"44-0'l-l.," Qr-.1S (.<.C\r-.jO:\ t.J(y Plumbina El ectri ca 1 ~'echanical PLU11B I NG ELECTRICAL MECHANICAL NO, FEE CHARGF Nn 'Ore r"'IRliE. JlO....I n~1=" Irl-l~ Each single fixture Residence of SQ, FT. furnace/burner to BTU's Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (1 bathl Duplex (1 bath) each Additional bath SERVICES Recessed wall ~nar.p hp~tpr ann vpnt Storm Sewer I I I I Of amps. Appliance vent S~Daril.te Stationary evap. cODl~r Vent fan with sinole duct Vent system apart from I hpatinq or A.C. Mechanical exhaust hood and duct Sewer Temporary Construction Change in existing rf:'s.;rteJlce mUltifamily. comm. or tnrlustrial ~Iater service COMfI,/IND, FEEDERS Install/alter/relocate rli~trih_ fppdpr~ Wood stove/heater Of amps. ISSUANCE OF PFR!11T TOTAL CHARGES WHERE STATE LAW REQUIRES ~hall not be valid until the TOTAL CHARGES TOTAL CHARGES that the Electrical work be done by an"Electrical Contractor. the electrical portion of this permit label has been signed by an Electrical Supervisor and returned to the BUilding Division I HAVE CAREFULLY EXAf1INEO 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 performed 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 OCCUPAtKY 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 ORS 701.055 will be used on this project. IWIE(please print) :\\ M f,? ..ljS:S SIGNATURE ~\~"' ~~..J~'\) FO~ OFF I CE USE DIlLY I \ Zone Tvpe/Const. Units Sq. Ftg. r~n ,x Fire Zone Bedrooms Dccy Load Sq. Ftg. Access x Flood Plain Stories Occy Group Sq, Ftg, Other x DATE~ Value Value Value TOTAL V ALUA Tl ON BUILDING PWlIT Charges and Surcharges / -; "'0 P1 an Ck. Conm/lnd ~~ '-J' 65%/B1do Per Fep ----n~~50- ~~~~B~~~ ~~~ Fee Fence Systems Development Charge (1,5~) , PLU!~BING PERMIT Charges and Surcha rges D~R1o 'Sidewalk ELECTRICAL PERIHT Cha rges and . Surcharges MECHANICAL PERMIT Charges and Surcharges A/C Paving ____________1 Curb Cut I Total Comb. Permit ...., I Co5, dU I TOTAL /~ r--'. i , ;' / . 1 ! ~ - COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address 8. legal Description I, exampIe- Tax Lot 100, Lane County Map Reference I! U3 43 2, examp]e- Lot I, Block 3, 2nd Addition to springtield Estates " C. Name, etc. of owner and construction lender D. . Energy Sources 1.' examp 1 e~ hea tie 1 ectri ca 1 ceil i nq/or forced air Qa5 2. exampJe- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - I, examo1e- 1250 sq, foot house, 500 sq, foot garage 2. example- if new project, ch~ck-new - if addition, check add, etc. F. Building permit information: 1:' 'examole - construct single family ho~se with an . attached garage . . - f- 2. examEle - remodel existing garage into family room 3. exam~le - 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, 'OESIGN TEAM AND CONTRACTORS To avoid design or construction delays. Building4 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 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. gGqlq0 ID')'~& V, FOR OFFICE USE ONLY Permit Clerk cI/ 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 signature date ,