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HomeMy WebLinkAboutPermit Building 1982-8-6 --,. . . INFORlIATION liNt _I 726-3753 Sq. Ftg. l'lain ~q. Ftg. Access. Sq. Ftg. Other flew Add Alter Rep. --Fence Demo Change/Use Other- - I IrISPECTION LlIIE. 726-3769 CITY UF SPRINGFIElD COMBIiIATION APPLlCATION/PERMIT EIlERGY 50URCES: Heat Hater Heater Address (J... c..; /, 'c.. ~ ," ll",; -7o~v ("h:Wd" I Range ValuE of Hark: "" /200- I,Buildina Permit Info: Oescribe Work{Le., D 7 I r Fami 1 v nes i dence Hi th A.t tached GaraQe) Build Single lK} IN ~ ~ \J Job Address 5'/1/. ~€WA-r'S7'- 1?030l0l ;200~1I,)6 Legal De5cription Owner Phon"loJ l (name) Phone (address 1 l.~.... <2 Ct.df c.,,- {1Ic- cF/I-Dbyy,r ('rJ.. J I"-St."I) rJ ev,,,d,,,,, _ ~/ H:' -+16- I ~ .io-l~ f.e.J- ~. (li~. no.)f-o (f!xoire.=.~~ _:.. ;... i .tf Construction Lender Address DES I GN I tAr., ~ (ohoM no. 'I ~;'-r)"i"<> l Primary ,-- Structural Electrical f1echanical CONTRACTORS (name) ~ General L~",Q C~....~t.~c...~(\.... Co Plumbina (address) If {'f D Oh.\~ Sf (lks. no. (pxnirp.s) (ahane no.) 6 H-- <) n1. nf\ c~rt Electrical ~1echani ca 1 PlUllB I NG ElECTRICAl MECHANICAl. NO. ' Each single fixture . FFF . CHARGF NO . ~~~ I r\.lAIU~1= NO_ Res idence of furnace/burner to SQ. FT. BTU's . 1=1=1= . rHARr.[ 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. hentpr ~nd vpnt Storm Sewer Of amps. Appliance vent sp.Qarate Stationary evap. cooler Vent fan with sinole duct Vent system apart from heatina or A.C. Mechanical exhaust hood nnd duct Wood stove/heater Sewer Temporary Construction Change in existing res j d~JKP. multifamily, COI11!1. or Industrial ~Iater servi ce COMH.{INO. FEEDERS Installlalterlrelocate dht.rih. fpprh'r<; Of amps. ISSUANCE OF PFRt1lT 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 EXM1INED 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 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 Bu;lder1s 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 ;n compliance with OP.S 7Ql.055 will be used on this project. IWIE(please print) SIGIIATURE FO~ OFF! CE USE DillY Zone CC Type/Const. s: "I Units Sq. Ftg. Fire Zone Bedrooms Occy load Sq. Ft9. Flood Plain Stories Occy Group___~ ~ Sq. Ftg. D~.TE t1ain Access Othe".0<;~Lt x Value x Va 1 ue W<wn:sW5Value TOTAl VAlUATION /"<'C6. ..0 /40::>. -. BUllDllIG PERflIT Charges anc Surcharges / -:::> .. "" Plan Ck. Conm/lnd ~ . 65X/Rlrln P@r ~ee ____n~y&- ~6~~B~~~ ~~~ Fee I Fence I O~mo I Sidewalk - un ~_~:' ~.~:~:lA/C Paving, {, I Curb Cut Systems Development Charqe (1. 51,) Plur1BING PERMIT Charges and Surcharges ElECTRICAl PERI~IT Charges and Surch~rges /IECHANICAl PERMIT Charges and Surcharges " . Jotal Comp:" Permit I TOTAL / 2. SIB . -,. COMBINATION APPLICATION/PERMIT (CAP) , I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference II 03 43 2. example- Lot 1. Block 3, 2nd Addition to sprlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceiling/or forced air Qas 2. .examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - 1. example- 1250 sq. foot house. SOD sq. foot garage 2. examyle~ if new project, check-new - if addition, cneck add. etc. F. Building permit information: 1. example - construct single family house with an attached garage 2. examole - 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. 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 fu 11 schedu I es 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 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 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. V. FOR OFFICE USE ONLY PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY: . \. .-1 :,.. PERMIT VALIDATION \".~,\ ," or Permit Cl erk sq S)-q c;70 /2.00 . '-If ~ Permit applicant exempt from registration with the Builder's Board because: AdditJ ona 1 Project.:Informati on: ~" '-- ,-' - - '"..-' -"'-"..- PLANS REVIEWED BY: name ~?1N'e ~~ Er-;;zj' signature ~..- , --:-..... '- -~........- :: -~ da~e " / , ., . ,g~--B~ ____.. .1