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HomeMy WebLinkAboutPermit Signage 1990-8-6 1'7" ..,- I INSPECTION LINE . CITY Uf SPRINGFIElD 726-3769 COMBINATION APPlICATION/PERMIT Job Address :j;)L<.,IJ (,/JJ-IJiY2L l ~~;~GY SOURCES: legal Description I'L /y::z,~? ,'L- -7;] 'ff..,.OZ:;D4> Nater Heater . I -, ' 1 Range . INFDR/lATION UNc 726-3753 Sq. Ftg. 1,lain :q. Ftg. Access. Sq. Ftg. Other flew Add Alter Pep, --Fence Demo Change/Use -Dther- -- .~ Q CJ ~ It-' ~ ~ Owner rno \alllfJ'OL Address ~ ~ (oC> 1'"A"r"'4frA.A) "'t Construction lender Phon"7I/7_II?/1 ValUE of Work: tJlrr BuildinQ Permit Info: Familv nesidence With Describe Work{i.e., Build Single Attached Garaoel ~lpr., Address Ut~ lliN If.Ar~ {namel Phone (address) (1;('<;. "'0.) (E!xoiresl (ohone no. Primary Structural L Electrical.tllIY'flev I~ fl~S F\'=ctY1c.... ~-I-rt e..- Mechanical I '31,0 \--teCt1O\u\ l1..lQ.I '_ CONTRACTORS (name) (addressl - (lies. nn.) 10/'10 fJ:/&-ft:,/2J (PlCO; rp"l (ohonp no. \ Genera 1 Plumbin<l Electric~\"t"0" / Pr^i\~ 11'(" ( i ~1echanical PlUflBI NG ELECTRICAl MECHANICAL NO. Each single fixture FEF r:HARr;F Nn ~I='I=' fl-lA.B.G.[ Nn Res idence of furnace/burner to SQ. FT. BTU's t;FF I CHAR(;F Relocated building (new fix. additional) \ New circuits alts. 'f g)en~M.- SERVICES 2:):$ . Floor furnace and vent S.F. Residence (l bathl Duplex (1 'bath) each Additional bath Recessed wall ~n~rp np~tpr ~nrl vpnt Storm Sewer Of amps. App 1 i ance' vent ~PDaratp Stationary evap. cooler Vent fan with ~inole duct Vent system apart from heating or A.C. Mechanical exhaust hood and durt Wood stove/heater Water service Temporary/Construction Change in existing res j d,.ence multifamily. corrm. or Industrial Sewer CO~1./IND. FEEDERS Install/alter/relocate dio;trih. fppdpr~ Of amps. ISSUANCE OF PFRllIT Zone Fire Zone TOTAL CHARGES TOTAL CHARGES TOTAl CHARGES WHERE STATE L\H REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this pemit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division , I HAVE CAREFUllY EXA~1INED 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 Soringfield and the laws of the State of Oregon pertaining to the work described herein, and that rm OCCUPArKY 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 th .s for exemption is noted hereon, and that only subcontractors and employees who are in compliance with OP.S 7~1.055 wil e u~d ~roject. 1lAf.IE(please print)~'1 OAt-iM.c.L SIf,fIATVRE / ~ DATE g/;;./QO \ -FOP. OFFICE USE QiILY (/ Tyoe/Const. Units So. Ftg. 11a1( Bedrooms Occy load Sq. Ftg. Access Stories Occy Group Sq. Ftg. Other , Value Value Value x Flood Plain x TOTAL VALUATION BUILDIIlG PERfllT Charges an~ Surcharges Plan Ck. Comm/Ind 65%/Blrlo Ppr Fpe ------------ Plan Ck. Res 30%lBl do Per Fee Fence Systems Development CharQe (1.5~l PlUf1BING PERMIT Charges and Surcharges D/l1l1o ELECTRICAL PERI~IT Charges and Surcha rges 11ECHANICAL PERMIT Charges and Surcharges V).,?-,5l) --lZiT):,-- Sidewalk A/C Paving I Curb Cut I Total Comb. Permit TOTAL ~ ' 1)-:5', &:2 . . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax lot 100. Lane County Map Reference 11 U3 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 ceil;n~/or forced air qas 2. examDle- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - I. example- 1250 sq. foot house, 500 sq. foot garage 2. exa~le- if new project, check:ruew - if addition, check add, etc, F. Building permit information: 1. exam~le - construct single family house with an attached garage 2. exam~le - 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. DESIGN 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 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: - ~ . _... _"" .._.. - I ,_ PERMIT' VALIDATION . %lY,q\l qt; I ~ I~ I\..,~ Permit Clerk ,~vtD~ I Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date