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HomeMy WebLinkAboutPermit Building 1989-10-18 " CITY Uf SPRINGFIELD COMBINATION APPLICATION/PERMIT EIlERGY SOURCES: Heat r;L F-...l'-Wc... I~a ter Ilea ter AS . INFOR/1ATION 726-3753 SQ. Ftg. I,'ain ~q. Ftg. Access. SQ, Ftg. Other Ilew Add Alter Pep. -Fence Demo Change/Use Other - - LINE I ~ --- "'". "~,, ~ J Ranfle Address , Phonc$~J7 ~luf of Hark: 'lF105.000,CX) Buil(iina Permit Info:; Describe Work(;.,e" Family nesidence With Attached Garaae\ Owner Construction lender I, rTRsr o f}-l(; $r: (name) F"\\-..\~ClX.. ~ 'So"-l Add I'C~~ Jj~ .TAJTr:"RTO~ WALLs :tAJgrA/"L JNle~ ~"AIA!:-S'~, 8AU/oI~W : sf~p"'1UJOM5 Phone f (address' !lies. no. \ (exnires) {ohane no. I UES I GI< TEAI~ Primary Structural Electrical /1echanical CONTRACTORS --Pt:t-/~ oJ- CAse; FTNFRr:f!h ~^' 7/...UM13m~ Electrical J:>IHJE gft:DoMskL (name) (address' (lies. no_ \ (pxoires) (ohane no. \ Plumbino 3X'1r MitrAl .,2;.);;J. IN. b tL 7L/-&-3,B3 ~9l./_ S .J..:J.:l, gtJt.- 3q~ ~~n~ra 1 ~lechanical PlUIIBING ELECTRICAL MECIlANICAl ? 5<:> 75'~ SQ. FT. furnace/burner to BTlI's F F "- J:JJABGI. I NO. FEF r.H~RGF Nn :.H r.HIlJ!G.E. Nn I,() Each single fixture Residence of Relocated building (new.fix. additional) S.F. Residence (J bath) Duplex (I bath) each Additional bath New circuits a1ts. or extensions Floor furnace and vent SERVICES Recessed wall Sn~cp hp~tpr ~nrl vpnt Sewer Temporary Construction Change in existing residence mul'tf{amily, conlll. or Industrial / Appliance vent seoa ra te Stationary evap. cooler Vent fan with sin~:J1e duct Vent system apart from heatinQ or A.C. Mechanical exhaust hood and duct Wood stove/heater \. " ,'- f\-. ~'a tel'" servi ce , / I' Of COffi~./IND. FEEDERS Install/alter/relocate distrih. fppder.; Storm Sewer amps. -: / Of amps. TOTAL CIlARGES WHERE STATE L\I~ REQUIRES shall not be vali~ until the I -7 G. "4 TOTAL CHARGES TOTAL CHARGES ~A'. /5: -e. that the Electrical work be done by an Electrical Contractor, the electrical [1ortion of this pemit label has been signed by an Electrical SU[1ervisor and returned to the Building Division e ~t!!Fc7?'}/4?'L. c:::: "rM' ,,=,,? ~~<... ~/V 5~hf'-fi": /-1~/;r: ISSUANCF OF PFR!IIT I Il^VE C^REFUlLY EX^"lINED the com[1leted ap[1lication for permit. and do hereb.y certify that all information hereon is true and correct, and I further certify that any and all work nerformed shall be done in accordance with the Ordinances of the City of Spri ng fi e 1 d and the laws of the Sta te of Orel]on pertai n i n9 to the work descri bed herei n. and tha t rm OCCUPAHCY will be made of any structure without the permission of the Uuilding Division. I further certify that my registration with the Builder's Uoard is in full force and effect as required by ORS 701.055. that if exempt the basis for exemptio is noted hereon. and that :~::(::::::t:::::~s ~~~oYe~.W~::~liance with :PI:il::~:;5~~h~~ DATE~~~~. FO~ OrFICE ,~~(~ -. - ~ J. I Type/Const. 5-/~ Units /S~. Ft~. 11ain / x Value Bedrooms Occy Load <: ~ SQ. Ft~. Access I x Val ue Stories / Occ.y Group A-~ Sq. Ftg. Other&r_...._~.c Value-"'1""~'- ~ t[') .In'~ 15C~ TOTAL VALUATION Conm/fna' Systems Development Per Fee ::2 /~.~.::> CharQe (1.5~) . Res Per Fee Zone c:.c.. Fi re Zone Flood Plain BUIlOING PERNIT J Charges ane Surcharges __3_~..:~_ /6. '7~ _ _ __ Z-:E_~_ ~.-7 :;- Plan Ck. 65%/Bl do Plan Ck. 30%/Bldo AlAt PLU!~BING PERMIT -./ Charges and Surcha rges ELECTRICAL PERI~IT ./ Charges and Surcha rges 11ECIIAN I CAL PERMIT Charges and Surcharges Fence D-ma //YT$7'I/6~ "~~~. /~-- .q[) _ ___ _ _ _ __ _-=.: _Sidewalk -.~ . .. A/C. Pav~ng. v "-. TotaJ,~o~b.rermit _~__i~~~_ .7S" ~ Curb Cut "--. TOTAL 4~1 ~O ~ ~ ,.,..------- . COMBINATION APPLICATION/PERMIT (CAP) " y. I. Applicant to furnish A. Job Address B. legal Description 1. ~xample- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot I. Block 3, 2nd Addition to , . sprfngfield Estates... . . . ~ ~. c': .. Namlf.\' ete. o{-'.o\;ner '"and cons trued on 1 ender \~,D.::..EnergYJSources"l'",'\"'''''''''\ .." \. . " . '" . -, ~ 4 'l~" ex~mple:':"neaf'electrical ceilfnQ/,or .fb'reed'air' Qas 2. examyle- waterheater/electrical/or solar E. Square footage or valuation, etc. 1. examole- ]250 sq. foot house, 500 sq. foot garage 2. example- if new project. check-new - if addition, checl< add. etc. F. Building pennit information: 1. example ~ construct single family house with an attached gar~ge 2. examole - remodel existing garage into family room 3. examD 1 e - convert s i n9 1 e famil y res i dence into restaurant (change of use) G. Value of work as defined in Section 303 (a) of the , Structural Specialty Code H., . DES I GN TEAl-l AND CONTRACTORS . ,.t To avoid design or construction delays; Building Division Staff must be able to contact app"rop"riate persons regarding design information or job sHe . 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 instdlled 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 electrical contractor for signature supervisor. The general contractor to sign the electrical label. Ill. Applicant to sign and date Whenever possible, the initia"l 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. .,' 't.......: ,. be delivered to the by his electrical is not authorized V. FOR OFFICE USE ONLY PROJECT CONDITIONS Tb BE SATISFIED BEFORE OCCUPANCY: I , \ " " , , . , ' ,\ PE~IT VALIDATION . \\)-\~%C\.~ '\ ,=>\\6U , ., \, , . " '~. ~::.'f~ ~ ',.\ . , ,"" PermH Cl"k~m~ . " , "'~,1. .,.' .... \ Permit applic~nt exe,mp,i:\'fromre.!iiStrati'6n with the Builder's ~oard bel;ause,: , . , , Addi:t i ona 1 Projec,t Infof:'ll:lati on,: ,~ . } PLANS REVIEWED BY: " . . \,' .. name ~~H~ ~-::::-~ ., 4-- '" . signature "..:;-"~:-' -.:~:: . i l; ~ ", ~ -~.. ~{:..''; .-, "'C;:~;-..',..., "- i:::::.o..;;:,.... .--- ~ date ~ /t!?-/:?-.l?5 -, . ..J ,.