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HomeMy WebLinkAboutPermit Building 1987-11-25 CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT EilERGY SOURCES: Heat l~ater Heater Range_ /' . " I INSPECTION LINE 726-3769 , Job Address ~ ") 2' 0 ~A-r--= Ju-A- <;;- <57 . Legal De'cription /7-"~'-:2?-?= e>6'~ ,. , Owner -;:;",c/F/C. ~~c:>~.<=z~,..,.., Address "")0 //,..,,4' 9"9 ,,1/ g;~/!5;Yc Phone Construction lender Address Ut~l(jN TEAl'! (""me) Phone (address) Primary Structural Electrical Mechanical CONTRACTORS lname) General K.;r;...,-.t:>-.::",r;C" (addr~c;,,,) t INFOR/1ATION UNt 726-3753 SQ. Ftg. "lain ~q. Ftg. Access. SQ, Ftg, Other ~ew Add Alter ~ep, -Fence Demo Change/Use Other- - ~ I~ \) ~ U C-I"/'S;;>' I I (ohone no.l ValUE of Hork: ")7"00. .-. BuilGina Permit Info: Oeser be Work(i.e., Build Single Familv nes;dence With Attached Garaael ~R~c:. r #w-...v....."..,....,.....~ ~.-IV po/€. TY, r.#-~- nics. no.) (exoires) (l ;r'c:.. no.) (pxni rp<;. \ (ohonp nn.) Pl umbi no ~q--5"r /O//Y ~"'-~""".A/=~~. gG;:>:9>:2 __ L"~~ -=<'_~ Electrical ~'echanical PlIJlllllIN.G -..!!Q" fEF rHAI!l;F No..- Each sil191e fixb.lre Residence of '., Relocated bujl~in~ (new fix. additional) IS. F. Resideoce (J bathl IOuple. (1 bath) each IAdditio"l bath I ~Iater service 1 Sewer IStorm Sewer I 1 I I I I INew circu!ts alts. or extenSlons I SERVICES I ELECTRICAL MECHANICAL ccc r':lAllliE jjQ.... ~~~...c.HAR!iE. SQ. FT. furnace/burner to BTU's Floor furnace and vent Recessed wall Sn~rp np~tpr ~nrl vpnt I I I I I I I I I ~l5C.r.;r:r./~ 1/5 I lu~~ ,P~/}- 1#..s?7ob '/601 I ITempOrary Construction IChange in existing rpc;idpnrp Imultifamily, camm. or Tndlld.rial 10f ICO~1./INO. FEEDERS 1 Install/alter/relocate rl;~trih_ f~prlpr~ 10f amp~1 TOTAL CHARGES WHERE STATE l,~ REQUIRES shall not be valHuntil the TOTAL CHARGES Appliance vent seoarate Stationary evap. cooler Vent fan with sinole duct Vent system apart from 1 heat;na or A.C. I'MeChanical exhaust I hond and duct. I ~Iood stove/heater I I I I I I I (lmps.1 I SSUANC, OF PFR!lIT 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 TOTAL CHARGES I HAV[ CAREfUllY EXAr11NED 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 Springfi~ld and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAr~CY will be made of any str~wre 'Witho'ut the permission of the l3uilding Division. I further certify that my registration with the Builder1s Board is in f~11 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 7nl.055 will be used on this project. NAf.fE(p1ease print) 1__iG (3,,r/<:/7n DATE //-;;zS-!?7 Zone~.c TyPe/Const. C-k Fire Zone Bedrooms Flood Plain Stories: / SIG~ATURE FOr. OFFICE USE O~I Sq. Ftg. SQ. Ftg. . Sq. Ftg. Units Occy Load , Occy Group ?....? BUILDING PERJollT Charges an':: Surcharges Plan Ck. Comm/Ind 65%/Bldo Ppr Fpp Plan Ck. Res 30%lB1 do Per Fee Fence ___S~_$.c> "2- B 3' PLUt1BING PERMIT Charges and Surcharges I Demo I Sidewalk ---------~-..~I.AlC Paving 1 Cu'rb Cut I ELECTRICAL PERIl IT Cha rges and Surchafges . - " MECHANICAL PERMIT Charges and Surcharges t1ain x Value Access x Valu~ Dther~......s?/~_ Value (~'~,~ TOTAL VALUATION 7/-."/3 syste,ms Development Charqe (1. 5~) #4 I I I. I I ITotal Comb. Permit 5"'7'- ? ;> I 7'6.66 ~ I TOTAL -1 - . --\ , COMBINATION APPLICATION/PERMIT (CAP) , '. , ':..'" .. . -, ~. '.. PERMIJ_VALIDATION l . _ .''- .", III. I. Appl icant to furnish A. Job Address B. Legal Description "'''. '.. \ 1. example. Tax Lot 100, LaneCounty"'Map Reference II oj 43 2. ~xample- lot I. Block 3, 2nd Addition to Springfield Estate~. .. .,., .. C~ Name ,_. etc. . of owner' 'and cons truct ion 1 ender D. Energy Sources _ 1. examole-"'heat/electrical cei1inq!or: for'ced air Qas 2. eX3"!ple- waterheater/electnca(/or solar E. Square footage or valuation, etc. ------ I. example. 1250 sq. foot house. 500 sq. foot garage 2. example- if new project. check new - if addition, check add, etc. F. Building permit information: 1. example - construct singl~ family house with an attached 9ar~ge 2. exam~le - remodel existing garage into family foom 3. example - convert single family residence into restaurant (change of use) G. Value of work as defined in Section 303 (a) of the ....... ..... Struc.tura1 Specia1ty_~o~e _.. '. .. Hr. DESIGN TEAl.! 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 OIVISION STAFF WILL FILL OOT ALL FEES ANO CHARGES ON THE SCHEDOLES 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. --- 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 penmit 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. ~ . . . ,'" ' ';.. '-.' .- ."'..., ", ',.;',' : .J. , , ..l\ -:.. ':'-~. ... , . '. "'- .- v" ." , . " '. ,"',:-. &e-.N- /C>6Q7 Permit Clerk ~~ V. FOR OFFICE USE ONLY . , """ " . ~' ~ " ...,' ,..... -,' . . PROJECT CONDITIONS TO BE SATISFIED BEFORE' OCGUl'ANCY r-""/7,:>// /S5,e;..".~2- " ;</0 70/>?/"r/55CJ~,ce V/9'.T/L ~.::;~ U-V6<=.?~~ ~R~ /Y7..,c,/y,7 /Ycz::e-/ V6'::> / / I' ' ~ Permit applicant exempt from registration with the Builder's Board because: ......... Additional Project Information: - .. ....' . I~#.?c:=- ~- -::;;~. : ;f/-r'c~..;J' /C) - 7-& -:::> r ~p 737> ,'-{ '- .~ ... -. ,"") PLANS REVIEWED BY: - naine:LP8~?~~ignature~~~.....:.S) date //"/'/-li?? '/ .r . - _ . '\ . ~'. " ,'" ...',