HomeMy WebLinkAboutPermit Building 1989-6-19
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LIlY 1)1 SI'RlrH,f IE,U
cOIm 111M I ON APPU CA T ION/ PERM IT
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I E!IERr,y SOURCES:
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Describe I-Iork(j,e_. Build Single I tIJ
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(Iics, no.) . fexlllresl fohone no,l
Job Address
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1.09.1 O.,criptioo /?'()"'!:>-27-2..I _ 11!>/"2.0
9Vf' / ~ ~~..-?>.t:#'V7'-':""'~ ~ <1 ....,
Owner ~""e>e:rc. q~r~ ,~~ ~_~
,'ddress _5"2'.~ ~/LL ~.
'5P~P. ,oR
Construction lender ~ - -
RanCJe
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f1fORfIAl: .:1 LI..:.
726-J75}
So. FlQ, ['lain
~q. fttj. Access,
So. Ftg. Other
rlel-l Add 1I.lter ~eo.
--rente Oemo Chantjc/Use
Other- --
Va I u( of Horle
S-~ ~--
Uuilt;ino Pernlit Info:
f.lI:lily nesldence "Iith
7 . Phone _
_ 2<:;_~..,..-I
,\Jdress
Ul~ll.irj [LAI1
(name I
Phone
I.address)
Primary
Struc tura I
Electrical
!1echanical
CONTRACTORS
(niime)
(itddres'i, )
General
~1./.,ALC7<: .
Plumbino
E I.ctri c.l ~/'IQo/("<"J!?
"echanical
PlUIIBlIlG
ELECTRICAL
I Floor furnace
and vent
~_S<.
I I I'. R ecessed wall
_____ ~n~rp ~et-f"~ ypnt
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I I I SSIIANCF OF PFP.!II T
-=<~-e>C> I TOTAL CHARGES ~~. b-----
ElectriCi\l Contractor, the electrical nortion of this perr.1it
Surervisor dnd returned to the Oui lding ~ivision
;:U,l
-----IE.Ch ,iogle fixture
-----I Relocated bui lding
(new fix, additional)
IS.f, r.esidence
(I b.th I
-----IOuPI.x (1 b.th) ..ch
jAdditional bath
I~!ater service
I Sewer
IStorm Se"/er
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..llL. CHARGE .llL
Residence of
SQ. FT.
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1 New ci reu! ts a I ts_
ar- ex tens lons
"':>. _~ /">I17~.s
/SERVICES
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I Temporary Construct ian
ICha'lqe in existing
rp'j.idf)'}1r,:
Imultifamily, conll!l. or
Induo;.trial
10f
ICm~I.!INO. FEEDERS
Ilnstall/alter/relocate
dio;.trih fppdpro;.
IOf .mp,./
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TOTAL CHARGES I TOTAL CHARGES
WI1H!E STATE L.'I'1 REQUIRES that the Electrical l-lork be done by an
shall not be v,,]H until the litbel has been signed by an Electrical
amns,l
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LEL .U!AllGl .
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(,.~nirr";, \
(uhon,. fl,n \
MECHANICAL
I-ITL J:IIllRGl
furnace/burner to
BIl'"
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I Apol iance vent
seo.al-alp
I Stationary evap.
cooler
I Vent fan l<li th
sinole duct
I Vent syster.l apart from I
heatino or A,C.
I ~lechanjcal exhaust
hnnrl ,1nd rlllr t.
IliDOd stove/heater
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y I e.K72F'...v p~~-,
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I IIAVE CA[![fULLY EXN1HlCD the completed ap!llication for Ilcrmit. c11HI do hereby certify that all information hereon is true
and correct. dnd I further ccrtify that any and all \-Iork nerformed shall be done in accordance with the Ordinances of the City
of Sonngfield and th~ Laws of the Stilte of Dreoon oertainin~ to the work described het-ew. and that UO OCCl!rAIlCY l-li 11 be made
of any structure wit.hollt the pcrmission of the nllildin~ Division_ I furt.hcr certify that lilY reflistration \'lith the Guilder's
Ooard is in full force .1I1IJ effect as required by OIlS 701,055, tll,ll if excllmt the b,lSis for exemntion is noted hereon. and that
,:~~(:::::'::::::' 'a~~:::. ;;:;~::'" ~:,::::" 4~::; M" L '" ~ _~
'-'" FO~ orFlr.~ USE DilL y r
Tyo./Coo,t.1"/,#-)l? .Uoits So. ftg. II.io x V'lu.
Gcdrooms Occy Load SQ, Ft~, Access )( Value
Stori., / OCC,Y Group &;'-/ S~. Ftg. Oth.~""'..~~l~~ V.lu..:5:;:....,..".... ~
TOTAL VALUATIOfI
- Zone-U.
Fire lone
Flood Plain
BUI,DIIIG rERnlT
CharlJCs an~
Su rcha rges
~ ~ PI.o Ck. Co"",lIod
. _ _~~!:.cl'"~ _ _ _ ~5!/Bld" Pnr fnn
Plan n. lies
Z-S3 JOt/Bldo Pnr F..
~'2, R3
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PlU'1B ING PERM IT
C:'argcs and
SurCharges
Fence
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Demo
,ElECTRIUl rERI~1T
Cha rqes and
SurCharges
_ ___~..p-c>' Sid..,lk
/ -/"'5 AlC r.vino
. 1&:.- _.:Curb Cut.
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11ECHMIICAl PERHIT
Char9~s and
Surchart)es
Syster:lS Development I
Ch'roe (1.5')
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Total t:ornb, rp.rmit I.
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COMBINATION APPLICATION/PERMIT (CAP)
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Applicant to furnish
'A. Job Address
8. legal DeSCription .. .. "".
1. example- Tax lot 100. lane 'County Map Reference
JI UJ 43
2, eXiJmp)c- lot I. Block 3. 2nd Addition to~
Springfield (stales . . ,
C. Name, etc. of ,owner and' construct'ion']endcr
D. Energy Sources \ .. ......'. _ ,
. "I. examp)e-' heat/electrical ccilino/or forced air llas
"'2. examole- water'leater/electriCill/or:sa!.lr
....~. Square 'tootage or valuclt'ion, elc, -
1. examoJe- lliQ sq, foot house. 500 sq. foot garage
2, examplc- if new project, check new _ if addition,
check add, etc.
F. Building permit information:
1. "examole - construct single family house with an
attached garage
2. examole - remodel existing garage into fami ly room
J. examoJe - Convert single family rcs;dencc into
restaurant (change of use)
G, Value of \'Iork as defined in Section 303 (a) of the
Structural Spec ill rty Code
II. OESIGN TEN-I AND COl/TRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding deslgn information or job site
corrections, etc.
Abbreviated Plumbing, ~lcchanical, & Electrical Schedules
A, Except \<there 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
8. Full Plumbing, Nechanical, and Electrical Schedules
are available at the 8ui1ding Division
1. To conserve space on the permi t 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 AIID
CHARGES 011 TIlE SCHEDULES
O. 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 permit is issued for his
signature.
Fees dnd Cha rges
Plan check fees are due and payable at the tilne of the
application, and no plans ,,,ill be processed until these
fees are paid. All other fees and charges are due and
paY~ble ..wh~n;.the permit is issued.
II.
III.
IV.
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FOR OFFICE USE OIlLY
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. PERMit "VALIDATION
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Permi t Cler
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PROJECT CONDITIONS TO BE SAT'ISfIED BEFORE OCCUPAtlCY:
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Permit appl icant exempt from registration with the ri~ilder's Board because:
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.~dd.itional Project Informat'io.n:
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PLANS REVIEWED BY:
name L.?lifhylE' /1: e:;. &=?
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signature~....]/.c5_ ~o..;;.;, '. datefi-/~-89
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