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HomeMy WebLinkAboutPermit Building 1988-3-11 --~ ~ .e CITY UF SPRINGFIELD COMBIHATION APPLICATION/PERMIT E1IERGY SOURCES: Heat Hater Heater Range . INFORJIATlON liNt 726-3753 Sq. Ftg. 1'1ain ~q. Ftg. Access. Sq. Ftg. Other --1lew__AddJ(Alter--Yep. Fence Demo Change/Use -Other - - D4 ;:Xl C> RJ I INSPECTION LINE 726-376g Job Add'ress /01 <I- Jla. y 10uJ -Road Legal Description !Jf[;L -r;LJ(. oJ- -;t}.v& S I~.t>":(;j__ j'il?, -::> r / b2?~ A!Y.I..J-- "nAlr~,.p...v? ~ I f?,.{ (J,/lht/'fU9t"nU Address ~-;;:~ f.~:J t:;! ~")~<,I , \,,p *". tk~_ Construction l~der ~~~ Address DESIGN TEAM inamel Primary --I?u.fZf.A I- valu;t35bO ~ BuilciinQ Pennit Info: Descr,be Work(Le., Build Single Phon"741~~,~~ Familv nesidence With Attached Garaoel ~....- ~;~ U.,;fJ!4 ch. r''/ h~ huPL't -/{,r"" . (\1."-;--,, %L- fJP,,-/,,~ oJ u'/!f!("p flies. no.) ~ Phone (ilddre"is) (exoires) (ohane no. Structura 1 Electrical Meehan; ca 1 CONTRACTORS Inamel General ~d,-J../ J- Plumbino 1..4../~O P/uhf6:...... ( Electrical /11'~ P.d.../rJ rP&rJP':7 _ ~'echanical (address) (1 ics. no.) (exn;rps) (ohnnp no. \ oZ3Oo ~/!') -'\I; .I/..v I OJAin.-,,). hk. / '/./5= "/7/( 7fJ.(.,- /9~/ PLUIIBING ELECTRICAL MECHANICAL NO. HF r.HAR!;F Nn I-EEL J:liARG.E. NO ~H. r~~ ~ Each single fixture ;/ .-yq.-..,~ 4<_0_: '/..5&-72.:>0 Relocated Duilding (new fix. additional) Residence of SQ. FT. furnace/burner to BTU' 5 S.F. Residence (] bath \ Duplex (I bath) each Additional bath New circuits alts. ~ or extensions '2 0;&(' ./'7?=J<T4i' SERVICES ::?~tx> Floor furnace and vent Recessed wall Sn~rp hp~tpr ~nrl vpnt Storm Sewer Of amps. Appliance vent sro.a ra tp Stat; onary evap. coolar Vent fan with sinala duct Vent system apart from heatinq or A.C. Mechanical exhaust hood i1nd durt ,/fi1P. ""i . Sewer Temporary Construction Change in existing rpc; j <1e!H"p multifamily. COlTlTl. or Tnnuc::triill ~Iater service L, t;P c:>F~ ~/"'7/,<h '" 7.St1:> CO~1./IND. FEEDERS Install/alter/relocate rl;~trih fpprlpr~ ./ Wood stove/heater Of amps. TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be vali1 until the I SSIIANCf OF PFRIIIT 3? ""t> TOTAL CHARGES =<:<. SO TOTAL CHARGES ~/.-<>'. /. 5"- coo 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 I HAVE CAREFULLY EXAMINED the compJeted 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 OCCUPAHCY 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 701.~~sed on this project. 1lAr-IE(please print)bLA~ r~JI:"'Q4Jood SIGNATUR / ~~p OATE3-/I-&P; FOP. OfFICE USE DIlLY / Sq. Ftg. 11ain x Value Sq. Ft9. Access x Value Sq. Ftg. Other ~67l Value~~_ - TOTAL VALUATION Zone .,c" ,-; Fi re Zone Type/Const.~Jlt ~~Vnits Bedrooms Occy load Stories I' Occy Group n' - .:? Flood Plain BUILDING PERfllT _____~~S-~_ Plan Ck. Conm/lnd Charges and 65%/Bldo PJ'r FpF! Surcharges ::c'-':l.3 Plan Ck. Res 30%/Bldo Per Fee PLUI1BING PERMIT 3c:? ...,. Fence Charges and ---- _:..._--- Surcharges /-9:> 0/11110 ELECTRICAL PERlm ----~:p~- 'Sidewalk Cha rges and Surcharges / ,/3" A/C Pavi ng MECHANICAL PERMIT __n/a:.~n Curb Cut Charges and Surcharges .75" "K<'{' ..,P~ ~1I10 Lo ....." ('\ "'- .l' [Systems Development <>/D..~ t1l~Charqe (1.5%) N.4 I i Irotal Comb. Permit I I TOTAL //?-bl . , I .. - " COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Oescription I. example- Tax Lot 100, Lane County Map Reference I! oj 43 2. examele- Lot I. Block 3, 2nd Addition to Springfield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examele~ heat/electrical ceilinqjor forced air qas 2. examole- waterheaterjelectrical/or solar E. Square footage or valuation. etc. - 1. 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 single family house with an attached garage 2. examele - remodel existing garage into family room 3. examele - 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. OESIGN TEN1 ANO 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. --- Ill. 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. (I ( 49 3--(CJ -/?f V. FOR OFFICE USE ONLY Permit Clerk CL PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: . PLANS REVIEWED BY: name ?aR~ n~~ signatur~. '/ ~-- /" -? da te .:r-,,{l:? 2? .8. -