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HomeMy WebLinkAboutPermit Building 1988-7-25 CITY Of SPRINGflELO CDMBINATIDN APPLICATION/PERMIT I EIIERGY SDURCES: Job Address //)2~ ..JL#Rt:./Jw 7;:>. ':!at L ID .t. ~ I ~ Wa~rHeater ega escnp lon, '7=.,y--~ ~-<~ Range \ 1 - D ~ - '2. "2. - (;) 0 - 0 -z. ~ 0 S WjUE of Hark: Ownerc.A.Q.; D,- I 100.1 ~ c:;;. c..~~1tr2."" \tZ"~' ~ G. a:;. =.C> . I BuildinQ P'ennit Info: Describe \~ork{;..e., (t 4. D Phone Famil V Residence Hith Attached Garaoe 1 l.\II.L D1Z-tr. ~74~C. Q.~ I\",.....r-.l>>\ \:2."'1"" -' i,.) ,- ~ .- .. I '\. IINSPECTIDN LINE 726-3769 Address 'P..O .. . I d0 O\l C) ~ I--C. IVl . ,( INFORlIATIDN liNt 726-3753 Sq. Ftq, f.lain ~q. Ftg. Access. Sq. Ftg. Other _'''3::;>''':5'' -1lew_Addj!(Al ter ~ep. Fence Demo Change/Use Other - - ...' ?> (I " Build Single ?L ~A .....~L..J\ Construction lender Address Ut::::d uN r EAr4 Primary Structural Electrical Mechanical CONTRACTORS ~'P A..,-.... (name) Phone {address) (exoi res) (ohone no.\ flies. no.) \v \,\ ILnt> ~)o.1o. -z.~~ 1V.l\....\"1..D~ <;i Ac.\\".~l.I" 4(.)..~2:Z. (n...,) (addres~;,) (l;~<;. no.) rt'. 'UQtIlA..l\1l ";.1 '-""'0 'tA..~~. ~A" ';~Do.. (pxnil"'p,,) (onnnfl nn. ) I C> ~ I e./ 7,1 Ie-to- I ( / Plumbina ~. C IJ. U" 'l:L."'PH?.... Genera 1 (. ~ a.4.4k' -:- I 4"'~D~;"2... 4(,'- Z{.,/ -C '2..~:r:. ^^ bN 1Z.DW c,r ~O, ~~~ !-H~i> ~\){}tCl.lt1 10/ l/A~ I I ',I.JJt....' &we MECHANICAL ~1echani Cd 1 e>lH LOtr<nt., lEL"-t"L "1\1....1 ~11_1J PN1'I.1.,)"" _l)'<" I'UIlIIIIib 7_0 -/.:ZL \"14~'Z. Electrical ND. ELECTRICAL fEf rHARr.F Nn ~~c r~GQr.c NO ccc rutuu::c Residence of furnace/burner to BTU's Each single fixture SQ. FT. Relocated building (new fix. additional) Is.F. Residena (] bath) IDuplex (1 bath) each IAdditional bath I Water service I Sewer I Storm Sewer INew circuits a1t5. ~ or extensions 7.o~ .~~ tE 'SERVICES I =.52> Floor furnace and vent ;z.... Recessed wa 11 S~~rp hp~tpr ~nrl vpnt #~~ .a-~~ &;:-y? -_. I' App 1 i ance vent . I I seOd ra tp 'Stationary evap. I I cooler Vent fan with I sinole duct I Vent system apart from I heatina or A.C. I Mechanical exhaust hood and dur:t I Hood 5 tove/hea ter I ITempOrary Construction IChange in existing r~"jcjf'.n{'p Imultifamily, camm. or Tnduc;trittl IOf amps. ICOMfI./IND. FEEDERS I Install/alter/relocate di..t.rih. fppclpr.. '.Of amp~1 I I I ISSUANC, nF PFRflIT TOTAL CHARGES TDTAL CHARGES -:::(";Z-t>e> TOTAL CHARGES ~h. /,c;:' ~ HHERE STATE L'Ili REQUIRES that the Electrical work be done by an. Electrical Contractor, the electrical portion of this permit shall not be YdJi1 until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREfUlly ~1INED 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 Derformed 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 UO OCCUPAUCY will be made of any stru~ture ~thout 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 the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 7nl'07Z!5 will b sed on this project. .O~9 ) IIAl.1E(please print) L ?li!1E.. P rE'/~f? I'E~ SIr.flATURE '.I? ~_ /L---f .- -1lATE" / Z.S)~ ~ FO~ OFFICE USi'OIlLY .- / ~ , Tvoe/Const. ~~~.RUnits Sq. Ftg. flain x Value Bedrooms Occy load Sq. Ft9. Access x Value Stories/,-.M...-?2 Occ.y Group t'-2 Sq. Ftg. OtherA"F~_~ lC>..",....~ Value~".-:e>.- TOTAL VALUATION Zone c.c Fire Zone Flood Plain BUILDING PERMIT Charges and Surcharges PLUI1BING PERMIT Charges and Surcharges - ELECTRICAL PERfm Cha rges and Surcharges flECHANICAL PERMIT Charges and surch!r.g~s Plan Ck. Comm/Ind __:3'.~~.~__ 65%/P1~n Po. >00 j, Plan Ck. Res ,/.~;;, 30%/Blda Per Fee I Fence ------------ I De.o ___2!5:~__lslde...alk /. /3'; I A/C Pavi ng -- - ~:ii-- -I Curb Cut 7-l.ft,-n I (q77 1'1<' 02 syste.ms Development '1~' /_ Charae (1.5~) N/?-~ I I I jTotal Comb. Permit .I I I I TOTAL :275:// - 4~ u .:;1..:} VNJ.1." " l-J , COMBIN~TION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description . .._.., ...,,-:i 1 " (".\ 1. examp e- Tax Lot 100, Lane 'County Map 'Refer~nce.' 17 03 43 2. exam~le- Lot I. Block 3, 2nd Addition to ~p,r1ngtjel.<!..Estates ... ' ., , C. Name. etc:. of. 'owner and construction&'lender '. '4 ~ " D. Energy Sources _ " .. 1. examp 1 e- hea tie 1 ectri ca 1 eei,] {n%r forced air Qas 2. exa~le- waterheater/electrical/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 single family house with an .~~ttaShed/gar.~ge .' ....~.. .'f,' 1,:' ,";" . 2. . Jexam~le- remodel 'existing 'g"arage"into family room 3. exam~le - convert single family residence into restaurant (Change of use) G. Va 1 ue of work as defi ned i n Sectio~1 ~93. (a) .~,f,;~~~:; : ..... Structural,Specialty Code- , :l , ~..... . . ...,.',~ " :. H. OESIGN'TEPJotAND'CONTRACTORS,j .'. .... ".;1,.'. " To avoid design or construction delays, Building Division Staff must be able to contact appropriate Rersons'regarding..design information or, job, s;itel/ t~. ...:".) corrections, efc:" + . - . '" :'::-. '.' I I, , Abbreviated 'P;l umbing', .Mechani ca 1 ;.& E.lectrical' Soh.dul es. ',' , ' r A. 'Except'where blank spac'es occl,';" i'nt tne desc"riptfon'..' 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. BUILOING OIVISION STAFF WILL FILL OUT ALL FEES ANO CHARGES ON THE SCHEOULES '.0.. As noted on the.CAP, the label must be delivered to the . .. efectrical'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 .. - ~.. ,. .\ .... ;.~ .:- V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . . ~.. . . . .0 .' \.. \ ",-" --." - ,..... ,.\<1 ,~ )'. ',' ~."'1 A, " ..&...:to-.-!'...."J. 1""..7,~...... ~.[l,.-t" " ..PERMI!. VALIDATION 'V ......~... " . , '-, '. . .. ~...-.. . Jo . . ...J " ",.,,, 'J," .',..., ~. , __,' 6......... _ ... ........., . ./. ..... . . ...."... . . ': ....., -:' .. ..;-.. , ..I... I. ~ ': ',l1.;.' (,.,;.~ ... . .~ ..,.\. . .,.1 '.' .....;- .. . ( , I ., . .' .'. 'I ~ ;-' " <-.- , ''Of .I..... ....... . " t' '.. ~ ' .. ., ...~ ">t1~;,.:...("~: '::r~ ;.7~~ \ "1.1.:.. ~""..' V .r" ~ /f7-bO CL Permit Clerk . :,' Pel'f!1it appl i cant~exempt from re~i strati on with the- Bu.! l,<jer,'.s 'Board becaus'e: Additipnal Project. Infonna~ion: ...- . , PLANS REVIEWED BY: .. ~. '. .;"1~,'. '. .~ name~,~;~R;;;;iijt.~ /'7 ~-". signature r ./~ " "or . date ,e-/.:::-;t;>g , ~ r.- f