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HomeMy WebLinkAboutPermit Building 1990-8-22 iloCS lo~ I ItlSPECTION LItlE "i 726-3769 - Job Address I.egal Description " . .;" . ,: ItlFORlIATION lIN" 726-3753 Sq, Ftg, 1,Iain ~q. Ftg. Access. Sq, Ftg, Other flew Add A lter ~ep, -Fence Oemo Change/Use Other - - CITY OF SPRltlGFIE~D COHBIIIATION APPLlCATIDtI/PERMIT EIIERGY SOURCES: Heat Hater Heater Range ~ ~ ~ \J\ vJ ,\ q \ ~ ..I"'1l...... RJ{) C'l~ l.J.JA.Rr ~.!;', ~e::..6 valUE.N C~ '1 ~ - Builo;nQ Pernlit Info: Describe Work(i.e., Build Single Familv nesidence With Attached Garaae) ~ c:JF--<=. '-tt::OO ctJ ~ ~ I:lJ.JO ~ -Wlf11 ~SS,"A"_'-l"~' , C7\...F>~ ~ """"~ I4>Oh ( ",-"~",,,-c.,R.,,,,,^,.JI,, . ,--- ... ~ lo.l.C _ -IV nics. no.) (exnires) (OhOM noj -~~ ~ Address lD l.P ~ ~"':Il.l.JOOD SL)0c..nO~ DD-I Construction Lender Address Ul;IGN llAI1 Primary Structural Electrical '1'1"6 Phone .:L~ S~ 91'-N '5 (namel Phone (address) Mechanical CONTRACTORS I name 1 ~ l? l.~ P\~......en ------ Plumbino Electrical ~lechan; ca 1 NO.1 faddresc;.) (l ;r'c;.. nn.) (pxnirI'H; \ (t')tln"p nn , \l/1..j I CVD ~UU-o'2 In"l 1.RO,4 ~.JJu.l iii? r-.. ~ J..N:' qlLlOl....> "~' , P~UI1BltlG E~ECTRICA~ MECHANICA~ I FFF I fHARGE Nfl I I HI=" I rl-lllRG.E. NO I 1r:.E..E.-1..c.HARG.E. Residence of furnace/burner to 'BTU's Each single fixture SQ, FT, Relocated building (new fix, additional) S.F. Residence 11 bathl Duplex (1 bath) each Additional bath ~Ja ter servi ce Sewer Storm Sewer , New circuits alts. or extensions Floor furnace and vent I I I I I I I I I SERVICES Recessed wall S~~~p hp~tp~ ~nrl upnt ITemporary Construction IChange in existing rp~; dJ'J1~p Imultifamily. COrTm. or Tnnud,r;al 10f amps, ICO~1,/IND, FEEDERS I Install/alter/relocate ni<:.trih fppnpl'"<:' 10f amp~ I Appliance vent s!='oarrlt,p Stationary evap. cooler Vent fa"n with sinole duct Vent system apart from I. heatino or A.C. Mechanical exhaust hood rind dud Wood stove/heater \. ..... ISSUAtlCF OF PFRIIIT TDTA~ CHARGES TDTA~ CHARGES TOTA~ CHARGES WHERE STATE L\H REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this pelTolit shall not be valij until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFU~~Y EXAMINED 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 Spri ng fi e 1d and the Laws of the Sta te of Ore~lOn perta i ni ng to the work descri bed herei n, and that NO OCCUPAr~CY 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 OP.S 701,055 will be used on t~ject, IWIE(please print) .::::s-, to-..... ~~ SIGN^TURE~~~ DATE '6b;:)j&:,{; FOr. OFF I CE USE OIjL Y So, Ftg, 11ain\ ~ Sq, Ftg, Access Sq, Ftg. Other Zone Fire Zone Flood Plain 8UI~DING PER~1lT Charges and Surcharges P~U'1BING PERMIT Charges and Surcha rges E~ECTRICA~ PERIIIT Cha rges and Surc~arges HECHANICA~ PERMIT Charges and Surcharges Type/Canst. Bedrooms Stories Units Occy ~oad Occy Group x Value Value Value x x TOTA~ VA~UATIOrl , Plao Ck, _ut_Z--2!?..__ 65%1Rldo ~ Plan Ck, -'L I ..) 30%/81 do I Fence ------------ I Demo I Sidewalk -----------.~I ~/C fayi.n~ I Curb Cut ____________1 COI1l11Il nd Ppr Fe!=' R.es Per Fee Systems Development Charpe (1.5~) , I I I I I I I I Total Comb. Permit I TOT A~ ~'5>_tb3 , . COMBINATION APPLICATION/PERMIT (CAP) I, Applicant to furnish A, Job Address B, Legal Description 1. example- Tax Lot 100. Lane County Map Reference 1/ oj 43 2, exa~le- Lot 1, Block 3, 2nd Addition to sprlngtie1d Estates C. Name. etc. of owner and construction lender D.. Energy Sources 1. example- heat/electrical ceil;n~/or forced air Qas 2. exa~le. waterheater/electrlcal/or solar E. Square footage or valuation, etc. - 1, exame1e- 1250 sq, foot house, 500 sq, foot garage 2. example- if new project, check new - ff addition. check add, etc, F. Building pennit information: 1. example - constru~t single family house with an attached garage 2. example - remodel existing garage into family room 3. examJPle - 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, DESIGN TEAM 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 fu 11 schedu 1 es C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE 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. --- III, 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 ~he permit is issued. V, FOR OFFICE USE ONLY PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY: . . PERMIT VALIDATION Je.'?/ # /r?? P.:> 7i '"2. "3-7'0 ~ IT 7"7~2 Permi t Clerk~~ ./ / / ' Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: " ~- name Lt5,?Y~jq~~ signature a~~~ v,-' - r r, date &'-"2 ~~Z>