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HomeMy WebLinkAboutPermit Building 1983-11-16 , . I INSPECTION LlIIE 726-3769 Job Address k.\ -:;\ 'l \\'?~\ ~/'>u n Legal Dmription\"'\ ()~ "?-'S 1\\ INFORlIATION LINL 726-3753 Sq, Ftg, r.lain ~q. Ftg. Access. Sg, Ftg. Other New Add Alter Rep, -Fence Demo Change/Use -Other - - ! , / j? ! Owner ,) s. .AJ~.~t, "'II~, I f)..o ~ ;,_ Addressp,....+ If?:' j (j """.^'~ .J CITY OF SPRIIIGFIELD COMB illATION APPLICATION/PERMIT E!lERGY SOURCES: Heat Hater Heater Ranqe i Va 1 Uf of Hark: t' \(; (') f'.}::) . ~ilri;nQ Penmit Info: Describe Work{i,e" flf.~ t.r2..4 Familv nesidence Hith ~.ttached Garaoel c.. \ \ ?J::;() Build Single e'en',,:; -{"<.<<1-, ;rf.. 7" ./1..' <' 'vi r /,,::.,..,.... Construction lender Address UL~ HiN I LAI1 (name) Phone (address) (lies. no.) (exni res) , (ohane no.) Primary Mechanical CONTRACTORS Inamel Genera 1 k/n f'-/ "'1 /.J'l', ,.-1 / Prr7('.o faddres!d (1ir.~ 00.,1 C1R SO .C;-l.,) T". /....J .oJ. R. ..--i, I' ,--/& ~ (p~oirp~l (ohnnp n~ \ Structural Electrical ~/'J.O" '.~/1~/'il1 .2.9:!..(,~:n Plumbina Electrical N~.. {"" {:/~.-k,;t ~'echanical PLUliB ING ELECTRICAL MECHANICAL NO. I I HF I r.HARGF jln H~' I r~l!.R.G.f. Nn SQ, FT. furnace/burner to BTU's . 'H-1.rJiARli[ /~. Each single fixture Residence of IRelocated building (new fix, additional) I'S.F. Residence (1 bath) IDuplex (1 bath) each IAdditional bath Iwater service I Sewer _____Istonm Sewer New circuits alts. \ or extensions \~~ Floor furnace and vent SERVICES Recessed wall ~n~~~ h~~t~r ~nrl vpnt TOTAL CHARGES WHERE STATE L'W REQUlnES shall not be vali1 until the I I I I I I I IOf amps,l I -!cOI-iH,IIND. FEEDERS I I IInstall/alter/relocate I I rH<:.trih fppnp.rc:. . IOf amps.1 I -I I I I I I I I I I I I SSUANC, OF PFRlilT TOTAL CHARGES \ 5. CO I TOTAL CHARGES \ rJ. ei=> 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 Temporary Constrvction IChange in existing rp'S--jdf.:l:n~p' . Imultifamily, corrm. or Tnnu<:.trial \ Appliance vent seoaratp Stationary evap. cooler I. Vent fan wi th sinale duct Vent system apart I HAVE CAREFUllY 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 performed 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 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 comoliance with ORS 7Ql.055lZWill be used on this project. , / IlAlIE(please print)-t:" u t--..., tJ Vl) Un '" t! 5 If,IIATURE no ~:~ . ' '. . //:;:._ ~ oim /cV~ I!~ , FO~ OFFiCE USE OIIL Y " " Type/Consn\) .-\ ~r Units Sq, Ftg, liain, Value Bedrooms -" Occy Load Sq. Ftl]. Access x Value Stories \ Occy Group \-)- () . Sq, Ftg. Other x Value Zone C C Fire Zone - Flood Plain TOTAL VALUATION BUILDING PERfIlT Charges ant' Surcharges k C') 00 Plan Ck, COllllllInd ___~_c.:.'______ 65t/Bldo PJ'r Fpp ? C::>'Cl Plan Ck, Res _ _ 30%/Blda Per Fee r,"l Q () """I !l. rlSystems Development --",r;).0 r /.14 A ,- ~barCle (1.5":) H-4.-~.~ D\QSZ. \ ':Y)_ 00 PLUr~BING PERMIT Charges and Surcharges Fence ------------1 Demo I Sidewalk I A/C Paving I Curb Cut I I ELECTRICAL PERlm Cha rges and Surcharges ___~~.co ~ ----\_Q~~-- .40 I I ____._1 ITotal Comb, Permit I I TOTAL, ___. I 2. ~.oB MECHANICAL PERMIT Charges and Surcharges . , ~ COMBINATION APPLICATION/PERMIT (CAP) 'PERMIT VALIDATION J. Applicant to furnish A, Job Address B. Legal Oescription J, example- Tax Lot 100, Lane County Map Reference 1/ 03 43 _ 2, example- Lot I. Block 3, 2nd Addition to ~pr;ngtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. example- heat/electrical ceilinq/or forced air oas 2. examole- waterheater/electrical/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, cneck add, etc. I F. Building permit information:. 1. exam~le - construct single family house with an attached garage \ 2. examole - remodel existing_garage into family room 3. example - convert single family residence into restaurant (change of use) . G, Value of work as defined in Section 303 (aJ of the Structural Specialty Code H, OESIGN TEM1 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. Abbrev.iated Plumbing, Mechanical, & Electrical Schedules A. 'Ex~-ept 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 DOT ALL FEES AND CHARGES ON THE SCHEOOLES D, As noted on the CAP, the label must be delivered to the electrical contractor for signature by his electrical '- : -'-,--.---- ~ 5upcrvisor. The general contractor is .not al!tho\"'ized ~.., 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 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. G,qqq , tP v , - - -,.. .;..,.. .-.. . ....:. '~--." ~-... V, FOR OFFICE USE ONLY (l, AdJJJ Permi t Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ~ ,\:J('"",,-\\..\~\-\?B~ Q~.~~,-, (')~ "b,<:2_\.Y"T\W~\ T\'\\'t=- ('...~,,~ C":J't- "t-,\~~~", \ \\~LL Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: \- <;1 ~~ , ~.~. ." - "11 -..,~ '\ . I . ~. , , /~ 1 . 1 J , . 1 ! j PLANS REVIEWED BY: , . - C-'\ ~~' nameD4)\\") ~ "'?J,-;\)\ signature'~Y'-c..\. <:::,\" '--)~\-- date \\-\{f"'\~ ,~