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HomeMy WebLinkAboutPermit Building 1983-1-13 INFORlIATION liNt 'I 726-3753 Sq. Ftg. 1.lain ~q. Ftg. Access. Sq. Ftg. Other flew Add Alter Rep. Ranqe_ -Fence Demo Change/Use ValUr of Work: Other- -- Se.+eI{~L. I 1 O~ .. v} J//:'./ f.:+r/ Pho 7,[77."'7~11(i'ino Pernllt Info: Describe Work(Le.. Build Single .,(:. ~7tee ~ no r -~ (G~~id~i~~~~~c~ GSi:I"e F.-~<o,^-,\- Se tf ())t.,J(Or.I)S ~ \)CfY 1I10!~l(i+;.J.. ~ Address Phone a,~>>aJJ~ aJ~M.~k.Lu" DESIGN lEAf-' (name) " (address) l iiies. no.) fexoiresJ (ohone 00:\ Primary (fi I tl. ~ ~<J!e~ ...J--A-!:.s~c '14:)- f<{~~ /' I . . . CITY OF SPRlflGFIELO COIIBIilATION APPLICATION/PERMIT EIIERGY SOURCES: Heat Hater Heater jlllSPECTIOil L IIIE. 726-3769 Job Address 11() /It"/~l s I..~"'-r Legal Description /7-0"3'- 3~- 3 / 7: L 7.g~ Owner 80 1/+ ~<t Address "3 () ( JXJ. i Construction lender Structural ~ ~r' 'Q Electrical Mechanical CONTRACTORS Iname) General (\.tCl--~ '{1tl~~'^-'" l{ I I no.l (~xoires) ....,4C.-5~~ . . (ohone no.) (address) _ flies. 'fO(a I i I-I-~ II +\.&.. Pl umbi no Electrical ~'echanical PLU1IBIflG MECHAN I CAL . ELECTRICAL NO. FFF [HARGF ~ rFF rl:lARliE .1lll..- Residence of furnace/burner to sq. FT. BTU's. Each single fixture IRelocated building (new fix. additional) Is.F. Residence (1 bath) 10uPlex (I bath) each IAdditional bath I ~Iater service I Sewer /1 Storm Sewer It? /f..... (,f= IP.- y ~..n ~WR.M)", I~.- I'New circuits a1ts. or extensions ISERVICES Recessed wa 11 ~~~~p hp~tp~ ~nrl vp~t Floor fu rnace and vent Appliance vent ~eoaratl:' Stationary evap. coolH Vent fan with sinole duct Vent system apart from heatino or A.C. Mechanical exhaust hood and duct Wood stove/heater ITempOrary Construction IChange in existing , rps i 4rn~p' . Imultifamily, com. or InrllJc;.trial 10f amps. I COI1l.1. /I NO. FEEDERS "Install/alter/relocate di~trih. fppdprc;. 10f amps. I I I I SSUANCf OF PfRllIT tt \.IJ ;~ I :E.L 1J:lJAIlGL ./ I I .I I I I I I I TOTAL CHARGES ~- TOTAL CHARGES TOTAL CHARGES WHERE STATE L~W REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pe~it shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXArllNEO 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 Springfield and the Laws of the State of Ore~on pertaining to the work described herein, and that NO OCCUPAI~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 ORS 7Ql.055 will be used on this project. ,----\ / (ry~ S1GrIATURE I/-/'?7'i??,-, ....6:./<"", 6 FOR OFFICE USE DIlLY Y Sa. Ftg. lIain ::';''3 /-?~CmValue Sq. Ftg. Access.f""""'/~~~alue Sq. Ft9. Other~cJC... "~~Value I~-- . TOTAL VALUATION /I~ a::>>.- NAr.IE(please print) Ot"1i (i 'H r <;-/=-rEIZFT oATELJ) <:Y"? Zone c.~ Type/Const. ~~ Bedrooms Units Occy Load 5'6 Occy Group~-~ Fire Zone Flood Plain I Stories BUILDING PERNIT Charges an~ Surcharges ~/ _ Plan Ck. -'>40. 65%/Bldo ------------Pian Ck. ;il.:29 30%/Bldo 2~. - Fence ------------ .$6 O~mo ~. 'It::> Systems Development Charoe (1.5~) It, ~ -=- Convn/Ind Ppr FF'P R"es Per Fee PLU/1BING PERMIT Charges and Surcharges ELECTRICP.L PERI~IT Charges and Surcharges Sidewa lk A/C Paving ____________1 Curb Cut I 7.,. 0", 2$0..'1L1 Total Comb. rermit I1ECHArlICAL PERMIT Charges and Surcharges ~ TOTAL h , . " I COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description 1. examole- Tax lot 100, lane County Map Reference II 03 43 2. exam~le- Lot 1. Block 3, 2nd Addition to Sprlngtield Estates C. Name, etc. of owner and construction lender D. . Energy Sources 1. examt,?le- heat/electrical ceilinq/or forced' air Qas 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. ------ 1. example- 1250 sq. foot house, 500 sq. foot garage 2. exarllPle- ;~. new project, check new. if addition, cneck add, etc. F. Building permit information: 1. example - construct single family house with an attached garage 2. exam~le - remodel existing garage into family room 3. exa~le - 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. DES I GN TEAI.I AND CONTRACTORS i . To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or job site corrections. etc. 11. 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 fonn 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. --- 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 the permit is issued. ~ -- (ocfjcJo / ., V. FOR OFFICE OSE ONLY Cle~Lffi ) ~ '--'J .. . Permit PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: #~l?/ r/~}/ A- ~ ~C'~I'~?;) ~~ ~ ~e:c-#-AlH/~ ~ M~A::>~ O~~ ~J"J ,,4~~ ~p~~,,?" P~}fJAu7!; L/HS7'~C7/~h"'.s PLGJRJ"I3I H~ ~ e:c: ec:. /;ii?/cA',- 'L r L;p .;?I"Pe l!F7"'/~~ k/H/C-# V-#4 c.. t/vc.'7" ~ /"'?'l?3' Permit applicant exempt from registration with the Builder's Board because: , . . Additional Project Information: ~e tblJ#- &/tJif''t'9 ~~ ~'J!lDAn6"'" ~7)~'5~~ P<.~ ~ ., 5EE ~lRpo.(S2,e>II~ F~;q /1?A"-50~'7" s.~~c.. (P~~~ ') PLANS REVIEWED BY: . /' >0' . name tJ>J9/A~ .n~~ signatur~ ~~A~? date /--1'"3 ~3 ;.::::: :- '.:..=~::-::::-':';':-::-:_=,';::-~-::'-::::~::'~=_-::'.: -:.'__;':' .-. ~-,:' ~::-:':--::.: .:....::.::....~~.:.-.'.:_::.:-.-::;.......... ':::::'=-=:::':t:::"..:..;.:;:::::.~~~..:;:-:::: ~=-,,=--=;- -.....-:.-=~7Z~,~-~: .. i .~