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HomeMy WebLinkAboutPermit Building 1981-8-11 , Job Address -, CITY Of SPRINGFIELD COMBINATION APPLICATION/PERMIT 5.2/- MA'/;V ST: ,. INFORMATION LINE 726-3753 INSPECTION LINE 726-3769 legal Description I ENERGY SOURCES: Heat I Water Heater Ran_ge Value of Work: . Sq. Ftg. Main Sq. Ftg. Access. Sq. fig. Other _New_Add_Alter_Rep. _Fence_Demo_Cnange/Use _Other_ ~ lD ~ ~ Ow",,, .A?, 7)5/1P /CK Add",.3426 -.506' AA/A/ Cr: -sP.e /"U"':;;=- /A'" L./) ~JI..:- ;'7,..., J!.uilding Permit Info: Describe Work \i.e.. Build Single Pho~..:.;J - Y /"'T.'J !Family Residence With Attached Goroae\ - Pep4/k!S 7,.., ~aMLSP/lU~,-<; Construction lender Address Phone DESIGN TEAM (nome) (address) (lies. no,) ,..._*--- -, Primary Structural Electrical Mechanical CONTRACTORS (name) (oddren) (lies. no.) (expires) (phone noJ GAneml Plumbino Af~ Electrical Mechanical PLUMBING ELECTRICAL MECHANICAL NO, I FEE CHARGE NO. FEE CHARGE NO. FEE CHARGE Residence of furnace/burner to ATU's Appliance vent separate Stationary evap. cooler Vent fan with single duct Vent system apart from heating or A.C. Mechanical exhaust hood and duct Each single fixture Relocated building (new fix. additional) S.F. Residence (1 bath) sQ. ft. New circuits, alterations or extensions SERVICES Duplex (l bath) each Temporary Construction Additional both Amps. Water service Sewer Wood stove'heater Storm Sewer FEEDERS Heat Pump Air handler to 10.000 CFM Air handler over 10.000 CFM Amps. ISSUANCE OF PERMIT TOTAL CHARGES A..6 k E TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES that the Eledrical work be done by the Electrical Contractor, the electrical portion of this permit shall not be valid until a label has been signed by an Electrical Contractor and attached to the electrical panel. 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 perforrrMd 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 herin, and that NO OCCUPANCY will be mode of any structure without the permission of the Building -Division. I further certlfy that my registration with the Builder's Board is in full force and effect os required by ORS 701.055, that if exempt the basis for exemption is noted heron, and thot only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. Basis for Builder's Board exemption' NAME (please print)~ DERRIC.k SIGNATURE:;#~O.M"vv .t;;J./-b OATE ~II-~I FOR OFFICE USE ONLY Zon~ Fire Zone Flood plain Type/Canst Bedrooms ~torie' I 'nits Occy load JCcy Group Sq. Fig. Main ct!. fig. Access Sq. Fig. Other x '.'olue x Value x Value TOTAL VALUATION BUILDING PERMIT Chorges and Surcharges Pion Ck. Comm/lnd 65%/ Bldg Per Fee Plan Ck. Res 30%/ Bldg Per fee Systems Development Charae (1.5%' Demo Total Comb. Permit I I 1 PLUMBING PERMIT Charges and Surcharges Fence elECTRICAL PERMIT Charges and Surcharges Sidewalk A'C Pavinl1 MECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL " 1""".'.- \,.:,..,;j'\j-J-;;- '", J ~~ ,COMBI.NATlON APPLlCATION/_ (CAP) - " . - .. l ' ".J t,.-'"d , , I. Applicant to furnish A. Job Address B. Legal Description 1. example-tax lot 100, Lane County Ma'p Reference 17 03 43 2. example:Lot 1. Block 3, 2nd Additi<>.n to Springfield Esta'tes C. Name, etc. of owner and construction lender D. Energy Sources 1. example-heat/electrical ceiling/or forced air gas, '-~,:\ ',', 2. examole;-wat.er: heater/electrical!~.r solar :"- ,,::~~ E. Square footage or valuation, etc. 1. example.1250 sq. foot house, 500sq. 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. example-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 (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 whe~e 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 abbrevi- ated schedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL Fill OUT ALL FEES Ar;W CHARGES ON THE SCHEDULES ' "', to; III. Applicant to sign and date Whenever possible, the initial application will be used as a worksheet on Iy., Where.possi ble,.Bui Id i ng..Division.Staffewi II~_ prepare a typewritten copy and return it to the applicant-at the time the actual permit is issu,ed 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: \\,' \" ." ''f' . ",:,' :..., " .,:..: \~ . - ~,,\\:':'.~ ". ~.' i. "..,. \ ,A . .' \.1 .~. Additional Project Information, PLANS REVIEWED BY, nam"" "iignatur'? ,/ '-...',' '. . t"./ '. J'\..; ...~, < ,.......:.1... .\ PERMIT VALlDATI,ON " .'. :'( - Permit Cler~ '. "; ~" " - " ,< ("-' \ -'" "'- ,"j '.' \", "-. .. ... ,.;.,,,... __ I ~ " - " ',' ..,,' ..' , y-"-- > 1 I , -._ -',_____ '_~---f " '1 , " , I, "'. ... '- ' ','" ,/.1.. J"" ~ '.\ , ' ~ate