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HomeMy WebLinkAboutPermit Building 1982-1-13 . . CITY Of SPRINGFIELD Cm1BI:IATION APPlICATION/PERMIT E!lERGY SOORCES: Heat (-later Heater Range INFORIIATION liNt I 726-3753 Sq, Ftg, 1.lain ~q. Ftg. Access. 5q, Ftg, Other New Add Alter ~ep, --Fence Demo Change/Use Other- - ~ \.)J ~ S;'. ~ I INSPECTION liNE, 726-3769 Job Address Co II ~n1.ClLn Sh p :; ,f-: Dmription 17,"~"'S-31 . ~?<'t::d , Legal 'D OJ\ C.O,,;''. -te ~-' Address :~. n. l~nX ~o+Ad . Construction lender F,() (() Phone 740. r;9S~ Valu'.t.P.f Hork: :)"' lJ 3 nOr) ( U BUlld;nQ Pennit Info: Describe t~ork(i-.e.. Build Single Familv ~es;dence With Attached GaraQe\ C-1L>ti~~~.lf')'; \ \.\ A^"__~.l~ M,-rE;;;}/6R 7?~&JEL. "'Z>P "3 e>rr/~~ tl ~~~,&. t 8.-, (lies. no.)' (exoiresl II no. ) Owner Address DESIGN TEAll (name) Phone (address) (ohone Electrical ~ Primary Structural Mechanical CONTRACTORS Genera 1 (name) N ~(},lljV (address) (1ir:~. no.) (~)[nire!i;) (ohone no. ) Plumbina Electrical (VE71IT'7') ~1echan;cal PLOIIBING ELECTRICAL MECHANICAL NO. . Each single fixture FFF . r.HARGF Nn ~r:r: rl-l.Q,Rr.~ NO. Residence of furnace/burner to 5Q, FT. BTU's . F'~~ . rHA~r.~ , , Relocated building (new fix, additional) .",. New circuits alts. 0:2 ex:,;~o.:%.sn e SERVICES IS'" Floor furnace and vent S.F. Residence (I bath l Duplex (1 bath) each Additional bath Recessed wall ~n~rp hp~tpr ~nrl vpnt Storm Sewer IOf ICO~1,/IND, FEEDERS Ilnstall/alter/relocate I l'iic:;trih_ fpprlprc:; 10f -'amps.1 amps.1 I I I I I Appliance vent <;'PDi'lr~tp Stationary evap. cooler Vent fan with sino1e duct Vent system_apart from I heatinq or A.C. Mechanical exhaust I hood and duct I I I I I I I I I I I I I I ~Iater service ITemporary Construction IChange in existing re<;.idence . Imultifami1y, comm. or Inrluc;.tri;11 Sewer Wood stove/heater TOTAL CHARGES . WHERE STATE lAH REQOIRES shall not be va1i1 until the I I I /$":011> TOTAL CHARGES 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 ISSUANCE OF PERlnT TOTAL CHARGES I HAVE CAREFULLY EXN1INED 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' ~ordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work des ed herein. and th UO OCCUPAI~CY will be made of any structure without the permission of the Building Division. I furthe certif)V'that my re 'st~ati with the Builder's Board is in full force and effect as required by ORS 701.055, that if exe t the basis for ption' noted hereon. and that only suhcontractors and employees who are in compliance with ORS 7nl,05/1"i~1~S~ s / t, I~AI-IE(please print).]:2.Cfl "! 1? (114 .eft? I'? SIGII^TURE ~d It ,/ 'L DATE/' I J ~F'2... ! FOR OFFICE OSE/Oi~L y--' , Sq. Ftg. r1ain Sq. Ftg. Access 1?- 2. Sq. Ftg. Other.u,T. ~e::. Tvoe/Const.;tZI:'-A~ Bedrooms Zone Fire Zone Flood Plain Stori es I Units Occy Load Occy Group Comm!l nd Ppr Ff>p R-es Per Fpp i-//~S :; 't .~ ., /':7.!~ 0 x Value x Value /.fEH6pEc.. Value TOTAL VALUATION ~~ '; ,-- ;,.,._____ <r ~ BUILDING PERfIIT Charges and Surcharges "-'li _ Plan Ck. .... T' 65%/Rldo ------------ Plan Ck. . ~~ 30%/Bldo { r, -i_~'? u..... f......., L~ (lL Systems Development Charqe (1.5%) PL0I1BING PERMIT Charges and Surcharges Fence Demo ELECTRICP.L PERlm Charges and Surcharges I~ - I Sidewalk ----- -~'o-I A/C Paving I Curb Cut ------~.~~~ Total Comb, rermit '1tP. 56 7"t:'.'5"'~ ~ " I IiECHANICAl PERMIT Charges and Surcharges I I TOTAL ,. .' COMBINATION APPLICATION/PERMIT '(CAP) PERMIT VALIDATION I, Applicant to furnish A, Job Address B, Legal Description 1. example- Tax Lot 100. Lane County Map Reference 11 03 43 Z.example- Lot 1. Block 3,Zrid Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. example- heat/electrical ceilinq/or forced air Qas 2. examole- waterheater/electrical/or solar E. Square footage or valuation, etc. ------ 1, examole- lZ50 sq, foot house, 500 sq, foot 9arage 2. examp.le- 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. examyle - convert single family residence into restaurant (change of use) G, Value of work as defined in Section 303 (al of the Structural Specialty Code H, DESIGN TEAM AND CONTRACTORS To avoid design or construction~deJ~Ys, ~uilding . Divis ion Staff must be-"abl'e' to~;ccint'act' 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 full schedules C. BUILDING OIVISION 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 si9n 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. diroDz/rJD ~ / . V, FOR OFFICE USE ONLY Permi t Cl erk (I~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: ., Additional Project Information: PLANS REVIEWED BY: . --. name L.,l'i'g~ ~F<;'~Signature+.--, --Y;;'~ date I-/~~ ! ",:',:~:.:-::~=:::::-:-:-=.::::::::;"":-:-:.::-:-: ,:-:: ,:-:-::,:"~~:::- --:.:- :':"'_, - -' -" ~.,- ''::_':.~:'':-,~'':;-''-::-_:=--:':'::: ',~,~:7 ::::"~::-~-:-_---"~ .u;:;C";',;..:~~~~;:, .7;=:~~::::=r~~__...... .__-'_........~ _.....:~;.: .:.:;':."-.-.-. ...