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HomeMy WebLinkAboutPermit Building 1990-12-3 7J,~~.~ . , .... -.... , e:/ INFORllATlON LINe 726-3753 Sq, Ftg, /.Iain ~q. Ftg. Access. Sq, Ftg, Other New Add Alter Rep, -Fence Demo Change/Use -Other - - 'I INSPECTION LItlE I 726-3769 - CITY Uf SPRINGFIElD COMBINATION APPlICATION/PERMIT EIIERGY SOURCES: Heat l~ater Heater Range lP\5 iVJA--IN ~. legal Dmription VI ()~ ~ ~~ ") \ N....{:yV (Fe1=>-~ -l- ~ . e.ou 'I' ~ fu~ll\..l) tv\:.P G-U L IVJ:l U s..f:. Address 2>5,'S N''-w. YGaN Phone.k-?~i: PO~t-.J"O (oou ~) Owner ValUE of \-Iork: ,ilfl q <1 Builriina Pennit Info: Describe Work(Le.. Familv nesidence With Attached Garaael Build Single I I~ '" "- ~ Job Address ~,---,.-r....R...l~""i"CIj:: Address UESIGN TEAI.\ {namel Phone (address) H.lnf"l =.;:::, v.J1 ~ ~"" ,. 1=\". '-I-M M e.L-'R-&l.J:.l;' I-lol"" ~PF80 R..oa1='I~.(<.:wG",,;>,="''''(,.-tl.: ,,,,,. M.' ,..""~._ 00. Construction lender Primary Structural Electrical /1echanical CONTRACTORS (name I ~ R.O'G ~Ol=--!.UCr-- (address) (1ic~. no.) (p~n;r,:>c:l (onnnp nn. 1 Plumbina L'ltt)'1'-l C"~D.en ~ ICH')~ ~c,..E UE: , '11'--10L IIl-Ilo,D 3H '-l - ClJ..., '\ Electrical t-lechanical PlUtIB I NG ElECTRICAl MECHANICAl NO. FEF rH~ ~n "-EL J:IJAB.GE. NO. ':.E..L J:IJAB.GE. Each single fixture Residence of SQ. FT, furnace/burner to BTU's Relocated building (new fix, additional) New circuits alts. or extensions Floor furnace and vent 5.F. Residence II hath) Duplex (1 hath) each Additional hath SERVICES Recessed wall ~o~rp hp~tpr ~nrl vpnt Storm Sewer Of COMt.I./INO. FEEDERS Install/alter/relocate (iic:,trih fpprlprc:. amps. Appliance vent "poa ra tp Stationary evap. cooler Vent fa"n with "inale duct Vent system apart from hea t; no or A. C. Mechanical exhaust hnod and dur:t Wood stove/heater Sewer Temporary Construction Change in existing r'P-S-jqPJlt'l'I multifamily, COIl1T1. or Tndlld.riil.l ~Jater serv; ce Of amps. ,'. , ..,. , ISSUANCf OF PFRt\1T TOTAl CHARGES TOTAl CHARGES TOTAl CHARGES WHERE STATE l,"/ REQUIRES that the Electrical work be done by an'-Electrical Contractor, the electrical portion of this permit shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division 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 fm OCCUPAflCY 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 7nl.055 will be used on thi~ject. NAI-IE(please print) ...j \ "^-' R...o s ~ SIGNATURE ~~) ~ ~ DATE FO~ OFFICE USE mIl Y I \ Zone Type/Canst. Units Sq. Ftg. f1ainV x Value Fire Zone Bedrooms Occy Load Sq. Ftg. Access x Value Flood Plain Stories Occy Group Sq, Ftg, Other;.1'G:,~.......-:>x Value Y'75i'<? TOTAl VAlUATION BUIlDING PERfllT Charges and Surcharges ~ Plan Ck. __~Q.,$~__ 65%/Bldo ". Plan Ck, .--::? -S,;;i' 30%lBI do I Fence ------------ I Demo ISidewa 1 k ------------ .IA/C Pavin9 ....... I Curb cu;- ------------ I COIllll/! nd PJ'r Fpp Res Per Fee Systems Development Charoe tl. 5%) PlUt1BING PERMIT Charges and Surcharges ElECTRICAL PERI~IT Charges and Sur~~arges MECHANICAl PERMIT Charges and Surcharges Total Comb. rermit TOTAl 53.03 . '''. '. . . , " , j COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATIDN I, Applicant to furnish A, Job Address B, Legal Description 1, example. Tax Lot 100, Lane County Map Reference II 03 43 2, example- Lot I, Block 3, 2nd Addition to Sprln9field Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. examJPle- heat/electrical ceilinqjor forced air qas 2. examole- waterheater/electrical/or solar E. Square footage or valuation, etc. ----- I. .examole- 1250 sq, foot house, 500 sq, foot garage 2. examole- if new project. check-new - if addition. checlc add, etc. F, Building permit information: 1. examele - construct single family house with an attached garage 2. exam~le - 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 (al 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 Plumhing, 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 DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES 0, 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. ~ /lcprlY /~8~7 /I" ,v ?-I% lIS i? (/~ /2~-7(7 ::;:> " V, FOR OFFICE USE ONLY Permi t Clerk~.s>.._ ~_? . /' ... PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: . Additional Project Informati'on: name ~~/Ve~~~signature _/1 ~.....j~date /-;;;:-f"'"3'tC> PLANS REVIEWED BY: