Loading...
HomeMy WebLinkAboutPermit Building 1984-12-14 " lINSPECTION LINE 726-3769 - Job Address blS /)(~ .41. Le9al Description )1(}~~ jfJJ// \'-Hf.l')~~~\ rJ..:\~ Owner ~ A tii-j.Po 1 _ Address -? I \ - u"" n ._~ \}/ ",; , ~DLIJ Cf7'f77 Construction 'L~nder CITY U; SPRINGFIELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Meat Hater Heater , lNFORl1ATIDN liNt 726-3753 Sq, Ftg, I~ain ~q. Ftg, Access, Sq, Ftg, Other New Add Alter Pep, --Fence Oemo Change/Use Other-- -- . - ~ Range Phone 7'1 J. 7S 39 valUEJ! Hork: 29rJo.oo. BUildinq Permit Info: Deser be Work{i.e., Build Single Familv Residence With Attached Garaoe) JLui ~.J> (l1I/'I~ If A.Ugj-<~ U ~ ~ l./,ICoO.t:9r. (l i CS.. no..) (axoi res) I (ahona no. I 0- 0- 00 C) ::J- \)0 Address Ut"GN TEAI1 (name) Phone (address) Primary Structural Electrical Meehan; ca 1 CONTRACTORS . (namel General o.1X7~aP.f/ ~ " (address) (1i~s. no.) .R(l1J JJ. ~.;3ZS3 c'-ST, 'vI ' (pxnirpsl (ohnnp nn 1 "/ '/6-57~ Plumbino Electrical Mechanical PLUllB I NG ELECTRICAL MECHANICAL NO. FEF rHARr.F Nn 'OFF r"8.B.Iif..Jln n.~ ru~ Each single fixture Residence of SQ, FT, furnace/burner to BTUls Relocated building (new fix, additional) New circuits alts. or extensions I Floor fu rnace and vent Recessed wall ~n~rp hp~tpr Anrl vpnt S.F. Residence (] hath) Duplex (1 hath) each SERVICES ~Iater service ITemporary Construction IChange in existing rp~ j dp'nr'~ Imultifamily, camm. or Inrtu<:.tri<'ll 10f amps,1 ICOMfl,/INO. FEEDERS IInstall/alter/relocate I rli<:.trih, hprlprc:, 10f amp5-1 Appliance vent c;eoarate Stationary evap. cooler I V"ent fan wi th sinole duct I'Vent system apart from heatino or A.C. I Mechanical exhaust hood olnd durt I Hood stove/heater I I I Additional bath Sewer Storm Sewer I SSUANCf OF PFRllIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L,\l~ REQUIRES that the Electrical work be done hy an,'Electrical Contractor, the electrical portion of this permit shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division Zone Fi re Zone Flood Plain 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 oerformed 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 110 OCCUPAHCY 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 ORS 701.055, that if exem the basis for exemp' . n is noted hereon. and that only subcontractors a~mpl0YeeS who ar~P1iance with ORS 701.055 111 be used on this oje . IW1E(please print) H J..,J.,BrJ L DAVI ~ SIGNATU ~,tI DAT/>-jc.flf'!... FOP. OhICE USE DIlLY Sq. Ftg. riain Sq. Ftg. Access Sq. Ftg. Other Tyoe/Const, Bedrooms Uni ts x Value Value Value Stories Occy Load Occy Group x x TOTAL VALUATION BUILDING PERfUT Charges and Surcharges . -:> 't """" . Plan Ck, Conm/lnd ____~_ :..____....Q2I/Rldo Ppr Fpp ~/' Plan Ck, Res r/rP 30%/Bldo Per Fee Fence 15". G>b syste.rns Development CharQe tl,5~) . PLU!~BING PERMIT Charges and Surcharges 0"'0 I I I ITota' Comb, Permit I I TOTAL tlt.jO,;>b ELECTRICAL PERIHT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges 'Sidewalk A/C Pavi ng I Curb Cut ------------1. , ?<-!oMfI - . ----... 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 II U3 43 2. examole- Lot I. Block 3, 2nd Addition to >pr,ngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examp-le- heat/electrical ceilinqlor forced air Qas 2. examole- waterheater/electrlcallor solar E. Square footage or valuation, etc. ------ I, examole- 1250 sq, foot house, 500 sq, foot garage 2. example- if new project, check-ruew - if addition. check add, etc. - F. Building pennit 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 3D3 (a) of the Structural Specialty Code H. DESIGN TEAM AND CDNTRACTORS 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 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 Plumbin9, 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 Q, 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 lahel, --- 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. (JJ la/;<I/~ '(Ji!- b 3 f/97 V, FOR OFFICE USE ONLY Permit Clerk fJtL . 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 signature date