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HomeMy WebLinkAboutPermit Building 1983-8-4 ~ INSPECTION LIIIE 1726-3769 . CITY Uf SPRINGfIELD COMBIilATION APPLICATION/PERMIT E!1ERGY SOURCES: Heat t~ater Heater Range . INFORlIATION LINe 726-3753 Sq. Ftq. 1.lain ~q. Ftg. Access. Sq. Ftg. Other Ilew Add A Iter Pep. Fence_Demo _ Change/U se _Other Job Address 7"11 M~ Legal Description \ -, r,-')?"S 'YL ()'14(l) , I Owner .r;~r~ke.hJ y~..-z;;_ ~r~ . - 7-7'"-- " Address .s; ~~ 747:;;-:J4~hane ValJ!! of Hork: c>-c.- J:;f '7177- BuiidinQ Pemit Info: Describe \~ork(Le.. Familv ~es;dence With Attached Garaael Build Single 0() ()J - ...D uJ ~ ~ Construction lender '7..eA'-4' n../~ J h~.-.e-~r.""',....-u- '>~- v ~~-"- '? 20 .,....~ ~ J! Address DE~ I GN TEAll (namel Phone (address) (1 ics, 110.1 (exoirFlc:.) (ohane no.l Primary ~ \If Structural Electrical Mechanical CONTRACTORS (name) (address) flies. no.) (exDires) 11/4/n. (nhonp M_ 1 General .li'D ~ /{rYo-r/,u,,;. / /1/C. -::z.w't)74 c;.;)(OW A1:J .t:f no"? ~c.e- o/'l'Jf~ 7- U4()2,1'1' Plumbinq Electrical ~1echanical PLUIIBING ELECTRICAL MECHANICAL' --1JQ." FEF rHARr., 'Ir' ~~~ r~~ NO ':.EL ..cJiARGE Each single fixture Residence of SQ. FT. furnace/burner to BTU's / I Relocated building (new fix. additional) IS.F. Residence (] bath\ IDuPlex <I bath) each IAdditional bath Irlater service I Sewer I Storm Sewer New circuits a1ts. or extensions Floor furnace and vent ISERVICES 1 Recessed wall Sl'lr'lrp hpiltpr ilnn I/pnt ITempOrary Construction IChange in existing rp'l i r1J'Jlrp Imu1tifamily, comm. or Inrluc:trial IOf COMM./INO. FEEDERS Install/alter/relocate r1;c:t.r;h fpprlprc: amps.1 1 I Appliance vent c:.t:!oaratp Stationary evap. cooler Vent fan with c:ino1e duct Vent system apart from I heatina or A.C. Mechanical exhaust hood and rluf"'t Wood stove/heater IOf 1 I I amps.1 ISSUANcr OF PFRIIlT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L\1~ REQUIRES that the Electrical work be done by an.'Electr'ical Contractor. the electrical portion 'of this pemit shall not be va1iJ 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 al' work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Orel]on pertaining to the work described herein, and that NO OCCUPAllCY 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 exempt the basis for exemption is noted hereon. and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. IWIE(please print) M I r: 1/ A E I- ,l[f)V A"1?E" SIGUATURd~......../ /f~..r/L.-,. FO~ OFFICE USE OIILY So. Ftg. 'Iain Sq. Ftg. Access Sq. Ftg. Other DATEffh/r;-3 Zone Fire Zone Flood Plain Tyoe/Const. Bedrooms Units Occy Load Occy Group x Value Value Value x Stories x TOTAL VALUATION BUILDING PERfIlT Charges an~ Surcharges _____L8JJO I./~ Plan Ck. Comm/lnd 6S1/Bldo P~r Fee Plan Ck. Res 30%/Blda Per Fee Systems Development Charqe 0. 5~) " PLUtIBING PERMIT Charges and Surcha rges Fence I Demo I'Sidewa 1 k I A/C Paving I Curb Cut I I ELECTRICAL PERI:IT Cha rges and Surcharges MECHANICAL PERMIT Charges and Surcharges ITotal Comb. rermit I 'I I I TOTAL $Zq.IL ~ . . . . . . ,; COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description I. example- Tax Lot 100, Lane County Map Reference II 03 43 2. example- Lot I. Block 3, 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinq/or forced air qas 2. example- waterheater/electricalJor solar E. Square footage or valuation, etc. I. example- 1250 sq. foot house, 500 sq. 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. exa~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. DESIGN TEM1 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 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 fu 11 schedu 1 es 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 ~ivision 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. 'l,yXS '0 ~~ V. FOR OFFICE USE ONLY Permit Clerk (0 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: I ,'". name signature date c