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HomeMy WebLinkAboutPermit Building 1986-10-7 I IrISPECT 1011 LINE 726-3769 . ~@, CITY UF SPRINGFIELD . INFORlIATION LltOl COMBIIIATION APPLICATION/PERMIT 726-3753 E!IERGY SOURCES: Sq. Ftq. I"ain Heat ~q. Ftg. Access. Ilater Heater Sq. Ftq. Other Ilew Add A I ter Pep. Ranqe . -Fence Demo Change/Use ;t505'~. I-Other-- Builriina Pernlit Info: Describe Work(i.e., Build Single Familv nesidence With Attar.hpd G~raop) ~()II ) f?nr-.~'~ ,- - ('j L 1 a... \ 9,7-(, S~ Job Address f?"(O 25 maJAu Owner ih~i7J0tw \.lk.fJ ~ 1f7~ 3' Jd/J ~ Phone 1cJ 1 5371/ CXl b ~ ~ UJ legal Description Address Construction lender Address Ut~Jl.iH ltm, (namel Phone (address) (1 ics. no.l fexoirfl's) (ohone no.l Primary Structura 1 E1 ectri Cd 1 Mechanical CONTRACTORS Inamel General (DODO OL I6D'--IC, (address) (lire; no.) (pxo;rpc:) lohnnp no. \ ~(JFI AJ c.., Plumbina 1\._ ~ Electrical ~'echan;cal PLUIIB I NG ' ELECTRICAL MECHANICAL NO, FEE Each single fixture CHARGF Nn I I Res i dence of SQ. FT. INew circu~ts alts. or extenslons 1 SERVICES 1 ~~~ I r~ARr.~ NO furnace/burner to STU' s 1 ~~~ r~ARr.~ Relocated building (new fix. additional) Floor furnace and vent S.F. Residence 11 bath) IOuPIex (1 bath) each Additional bath Recessed wall ~n~rp hp~tpr ~nrl vpnt ~Iater service ITempOrary Construction Change in existing rpc;.;rlpnrp multifamily, comm. or Tnrluc;.tr;al Storm Sewer Of amps.1 Appliance vent spoarat.~ Stationary evap. cooler Vent fan with sinale duct. Vent system apart from heatina or A.C. Mechanical exhaust hood and duct. Wood stove/heater Sewer : 1 1 ,I I I COMM./IND, FEEDERS Install/alter/relocate rl;c;.tr;h_ fpprlprc;. Of amps.1 TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be valid until the TOTAL CHARGES that the Electrical work be done by an label has been signed by an Electrical ISSUANCf OF PFR!IIT TOTAL CHARGES Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFULLY EXM1INED the completed aprlication for permit. and do hereby certify that all information hereon is true and correct, and I further certify that any and all work oerfonmed 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 f~O OCCUPAIKY 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 com51iance with ORS 7Dl.055 will be used on this project. Zone Fire Zone Flood Plain Tyoe/Const. Bedrooms Stories Units Occy Load Occy Groun SIGIIATURE~ FOr. OFFICE USE miL Y Sq. Ftg. riain Sq. Ftn. Access Sq. Ftq, Other ~ OATEltl'7- rj, NA/,'E(p1ease print)keHe /;51;,;,1'1" x Value Value Value x ,x TOTAL VALUATION BUILDIIlG PERIIIT Charges and Surchargesj tr::f '--'" Plan Ck. 01o.~ 65%IRldo -------c:?~~-~ ~b~~Bi~~ Fence Conmll nd Pf>r Fpp Res Per Fee Systems Development Charqe (J.5~) PLU'1BING PERMIT Charges ana Surcha rges! ELECTRICALi PERI~IT Cha rges an(l I Surcha rges! MECHANICAL! PERMIT Charges and Surcharges ;. Demo Sidewalk A/e Paving Total Comb. rermit Curb Cut TOTAL S~ ,r-; to . . .' COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description ... 1. example- Tax lot 100. Lane County Map Reference II 03 43 2. exampJe- Lot I. Block 3, 2nd Addition to Spnngtield Estates. C'. Name, etc. of owner and construction lender O. Energy Sources 1. example- heat/electrical ceilinq/or forced air qas 12. exampJe- waterheater/electrical/or solar E. Square footage or valuation, etc. ------ 1. examole- 1250 sq. foot hOus€;,SOO sq. foot garage 2. examole- if new project. check-new-- if addition, check add, etc. F; Building permit information: 1. example - construct single family house with an a ttached garage 2. exam~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 TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact apprapriate 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 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 Division Staff wi:ll 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . PERMIT VALIDATION ~6dJ 225: t 0- / - g 0 Permit Cl erk Q2/ , Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature I date