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HomeMy WebLinkAboutPermit Building 1984-3-28 I !rlSPECTIOti LWE 1726-3769 Job Address <r-<i C') 71 \\ ~\" \ S\\? r- H Legal Description \"\-a~-';\'5 -L\ L Owner\\, \\n.>.\\'\s' "\. ,\-\"\:r-.0\(3\') \\r'i'q,~S. Addre'W ~ ~ '\\ ~ '\.\.. '\ <;:..;, ~ r-;F.\ Phone 1~-:-, ..JOJ~'" \\ ~ \( \-\1'\\ ~(' ...n,,~1..,> - 'SL 'P\ Construction Lender\ '()\ \F, 'tr. ,.. Address Ut~lur. 1f.m-1 ~ -. ~a "'I INFORJIATID:i ':'~ 726-3753 SQ. Ftg. 1,Iain ~q. ~t9. Acc,ess. Sq. Ftg .".mher -'lew L1\'dd..Jol ter _Pep. Fence Demo Change/Use -Other - -, - ""''-{,/)~l'lI d0 ..c:::. o - oJ rv CITY UF SPRINGFIELD COtIBIiIATION APPLlCATION/PERMIT EilERGY SOURCES: Heat (,)~~\aJ Water Heater Ran~e \J\~ ValUE of Hork: \\,~ Buildina Permit Info: Describe Work(;-.e.. Build Single Family l'Ies;dence Hith .A.ttached Garaae) ~~ ~'""'\("\.\ \=(") '\L. \. \HD ~'C')'C'"'\'\\'\,-.,\." C'\ \J\. '-II (name) Phone (address) (ohone no. (1fe5. no.) (exniresl Primary l \\. 'Ie'..... ~ ~s..q' , ~ SlP"\?N'') Structural Electrical (oS\ ~.\.l\ ~WV~\ CC')'\\'Ju.ll \~ Mechanical CONTRACTORS I name) (address) General\.l...\,\.l ,~~ ~ '\.~'- W~'\.\..'& Plumbina Electrical ~1echanical NO, flies.nn.) (~xoirps) (nhnnp nn 1 'll\ '1, --:\~'1~ 9(,,;\ '\-\~" '\~ S.V~\<\' PLUf1BING \\.~ FEr CIIARr,F 'IP \\,~ ~1~ ~-~Rr,F NO ELECTRICAL MECHANICAL Residence of furnace/burner to BTU's Each single fixture SQ. FT. ... Relocated building (new fix. additional) S.F. Residence (1 bat.h] Duplex (i bath) each Additional bath Water service Sewer Storm Sewer New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall ~n~rp hp~tpr ~nrl U~"t Temporary Construction Change in existing reo~5r1.?.ncE' multifamily, COJml. or Tnduc:.trial Appliance vent ~~Da ril. t~ Stationary evap. coolE'r Vent fan wi th sinole duct Vent system apart from I heatina or A.C. I'Mechanical exhaust 1 hood and dUI" t. l Hood stove/heater l II 1 I I I Of amps.1 COffi1./IND. FEEDERS Install/alter/relocate dic:.trih. fpederc:. Of amps. I I I I ISSUANCE OF PER/lIT TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES , WHERE STATE LAW 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 oerformed shall be done in accordance with the Ordinances of the City of Spri ngfi e 1 d and the Laws of the Sta te of Oregon perta i n i ng to the work deseri bed herei n, and that IW 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 compliance with OP.S 7Ql.055 will be used on this project. IWIE(please print) Zone c..C Fire Zone Flood Plain BUILDING PERflIT Charges an~ Surcharges PLU'1BING PERMIT Cha rges and Surcharges ELECTRICAL PERr~IT Cha rges and Surcharges 11ECHANICAL PERMIT Charges and Surcharges Tvoe/Const. ~- \.:} Bedrooms Stories SIGflATURE FOr. OFFICE USE OHLY Sq. Ftg. Sq. Ft9. Sq. Ftg. r1ain x Value Access x Va 1 ue Other..fu~('\~O\..)\~ Value \\,~ J...J TOTAL VALUATION \",~~.~ DATE Units Occy Load Occ.. Group~ '2... 't \\-~ 'L ~ 1<2'2.LlC? ~--g~'7_\ -qll Systems Development Char~e (!.5~) , ~\\~ \.T\'\I.\l:ii\\'\G '7'\"I?-F. ~,~ '?-I=: -;r,f;1r- ":.C!)UII.l. rr- C:l';: Vc=\-\~\~ \~~..)k ~r-:Q\-\,,~ I ' I I I ITotal Comb. rermit I I LT~TAL 1'0 00 Plan Ck. CorrmlInd ~. 65%/Bldo Ppr F~e -----()--~a-- Plan Ck. Res C-- 30%/BldQ Per Fee --\J~-~----_ Fence Demo --~-t ~ __~\~\-___J Curb Cut I Sidewalk A/C Paving Co 2. ~o ,e . ... " --, '" 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 03 43 2. example- Lot 1. Block 3, 2nd Addition to >prfngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examele- heat/electrical ceiling/or forced air Qas 2. examyle- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - 1. examDle- 1250 sq. fODt hDuse, 500 sq. foot garage 2. example- if new project, check-new - if addition, check add tete. F. Building permit information: 1. example - construct single family house with an attached ga..ge 2. example - remodel existing garage into family room 3. examole - convert single family residence into restaurant (change of use) . G. Value of wDrk as defined in Section 303 (al of the Structural Specialty CDde . H. DESIGN TEM4 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 ND. Boxes adjacent tD the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Division I. To conserve space on the permit form the schedules have been abbreviated 2. If the item(s) to be installed are not cDvered 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 Dn the CAP, the label must be deli~ered tD the electrical contractor for signature,by hjs electrical supervisor. The general contractor is'.not authorized to sign the electrical label. --- III. Applicant tD 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. V. FOR OFFICE USE ONLY Permi t Clerk II PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because': Additional Project Information:"\\,~<i; \?r-:\?Y\.,'" \ s.. ,\-<">'V "\ \~R- \.=ri..)~ ")~~'()\" ()\.. ,,\~ _ ~D~\\\r)~)~ \=>1=i'\2..t'\\T'=t.. '\(') ~e - .- -- ()W~\.\~r-X-'.. \?..E'R)'Vf= \.uCl';;>" '?~(r-:FDs:.. \?,p...U'..)\.)~ ~'\ \...) G. l\. ,-()~ ~ C') ~:\'" \.()"- """ PLANS REVIEWED BY: I nam~'\::::~~..'l'\\) '\={ )P.\ \\' SignaturUA ~,--y- 'date ~~-~C\ ,