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HomeMy WebLinkAboutPermit Building 1984-7-24 . . 1l1lSPECTI01I lItlE CITY UF SPRIIIGFIELO 726-3769 COMBIOIATION APPlICATION/PERMIT Job Address :~2> \ ~(\ ~ f\ Jtr ~ ~~;~GY SOURC~: Legal Oescription r-'\ Q~:~S'3 \ - \~ !-later Heater' 'ci- Ranqe Owner \---\ <>\ ,1<.. , ~~0 \C.J Address cQQn ~ C' f)~ )\("1 ~O\ Phone f l ,(\Ql'\Q . ~ \':, . C{l=:\()\ Construction-len~r \ Address Ut:.~lliN IE.AH Primary Structural Electrical INFORlIATION liNt 726-3753 Sq. Ftg, '.Iain ~q. Ftg. Access. Sq, Ftg. Other --1lew__AddJ<tnter-"~ep, Fence Demo Change/Use va~r I-IrtL((().CO, Other-- -- BuilriinJ Pennit Info: Describe Work(;..e.. Build Single Familv nesidence With Attached Garaae) :-'i\..)J\O\.Y\.. -t\ ~ ,~ \.\_~ 0I\Q t"t\ '\ 0G .~~~ . flies. no.) {exnires} (Dhorll~ no. I ~ ;, lname) Phone (address) Meehan; ca 1 CONTRACTORS (name) (address) General ",~D\ 1 :r\f\~'~ \[\~ ~cl-{" \\<7_ X\ Plumbino \~ ~ "i:"\J Electrical ~a.. ~ r~ ~ .~~ "echanical .('~~ -C\ ~\.\ PLUIIBHIG \) -1!Q.,. Each single fixture (lic~\no.) !J.A ~ ~\- ~ Q f) 't\ {\e'\J ELECTRICAL (j FEE CHARGE Nn ... r~ NO, Residence of Relocated building (new fix, additional) / D.Cf. SQ, FT, New circuits alts. or extensions I!emporary Construction IChange in existing r~s_i d~nce . Imultifamily. comm. or I industrial I -.SIOf r9tJ<j:r.- amps{..OS'I7S/ I ICOMI-I./IND, FEEOERS I I I I I.~~~;~~~~a~;:~~~~locate I I I I IOf amp~1 I I I I I I I I I I I I I J ISSUANCE OF PFRlm /0,00 TOTAL CHARGES fl. '5 ~ TOTAL CHARGES WHERE STATE L\H REQUIRES that the Electrical work be done by an"Electrical Contractor, the electrical portion of this pemit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division IS,F. Residence (1 bath 1 louplex (1 bath) IAdditional bath Iwater service I Sewer IStorm Sewer I I I I I I TOTAL CHARGES SERVICES each ?R J I~ I~ I ) t~ilO~ ~ (-)4"~I()ro\ "'-"\lJ " MECHANICAL furnace/burner to BTU's m,...JQiAIlliE. \(\~ Floor furnace and vent Recessed wa 11 Sn~cp hp~tpr And vpnt Appliance vent S~P!H.ate Stationary evap. c.Qo 1 er Vent fan with sinole duct Vent system apart from I heatinq or A.C. , I Mechanical exhaust I hood and duct I Hood stove/heater I I I I I I I' I(),CC I HAVE CAREFUllY EXAMINED 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 oerformed shall be do~e 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 NO OCCUPAI~CY 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 exe t the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with OPOS 7Ql.0 wi ~p ~on this project. ~ IlAl-IE(please print)Ci&-lN f(~~j,.(,(A.flfj L\...- Zone Fire Zone Flood Plain BUILOING PERl-IlT Charges an~ Surcharges PLU'1BING PERMIT Charges and Surcharges ELECTRICAL PERI:IT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges Tyoe/Cons t. Bedrooms Stories SIGfI 'RE FOn OfFICE OSE OIILIY,' / Sq~ !lain Sq. Ft~. Access Sq, FIg, Other Units Occy Load Occy Group~~ __\jCQ~_ ~~~~Ri~~ ~ Plan Ck. , 30%/Bldo ...__LO_.~_ Fence ,4'D Demo ___~-S~- Sidewalk ~ ,c--r: A/C Paving -___\O_,_~I Curb Cut "N . Conrn/l nd Ppr F'PP R-es Per Fee OATE.;l~~\f'~ . , .x x Value Value Value x TOTAL V ALUA TI 011 Systems Development Charqe (1.5%) . I I I ITotal Comb. Permit 1 TOTAL ~rA ,0 J . . ~ , . -' COMBINATION APPLICATION/PE~~IT (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, examole- Lot I. Block 3, 2nd Addition to Sprlngfield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. exam~le- heat/electrical ceiling/or forced air Q3S 2. examDle- waterheater/electrlcal/or solar E. Square footage or valuation, etc. ------ I, examole- 1250 sq, foot house, 500 sq. foot garage 2. example- if new project. check-new - if addition, cneck add. etc. F. .Building permit information: 1. "example - construct single family house with an attached garllge 2. exam~le - remodel existing garage into family room 3. examole - 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 8. 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 signa ture. 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. I ~ ~'h~ . \\'~ . '8\ \.Q ~')) V. FOR OFFICE USE ONLY Pennit Clerk ~'J(D . PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Infonnation: , PLANS REVIEWED BY: name signature date