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HomeMy WebLinkAboutPermit Building 1984-01-31NSPECTIOII L IIII ?6-37 69 CIIY OF SPRINGFIEIT COHBI iIATI ON APPL I CATION/ PERMIT i,ti 726-3753 Job Address 2 EIIERGY SOURCES Hea t llater Heater q. Ftg. l'lain_ 5q. Ftg. Access.-- Sq. Fto. Other_ _l'lew_Add_A1 ter_Pep . _Fence_Demo Change/Use 0ther IN P Lesar Descrietion \\()A 3: aa ft}ffi, Value of l.lork: ISSSrooo0wne"Eoqtrr cue\\\cur c- Address to\x\\ els\Phone Buildinq Pernlit Info: Describe llork(Fanrily Residence l,lith Attached Garaoe .e., Build Single -trQB,tlcF\R--r)T*rtX Eu/cloSqze beoat (trwrcn- Construction Lender P,eg -a,la /.) @z& 97ru STkuciuzz Addres s Phone 8/ Buft4 rVNuF,4 tr42/^/O CO . I]E5 GN TEAI4 name address I ics. no.exot res phone no. Pri ma \(\rtsss c \\\ \l\+sr*.r..,p r Structura I EI ectri ca l i'lechani ca l name addres s lcs. no.exD l res ohone no. Genera I P \ r\s\\\B.F Bcx is-,q r-g,rl -Qr-\r\s Pl umbi no E I ectri ca l l,lechani cal PLUl,lB I NG ELECTRI CAL MECHAN I CAL FFF CHARGE NO FFF NHARG F NO FFF CHARGE Each single fixture Residence of SQ FT furnace/burner to BTU' s Relocated building (new fix. additional)New circuits aits. or extensions Floor furnace and vent S. F. Res idence(l bath)SERV I CES Recessed wal i Soace heatpr and vent Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent seDarate Change in existing res i dence Stati onar.v evap cool er Sewer multifamily, comm. or Industrial Vent fan with sinole duct Storm Sewer 0f s.Vent systern apart from heatinq or A.C. COMII./IND. FEEDERS Mechani cal exhaust hood and drrct Instal I /ai ter/rel ocatedistrib. feeders l,Jood stove/heater 0f amps. ISSUANCE OF PFRI1IT TOTAL CHARGES TOTAL CHARGES WHERE STATE LAN REQUIRES that the Electrical work be done by an Electrical Contshall not be vali'l until the label has been signed by an Electrical Superviso. inJ ractor, the electrical portion of this permit returned to the Building Division Y EXAIlI N ED c0mp e te appl i ca'and all' Oregon the Buil tion for permit, work performed hereb.y cert 'I fy tha t a l nf 0 rma t '|0n hereo n 1 s truendcorrectandIfurthercert1fythatanyshaIIbedoneInaccordancew1+h the 0rd 'I n an ces o f th e c '|tyofspr1ng fi e I d a nd the Laws f th e s ta te o f pe rta ,l n 1 s to the wo rk d es crl bed here i n a nd tha L l,lc OCC UPAI.I CY wl I I be ma deofanystructurewithout the permi force and effect 'I of d 'I vl 'ls0nngDis on I fu rt he r cert t fy t ha t my re g '|stra t I n l.rI +h the Bu I I der I SBoard1tnfuIIasrequ'I red by 0Rs 701 055 tha +1 f t the ba s '|s fror exempt 'l 0 s no ted hereo n a nd tha tIbctractorsandInvsu0nernpoyeeswhoareIncomcI'I a nce t{l th ORS 7ot 'I I be us ed 0n th 'l s p roj ect rE/A/rttlAtlE(please print)SIGNA USE-di.ll Zone $r\- fyoe/Const ts So . Ftg. l,lain x Val ue Fire Zone =_ Bedrooms -- 0ccy Load Sq. Flood Plain -- Stories \ - 3Q,'\-R\ 0cc,y eroupF-$__Sq. Ftg. Access Val xr Val TOTAL VALUATION 1I$3\\5\ Ftg. 0ther BUILDING PERNIT Charges and Surcharges _t!2_ G B--- Plan Ck. Conrn/Ind 65%/Bldq Per Fee terns opmen \)\ PIan Ck. Res 30%/Bldq Per Fee PLUI,IB ING PERMI T Charges and Surcha rges Fence Dgmo ELECTRICA,L PERIlIT Charges and Surcha rges Sidewal k A/C Paving Total Comb. Permit I,IECHANICAL PERMIT Charges and Surc ha rges Curb Cut TOTAL \q\ GB RAC I(]R5 llater service TOTAL CHARGES COMBINATION APPLICATION/PERNIT (CAP) I. Applicant to furnish A. Job AddressB. Lega l Description l. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, 2nd Addition to SpTiffiield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/2. example- water Square footage or air gas E II. 1. 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. example - remodel existing garage into family room 3. example - convert single family residence into ilestaurant (change of use) G. Value of work as defined in Section 303 (a) of the Structural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or iob site corrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occulin the description portion of the Mechanical and Electrical Schedules, the appficant need fill-in only the No. Boxes adjacent to the appropriate item(s) to be installedB. Full PIumbing, Mechanical, and Electrical Schedules are available at the Building Division 1, To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the ful l schedules C. EUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be de'livered to the electrical contractor for signature by his electrical supervisor. The general contractoris not authorized to sign the electrical label. Applicant to sign and date l,lhenever possible, the initia] application will be used as a worksheet only. Where possible, Buiiding Division Staff will prepare a type written copy and return it to the applicant at the time the actuai permit is issued for his s i gna ture. Fees and Charges PIan 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. III IV V. FOR OFFICE USE ONLY PERMIT VALIDATION u-/ Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Informat'ion :\ I lF \\tl ?, \S s.I <'\-*l't' PLANS REVIEWED BY: /."/& f/?'6 S1 gna tu date q \\ e t \.T' .e$.R?$\[,', Tl.B IIISPECTIOII LIIIE726-37 69 CTTY OF SPRINGFIELD COI1BI iIATI ON APPLI CATiON/ PERMIT INFORIIATION LINE 726-3753 Job Address G t C> 1ou tH 7 All> Lesal Descrintion\ll Cta \S \ -.- ,i$.:-.:.l.later Heater Ranqe lue of l,lork: tt,€o7a EIIERGY SOURCES Hea t (0wner borzt>ttL( CL\nrrrtc-a L- Cc> So. Ftq. l''la in_ Sq. Ftg. Access._ 5q. Ftg. Other_ l,lew_Add-Al ter ,9ep. _Fence_Demo Change/Use 0ther PhoneAddress uta gouTt-f zAP scr Farni I dence tli th n e ng e 9?ZLruzt n I KLr-)Tnu-( Fo u,.{ D /l ? r 614 <, Construction Lender lfu rat< -Phone 9<UlL i.j -a name address 1CS. nO-exDl res phone no 342fttt N L Hechanical El ec tri ca I Structura l Pri CONTRACTORS name addres s Iics. no.exD 1 I'es ohonp no- ) Eu lo >lL60b c IPI Genera I A^f1 f'lechan ical PLUI{BING. -r I \\ lt i\.ELEcTRTcAL \"jlL MECHANTCAL \ \ lL ..FEE CHARGF NO FFF CHARG F NO FFF CHARGF Each single fixture Residence of sq. FT furnace/burner to BTLI' s Relocated building (new fix. additional)New circuits aits. or extens ions Fl oor furnace and vent S . F. P.es i dence ( l bath)SERV I CES Recessed wal I Soace heater and vent Duplex (l bath) each Additional bath Temporary Constructi on Apo'l iance vent seDa ra tc l.later servi ce ge in existing dence C han res i Stationary evap, cool er Sewer multifami ly, comm Indrrstrial or Vent fan with sinoie duct Storm Sewer 0f a mps.Vent systern apart from heatino or A.C. c0Mr.1./IND. FEEDERS Mechan i cal exhaust hood and duct Instal I /al ter/re1 ocatedistrih. feedprs l'lood stove/heater 0f s. ISSUANCE OF PFRIIIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES TJHERE STATE L.{tl REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this perr,ritshall not be vali'l until the label has been signed by an Electrical Supervisor and returned to the Building Division n oertaining to the work described herein, and that NC 0CCUPAI{CY wili be apP and Ci ty made' 0rego the Bu exemp 055 wi --;\ P I HAVE CAREFULLY EXAtlINED the completed 'lication for permit, and do hereb.y certi fy that all information hereon is trueand correct, and I further certify that anyof Springfield and the Laws of the State oi all work performed shall be done in accordance with the Ordinances of the sion. I further certify that my registration r.rith the Builder'sof any structure without the permission of ilding Divi Board is in full force and effect as required by ORS 701.055 , that if t the basis for exemption is noted hereon, and thatonly subcontractors and ernployees r.rho are in compliance with ORS 70i.'I I be ed on roj ec t t{AtlE(please print)tL 7 zvftrzft S IGNATURE /4141 Fire zone Bedrooms 0ccy Load-* Sq. Ftg. Access x va1 l4ain Val ue \ a f--.'Value TOTAL VALUATION x x llp Uni ts FtgFlood Plain Stories Occ.y Grou Sq. FtgTYPel ConsZone i 0the * Plan Ck. Conrn/Ind 65"/./B1do Ppr Fpc I 'A:C.es .Q{Svstems Deve charqe tl.5c opmeot 5n(.,.25BUILDING PERI'IIT Charges and Su rcha rges _\39_OC> tr 6(p IPlan Ck. Res 30%/81dq Per Fee Lo\qt.rq FencePLUI4BING PERMIT Charges and Surcha rges D6mo Sidewa1kELECTRICAL PERIIIT Charges and Surcha rges A/C Paving Total Cornb. Permit Curb CutI,IECHANICAL PERMIT Charges and Surc ha rge s 8t5CTOTAL Addres s I IAI,1 d'-- I COMBINATION APPLICATION/PERIIIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot l. B'lock 3, Znd Addition toS[iffi!"Field EstaresC. Name, etc. of owner and construct.ion IenderD. Energy Sourcesl. examDle- heat/2. example- waterE. squaFET66Tase or el rca eili forced air gas or solar valuati on, etc1. example- 1250 sq. foot house, 500 sq. foot garage2. examtier lT-new project, cheik-new - it aooitioi, check add, etc.F. Building permit information:l. example - construct single family house with an attached garage2. example - remodel existing-garage into family room3. example - convert single family residence intorestaurant (change of use)G. Value of work as defined in Section 303 (a) of the !!tygtrtal Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriate persons regarding design information or job sitdcorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Hechanical and Electrical Schedules,the applicant need fil'l-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Piumbing, Mechanical, and Electrical Schedules are available at the Building Division1. To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful l schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical label. Applicant to sign and date l,lhenever possibie, the initial application will be used asa.worksheet otrly. Where possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his s i gna ture. II III IV. Fees and Charges Plan check fees are due andapplication, and no plans wi fees are paid. All other fe payable when the permit is i V. FOR OFFICE USE ONLY ayable at the time of the 1 be processed until these es and charges are due and ssued. p 1 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: \r P\- PERMIT VALIDATION GPoaA ,-'rA-gbIU- Permi t Cl erk A S\ Permit app'licant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: s'ignatu datename .{=>rl 'r t\D*-i \ 0"^"