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HomeMy WebLinkAboutPermit Building 1989-3-10 I INSPECTION LINE 726- 37 69 . CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat \~ater Heater Ranqe_ Valuf of Hork: . INF0R11ATION LINt 726-3753 Sq. Ftq. 1,1a i n ~q. Ftg. Access. Sq. Ftg. Other New Add Alter- I~ep. --Fence Demo Change/Use Other- - ~ ~ ~ Job Address '20.:;0 /77A'Rc:.4<;1L- );:-2:> . Legal DescriPtion/7-&'~'2.~~ .7/.,;7...1' 9~ Owner ,h0L.~~X/ fr~;P~7/r5 "":/.W: Address '7.?d XI' ~.... fic,,'-"'7'\.l)<;> Phone ;:z.=",-,,< ' L7.A> - 972/'/ Construction lender I' BuiltiinQ Penmit Info: Oeser.be Workll.e., Build Single Familv Residence With Attached Garaoel ~ hv5':i!1'k ~ ~ . . ~:!7.?..aoL~ <n>. ~~~~ Phone &~ ~ JJ;-/~L.Z?/~ )-!')',v> . (address) 111cs. no.) (exnires) (ohone no.l ?'f7/ '<;)F'!P-~. ::;'6' . PrimaryW-"'5r~.-'-~,-/N,B~/~~. ~=-___..-<>A ~:;:>";7c:::> ... ,5:',.. ._:>-A ~Lv. r/J Adtlress DES I GN TEAr' (name) ;s- "g .>-- ;:;> v.?S-' ". Structural .~~ .q~ Oks. no.1 (~pires.) (ohane no.) Electrical Hechanical CONTRACTORS I name J (address) General :P~TA ~-r:~R~O/( 41/L? Zl<'<5'<"/V: 7"tt:/-z~ Plumbina Electrical ~lechanica 1 PLUllR !rIG ELECTRICAL MECMANICAL ....ill' I FFF rIlARGE.J!(l rn r~o\RG..E. un n~ f'uo1R.G( sq. FT. furnace/burner to BTO's Each sjngle fixture Residence of Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (j bath) Duplex (I bath) each Additional bath SERVICES Recessed wall Soace heatpr ~nrl vpnt ~Iater service ITempOrary Construction IChange in existing res i Qf'nce_ Imultifamily, conln. or lnc1ustrial IOf ;:!ml1s. C0/111. /I NO, FEEDERS Install/alter/relocate rli~tr;h, fpprlprs Appliance vent seoarate Stationary evap. cooler Vent fan wi th sinale duct Vent system apart from heatinq or A.C. Mechanical exhaust hond ~ nd riue- t Sewer lStorm Sewer Wood stove/heater or amps.l I I I I SSUANCF OF PFRllI T TOTAL CHP,RGCS TOTAL CHARGES TOTAL CHARGES WHERE STATE L.\l.J REQUIRES that tile Electrical work be done by an Electrical Contractor, the electrical portion of this perlilit shall not be valH until the label has been signed by an Electrical Surervisor and returned to the Building Division I HAVE CAREFULLY EXN1INED the completed ap['llication for permit. and do hereby certify that all information hereon is true and correct, and I further certify that any and all work nerformed shall be done in accordance with the Ordinances of the City of Springfield and the LaviS of the State of. Orel)on pertaining to the work described herein, and that UO OCCUPAllCY will be made of any structure without the permission of the [!uilding Division. I further certify that my registration v/ith 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 emrloyees who are in compliance with OP.S 7nl.055 will be used on this project. 1lN-IE(please print)ELkL~t;.J(-' SlhlIATURrCl2u!/ (2;J)~'p DATE 3-lo-'i?9 Zone 6C-- Fi re Zone Flood Plain Tyne/Cons t. Bedrooms Stories . Units ro~ OfFICE USE OIlLY Sf!. Ftg. riain )( Sq. FtQ. Access x Sq. Ftg. Other~~4'__:-" N-&:L ~-/S-:59 REL,j":1-,zO<'/ .c..7(: Plan Ck. Comm/lnd" ____ syste.ms Developme:Jt 65VBldo Per Fee =>~..- CharQe (J.5~l Plan Ck. lies " "i7 :;;7- 30%lBldo Per Fee e_()FWi'!"~ Fence I ~~~.....iJ_., I I~~~,t~'t"'/~P,?;~".d'r~ &~75; I . Total Comb. Permit IL- I l~r.(EI"7' ...L.~#?'~ I I I TOTAL IYL~. Value Value Value .Occy Load .Occy Group TOTAL VALUATlOtl BUILDING PERI,UT Charges an~ Surcharges " Demo 40.. -0 \. /&p..:r= . '. // PLUt1BING PERMIT Charges and Surcharges ----------....,.. EL[CTR I CAL PERI:I T Cha rges and Surcharges ; ------------ I Sidewalk I A/C Paving I Curb Cut I 11ECIIAN I CAL PERM IT Charges and Surcharges . ,COMBINATION APPLICATION/PERMIT (CAP) Ie Appl icant to furnish A. Job Address B. legal Description 1. example- Tax Lot 100, lane County Map Reference II oj 43 2. examEle' lot 1. Block 3, 2nd Addition to ,pringtield Estates , C. Name. etc. of owner and construction lender D. Energy Sources ' " 1. exam~le- heat/electrical ceilinq/or forced air qas 2. example- waterheater/electrlcal/or solar E.,- Square footage or valuation, etc. 1. examole- 1250 sq. foot house, SOD sq. foot'garage ," 2. example- if new project. check~w - if addition, cneck add. etc. F. Building pennit information: 1. example - construct single family house with an attached garage 2. example - remodel existing garage into family room 3. exam~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. OESIGN TEAM ANO CONTRACTORS To avoid design or construction delays. Building ~ivision Staff must be able to contact appropriate persons regarding design infonmation 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 fonm 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 O. 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. --- Ill. 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 penmit 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 penmit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY; , PERMIT VALIDATIpN ~ ID,R&C1 , ~~33<sq , Permit Cl er Permit applicant exempt from registration with the Builder's Board because; Additional Project Information;, PLANS REVIEWED BY: . name.i.&A'#~ h~ signature /2,,~~ 7// ./ date 9-9-:f5'9