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HomeMy WebLinkAboutPermit Building 1990-9-12 I INSPECTION LINE l' L. CITY OF SPRINGFIELO .. INFORllATION liNe I 726-3769 l1li' COM~INATION APPLICATION/PERMIT 726-3753 Job Address,-~LfCj~ ,I YJ(l/lQnU U. E~;~GY SOURCES: ~~: ;~~: ~~~~ss. J:J Legal DescriPtion!' )rv.r 8DC[) ('ir"'\',,('Y'1ater Heater Sq. Ftg. Other D I .Jt7\ .A ~ ) _ {an~e Ilew Add A Iter Rep. - -Fence Demo Change/Use I va}j{),(J(f),od, -Other- - 0 BUiloind Permit Info: Describe Work(i.e., Build Single ~ t F~l ~~d~CO I~i~~h\~ Gar~~r1 it1rJilS ~' - owner-n\ <l. .\.'fu VCiJ \ ~O f\\ QJ? ) Address ?{)! Y s. "'r\11 ^ rIll [)hone) ~ro ' , UV ~q1tJB construc~~) I Address Phone Ut~Il.iN 1~t:N1 (name)" ~addr.ess} (lies. no.) (exo;res) '~hr:~~ "0." primarYU\\~_~t~()'W, \~()~\(\Y~J\f\~~ r J ,Ii. rA-~-lQoloq____ StructuralU-.{~l(L\lQ n I, \~ Db('{\. "'V \~ffic)\\, _ \ ~ ~ w'\ LL Electrical () ~ ~ I I 1 ".6;~/~'o/'"~...:::;:, > ....j,~LL ~~/AY' #1 ~ ~l0',w;/ ~ ~~ 1"~ .J?":' ISSUANCF OF PFRIHT TOTAL CHARGES ~_""". TOTAL CHAR~ES TOTAL CHARGES .):O1'~""'" /<: ~ WHERE STATE LAW REQUIRES that the Electrical work be done by an, Electrical Contractor, the electrical por{ion Of'tfiis permit shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division 11echanical CONTRACTORS . ~ame 1 , General aI\ rt ~~ W ~ . Plumbino. fr~, ) \ \ fu.b1JJt); El~ctrical ~ Y ~~f0 ~ ~1echani ca I <c:\r{\ 9--\\' PLUll~NG NO, FFF CHARGE 'I Each single fixture ?~ "3t? Relocated building (new fix. additional) S.F. Residence (1 bath) Duplex (1 bath) each Additional bath , Water service Sewer Storm Sewer&~~' ~ l~i~rH\n r fW('^~,b ~\t\fl If z. N\(\ t f\ J 6~ b ~NYJ \.0\1. \ \~ 0 st{Y~ l?., G (exoirec:,\ ~n~1.;51oL , f\4V'\ ~~qCXq .- 4 'fA ..Ll~'S5\ ELECTRICAL MECHANICAL Nn~1 Residence of rHARGE. NO. FEF FEF r"~ furnace/burner to aTU1s SQ. FT. New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall Sn~cp hp~h:>r ~nrl ---- ~',~j Appliance venf. c:,eo~r~tp Stationary evap. cooler Vent fan wi th sinale duct Vent system apart from heatina or A.C. Mechanical exhaust hood and durt s:<<1> ~ Vj:>n! Z1.. '77"" ~~ Temporary Construction Change in existing res j rl_e]lcP multifamily, COIl1T1. or Industri~l / Of 'l.mps. CO~1,/IND. FEEDERS Install/alter/relocate dic:.trih. fPPdprc:. Wood stove/heater Of amps. I HAVE CAREFUllY EXM1INED 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 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 Builder1s 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 701.055 will be used on this project. IlAl-IE(please print) WI ARII,i{t..J ~/.dl.vA<9-A{A") SIGII^TURE~.l~100v1A.A,,~ DATE--=t:.f;:> -90 FO~ OFFICE USE ONLY Zone-/i-l Fi re Zone Flood Plain Tyoe/Const..~~ Bedrooms Stories / BUILDIIIG PERI1JT Charges and Surcharges -_Jl!t5=~_ /7./S- L2?&JC? ____vv.... Z~ PLU'iBING PERMIT Charges and Surcha rges ELECTRICAL PERIHT Cha rges and SUrl;ha rg~s rlECHANICAL PERMIT Charges and Surcharges ----/~~~ ,:/5 Units Sq. Ftg. r1ain x Value Occy load Sq. Ft<1. Access x. __ ~e Occy Group€--?_sg. Ft~. Other~ ~'f"~ue ~,c;:: _ f'f.\~~\\L.A.pA.qf) "IS I~T~VALUATlON Plan Ck. Corrm/lnd \'}" L\ n~' ISystems Development ;"-'" ~ _ 65%/Bldo Ppr Fop / --y C l\ '-'\::- '\ CharQe (1.5~) ,"" ;:> c.,.t. Plan Ck. Res - I 30%/BldQ Per Fee Fence I. Demo I Sidewalk I. AIC Pa~i ~g _ Curb Cut ITo_t~l. Comb. Permit I I TOTAL ,....... {~ '. . ~::?&. '7'.0 /1f7~ 7"b .. COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100. lane County Map Reference 17 03 43 2. example- Lot I. Block 3, 2nd Addition to ;' Sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinQ/or forced air qas 2. examyle- waterheater/electrica(/or solar E. Square footage or valuation, etc. - . 1. examole- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project. check-new - if addition, . check add. etc. F. Building pennit information: 1. examele - 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. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division 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 penmit 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 SCHEOULES 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 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 penmit is issued. V. FOR OFFICE USE ONLY PROJECT CONQITIONS TO BE SAT}SFIED BEFORE OCCUPANCY: II 'I ,I PERMIT VALIDATION 1-/2.--.7 (). Gkvtv-. ~-tc.e~t* ;\:J::(' [ ~Z-7 L Pennit Cl erk (J.A;v ~ l -' " Permit appJicant exempt from registration with the Builder's Board because: I Add-itional' Project Infonnation: PLANS REVIEWED BY: -, .' na~~ -~~~~~~~s;gnature ~?~~J:) {' , -., .: r date 9-? ""!7t:J ......., , 'I ... .