HomeMy WebLinkAboutPermit Building 1983-12-7 . . II NSPECTI ON LI NE 726-3769 Job Address 5t? '1? IY/u In CITY OF SPRINGFIElD INFOR/IATlON liNt COMBJlIATION APPLlCATION/PERHIT 726-3753 II 1 /l -. E!lERGY SOURCES: Sq. Ftg. /.Iain <::).:, r d, // yf!. I Meat ~q. Ftg. Access. Description\~,......"n "2." ..;..J.?' ..L <C.\ \ I lIater ~eater _ _ Sq. Ftg. Other \. \ \. lL. .>'4~"""\ Ckl _ __ !lew Add Alter Rep. - 'I Rap,qe ----"'-- -- . -Fence Oemo Change/Use ~\ ~\17)1."~ fr17Df!OD~ , )=Other- - P.h - . Bu'i~'lciinQ-Penni.t-Info:--Descr;be Work{;-.eo. Build Single one7"/t'3<?,, Familv nesidence ,~th Attached Garaael r-, :1/ ii, /t/v -r -Ii urJ n f.: / '" -k '"' (;r ,.,1 /\/ h_ /7'.A.I/lrt'~ / legal Owner f'- Lv Address / 7/7 Construction lender Address UI:~llJN IEAf1 Qo~cw- J rl7~;'!I- CX) \)J N l,\) VI - >;1;:- 5""" "" e (name) Phone ~""I (address) (lies. no.) {exoiresl (ohane no.-') 91 C,/,:; f ~t ...., ' ~ (lie". no.) (pxnirpc;.,r "1. (ohnnp nn.) ~/?/!I,. 1)1' ~ ~ Pri ma ry Dr-/ALJ"~ J Structural Electrical k:~.i Mechanical CONTRACTORS General Plumbina Electrical ~1echan1cal NO. <0 Each single fixture T - LP /Ie /.--. J.{ / {I r:f.;"<-c (name) <::;,p r ;: (address1 r: -L... m ;) "/w 4, ">0//1 J 7/7 PlUIIBHIG ElECTRICAl MECHANICAl FEE r.HARr.F NO CEL...cJlARG.E. NO, ?:iJ.($) Residence of furnace/burner to 5 SQ, FT. BTU's New circuits alts. \~c;s;y~.Cf) Floor furnace \ or extensions and vent SERVICES Recessed wall Sn~rp hp~tpr ~nrl vpnt I I I I 1'3 cD I Co. CO I I I FFF r'fARliE. ; Relocated building (new fix. additional) S.F. Residence II bath) IDuPlex (1 bath) IAdditional bath lwater service Sewer Storm Sewer each ITemporary Construction IChange in existing rpsi~p'nr~ Imultifamily, COrTlTl. or Tnrlllc;tri~l IOf ICOW1./IND. FEEDERS I App 1 i ance vent seoarate I Stationary evap. cooler (") I Vent fan with L sinole duct I Vent system apart from I heatino or A.C. I Mechanical exhaust I' hood and rlur t. I ~Jood stove/heater j f , J,...", ~<'>'" , I amps.1 I 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 performed 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 OCCUPAllCY 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. SIGrMTl~~-., O~..;~:v~ FOP. OFFICE USE orll Y So. Ftg. 'lain Sq. Ftg. Access '751?O Sq. Ftg. Other &;lDZ7 ,LI\"'i=>' nil' I Systems Development , 3l~40 - p:. ,--., CharQe (1.5~) . MR.G) , I HAl.IE(please print) .sht:J.."Y\ -r. -rAl~i'JmA'" DATE ,,+"~'-,L",, Zone \,.(,,~ Tyoe/Const. S- "-.\ Fi re Zone - Bedrooms Flood Plain _ Stories BUIlDING PERIIIT Charges and Surcharges Plur1BING PERMIT Charges and Surcha rges ElECTRICAl PERr:n Cha rges and Surcha rges MECHANICAl PERMIT Charges and Sure ha rge s Units \ Occy load Occy Group~? , x Value xlO.00 Value~?". 9J.D x Value TOTAl VAlUATION \ '> \ 00 Plan Ck: Conmllnd ~~ . 65%/Bldn Ppr ~pp --- -u-Oi"u--PTan Ck. lies ~ \ C) ~ 30%/BldQ Per Fee "').r-" 00 I Fence --n~~zc--I Demo ~Q. CO I S1dewalk __n__ \ ~~--I A/C Paving (!>o I _,___1..Q-:____ Curb Cut .~O I 40B.CO I b.c\\~l>o.lt'< ~ I ITotal Comb. Permit IL.\?~ i I ? ,na.. ,ClJ; f Co ~f\ .'2.,\ I I TOTAl . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. examole- Tax lot 100. Lane County Map Reference II oj 43 2. .exam~le- Lot 1. Block 3, 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examr?le- heat/electrical ceil;nq/or forced air Qas 2. example- waterheater/electr;cal/or solar E. Square footage or valuation. etc. - 1. example- 1250 sq. foot house, 500 sq. foot garage 2. examyle- 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. 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 TEAM 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 B. 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 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. --- 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. , Ill. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . PERMIT VALIDATION '\ 8~ I tl::-lD~O"ll "- Penni t Cl erk FA LQ(L) I Pennit applicant exempt from registration with the Builder's Board because: Additional Project Infonnation: r()~~u:::"n::: \....F.'i)..~E ~~~ ~t )\\ tl\\....Ch ~\.~~.l....L. ~\ ~\:1'-.. '0- Ron (}"1 PLANS REVIEWED BY: nameD ~\\~~ ~ E\J\ s i gnatur~')\^."L.~-'=~.\ @A.. r-- date\? ~-D\. -<'?:>~