Loading...
HomeMy WebLinkAboutPermit Building 1991-1-4 IINSP.ECTION LINE 726-3769 . CITY U, SPRINGFIELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat l~ater Heater I . INFOro1ATION LINE 726-3753 Sq. Ftg. 1,Iain ~q, Ftg. Access. Sq. Ftg. Other New Add Alter Rep. --Fence Demo Change/Use Other- - '1\ \ ." Owner' Job Address b 330' Mtclll""l S T ~;;I') Y2 Legal Description l7-tJ.;)-,3t/-...i'-/- 03003 , 3a . Range o 300/ J 0 'ValuE of Hork' 1~,q/"'J'\o'\.....,""7...O't.... :lFtJEJ,- I BuildinQ Permit Info: Oeser,be Work(Le., ,'-Iv" J '7 VI' Phone Farnil y Residence \~ith Attached Garaoe \ ?</6-/lf61 Address LS~;. L, 0... Ie ~o Box ~ Build Single ~ (J \J ~ " ("')r;:'"" \ (' (" tP,c"-?'!<lllef Construction Lender. Iv/ /(J. Address UlS IIjN IlAl1 (name I Phone (address 1 flies. no.) (exo;res) (ohane no. I Primary ,t/e- A/ ~/j r /?/ /?,t.n./1) ~~c? ,;)c. ~JT ~ ~e6 tf. '7SJ .5"-;/-9/ ^ -1.;J~ -~U-/ ..--1tLH ~ Structural Electrical Mechanical CDNTRACTORS Plumbina lnamel f::>AI2.I'I1/"......,,,_ 1"'"... I, f' /J~"" t> >-. ,nJI>,!. Co I - , /~/..pc7....,C.- {addr~ss , fl ics. no. \ (exo;res) (ohane no. 1 Electrical KIll", ?" uo< i"I ,u..,,.,7,.1 ~ 3~~/fr' ~c,."vo" J .'f ,...,...... 3 170 ?J. II!! ~ '/(/(,-(</61 :)", ., u rC\ 6-30-"(/1/1,,-//'>1; PYn.. 2/J5'I.q-;).,,,,,I&.f7-//.r/ Genera 1 ~lechan;ca' PLU'1BING ELECTRICAL MECHANICAL NO. FEE CHARr.F NO <r> CHAJlGE. ..llO ~F"~ .cHAR..GL IOtJ!2 15"" SQ. FT. furnace/burner to BTU's Each single fixture Residence of Relocated building (new fix. additional) New circuits a1t5. or extensions Floor furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall ~n~r~ ~p~tpr ~~rl vpnt Storm Sewer Of COffi~./IND. FEEDERS Install/alter/relocate ~i~trib_ fppder, llmps. Appliance vent !;:po#l ra te Stationary evap. cooler Vent fan with d n01 educt Vent system apart from heatino or A.C. MeChanical exhaust hood and dud Wood stove/heater Sewer Temporary Construction Change in existing rpsjrlJ'Ju'p multifamily, camm. or Indll"trial ~Ia ter serv; ce Of amps. ISSUANCE OF PFR!1IT TOTAL CHARGES WHERE STATE LAH REQUIRES shall not be vali~ until the TOTAL CHARGES TOTAL CHARGES that the Electrical work be done by an.'Electrical Contractor, the electrical portion of this pemit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFUllY EXAMINED the completed application for permit, and do here~v 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 HO OCCUPArKY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builderts 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 employees who are in compliance with ORS 701.055 will be used on this project. NAi,IE(please print)d~-,-. /7~ SIGIIATURE b~n"1/.J /P"'}",;;/? 7""" Far. OFFICE USE ONLY Sq. Ftg. t1ain Sq. Ft9. Access Sq, Ftg. Other DATE /- "'/-7'/ Zone Fi re Zone Flood Plain Type/Const, Bedrooms Stories Units Occy Load Occy Group x Value Value Value x x TOTAL VALUATION BUILDING PERflIT Charges anC; Surcharges :3 'D .)'0 Plan Ck, Corrrn/Ind ____________~/Rldo Pj'r FpfI I 93 Plan Ck, Res , 30%/BI do Per Fee 1-00 "j . Fence ------------ , 7.1 D,mo 'Sidewalk 2- 5. 03 Syste~s Develop~t Charqe (1.5~) " N/A PLW1BING PERMIT Charges and Surcharges ELECTRICAL PERIHT Cha rges and Surcha rges ~ MECHANICAL PERMIT ~ Charges and l" Surcharges / A/C Paving /fjtL/ep~/IOT C<>/l'e.5 . .0 If!, /"{2 Total Comb. Permit 0~ Curb Cut TOTAL ~'1 z 1 r J . . . '. J COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION 1. Appl icant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference II U3 43 2. example- Lot 1. Block 3, 2nd Addition to spr,ngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinq/or forced air qas 2. exam~le- waterheater/electrlcal/or solar E. Square footage or valuation, etc. ------ 1. example- 1250 sq. foot house, SOD sq. foot garage 2. example- if new project, check new - if addition, check add, etc. F. Building pennit information: 1. example - construct single family house with an a ttached garage 2. exam~le - 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 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. --- 111. Applicant to sign and date Whenever possible, the initial application will b~ 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 permit is issued. fJJ 07V- j) I ~"r'! / 1(1)[)~2- V. FOR OFFICE USE ONLY Permi t Cl erk _d! ;e;plO/>-<- PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: . PLANS REVIEWED BY: name signature !i, date ,\: i'., ., 'J