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HomeMy WebLinkAboutPermit Building 1984-11-16 CITY UF SPRINGFIElD COMBIIIATlON APPliCATION/PERMIT EiIERGY SOURCES: Heat Ha ter Hea ter I INSPECTION 1I11E 726-3769 . Job Address S?'()-:<' ~ .'}flVa. legal Description f?1C/'VVLOL ('~ G~~ /7.~2~/, "73~:f' Owner., C\.-,..LJ. I))~ Address ,'2.1<.<; ~ l.CjlJOI.( /~P.dt Phonell(/"f?~?? '1/, ~ j rri;,~.J b,e rzJ1. Construction lender Address DESIGN TEAI~ (name) Phone (addre5" ) Primary Structural Electrical Mechanical CONTRACTORS (name) (addres~ ) Genera 1 -~- Plumbina Electrical -~- ~1echanical PlUIIB I NG NO. FEF I cHARGE . INFORlIATlON liNe 726-3753 Sq. Ftq. i'lain-L2~~ ~q. Ftg. Access. Sq, Ftq. Other flew Add Alter Rep. --Fence Demo Change/Use -Other- - ~ ~ 00 ~ \X) I Range JIUE of Hork: Bu~-Bi~~penllit Info: Describe Work(i.e.. Build Single Familv nesidence With Attached Garaae) 16"L<'-(Y/ ~ 'if 'X IS I (l;es. nn 1 (exoir~~) (nnnnp no * f1 ;r:<;._ nn,) {~yn;res' (ohon~ no. 1 ?Y7r lJjl~" ElECTRICAl MECHANICAl .Nn I I'Residence of SQ. FT. 1New circu~ts alts. or extenslons I SERVICES I Each single fixture Relocated building (new fix. additional) S.F. Residence (l bathl Duplex (1 bath) each Additional bath "L U;IJARIiE. NO .I.H.L J:llARIiE furnace/burner to I BTU's Floor furnace I and vent Recessed wall I SO<ll'P hP<ltpr <Inri vpnt ' It?- rIa ter servi ce !Temporary Construction IChange in existing rp~ i dJi~nrp Imultifamily, comm. or Inriuc;trlal COMM,/IND, FEEDERS "Install/alter/relocate did.rih. fpprlprc:. IOf I I I Sewer Storm Sewer Of TOTAl CHARGES TOTAl CHARGES WHERE STATE LW REQUIRES that the Electrical work be done by an shall not be valiJ until the label has been signed by an Electrical amps.! Appliance vent C:f>O<lr.:tte Stationary evap. cooler Vent fan with sinale duct Vent system apart from I heating or A.C. Mechanical exhaust hnnrl and duct Wood stove/heater amps. I I It'. p. ISSUANCf OF PFR'1lT TOTAl CHARGES 'Electrical Contractor. the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed aprlication 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 rw OCCUPAfKY will be made of ,any structure without the permission of the [3uilding Division. I further certify that my registration with 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 employees who are in compliance with OP.S 7nl.055 will be used on this project. SIGIlATURE FO~ OFFICE USE miL Y Sq. Ftg. t1ain Sq. Ft9. Access Sq. Ftg, Other (j.,u~-,-"..., 1'. 15 (. 3S Z. <{ 'Ii 9 ..-' n(} Systems Development .1., rOt CharQe (1.5~) , rAx. Po.!.O (J795f( IlAI.IE(please print) Zone C. ,c:. Fire Zone Flood Plain Tyoe/Const. ~-)tf Bedrooms Occy load Occy Group~'~ Units Stories I BUIlDING PERflIT Charges and Surcharges J~ cC'" Plan Ck, COl1lll!lnd __4...;...l.L_____ 65%/Rldo PJ'r F="pe ",-, Plan Ck. Res . ~ 30%/Bldo Per Fee ____________, Fence I D~R1o ___Lt;?.!~_JSldewalk . Y&> I A/C Pavi ng !"Curb Cut I PlUI1BING PERMIT Charges and Surcha rges ElECTRICAl PERIHT Charges and Surcharges /lECHAN I CAl PERMIT Charges and Surcharges DATE 17CJI" x Value---.L5"~. 00 Value Value x x TOTAl VAlUATION :z 2.S~ ..2f) !Tota1 Comb. Permit I I, ''ZtD. dO ,-- TOTAl ..11.'10 . . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100. Lane County Map Reference 11 03 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. example- heat/electrical ceiling/or forced air QdS 2. examole- waterheater/electrlcal/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 infonnation: 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 OOT ALL FEES AND CHARGES ON THE SCHEDULES 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. --- 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 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. V. FOR OFFICE USE ONLY . PERMIT VALIDATION , . Permit Clerk PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY: ~ 10 v) D L .I Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name .L4~~~~~ -V;;. '9It"~ \'j \,;, II Signatur~ , . ., ~ . date.H:~/~.a'Sl