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HomeMy WebLinkAboutPermit Miscellaneous 1980-9-18 . 5(PC>~Ma.,l"\ S-\-. Description '"thUr5",,,^ ~\a..'2.0. ShOpS lINSPECTIOII LIIIE 726,3769 Job Address legal Owner Address Construction lender Address Ut" till I tAI1 {namel Primary Structural Electrical f1echanical CONTRACTORS (namel Genera 1 M e.'l \ i G:,(\ S-'<;C'. ~ ~o..se Ce. Plum~ino Electrical '.lechanical PlUI1BIIIG 110. FEE CHARGE Each single fixture Relocated building (new fix. additional). S.F. Residence (I bath\ IDuPlex (1 bath) each Additional bath ~!atp.r service Sewer \ Storm Sewer I ~S\r \>I"(n,lf:o I/o~ I ~ I I I I I TOTAL CHARGES WHERE STATE l'W REQUIRES shall not be valiJ until the I I I IO:!.!:l C ITV OF-. SPRI NGFI ElD CDMBlIlATIDN APPLlCATION/PERMIT E!IERGY SOURCES: Heat Hater Heater Range .. . INFOR/IATION LINt .1 726-37S3 Sq. Ftg. !'Iain ~q. Ftg. Access. Sq. Ftg. Other Ilew Add A Her Rep. -Fence Demo Change/Use Other- - cD o o J' ../' ---- Value of Hark: Phone Builtjinq Pennit Info: Describe Hork(Le.. Bu;ld;Single Family l'1.esidence Hith .A.ttached Garaoe) " s~ -Y uJo..J:Q.y { LYLe- Phone (address) \ flics.no.l lexoiresl (phone no. ~ I i .~ ~ I fp' hone no. j; ,I 'j/85~/l.\n ~ t7..2~-/~8 L: i : , (address) (lies. no.) (exo; fes) /6 V 0.(\ ~L.I('er'l ~D.'!>>oV' 554 q ELECTRICAL MECHANIC,\l I ~;J III J:JJAlli} F. - -, j (\. , .r '0. . ~ . ~ ' , NO I I' Res i.~ence of , SQ. FT.i INew circu~ts alts. or extenslons ISERVICES <<r r'JARG.E. NO furnace/burner to BTU's Floor furnace and vent I I I _,.._J Recessed wall So~cP hp~tpr rtnd vent' Appliance vent seoarate Stationary evap. cooler Vent fan with sinole du'ct' Vent system apart heatino or A.C. I Mechanical exhaust hood ilnd dud I \'Iood stove/heater I I I frof(l Temporary Construction': Change in existing ___._ U.ll'kn~__. multifamib. conm. or. Tndustri;Il' amps.1 I I 10f I COli!.!' II NO. FEEDERS Ilnstall/alter/relocate di~trih_ fppdpr~ . 10f amp~1 I SSUANCF OF PFRllIT . TOTAL CHARGES . TOTAL CHARGES that the Electrical work be done by an Electrical Contractor, the electrical portion of label has been signed by an Electrical Supervisor and returned to the Building Divisi~n this permit I HAVE CAREFUllY EXArlINED tre 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 oerformed shall be done in accordance with the Ordinances 'of the City of Springfield and the Laws of the State of Ore~on pertaining to the work described herein, and that UO OCCUPAUCY 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 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 701.055 will be used on this project. NA'IE(please print) C'~~ Cf.:,..- ('h.o..('\~nf' ~i~~!IG;IATURE ~ \)~ FOr:OFFICE USE Q;llY Sq. Ftg. riain Sq. Ft9. Access Sq. Ftg. Other . Plan Ck. COIl1l1/Ind 65%/Rlda PPr Fpp ------------ Plan Ck. Res 30%lBldo Per Fee 10 .00 Fence ------------ . 4D Demo Zone TyoelConst. Bedrooms Fire ZOnE' Flood Plain Stories BUIlDHlG PERI.IIT Charges an': Surcharges PLU!iBING PERMIT Charges and Surcha rges ELECTRICAL PERI:IT Cha rges and Surcharges 11ECHAIIICAl PERMIT Charges and Surcharges ~ DATJ'i:JS-M Units Oeey load Occy Group Value Value Value x x , TOTAL VALUATION 'Systems Development I Charqe (1.5~) Sidewalk AIC Paving Total Comb. rermit Curb Cut TOTAL lo.6.() ., . ;- , 1\1 ."! . a:'-" ..~...!. COMBINATION APPlICATION/PERMIT (CAP) . , I. Applicant to furnish A. Job Add res; B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 43 2. example' Lot I. Block 3. 2nd Addition to Springfield Estates C. Name. etc. of owner and construction lender O. Energy Sources "- 1. example- heat/electrical ceilin~q/or forced air Qas 2. examole- waterheaterjelectrical/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: 'j l. examole - construct single family hou$e ~..ith an attached garagp. _ 2. example" remodel existing garage into family room 3. example - convert single family residence into restaurant (change of use) : G. Value of work as defined in Section 303 (a) Qf the Structural Specialty Code ,'I H. DESIGN TEAM AIID CONTRACTORS To avoid design or construction'delays, BLdlCLng Division. Staff must be able to contact appropriate persons regarding" design information or job Site corrections, etc. { II. Abbreviated Plumbing, Mechanical, & Electrical S~hedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the appl.icant need fill-in only the No. Boxes adjacent to the appropriate item(s) to be installed. . B. Full Plumbing, Mechanical, and Electrical Sc~edules are available at the Building Division .; . 1. To conserve space on the permit form the;schedules have been abbreviated j 2. I~ the item(s) to be installed are not c6vered on the abbreviated schedules you should consult the full schedules C. BUILDING DIVISION STAFF WIll FILL OUT 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. --- I Ill. Applicant to sign and dat,:,.. ... . \Jh':~~'!~f pc:;:;!bl.::. Hit:! :n1',:::.;; ap~l'cJ.tlOn wIll be j:;ed as a \.'Iorksheet only. Where possible, Building Division Staf1 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. j V. FOR OFFICE USE ONLY . PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: """*? ..............;...: ~ " ~ . , : , , , , . PERMIT VALIDATION Permit Clerk Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature' . date I 'j :I i 'j 1 I , . " .1 I ., :1 :1 'i ., .' ;} " ., " ) i . 1 , I I ., .j J/ ;J :1 .I ! ~ , " ,I .~ i.' ; ~ " .I :; ; " i 1 ~ i , I ~