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HomeMy WebLinkAboutPermit Building 1984-6-27 I HiSPECTIQ;1 LlIIE 726- 37 69 Job Address Legal De5cr;ption Owner Ranqe va~' of Hark: H~ .5tz>, l'>~e ,- Builtilna Permit Info: Describe Work(i.e., Familv n~~id~nce With Attach~d Garaoe) .' - '-L1-f~5- '7 r ffi.Il:.,.0 <;-;- I \\1 62. 3'2. U. 7. DD'-Iucd r \ 1==,1,..., Address M,_~-r- t:?, r",,.,,,, ~'F=' I., GCLJ f'< .....--"''''' A. Phone~fSb'l'T), Construction lender F5.ut:-Jg.<..J~ IJ 'H.J F' Address Ut~ lliN I l:Ar.' Primary Structural Electrical Meehan; ca 1 CONTRACTORS '"'fl q 7'fo/ a~-".l '-J u.l!Z::..' ~ t "C ":2.,...., {name) Phone (address) <'"'L:>.-, I n , '_'t" ~~ , (lies,no.1 :T,M 7<. I?_D~/>...~ -;...."^~ s!+-l.J....f.. SA-Mc.. _ (namel (address) (1 ics. no.) L'.' c:""J;lIJ~~~.J&;.o. u.......\-t, CUr.. '''\u'''_~ ' General M A-'l'r R I ..,- ~Qa..(.I., s= r ------:::"'"',;7 "', Plumbi'1o, . ~_..~,~ -? ~~, Electrical: ) -----,-' ~lechanical PLUilBIrIG ELECTRICAL 6 -1!Q,.1 Each Single fixture Residence of , fFf 'CHARGf yo 5~ '2S~~ , ~~I=' 'rl:iARGI. NO_ furnace/burner to SQ. fT. BTU's . HI=' 'fJ.1JlB.G.E. Relocated building (new fix. additional) S,F. Residence 11 bath 1 Ouplex (1 bath) each Additional bath ~t)' ~ ~!ater service Sewer Storm Sewer New circuits alts. or extensions SERVICES \ \1')-: ~():C I ?J~ IK;~ I I I I I \O~ "25.- \.!).1>.CJ. ?5.g';,l \ Temporary Construction Change in existing rp')irlpncp multifamily, comm, or Industrial Of amps, CO~1./IND, fEEDERS Install/alter/relocate rli~trih fpprlpr, Of amps. -., --....;- INfORlIATION liNE II 726-3753 Sq, ftg, 1,Iain !:q, Ftg. Access. Sq, ftg, Other --1lew "':"Add If.A 1 ter x:~ep, Fence Demo Change/Use -Other- - Build Single " C\i /--- .:-- r--. / '-./ .c jJ "0 .:: ~I 9r/~ I , '<' q,.., j nn \ (exo;reo;) (onn,..p i< (pxnirp~) (ohnnp nn.) MECHANICAL Floor furnace and vent Recessed wa 11 So~cP hp~tpr ~nrl vpnt 'L I I I 1:<.- I to ,.. (n. Appliance vent c;eoaratp Stationary evap. cooler Vent fan with sinole duct Vent system apart from I heatinq or A.C. Mechanical exhaust ' hood and dur:t Wood stove/heater ~ \:"'- l,\~\~n,"", .,~~.\\ (',cD TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be valiJ until the ISSUANCE OF PfR!lIT ,...,'j ,,;: TOTAL CHARGES :....\ t::.. .~ TOTAL CHARGES ! ,~, ~. . '--~.. that the Electrical work be done by an Electrical Contractor, the electrical portion of nits pernit label has been signed by an Electrical Supervisor and returned to the Building Division . I HAVE CAREFULLY EXM1INEO 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 nerformed 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 rm OCCUPAr~CY will be made of any structure without the permission of the Building Division, I f1 ~L., ~;tt:mt ~ i~i..~\"C.o,:.:"" ,:.~' " :.~ 0.' ~~:~. .,~-';..~~ .::-.:.___ :::..~A ,&fec. ~~ ---,.~..:... '\' Q~[ :'81.~. that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 7Ql.055 will be used on this project, 1lAf.IE(please print) Zone ,-,C_ Fire Zone -.. flood Plain .~ BUILDING PWIlT Charges and Surcharges PLU'~BING PERMIT Charges and Surcha rges ELECTRICAL PERI~IT Charges and SlJrcharges /1fCHANICAL PfRMIT Charges and Surcharges N\ pt-T-r ~ I 'T'''2.:C7'' f!...("'- SIr,II^TUR[~~~ ~ fO~ OffICE USE or~L Y I 1/ 1'/ So, Ftg. liain'!"!,"'>/) x " Sq, Ftg, Access x .~~Sq. ftg, Other x Tyoe/Const. V.i\) Bedrooms .- Stories \ Units Occy Load Occy Grou.B\ _____:1~, 00 "3, ca<"{ Plan Ck, 65t/Rldo Plan Ck, 30UBlda ( "':; _____>1Q'~___1 fence .J '~Q Demo "--, \...).5,'.J,.:) I Sidewalk ------l~80---1 A/C Paving ____\.OJ~_J Curb Cut 40 I Conroll nd P~l'" Fpp Res Per Fee f\q, ~O \0,5<;' I I \ '2., 60 I OATE ,,J:L 7 fgy-. Value Value Value TOTAL VALUATION Systems Development I .....,,....,,..,, o:e... Charae (1.51,) , ;)\... ) Irotal Comb, rermit I I TOTAL ,',:: ,:-;" (;"1.1, I '..' " i. I - . . '. ,\. " COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION III. I. Appl icant to furnish A, Job Address B. Legal Description 1, example- Tax Lot 100. lane County Map Reference II 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. examole- heat/electrical ceilinQ/or forced air Qas 2. examole- waterheater/electrlCa(/or solar E. Square footage or valuation, etc, ------ I, examole- 1250 sq, foot house, 500 sq, foot garage 2. example- if new proj~ct'l checkli'ew - if addition, \ " check add, etc. . . , - l_j .,- F, Building pennit information: 1. exam~le - construct single family house with an attached garage 2, exam~le - remodel existing garage into family room 3, exa~le - convert single family residence into restaurant (change of use) .. G, Value of work as defined in Section 303 (aJ 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 blant 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 0, 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 ~ivision 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. ~' \~2f\ \i>? ,-\ \-,. , >" h' '- , . , '" v. FOR OFFICE USE ONLY Permit Clerk <- ~U1U PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: \\\G (\p\::'.\\,c;. s;:\()';-\ ~r--<? '(;:\~ ),\\ A.\\ \('\ t. t"(',,-,[,"!.",\,p,,\ ~ """"-e... 0~Clf' ,\;'->., , '\' ~ c..\~Nt '%:::J? ~,,~ eceJ,.. \\,,\>o.\... 'l~ \ Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: " I name \. '. ----~ --- ",-, \\~ ..-- \.'-'" "I . '..:..\ J \~'._.. \ \ r-l..,l\ signature\" .' \ ~" ,,,',, \ i\ I .r'. ," '.---..,.-..,~ J , .----- \ da~e '1- \ \ -~U , , . .. ,I ~' L-- ;=:,0, 7- to-i-i