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HomeMy WebLinkAboutPermit Building 1983-11-18 . " , I INSPECTION LINE 726-376g CITY Uf SPRINGfIELD COMBIIIATlON APPLICATION/PERMIT . Job Address \ {\f\fh f\ ' J;h ' l!)l ~0t'Cf1),D) E!lERGY SOURCES: Heat ~ ~ INfOR/1ATlON L1Nl ~ 726-3753 , Sq. Ftg. 1,Iain ~q. Ftg. Access. Sq""Ftg. Other Vllew Add Alter Rep. --Fence Demo Change/Use Other - - 0J ~ ;:') :". ~~ \ Owner' ~Jf.~~) AddressA~?} \ \ 1l\'~~C1 l'nQtto o f\ 0 t G-~ Phone ValUE 0\ H17D.cO BuildinQ fermit Info: Describe Work(i.e., Build Single Familv Residence With Attached Garaoel . ~\ 0\\ t f\7\ <::., .f'I"( +"1'1 L,., \ J 0.f\:lf\Yl.\y '\ , I '1 (\.J (lies. nO.1 (exoi res) (ahone no.') (I\) (\ ~ 0, Address Ut:"uN IlAI1 {name} Phone (address) Primary ~ t3; ~" Structura 1 Electrical Mechanical CONTRACTORS _.... lname) A\.lALJ{\~ ) (addr@ss) flies. no.) (pxnirpc;.) (ohonp no ) Genera 1 \ Plumbina Electrical ~'echanical PLUllB I NG ELECTRICAL MECHANICAL -1!!h1 Each single fixture I FEE I CHARGE NO I I <<L IJ:IlARliE .J:lll....1 Res; dence of furnace/burner to SQ, FT. BTU's J n~ Ir~JlR!iE. ./ Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (] bath) Ouplex (1 bath) each Additional bath SERVICES Recessed wall ~o~~p hp~tpr ~nrl vpnt Water service !Temporary Construction IChange in existing rP'S j dJ.nc:p Imultifamily. comm. or TndlJc;.tri~l IOf ICOMfl,/IND. FEEDERS I Install/alter/relocate rlic:trih_ fppnprc: IOf amps.1 I I I amps.l. Appliance vent seoarate Stationary evap. cooTer I Vent fan with sinoTe duct I Vent system apart from I heatinq or A,r. I Mechanical exhaust hood and durt I ~lood stove/heater I I I I I I I TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES WHERE STATE L~H REQUIRES that tile Electrical work be done by an Electrical Contractor, the electrical portion 'of this permit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the BUilding Division I Sewer Istorm Sewer I I I I I I I SSUANCf OF PFRllIT Zone Fi re Zone Flood Plain I HAVE CAREFUllY EXAr1INED 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 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 NO OCCUPAr~CY will be made of any structure without the permission of the Building Division. I further certify that my re ~stration with the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis for e~ tion is noted hereon, and that only sUbcontractors. and employees who are in compliance with OP.S 7nl.0~ed on t (s/project. IIAlIE(please print) SIGIIAT~~ ~ Dim/I-if-.J:/' !'cm ii'fFICE USE 0I1LY po Sq. Ftg. liain Sq. Ftg. Access 5q. Ftg. Other Tyoe/Const. Bedrooms Stories. Units Occy load Dcc'y Group x Value Value Value x x TOTAL VALUATION BUILDING PERIIIT Charges and Surcharges JO <:.:X:) Plan Ck, ~ ~ ______ 65VBldo , /1;-..... Plan Ck. ,-r\ ) 30%/Bldo Fence CorrmlI nd Pj'r Fpp Res Per Fee Systems Development CharQe (J.5~) , PLUI~BING PERMIT Charges and Surcharges I D~mo I Sidewalk I AIC Paving I Curb Cut I I I I '-I Comb. Permit I ELECTRICAL PERI~IT Charges and Surcha rges ITotal , I TOTAL (O,1C) J MECHANICAL PERMIT Charges and Surcharges ~ COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Description I. examp.le- Tax Lot 100. Lane County Map Reference 1/ 03 43 2. example- Lot I. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner-and construction lender D. Energy Sources 1. example- heat/electrical ceili~qjor forced air qas 2. exa~le- waterheater/electrical/or solar E. Square footage or valuation. etc. - I. examole- 1250 sq. foot house, 500 sq. foot garage 2. examjple- if new project. checkiruew - if addition, cneck add, etc. F. Building pennit information: 1. example - construct single family house with an attached garage 2. exam~le - remodel existing garage into family room 3. exam~le - conve~~ single family res1dence into restaurant (change of use) G. Value of work as defined in Section 303 (aj of the Structural Specialty Code H. DESIGN TEM1 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. I f the item( s) to be ins ta 11 ed 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 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. --- 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. , I II. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . PERMIT VAll DATION ' lo'[CO l~1 JlW, l<6/S'~ t,G ~ \)cl- . Permit Cl erk('){ /r1 -, , ) II Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date