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HomeMy WebLinkAboutPermit Building 1984-4-24 (2) INSPECTION LIfIE i 726-3769 CITY OF SPRINGFIELD COMBIrIATlON APPLICATION/PERMIT -. Job Address gR", IIUI fJ ","~ ~~ 71.\-' I ~~;~GY SOURCES: Legal Description il\V LO'" ?6C1O r 1700 \later Heater Ranqe ~~)...~ ll{"p ,p-01-~/-Lf-I_ Owner ~\ 6a.J~~ r With'lIMo \?'.....Jo.- Address 40 I G IO~ 41-%0 j;VU\\.. ()f'" q;I.fO / . .-. INFOR/IATlON LI~L 726-3753 SQ. Ftg. Hain 2. '100 ~q. ~t9. Access: SQ. Ftg. Other Ilew Addl-1l"lter ~ep. Fence_Demo _Change/Use _Other % ~(J~,k P'-'I'P""'" Phone V~E of Hark: '!l.J~ SI~. .00. BuilrlinQ Permit Info: Describe Work{Leq Bui ld Single Familv nesidence Hith /1.ttached Garaael QI'WlUJt\ "t r"'IMMerYl'a.l OJ,,'I Sp"l"~ !~ ~ 'vJ f; 'Ie ~""c.J~ofl Construction l~nder Address Ut:::dbN II:JU" Primary r;;....\\e. fnamel ~t-~\'''''' ~t Phone f. I!;.."c(af'f.fss) ~ (lics. no.) ,'-" ~'::F...e 1Ll'1 ",;'jlll. ,Q7480 ~/62. (exnires) (ohon!'! no. : 't<rsI(JlOfJO Structural Electrical M~\\ ~l.ill'?'" 30lbQ L,.F,I..u Qd r;;V~r.I' 17VO,> 20-rlU' 'i-30-'8b Mechanical t'<JM_r<l"'\ ~t.. 1/5"5 \AI ~ &'c.<'W' e(7lf02. 2t;e-~O" CONTRACTORS (name) (addre~s) (lies. no.) (pxnirp~l General 2(, ("n......-t..,c-~ QD ~'>C 11000 ~.., Q7'lilO '-1(:)$5'1 5"-/6-e6 \_ Plumbina ~~").J... P\"IM.~/j loBS ~ 3S-rlo ~~C,"'W1 Q14CJ<; ').o-/~B- PB Electrical "'~ Q"'i\l\V~ ?,O\&,q Lel2::\..." (2c9.. Gvo,~.." q7l{O~ 10-/7Q C ~lechanical tcM.tW'<1vn...1 I\t.. 3/57 W ~ i:-v"'......... q7~ ?-<>'is- !;."'50 PLUMBING ELECTRICAL'! --1!Q.." FFF rHAPf.F...llil.... FFF rlJAR&l: JJll...1 Residence of 3"s:.O~it( '3LfS-237i./ ! (ohnnp nn l '1-~-i)6 Itp,.,-342R i , b'i33- 7be,! I ~4S'--o~7l/: ! 3,,~""'237':1 MECHANICAL Each single fixture SQ. FT. furnace/burner to BTU's IJ:LICHAPf.F I I I I Relocated building (new fix. additional) ./ New circuits alts. or extensions 7 e:JE Nl6X?8 SERVICES tr- Floor furnace and vent '. ..~ S.F. Residence 11 bath I Duplex (1 bath) Recessed wall Soace heater ~nrl vpnt /~.-i I ! I I ~.4 ~~ ......, r- lJood stove/heater I I I I /A.OO I.,r-- TOTAL CHARGES "". TOTAL CHARGES ~ . TOTAL CHARGES WHERE STATE L\l; REQUIRES that the Electrical work be done by an -Electrical Contractor, the electrical portion of this pemit shall not be vali1 until the label has been signed by an Electrical Supervjsor and returned to the Building Division / Sewer lstorm Sewer i~~ 1$"1'l17f I 1 I I I /11.... 10f I COHl.I./IND. FEEDERS I Install/alter/relocate rl;~tr;h fj)prlpro:. Of amps.1 amps. t/ AL."'IZ!R P"'~7~ ~ Ap!> 1 i ance vent seoaratp Stationary evap. r:ooler Vent fan with ~;n"lp ,f"r... Vent system apart from heatino or A.C. Mechanical exhaust hnnd and durt each Additional bath lremporary Construction _IChange in existing rp~ j r1J'JH"P Imultifamily. comm. or T",-i,'o:.td"l Water service ISSUANCE OF PFR!UT I I I , I I /~ .....1 1 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 Ore90n oertaining to the work described herein, and that 110 OCCUPAllCY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s Board is in full force and effect as required by ons 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. .......... IIAI-1E(please print) \ 0"'" ,-..... \ T' l...-:.JL Il . ~ r---- SIr.IIATURE \~ \ ~ DATE I(-).Il-el/ Type/Const. Bedrooms FQ~ nrF~(~ '.I~~ ~:JI_V Sq. Ftg. 'lain Sq. Ft!J. Access SQ. Ftg. Other~7: ~eb15'7f , Q?...o' Plan Ck. Conm/lnd ':117" _1" ____15.:..____ 65%/Rldo Pi'r Fpp (,/,c;;\..t..../ ? "8 Plan Ck. Res ~.e>, 30t/Bldn Per Fee ./ t:? ~ F enc. ____..Lc_:____ _ yo ----/.s.~__1 S1dewalk . (;0 I A/C Paving ~____l~_'~~_: Curb Cut ., '. Zone t!:.~ Fire Zone Flood Plain G:N Units Occy Load Occy Group--.!3 -2 x Value x Value ~G"c... Value.~~- TOTAL VALUATION Stories 7 BUILDING PERmT Charges and Surcharges Systems Development Charae (1.5~) #A PLU'lBING PERMIT Charges and Surcharges ~ ELECTRICAL PERIHT Cha rges and Surcharges MECHANICAL PERMIT Charges and Surcharges I I TOTAL 1l't-4Y~N4<K~ /.'"". LI~ ~A"M<i!'iYr - v T' I I ITotal Comb. rermit I I';;r~. ~~ - ~ / ~'1':68 . DIjIllO . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 1/ 03 43 2. example- Lot I. Block 3, 2nd Addition to Sprlngrield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinq/or forced air Qas 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation. etc. ------ I. examole- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project. check-nfw - if addition, check add. etc. F. Building permit information: 1. example - construct single family house with an attached garage 2. examyle - 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 TEAll 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 8. 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 fu 11 schedu 1 es 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. --- III. 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 signa ture. 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 PROJECT CONOITIONS TO BE SATISFIEO BEFORE OCCUPANCY: . PERMIT VALIOATION y~ lY Pennit Clerk ~ Pennit applicant exempt from registration with the Builder's Board because: ".Additional Project Irifonnation: .; .... \ PLANS REVI EWEO BY: . .' name L6RA/a" ;z:tEtSt!F..l? signature ~ ,. . ~ .;"~ . , ~. ..... .-.' date 5-9.8:5' .. .. ~ "