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HomeMy WebLinkAboutPermit Building 1988-2-23 (2) ..~""'t '!.' ! I I INSPECTION LINE 726- 37 69 . CITY Of SPRINGFIELD . INFOR/1ATlON UNt COMBINATION APPLICATION/PERMIT 726-3753 EilERGY SOORCES: Sq, Ftq, ',1. i n Heat ~q. Ftg. Access. Water Heater Sq, Ft9, Other flew Add A lter ~ep, Ranqe Fence_Demo_Change/Use ValuE of f1ork: _Other :<'.:1/",,4:>, ~"" , BUlldlnQ Permit Info: Describe Work{i.e.t Build Single Familv ~esidence With Attached Garaoel Phone ~ () ~ f:I3 Job Address 3.,.,,. NU.I~ 5t , 5f'f1?. O~ . Legal Description 17YJz.,?/-Q/ c!>L"'f~ , Owner M'~, I..ES e Address C,B2. IV7WJ.N '$Pf~J}1l. '11A17 74G. . .,q'52. ~XI71ING ~~fA~~1 Construction Lender J<:.~~: Aw WINWW5, aM09.1.rr,c9N of Address Phone f/f(,ff~ U;V~/../NGI flF ,:~ DESIGN TEAr~ (name) (address) - (lies. no.) r~xoires) (ohona no. \ Primary A.lJk:LL, ft7R.~R... ~rr1r,cr /3li3 flN~ !'J1. I ~rfr?, nf_ q741J 11.(.. '5r.gp' Structural Electrical ~),~ 1 S~M Mechanical CONTRACTORS (name) (address) (lies. 1'\0.' (pxoirpc:. , (ohnnp nn Plumbina Electrical -..{ ;1 ......, I 11 ~ Genpral ~1echani ca 1 PLUf.1BING ELECTRICAL FFF f.HARr.F Nn Residence of ~6 5'2. $"C SQ. FT. New circuits alts. )< or extensions 7"",P,""b~ SERVICES MECHANICAL NO. ;i7 Each single fixtur.e Relocated building (new fix, additional) rrr rH~ NO_ rH rl-I~ furnace/burner to BTU's -;>2,se. Floor furnace and vent S.F. Residence (J bath) Duplex (1 bath) each Additional bath Recessed wall ~n~rp hp~tp~ ~nd vpnt Storm Sewer Of amps. Appliance vent c:.eDilratp Stationary evap. cool~r Vent fan with sinole duct Vent system apart from heatina or A.C. Mechanical exhaust hood ilnd durt ~/ater. service Sewer Temporary Construction Change in existing rj:l<ijdYJlrp multifamily, comm. or Induc:.triill COMf1./IND, FEEDERS Install/alter/relocate dic:;trih_ fpprlpro;. Of amps. Wood stove/heater ~ ~.N~~.,/'p' ~,., 2~'- 9 /,' -vDuru;r.s ~' r/>>'~ I ~,= /HSPGr7/6Nrae ?s:- ~~ I SSUANCE OF PFRrllT TOTAL CHARGES .)2-::>0 TOTAL CHARGES :;22.5'.:1 TOTAL CHARGES (j? S"G' WHERE STATE L.\Ii REQUIRES that the Electrical work be done by an"Electrical Contractor. the electrical portion of this permit shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division J HAVE CAREFUllY EXAMINED 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 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 UO OCCUPAr~CY 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. IWIE(please print) / Units Occy Load Occy Group .,1- '3 SIGNATURE FOP. OFFICE USE orlLY Sq, Ftg. 5q, Ftg, Sq, Ftg, DATE Zone. Co": Fire ZonE' Flood Plain Type/Canst. Bedrooms Stories 5"'# r1ain x Value Access x Value / Other~".. .J.?F~L Value~~co:--' TOTAL VALUATION PLUt~BING PERMIT Charges and Surcharges s ro u-" Plan CL Conm7Thd ____~~-'-?~__..M!/Bldo P.l'r Fee Plan Ck. Res 7.03' 3nt/Bldo Per Fee ____ff.?.?~__ Fence 7.63 2'2- '5"0 ------/~/5_--1 AIC Paving ____7"~:..~<2__1 Curb Cut <,18 I :;:-II'''~ Pc..}If:1J> ~/~~ - - Systems Development "1/,~? Charqe t1,5~) #,.4'. BUILDING PERfIlT Charges and Surcharges ~ ELECTRICAL PERr:IT Cha rges and u Surcharges -I Demo I'Sidewalk I I I ITotal Comb. Permit MECHANICAL PERMIT Charges and Surcharges f.t? I I TOTAL '27/. ?7 ;,..- . . COMBINATION APPLICATION/PERMIT (CAP) ;----., , . PERMIT.VALIDATIDN I, Applicant to furnish A, Job Address B, Legal Oescription I, example. Tax Lot 100, Lane County Map Reference II U3 43 2, exa~le. Lot I, Block 3, 2nd Addition to spnngtield Estates ' C. Name, etc. of owner and construction lender D., Energy Sources , 1. examele- heat/electrical ceilinq/or forced air Qas 2. exa~le~ waterheater{electrical/or solar E. Square footage or valuation, etc. I, example. 1250 sq, foot house, 500 sq, foot garage 2. examp'le- if new project, check new - if addition, check add, etc. F, Building pennit information: 1. example - construct single family house with an attached garage 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) 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 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 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. --- Ill, Applicant to sign and date Whenever possible, the initial application will b~ 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. 12~~IPT Permit CI erk V, FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: /D9 8.5 ;=I. R...- ~-~o-~ Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name L".,R/VG' 7? ~c;. ~ Signatur~___~/-"'7 J date ;2'- 73..-'5'9: