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HomeMy WebLinkAboutPermit Building 1986-2-14 1. I ,j ~ 0\ :8 -.hI ~ Construction lender Address Ut~IGrl TEAI1 (namel Phone (address) Primary Plumbino PIa If I 'address} (lics. no.) .P 1./ ;' h: -n,/. ~ 1/ ~ x,...... II . ~ - -. ~' --'f (pxoirpd ' (ohnnj:> nn.1_ Structural , Electrical Mechanical CONTRACTORS (namel General '""t\r '').1/7 '7 y6 - ;>, ;;.. "Jt') Electrical ~1echantcal PLUI1B I NG ELECTRICAL MECHANICAL NO. FFF r"~ ~n Each single fixture Residence of I="~~ rl-laB.G.E.I_tlQ..a...J SQ. FT. furnace/burner to BTU's ILEL' ..cHAB.G.E. Relocated building (new fix. additional) , New circuits alts. or extensions Floor furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each SERVICES I Recessed wall ~n~rp np~tpr ~nrl vp~ ITempOrary Construction 'Change in existing r~~j<<jp.J1r:P Imultifamily, camm. or TnA"c:trio'll IOf . I COMl.I./lND. FEEDERS I "Install/alter/relocate I I rl;~trih fpprlprc: 1M ~p~ I , I I I i I ISSUANC, OF PFRllIT TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES WHERE STATE L.\l/ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pe..,it shall not be valtJ until the label has been signed by an Electrical Supervisor and returned to the Building Division I Stann Sewer amps.1 Appliance vent , 'ifl'o!,!rM.p I Stationary evap. r::ooler I Vent fan with ~inole dUc:':t I Vent system apart from heatino or A.C. . 'Mechanical exhaust hnnc1 ilnd r1ur-t Additional bath Water service Sewer Wood stove/heater I 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 Derformed 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 110 OCCUPAIICY 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 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 7D1.0?5 will b~ used on this project. Zone ~ c::: Fire Zone Flood Plain rlAllE(~lease print),M.1"" /? R r--:TfJ 1I&tt/tl r(/SIGIIATU-(jj-d~H.#fJl~~ATE:?- "C . Fan OFFICE usE" Or/L'Y -. /" Type/Const. 5-/V Units Sq. Ftg. 11ain x Value Bedrooms Occy Load Sq. Ftg; Acces,uloeli/' 1~~, l~ ./) ......l ue Stories Occy Group'''~ Sq. Ftg. Other )t Value -/~ ,};~ /":2#0 TOTAL VALUATlml BUILDING PERfllT Charges an~ Surcharges ...,.........0 Plan Ck. Conm!lnd ____~!::"'"...!~~___ 65%(Rldo P.rr FFI~ ~ Plan Ck. Res . 04 3D%/Blda Per Fee Fence ELECTRICAL PERlm Charges and SurCharges HECHANICAL PERMIT Charges and SurCharges .Sidewal k l--.-ft. ~~ I i I , I , I Systems Development Charae tI.5%) , PLUljBING PERMIT Charges and Surcharges ---.....-------- I DfIIIlO I I A/C PaYing I Curb Cut I Total Comb. Permit ~ (. 3:l P f{.6$" I I TOTAL . .' '.' '-" -. - ~ . ...~- ,"' , .-i r I, ,~. . ~ ~ ~ 'I. ., .........:-:'. '.. l,l '. ~ .~.~. :\,;. ,"~' COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description I. example- Tax Lot 100, Lane County Map Reference II OJ 4J 2. examEle- Lot 1. Block 3. 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. examele- heat/electrical ceilinqjor forced air Qas 2. examole- waterheater/electrlcal/or SOlar E. Square footage or valuation, etc. ------ I. example- 1250 sq. foot house, SOD sq. foot garage 2. example- if new project. check new.- if addition. cneck add, etc. F. Building pennit information: . 1. examole - 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 infonnation 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 ;'tem(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 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 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. V. FOR OFFICE USE ONLY .. , 'TV OF SPRINGFIELD City Hili 'Sprlngftlld, Oregon .' ~"'" ~;, ..... -..I~'~~', ~ Department at Public Warkl., :.:.:, OFFICIAL RECEIPT ~ J ..\'~~' . ~" ~ ,~. ~I'.' ;'" 65972 (, p. C. -g:p. (IJ~ (t ;1;"~ 3~_ t,S- (I (I ~5'"~:?~ o Amount ReCejlled~ P "f. cs- o _ ~ (. ". "I ... ~ ,r:tz,~UTHORlZEO SlQf.M,TURE . Pennit Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: " Pennit applicant exempt from registration with the Builder's Board because: , ... Additional Project Infonnation: PLANS REVIEWED BY: ,., I name LC>B~ .J?:.~~ signature ~~- -:.. ?L_~~ -'," -(' ~ date ':2"""~-l?~ :.