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HomeMy WebLinkAboutPermit Building 1991-1-4 4,\ -p "( ~ 0 Z- 2--- Owner'.~.~ Address Iq~q 11/J:j.,;., p~ Prz-.--rJv........-J:::; . CITY Uf SPRINGFIELD . INFOR/tATlON UNL . COMBINATION APPLICATION/PERMIT ' 726-3753 EIIERGY SOURCES: Sq. Ftg. 11a;n Heat ~q. Ftg. Access. Water Heater Sq. Ftg. Other Ilew Add A Her pep. Range -Fence Oemo Change/Use va1u~~ Other- - BuilGinQ Permit Info: Oeser be Work(i.e., Build Single Familv nesidence With Attached GaraQe~ II~)PECTION LINE 7l6-3769 ~ Job Address 1199 1'I1#{;J 5T' ('.f'A).oiZ. . legal Description c.. _A ~~'1.....l 0.r'rr-.rt ,. () J~. I~ la ~ ~- Phone Construction lender, ~ ~~<-- r2u-,~ J U Address DESIGN ILAr1 (namel Primary SP,c"C:W....-p- g,:Jf'h",S Structural ~c: Electrical NOt-i&- Hechanical flbNh. CONTRACTORS {namel Genera 1 c.t?Gc."";y).,9- S ,,\"'~ PlumbiM Norl'f;. ~l~ctrical f.a7., r6- ~'echan; ca 1 J-f"1-vI4~ PLUI,1BING Phone {address' (lies. no.1 ... 5(,07..'2- (exoiresl (ohone no. ..W7 .91Gt-l..G" ST: PfO I "3 -j~-1( (addr~ss 1 {l ics. no. \ (exni re~;.) (ohnne no. 1 ELECTRICAL MECHANICAL NO. FEF rH~Rr,E Nn ~~~ r~ARr.~ NO ~rr 1..c.J.iARG..E.. SQ. FT. furnace/burner to BTU's Each single fixture Residence of Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence il bathl Duplex (1 bath) each Additional bath SERVICES Recessed wall So~hp~tpr ~nrl vpnt amps. Appliance vent ~~oarat.p Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from heatino or A.C. Mechanical exhaust hood il.nd duct Sewer Temporary Construction Change in existing rp~ j 1em"p' multifamily, comm. or Tndll~tr;al Water service Storm Sewer Of COMfI./IND. FEEOERS Install/alter/relocate rlic:;trih. fpprlpro; Wood stove/heater Of amps. ISSUANCF nF PFRlilT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LMi REQUIRES that the Electrical work be done by an,'Electrica1 Contractor. the electrical rortion of this pemit shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed aprlication for rermit. 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 110 OCCUPAUCY w;ll be made of any structure without the permission of the Building Division. I further'certify that my registration with the Builder's Goard 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 ORS 701.055 ., -~ ~~~5 project. Type/Canst, Bedrooms Stories Units Occy Load Occy Group DATE/-'f~ UAI.IE(please print)-0b \-\f.J ~'l/\ 6N H,IA~l" ~ Zone Fi re Zone Flood Plain x Value Value Value Sq. Sq. Access Other x , TOT^L VALUATION BUILDING PERNIT Charges and Surcharges _ _ -"'2Q '-~? __ _ ~~~~B~~~ 2 t~] ~~~~B~~~ Fence COITlll!l nd Ppr Fpp Res Per Fee Systems, Development I Charqe O.5~)'''' PLU!1BING PERMIT Charges and Surcharges D~~o' 'Sidewalk A/C Pay; ng Total Comb. Permit ELECTRICAL PERIIIT Charges and Surcharges 11ECHANICAL PERMIT Charges and Surcharges ~\ TOTAL /'5'3,Z;s Curb Cut - . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description I. example- Tax Lot 100, Lane County Map Reference 1/ oj 43 2. example- lot I. Block 3, 2nd Addition to Sprlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources '1. example- heat/electrical ceiling/or forced air gas 2. exa~le- waterheater/electrlcal/or ~ E. Square footage or valuation. etc. !. example- 1250 sq. foot house, 500 sq: foot garage 2. example- Tflnew project. check-new'-,if addition, cneck add, etc. F. Building permit information: . 1. examele - construct single family house with an attached garage 2. example - remodel existing garage into family room 3. examele - 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 CDNTRACTORS 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. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the full schedul es C. BUILDING DIVISIDN 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 tit .. . I. . .. i , ; PERMIT VALIDATION II ;J?J /I. -)! ;-?f #- )/020 \, Permit Clerk ~LC- PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permi t appl i cant exempt from regi strati on with the Buil der' S' Board liecause: Additional Project Information: PLANS REVIEWED BY: , .i , i .I I i name " signature . , i' 1,,'. P ~ ~ "~:' \ , '1:''1,':.. r,,~/'r' \';, ;!.:; '. ;.,1" I-l~', date "'~ ",;~ljl>t;H'. ,;,,~ '"" \~. ." J