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HomeMy WebLinkAboutPermit Miscellaneous 1989-10-6 v \/ rto ~ . INSPECTION LINE . 1.726-3769 Job Address c-0r)n~ \\'fl. ~ fl. ~. '- Legal Omription \, n -~ '?1l 04 'L04 ::xJG I CITY Uf SPRINGfiELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat I~ater Heater INFORltATION LINt 726-3753 Sq. Ftg. 14ain ~q. Ftg. Access. Sq. Ftg. Other lIew Add Alter Rep. Range _. -Fence Demo Change/Use ValuE off\r1: D) Other-- BuihiinQ Pentit 1Iil"0: Deser be Work(i.e., Bulld Single Familv nesidence Hith Attached Garacel l 1 UJ1-\t\ a Q \'{\OTo v hn D:L . 1) -.Q \ 0 ~f<--:\\\5\. U h~ Address ~ ()nCl ~ ~ (\ c;;,{ . Phone ~ ri ((i{cj a 14n construct~n\~~ 1 - - - - .~ v .'(S'- ..Q Address DESIGN TEAr4 (name) Phone (addressl flies. no.} {axoirasl (ohone no. Primary .. wi n,-. ~ Structural Electrical Mechanical CONTRACTORS (name) {addrps~1 (lies.no.l {exniresl (ohane no.l General Plumbino Electrical \. \11)JLO lit) fOo t-t ~lechanical PLUltBING ELECTRICAL MECHANICAL NO. FEE . CHARGE .lln FFF r,,'IRliE. Nn FFF r,,'IRliE. SQ. FT. furnace/burner to Blll's Each single fixture Residence of Relocated building (new fix. additional) New circuits alts. or extensions Floor fu rnace and vent S.F. Residence 11 bath) Ouplex (1 bath) each Additional bath SERVICES Recessed wall SD~CP hp~tpr ~nrl vpnt Storm Sewer Of amps. Appliance vent seoarilte Stationary evap. cooler Vent fan with sin91e duct Vent system apart from hea t i no or A. C. Mechanical exhaust hood itnd durt Sewer Temporary Construction Change in existing rP'l-jqf,:ncp. multifamily, comm. or Tnrluc;,triitl Water service COMft./INO. FEEDERS Install/alter/relocate di~trib. fppdpr~ Wood stove/heater Of "lmps. ISSUANCF OF PFRltlT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L\I/ 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 Surervisor and returned to the Building ~ivision 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 Orel]on pertaining to the work described herein. and that UO OCCUPAI~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 ORS 7nl.055 will be used on this project. IWIE(please print) IAl'A\/r.J?i" A",,;;;: 0 SIr,rlATUREJ~<LA..P ./a.z DATE FOr. OFFICE USE DilLY / Sf!. Ftg.)*iin Sq. Fta. Access Sq. Ftg. Other Zone Type/Canst. Bedrooms Stories Units Occy Load Occ.y Group x Value Value Value Fire Zone x Flood Plain x TOTAL VALUATlOII BUILDING PER/lIT Plan Ck. Comm/Ind Charges and ------------ 65%/Bldo ~er Fee Surcharges Plan Ck. Res 30%/Bldo Per Fee PLU'4BING PERMIT Fence Charges and ------------ Surcha rges Dpmo ELECTRICAL PERIHT \5 CX) Sidewalk Charges and --- ~-~- Surcharges A/C Paving ~ MECHANICAL PERMIT I Curb Cut Charges and ------------ Surcharges I Systems Development CharQe (J.5~) ,j~o~ 50~, . blO Tota' Comb. Permit TOTAL \CO.q cs . ~ . '"' COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Description I. example- Tax Lot 100, Lane County Map Reference 17 03 4j 2. exa~le- Lot I. Block 3, 2nd Addition to Sp~lngtield Estates C. Name~ etc. of owner and construction lender O. Energy Sources 1. example- heat/electrical cei1;nq/or .forced air Qas 2. examyle- waterheater/electrical/or solar E. Square footage or valuation, etc. I. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project. check-new - if addition, cheCK add. etc. F. Building pennit information: 1. exam~le - 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. OESIGN TE~1 ANO 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. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the full schedules C. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES ANO 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 penmft is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . , I . PERMIT VALIDATION , \soS9 . I \O_wfOC\ Permit Clerk d~ Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: .. name signature ,} date iJ