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HomeMy WebLinkAboutPermit Building 1990-3-23 'J IrlSPECTIOrl L1r1E 726-3769 Job Address IOolIVlAJ.A/ Legal Description 17 03 - Phone INFORlIATION liNt 726-3753 Sq. Ftg. ',Ia i n ~q. Ftg. Access. Sq. Ftg. Other -1lew_AddXAI ter _Pep. Fence Demo Change/Use ValuE of 7:21000 Other-- Builriino Pennit info: Describe Work.(Le., Build Single Familv nesidence \~ith .A.ttached Garaae) D RUlLO AA/J:A1Ct..QSfD 5TCJRI'/{;EAR.#l 8>, _ /lDDJA/6- e IAJAJ.LS Tn Ex l"iTING- 'TRiAcl( e , S TORt9GE f?U/i.f?/A/G flies. no.' (f!xoires) . SI 35 L/ / ... LoT S,(r?n CITY OF SPRlrloFIELO COMBINATIOrl APPLICATION/PERMIT EilERGY SOURCES: Meat A/OA/LF Hater Heater~~~ Range ~~ -C 3 Q) Owner SPR/A/Gr/ELO Address 250 AI' A UTi/.- /T'/ sT 80A/?O Construction Lender /V'l)A/'~ ~i7~ ~- ~"'S/. '39.P , Address Ut:)ll:ir~ I EAr~ (name) Primary S et.j:: Structural SELF Electrical A/ rwl1 Mechanical A/OAIe CONTRACTORS (name) General SELF Phone (address) (ahone no. (suRI iSUR1 ~ (address) flic<:;.no.1 (PXr:li,..pc,' flJJ,nnp nn,) (SUR) Plumbino Electrical ~1echanical riO, PLUMBING ~t'AV'~ FEE rHARr.F Nn ELECTRICAL ~t'A/~ MECHANICAL /l/OA/E ~~~ ru~ NO SQ. FT. furnace/burner to BTU's E:'E:'E:' Q!ARGE.. Each single fixture Residence of Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (l bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall ~n~rp hp~tpr ~nrl vpnt Sewer Temporary Construction Change in existing rps i d_PJ'l"P multifamily, comm. or IndlJc;:tri~l Of amps.1 !COMM./IND. FEEDERS l'Install/alter/relocate distrib. fppdpr" 10f amps.1 I I I Appliance. vent ~Pl'\i'I ra tp Stationary evap. cooler Vent fan with sinnl~ rtllCt Vent system apart from- heatina or A.L Mechanical exhaust hood and durt, Water service Storm Sewer Wood stove/heater ISSUANCE OF PFRillT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L'H REQUIRES that the Electrical work be done by an, Electrical Contractor, the electrical portion of this pen:tit shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division 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 UO OCCUPAIKY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builderls 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 7Ql.055 will be used on this project. rWIE(please print) ~',--( &,<; r/ SIGIIATURE ~ ~.3L FOR OFF I CE USE OIlL Y Sq. Ftg. riain Sq. Ftg. Access Sq, Ftg. Other&Lr~.e'" OATE~-2,)- <JO Zone_-r.' c.. . Fire Zone Flood Plain Tyoe/Const. Bedrooms Stories 57\/ Uni ts Occy load Occy Group ~.1 x Value x Value ~~elalue TOTAL VALUATION ~ ~.-.:--. / BUILOIrlG PERmT Charges an~ Surcharges '2.r- Plan Ck, ConrnlInd ___d'_:;C='2~__ 65%/Rldo P-"r Fpp / 3 Plan Ck. Res .6 30%/Bl dQ Per Fee I Fence ------------1 . D~mo I Sidewalk I A/C Paving I Curb Cut I ";Z /. /3 Systems Development Charoe (I.5~) //.4 , .. , PLUllBIrlG PERMIT Charges and Surcha rges ELECTRICAL PERi~IT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges TOTAL '3~j3 6"5: '2.6 .. Total Comb. rermit . - " COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Description 1. examole- Tax Lot 100. L~ne County Map Reference "1/ oj 43 2. examole- Lot 1. Block 3, 2nd Addition to springtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. example- heat/electrical ceilinqjor forced air OdS 2. examDle- waterheater/electrical/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 pennit information: 1. example - construct single family house with an attached garage 2. example - remodel existing garage into family room 3. exam~le - 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 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 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. --- Ill. 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 PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY: - \ PERMIT VALIDATION 103-<;,7 ~.. Permit Cl erk Ov Permit applicant exempt from registration with the Builder's Board because: "Additional Pro~ect Information: .. PLANS REVIEWED BY: name L&>//#E ~ C:<;,tF~ Signatur~-"" -- // ~~ ", date '""5-'9-9C:>