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HomeMy WebLinkAboutPermit Building 1983-9-19 . . I INSPECTION LIIIE. 726-3769 Job Address \C":O \ ~(\ \ 0 0t, . Legal De<cription \l()~~~4-\ -C5~ CITY UF SPRINuFIELD COMBIIIATION APPLICATION/PERMIT EIIERGY SOURCES: Heat Hater Heater Range Phone JNFORllATION liNt 726-37S3 Sq. Ftq. 1.lain ro ~q. Ftg. Access. ~~ Sq. Ft9, Other V'" Ilew Add Alter Pep. E) -Fence Demo Change/Use Vjt' ~~lc:A.00 -Other- - Bui16ino ~rmit Info: Desc~lbe Work(i.e., Build Single ~"'\, Familv nesidence With Attached Garaoel ~ l ~Q--!o")\'~b C\'PI'<'f\ffio1\.1' ioQ. ~ Owner .0\ L~ Address 2- ~() 'i\..,: ~. ~. ~Orl (\)e l')4~-~~ Constructio), Leiltler I Address UtSluN IEAI1 (name) Primary Structural Electrical Mechanical CONTRACTORS Genera 1 ~ , Phone (address) (lies. no.) (exoires) (ohone no. M ~ l' l1ic5. no.) !pxoires) (ohnnp nn, \ ~l~ ~l ith ...,.1) l()::~l.\\~ (rP,~44q1<" ) Jnamel (address) ;~.~ '~~'~RJ aru\On , \- Plumbina Electrical ~'echani ca 1 PLUllBI NG ....lliL,1 ' FEE 'CHARGF lEaCh single fixture IRelocated building (new fix. additional) Is.F. Residence (l bathl !DuPlex (1 bath) each IAdditional bath I ~Iater servi ce Sewer Storm Sewer ELECTRICAL I - ~ MECHANICAL I r\.ll1R.G..E Nn I ~~J:' "--fw:nace/burner to BTU's I ru"liiG.E. Nn ' I ~H Residence of SQ. FT. New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall ~n~rp hp~tpr ~nn vpnt Temporary Construction Change in existing rf'<;' i n_encp Imultifamily, COTllll. or Tnnll<:.trial IOf amps Ico~4./IND. FEEDERS IInstall/alter/relocate rli<:.trih_ fpprlpr<:. IOf amps.1 I I I Appliance vent <;'PDar~tp Stationary evap. cooler I Vent fan with c:inole duct I' Vent system apart from , heatinq or A r: I Mechanical exhaust hood and duct I Wood stove/heater I I I ISSUANCE OF PFRt1IT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES , WHERE STATE L,'l~ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pernit shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXNlINED 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 oerformed 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 NO OCCUPAIKY 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. NAME(please print) rj",.,J ;T /00.../ C.V" SIGN^TURE~O iAJA OATE 9-/'1-'13 FOR OFF I CE USE OIIL Y , Zone Type/Const. Units Sq. Ftg. riain x Value Fire Zone Bedrooms Occy Load Sq. Ftg. Access x Value Flood Plain Stories Occy Group Sq. Ftg. Other x Value BUILOING PERI.IIT _d6~ Plan Ck. COIllllII nd Charges ana 65%/Bldn PJ'r ~J;>e Surcharges J. , '2,.. Plan Ck. Res 30%lBldo Per Fee PLUI1BING PERMIT Fence Charges and ------------ Surcharges Demo ELECTRICAL PERI:IT Sidewalk Cha rges and ------------ Surcharges A/C Pavi ng 11ECHAN I CAL PERMIT I Curb Cut Charges and ------------ I Surcharges TOTAL VALUATION Systems Development Charce tI.5~) Total Comb. Permit I TOTAL J ~ ~9 . 1:)./ . COMBINATION APPLICATION/PERMIT (CAP) I. Appl icant to furnish A. Job Address B. Legal Description 1. example- Tax lot 100, lane County Map Reference 11 oj 43 2. examole- Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. example- heat/electrical ceilinq/or forced air Qas 2. exa~le- waterheater/electrlcal/or SOlar E. Square footage or valuation, etc. 1. example- 1250 sq. foot house, 500 sq. foot garage 2. 'example- if new project. check-new - if addition, . cneck add, etc. F. Building.'pennit information: 1. example - construct single family house with an 1 attached garage 2. examole - remodel existing garage into family room 3. examole. 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.~ 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 signa ture. 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 CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . PERMIT VALIDATION \ ~ \f\\lO '\.Q \ ~)q_~3 Permi t cle~{[1L) Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature M "_.. .....___~"'-~'"""""....,~......~.......,_ ,I . date