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HomeMy WebLinkAboutPermit Miscellaneous 1982-1-5 ., . ~ ,. ;~ INFORlIATlON llNt 726-3753 , Sq. Ftg. "lain ~C]. Ftg. Access. Sq. Ftg. Other flew Add Alter Rep. --Fence Demo Change/Use Other - - 'I BlSPECTIOII LIIIE. 726-3769 CITY Of SPRlIlGflELD COI1BI;IATION APPLICATION/PERMIT E!IERGY SOURCES: Heat Hater Heater Job Address t{lOr M/J/Al ~r. legal Description ~PRJNhf1&UJ i/Tll-Irf WARD e-B(..>T'{<It'.> OPr::j</tTlPJJ0-{D. Owner ~,{), & Address '2-0 NORrH A. or. -; 1J./9~ :;" 'PhonY' Valu~ Harle I. tJ tl1J BuilGlnQ'Pernlit Info: Oeser.be Work(i.e., Familv nesidence With Attached Garaae) Build Single ~ )j ..... I..IJ W IJJ Ranqe Construction lender ~ /' IIlfJmll.-- et'/A#. lJf<MMO/'/tt;f, m U f/.J1'.JjJfV/100 10 IY '5V!<./vr SettfV'-, Address Ot:>lf.ir~ TEAf,' (name) Phone (address) !lies. no.l (emires) (ohone no.' Primary 1)/%/(:1jJ ~i~~ f'tJ gm ?'<HhJV~. (JR. "'17407, 6f33{/f3cR -. - Structural Electrical fiechan i ca 1 CONTRACTORS lnamel Genera 1 MJ 13 Plumbino I-ImY-I/P./ U/I/ (addrp<;.c;) 11 ic:C';.. no.) 1f (nhon~ nn Electrical f.lechani ca 1 PlUlIB HIG NO. Each single fixture Relocated building (new fix. additional) S.F. Residence (l bath) Duplex (1 bath) each Additional bath ~Iater service Sewer /~i?' Storm Sewer ElECTRICAl MECHANICAl FrF FHI\BlI.L Nn >>> CHARGE ....llil.... Residence of furnace/burner to SQ. FT. BTU's CELI.cHARliE. I I New circuits alts. or extensions Floor fu rnace and vent SERVICES Recessed wall ~o~rp hp~tpr ~nrl upnt Temporary Construction Change in existing rPS i d_e.nce Imultifamily, COrml. or lndus.tri~l 10f amps.1 ICO~1./INO. FEEDERS I IInstall/alter/relocate I r1ic;.trih_ fpprlprc;. 10f amp~1 I I I I I I lSSUANCE OF PFR!IIT TOTAl CHARGES It? <><-' TOTAl CHARGES I TOTAl CHARGES WHERE STATE l~H REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be valij until the label has been signed by an Electrical Supervisor and returned to the Building Division 1tJ.- Appliance vent s.eoaratp Stationary evap. cooler Vent fan with sinole duct I'Vent system apart from ,heating or A.C. I Mechanical exhaust hood and duct I ~lood s tove/hea ter I I I Fi re Zone Flood Plain I HAVE CAREFUllY EXMIINEO 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 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 NO OCCUPAr~CY will be made of any structure without the per~ission of the Building Division. I further certify that my registration with the Builder's Board 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 7Ql.055 will be used on this project. SIGNATURE tJ/"'ZCAa 4f..Ia FOn OFF! CE USE Qill Y So. Ftg. Sq. Ftg. Sq. Ftg. Crlt<-1S A sm/71t OATE~ IWIE(please print) Zone Tyoe/Const. Bedrooms Stories Units Occy load Occy Group riain Access Other x Value Value Value x x TOT^l VAlUATION PlUI1BING PERMIT Charges and Surcha rges ~.:oo~ ______1<_:.___ .'1" Plan Ck. Comm/Ind 65%/Bldo PJ.r Fpe Plan Ck. Res 30%181 do Per Fee Fence Systems Development Charoe tl.5~) . BUIlDING PERIIIT Charges an': Surcharges ElECTRICAl PERI~IT Charges and Surcharges Demo I Sidewalk I AIC Paving I Curb Cut --------~~~] ITotal Comb. Permit I : TOTAl I /,?).~C> I b /1ECHMIICAl PERMIT Cha rges and Surcharges ~ c' COMBINATION APPlICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax lot 100. Lane County Map Reference II 03 43 2. example- lot I. Block 3, 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinq/or forced air Qas 2. exa~~le- waterheater/electrical/or solar E. Square footage or valuation, etc. I. example- 1250 sq. foot house. 500 sq. foot garage Z. examole- if new project, check-new - if addition, ehee k add. etc. F. Building permit information: 1. example - construct single family house with an attached garllge Z. example - 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. DESIGN 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 8. 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 O. 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 CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . '~ ~ PERMIT VALIDATION ~ ) 0-83 00 Q IJ-. . ~ / - . Pennit Clerk ({\f\(\ ) ". Permit applicant exempt from registration with the Builder's Board because: Additional Project Infonnation: PLANS REVIEWEO BY: name signature ... _._ __...-_. .._ ..._~:-:;:::-.--:,,=':'':::7~-;'::':''.-:, .!~:,;:,'::::"::-:~::;~:::~E.;:-:':::':::':-'-,._..-...... I date ._'. .'---~ _':.::-:-:::_. - -- --,,,,---,,'.--.. , ._- -~-:;~... ~