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HomeMy WebLinkAboutPermit Building 1990-5-29 j .\-r""~~. ':r; J ';-;! j m~~mON LINE , C~~:I'I:~H:';o~~~r~mm;~E~:~' _ _ ~~~~~7~~ION UNt J~b Address I{)! of)<=>l.lrJ-I Co 1m 1 n 11" ~~;~GY SOURCES: ~~: ~~~: ~~~;ss. ~ Legal D..cripticn r 1'\" '? ':jc!..?\ \ (~l t"\r--.. I;ater Heater Sq. Ftg. Other @ . 1f}:J I<.JI: 1 \'-'\\ J\ ) Ilew Add Alter Rep. - _\ 1'"'\,1\1 '{:'I," ' Range Fence_Demo_Change/Use own~~' to1 \''(\1 ~\'\ f>~~~'rli~~ ValuE.~Jk6~?_gJ, _Other Address \ i'\. n "'180' -l f\ d"...:L Pho:)e. Buildino P~~it Info: Descr,be Work(Le., Build Single - _ ~,))' I N ~ \ ;:tvl1-. _ Fam,ly nes,dence \;,th Attached Garaoel ::J '-.~~.Jdi I ) , (,\'\4\1 I.)...\;L'C\(,)'-"n-\\~ O1_\0C\.\\m.Cfl'\\S,)() construc\io)'Vnder I ( ;:-' /~n"l to \ 3 \ ~ C\ \) 0 t ~.\\ ,")'"le\ \ \ \{\t;s. \' X\~ .. '- Address \JC\ ~ n ....010J\g. _ t\\.rN. ()\ \ !--"ifx'V"\ l\"':'--.~-+"; d ,,~ UI::::dl:iN 1l:.Ar-1 lnamel (address) - -l\ 'T('ics. no.) (exoires) \ (ahone no.' /. "?S= j!:vf/<e.... 4YC'- ~ E~~/6r? Q"?y",.? Primary Fi:>~/) L .hPFr-7'r , - * ?q-~ '?'9 Structural Electrical Mechanical CONTRACTORS. (name I (address 1 Genera l~. HlJv!...\) 6) A ~, V1- i, .., ,}...... Plumbin ..Qcj~u-~ MV\...!! ') \ '-- Electrical (lies. no.' (exnireos.) (ohnn~ nn. , l ~1echanical PLUlIBING ELECTRICAL MECHANICAL -...llih FEE 'CHARGE 'ill...... FFF rH~ NO. ':fL' SQ. FT. furnace/burner to BTU's Each single fixtu~e Residence of Relocated building . (new fix. additional) S.F, Residence (1 bath) Duplex (1 bath) ~ New circuits alts. Y or extensions 1/ -::!_"'~~R6E" SERVICES :2 (7.;9<' Floor furnace and vent Recessed wall SD~rp hp~t~r ~nrl vpnt { ea,ch Storm Sewer Of amps. Appliance vent S~DaratE' Stati onary evap. cooler /.'/ Vent fan with =,~ t:;;J sinol~ duct ~ ~&. Vent system apart from heatinq or A.C. Mechanical exhaust hood and dur:t. Wood stove/heater Additional bath Sewer Temporary Construction Change in existing rE'S i Qf!J1Ce multifamily~ comm. or Tndustrial Water service COMfI./IND. FEEDERS Install/alter/relocate (Ii <:.tri h. f~~d~rs Of amps. ~ ?~r-=' ,EcGC; ~/""?-C ~~/T ~..&. ? ~ ~ e:;Z: & B' c-L.r..../~c ':::::;'A~..J,~ ISSUANCE OF PFRIIlT TOTAL CHARGES TOTAL CHARGES~Y7.~'" ,-?~~<;i.I~ . TOTAL CHARGES 41 ,R. ao 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 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 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 here;n~ 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 Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption ;s noted hereon, and that only subcontractors and employees who are in compliance with ORS 7~1.055 will be used on this project. cJ: IWIE(please print)'~ V-,1 VI Caz r' / );V SIGrlATURE -;./~ '-l FOR OFF I CE USE OIII'Y ( Tyoe/Const. ,~~# Units Sq. .ltg. 11ain, Value Bedrooms O~cy Load Sq. Ftg. Access x Value Stories / Occy Group P- / Sq. Ftg. Other x Value . - - . . ~Q'n Q.t-.-{J:)-0..q()~11JCf?Ar~lOrI 'qs' UJ ' Plan Ck. COIllTI/lnd ' ~/\ '/ \ 'syste, ms Development' II 4' . 65%/Blda P.r F.. '-- n . CharQe O.5~)' oR- , - -'0-- Plan Ck. Res I' . ' . 30%/BldQ Per Fee Zone cc. Fi re Zone Flood Plain BUILDING PERflIT Charges and Surcharges I PLUt1BING PERMIT Charges and Surcharges Fence ELECTRICAL PERf~IT Cha rges and Surcharges MECHANICAL PERMIT, Cha rge sand Surcharges Demo Sidewalk \J V:. . ~ 'l\oAJ t, -,..()~ ~U - I ~~Jl(D ~ AIC Paving Total Comb. Permit ____1'"8--'--~~u -:z. Yo Curb Cut -- TOTAL ~ , . - " I."" ..,__ 0_ ./" . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION J. Appl icant to furnish A. Job Address B. legal Description ' ", If 1. example~ Tax lot 100, lane County Map Reference 17 oj 43 2. example- Lot I. Block 3, 2nd Addition to spr,ngtield Estates C. Name, etc. of owner and construction lender O. Energy Sources 'I. example- heat/electrical ceiling/or forced 'air qas 2. exa~le- waterheater/electrlcal/or ~ E. Square footage or valuation, etc. I. example- 1250 sq. foot house, 500 sq. foot garage 2. examole- if new project. check-nfw - if addition, . cneckadd, etc. - . F. Building permit information: 1. example - 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. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or jab 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 fu 11 schedu 1 es 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. --- III. Applicant to Sign and date Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Oivision 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. s,zq.qo (l\<64 V. FOR OFFICE USE ONLY "" Penni t ",H?m ) ......... PROJECT CONDITIONS TO BE SATISFIED B'EFORE' OCCUPANCY: .. . ~ . Permit applicant exempt from registration with the 8uilder's Board because: ..J Additional Project Infonnation: . PLANS REVIEWED BY: name signature date