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HomeMy WebLinkAboutPermit Building 1986-3-31 CITY Uf SPRINGflE~D COMBINATION APP~ICATION/PERMIT EIIERGY SOURCES: Meat ' l~ater Heater Range Val,uJ'. nf Work: 37 c::t::>, ...-1> Suiloina Permit Info: Describe Work(i.e., Familv Residence Hith .A.ttached Garaae) _.~"..-~ ".- _.- -.- ..... -....-.. ". " I I INSPECTION ~INE 726-3769 Job Address e J t:/6 2 h?.I9.&' .~7: -11'-7-/2 Legal Description 17-tJ"3-9'$'-l./1 ~4"9~ / Owner "6:"~i~RBs/ ~~~W/7'Y" ~v/~, Address lOb '2 m-~ 5;7";. Phone ")7-:>r:d::> O'1=': 9':? y/;;> n~-8F.:2S Construction lender INFORllATlON liNt 726-3753 Sq. Ftg. "lain ~q. Ftg. .Access. Sq. Ftg. Other New Add Alter Rep. -Fence Demo Change/Use Other- - I~ . I~~ ~\) ~t.J '-\I' O()~ l.oJ Build Single //hc.-r'$/~ ~el'~-.a;: Z UN.rr~ 9-/? Address Ut~l~N T~AM (name) Phone (address) (lfcs. no.) Primarv /?WN~ . Structural Electrical Mechanical CONTRACTORS I name I General ""'IN&~ (addrpssl (li('5. nn. \ h Plumbino , E1ectrical-'2:'t ~lechan;cal L(-7~Yt, M.L,ft ~ PIll tI ~ PLUflBI NG ELECTRICAL --'!Q.,. FFF C'iARC,F #IllY . 7. 5::> 1'5. ~ Nn~ u.L1..cJJAB.liE. "n Residence of / Each Single fixture SQ. FT. Relocated building (new fix. additional) New circuits alts. o-2e~>>i~""/1~ SERVICES or 225': S.F. Residence (J bath) Duplex (1 bath) each Additional bath Temporary Construction Change in existing rp} i rlJ'J1l":P multifamily. comm. or TnrllJ,tri~l I I I I I I I I I ~ '2~~"'2) Water servi ce I I amps.l Sewer Storm Sewer Of ICOffi1./IND. FEEDERS l'Install/alter/relocate di,trih fpprlp~~ 10f amp..1 I I I TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be valid until the 15: DC> TOTAL CHARGES that the Electrical work be done by an. label has been signed by an Electrical Electrical Contractor. the electrical portion of this permit Supervisor and returned to the BUilding Division Tb (exoires1 (ohone no.) j *" (pxoirpc;.l (ohanp nn.. \ MECHANICAL c>< r"1l.RliE furnace/burner to BTU1s Fl oar furnace and vent Recessed wall Sn~l":p np~tp~ Anrl ~pnt Appliance vent SPOijratp Stationary evap. cooler Vent fan wi th sinale duct Vent system apart from heatinq or A.C. Mechanical exhaust hnnrl i'lnd duct Wood stove/heater ISSUANCE OF PFRr1n TOTAL CHARGES I HAVE CAREFULLY EXAMINED the completed aprlication 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 OCCUPAr~CY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s 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 OP.S 701.055 will b~ used on this project. IWIE(p1ease print~~)./AI >>~cP~/...>t:f# SIGNATURE4 ~ ~~~ DATE...J-f,/ .J-t!, FO~ OFFICEJM OIIL Y ~ Zone~ TYDe/const;~r;v ??':'1inits /"2. ~/l>7. Sq. Ftg. riain x Value . ..r..~ Fire Zone Bedrooms uccy load Sq. Ftg. Access x Value Flood Plain 'Stories I Occy Group if?-/ Sq. Ftg. OtherAk........P~x Va1ue~ .,...' ..... ~ . TOTAL V ALUA TI ON BUILDING PERfllT Charges ant: Surcharges Plan Ck. Comm/Ind 65~/Rldo Ppr ~pp Plan Ck. Res 30%/B1do Per Fe. ,...-.- -- ~ Systems Development , "'ZR_ ,.. ~'3 CharQe tI.5~) , J/. /4 . ELECTRICAL PERI~IT Charges and SurCharges f1ECMANICA~ PERMIT Charges and Surcharges ____'i.'i.:.sc -;. 7~ ___../;5;_~__ Fence . 60 "':(<-:5""""::::> ISidewalk ------~-?O--I A/C Paving I Curb Cut ------------1 PLUr~BING PERMIT Charges and Surcharges D/j1l1o Total Comb. Permit J?5"-2B -'. ::11 tt. 2l I I TOTAL e COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax lot 100. lane County Map' Reference II Uj 43 2. example- Lot I. Block 3, 2nd Addition to Sprlngtield Estates . C. Name. etc. of owner and construction lender O. Energy Sources ~~ 1.' examole- heat/electrical ceilinq/or forced air QdS 2. example- waterheater/electrlcaltor 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 permit information: , 1. examele - 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, Buildlng 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. --- III. Applicant to sign and date Whenever possible. the initial application will b~ 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 penmit 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: " e iii" .. PERMIT VALIDATION " ~ 1)-\ \0 ~~ $.. \) ::i "\ ~~ Permit Clerk ~ . Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: '. .'- " name LC>"R~tE ~~~ Signature~~_ -' ", " . date t;/--:?~ '. .1.. . .