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HomeMy WebLinkAboutPermit Building 1987-8-16 INFORllATIDN liNt 726-3753 Sq. Ftq. 1,Iain "'NO<:: ~q. Ftg. Access. Sq. Ftq, Other 20lew_Add_AI ter -,~ep. _Fence__Demo__Change/Use Val~*2.~()V =- _Other .l'\ojL-PhoneD>]. Buil<iinQ I"ermit Info: Oescribe Work(i.,e., Build Singlej..9 v..... ", '(3tO ,~-""..., Ilesidence. With Attached GaraQe) J to-/O/~ ~~ElD ~ -:':PJ\b - f"J Iml\Jlt::>U r; ~.~.Cf'~ to/~_~'(.~l~. Address Phone ~ f!:l"'C15. Ut~ll:irj It:AI''' (name) (address 1 (lies. no.) (exoiresl (ohone no.) ~~~~;i~:::;:~:::~::~~.~:: :::+ CONTRACTORS (name) (address) (lies. no.) (pxn;rp~) (ohonp no.) Hde.... I INSPECTION LINE 726-3769 - " . , , .---.. I~ CITY U~ SPRINufIELD COMBINATION APPLICATION/PERMIT EilERGY SOURCES: Heat ~1" e..5. Water Heater ~~ Job Address 1100 f\t\AlN "OT, ::PZI~eLD,C1l. Legal De<cri~tion IA.X LOi # 4SOD 1. MAP 17 03 % 41. ~"II ~~.t.I~~* Owner "'V dt-.... .? <>1, ., k "'1 / Address If') Cr..jt '1)".. E~ Construction lender Genera 1 , Plumbina r/-'n k~'11 Electrical 7>c...J,.../ dc... t:~L.eJ.,.-, d ~1echan; ca 1 NO.1 ~I Each single fixture PLUf1BItlG I FEE I rHARr,[ !:- ZOS'"" Relocated building (new fix. additional) S.F. Residence (] bath) Duplex (1 bath) each I I I I Additional bath Water service It),~ Sewer -;;'S-~.! M:- Storm Sewer~'t ~ liii<KFC~W ?kF~ eN,); '<!!## 'pG'/, etS' 5:- Range eX) (}J v Ifr(~J. V.-- ~-...~~ n~ ~., GO<S Plan Ck. Comm/lnd ~~. 65%/Rlda P~r Fp~ -- ---------Pl'an Ck. Res ~.O", 3Dt/BldQ Per Fee __"J!..'~~__ Fence 11.60 D~mo ____~$7-Sidewalk I. lit> A/C Paving S' '< . -0 Curb Cut ------------ ~ . C,a. :r "" c.. P.:J, i'3 CoY; ELECTRICAL NO I Residence of SQ. FT. New circuits a1ts. or extensions SERVICES , Temporary Construction Change in existing rps j q~nq: multifamily. comm. or Induc;,trial I Of "'200 amps, COMM,/IND. FEEDERS Install/alter/relocate rl;~trih fpprlpr~ Of amps. 77ti"; t;~k-t Ollte-q 7(,1()/ ~~1'1~.~ MECHANICAL I i=H. I rl-lARG.E. NO. I furnace/burner to BTU's Ii=i=i= I r"A.RIi.E. ./ Floor furnace and vent I IliI.- I I I~- I I I I Recessed wall SI)<I~P np;ltpr ;lnrl vpnt J tI ~'--J/ /SI" -11) tJ /1"' 'If. Appliance vent s~oaratp Stationary evap. cooler "? Vent fan with """ sinale duct Vent system apart from I heatinq or A.C. Mechanical exhaust I hood ilnd du..t. I >-' C$A-J 71p/1'Ji'<4 I I I I I 13;- 6.<<> Wood stove/heater -:il,- :r.(':..::.:::=-:.:--~ TOTAL CHARGES "Z~t),- TOTAL CHARGES ~S':- TOTAL CHARGES S"<. .... WHERE STATE L.'li REQUIRES that the Electrical work be done by an,.Electrical Contractor, the electrical portion.of this permit shall not be va1i~ until ~~e label has been signed by an Electrical Supervisor an~ ~e~urned 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 1 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 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 ORS 701.055 will be used on this project. IWIE(please print)~V ~ 1/ Tyoe/Const. ~~ Bedrooms~~. Stories I Zone . c:::<::::: -. Fire 20ne .#>4 . Flood Plain 8.4. BUILDING PERf,1IT Charges an~ Surcharges PLUt1BING PERMIT Charges and Surcha rges ELECTRICAL PERI~IT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges i< ""'-Vl SIr.iIATURE.~ J- /1.,1 DmJt;(;/P;7 ~ FOr. OFFICE USE OllL Y v . Units N A . Sq. Ftg. llain_ ~~ x Value.~~.- Occy Load ~S- '.' . ...." .4!:c:s;lu.....P~~... Value~.~.OCl Occy Group K-"2 Sq. Ftg. Other i'!9YIhG.. x ' Value~~.." TOTAL VALUATION~~''''' U.., oU'-=, Jystems Development 7 . 7" Charoe (1.5~) . '~~ (.01 Sl q. 8-1170 6t:)t:). ",,0 zs.~c / 'I, B8 ITota' ~omb. I I TOTAL Permi t 5'1 'I. 00 Y .~}t';~ f r . ~ 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, examele- Lot 1. Block 3, 2nd Addition to ')prlngt-ield Estates '. \ C. Name, etc. of owner and construction iender . 0... Energy Sources . .... '.' f' 1. example- heat/electrical ceilinq/or forced air qas 2. examole- waterheatertelectrical/or .solar E. Square footage or valuation, etc. - 1. example- 1250 sq. .foot house, 500 sq. foot gara.ge 2.. example- if ne~ project; check new - if addition, check add, etc. F. Building permit information: 1. example - construct single family house with an attached garllge 2. exam~le - 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 (al of the Structural Specialty Code H, OESIGN TEAf1 AIIO 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 fu II schedu I es C, BUILOING 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 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. ". 'j' .'1 " '" "", V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY: "?AViS" ~/..s . ','. 'PERMIT VALiDATION .. . ~ L,r~ I ( ~~ .\ lq 'V ~ ; , . .... , . L . ;;>.AR~E:C 7N~ A<.~~ ~ A~DIV.s ?He .),bR7#l5R1,. c,.- ~.N7"'~ ~ ~~~ .... ...JolJ,~EiJI9-RP5' . c;r:- Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: Sig~~tur4~~~ ..name~~?2~6T' d~te A~ -:;t::>-B ~ , '