Loading...
HomeMy WebLinkAboutPermit Building 1993-8-9 /, " lLNSPECTlON LINE 726-3769 . . II ~ " \h 't " CITY OF SPRINGFIELD CGrlBlIlATlON APPLICATION/PERMIT E!lERGY SOURCES: Heat Hater Heater Range ValuE of I'lork: ,;;tJcrft!I BuilrilnQ Permit Info: Oeser be Work(i.e., Familv Residence With Attached Garaael INFORlIATlON UNt 726-3753 Sq. Ftq, ',Iain :q. Ftg. Access. Sq, Ft9, Other New Add Alter Pep, -Fence Demo Change/Use Other - - Job Address 143" Iv\. ~ - Sel/1J6FtELb Legal De5cription /?~c.7''' 3G::~;l';l.. o"3/~t:> , Address ot.b /4If(, L.AIJU; PoSEY K IUfU- rA (JEll Al MA-i,.;) Owner. Construction lender Address Ul:.~ HiN H.Ar1 Primary Structural Electrical Mechanical CONTRACTORS Genera 1 Plumbina Electrical "lechanical -.!ill..,. Phone 7Z"- ,,-qt'/ Build Single (name) Phone (address 1 rcd~,j) Or.'aJ.1Jg"/ C""'ll"ifflucr/#tJ I' I . 'AJIT'tf EIJMJ<; 4-{"'( AlIt/LII8LJ<'" !ll.q(. (lies. no.) (exoires) I rohane no. ' * (name) (addrpss) l1ics.no.) (pxoirps) (ohonp nn.' R A-IAJ 8tJw /(OOF'OJ{, .:1.9715 Ct>t.o.r LitKE :J'1tt/1. ~-~f.::i:..~ t.8i'-Kl17 PLUI1BIrlG ELECTRICAL MECHANICAL I FFF I r:HARr.E Nn I Residence of I-EEL' J:HARG.E .JilL...' furnace/burner to SQ, FT. BTU's I ~~r Ir\..l~ Each single fixture IRelocated building (new fix, additional) IS.F. Residence (] bathl IDuPlex (1 bath) each IAdditiona1 bath I ~Ia ter servi ce I Sewer I Storm Sewer ,/ New circuits alts. or extensions Floor furnace and vent ISERVICES I I!emporary Construction IChange in existing rpSi rLpn('_p Imultifamily, comm. or Jnoustrial IOf amps,l ICO~~,/IND, FEEDERS I IInstall/alter/relocate I oi~trih_ fppopr, IOf amp~1 I I I Recessed wall Sn~('p hp~tpr ~nrl vpnt Appliance vent st:l:oarate Stationary evap. cooler Vent fan with sinole duct Vent system apart from I heatinq or A.C. I Mechanical exhaust hood and dur:t I ~'Jood stove/heater I I I ISSUANCE OF PFR'llT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L\H REQUIRES that tl,e Electrical work be done by an. Electr;cal Contractor. the electrical portion of this permit shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division 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 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 fm OCCUPAr~CY 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 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 7Q1.055 will be used on this project. IWIE(please print) Zone <: c::... Fire Zone Flood Plain BUILDING PERI,IIT Charges an~ Surcharges PLU'1BING PERMIT Charges and Surcha rges ELECTRICAL PERlm Cha rges and Surcharges MECHANtCAL PERMIT Charges and Surcharges .sH€~RY ItJI L..SOtJ SIGIIATURE~, ~ FO~ OFFICE USE DIlLY V Sq. Ftg. Hai" ,x Sq. Ft~. Access x Sq, Ftg, Other Rl!!..1:t_",r:- x , TOTAL VALUATION ':2 If eJd>.- DATE '!-"I-Y'1 Tyoe/Const, Bedrooms Stories Units Occy load Occy Group Value Value Value <~ ...0 Plan Ck, _ _ __ _ _: __ _ _ _ ..M!/Bldo .-" Plan Ck, ... 30%/B1 do Fence Corrrn/! nd Ppr Fpp R"es Per Fee Systems Development Charqe (1.5~) , Demo Sidewalk A/C Paving ____________, Curb Cut I. Total Comb. Permit J I I TOTAL :?t{.% . ,. ,.... ~ ; u..... COMBINATION APPLICATION/PERMIT (CAP) 'PERMIT VALIDATION I " III. I. Appl icant to furnish A, Job Address B. legal Description 1, example- Tax lot 100, lane County Map Referen~e . II 03 43 2, example- lot 1, Block 3, 2nd Addition to _ ::iprlngtield Estates. C. Name. etc. of owner and construction lender D. Energy Sources . ' . 1. . examole- heat/electrical ceilinq/or forced air Qas 2. examele- waterheater/electrical/or solar E. Square footage or valuation, etc. 1, example- 1250 sq, foot house, 500 sq, foot garage 2. examp'le- if new project. check-new - if addition, check add, etc, F. Building pennit information: 1. examole - construct single family house with an attached garage 2. examele - 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. 11. 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. BUIlOING DIVISION STAFF WIll FIll OUT All FEES AND CHARGES ON THE SCHEOUlES 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. --- 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. ,r " 'g?J ~;~; . ,./ Co IS?'=> ..- bJ' (( V. FOR OFFICE USE ONLY Permit Clerk r~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permi t appl i cant exempt from regi strati on with the Builoer 's' Board because: Additional Project Information: PLANS REVIEWED BY: "., -&rN- (Jl1Pj/Y 'i,,,t",.[ll~ I date