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HomeMy WebLinkAboutPermit Building 1998-1-22 CITY U~ SPRINGFIELD COMBINATION APPLICATION/PERMIT ENERGY SOURCES: Heat \~ater Heater Range ValuE of Work: -=< ;5'<:::> c:: c.e> " BuildinQ Permit Info: Describe Work(l~e.. Build Single Famill nesidence With Attached Garaael L"~v~~.7 F~"""'E?'i' ~~ ;'.;; L--y/~ /- Av// h c: f 5 r .m~rcc , llies. no.) .\ INSPECTION LINE i 726-3769 Job Address / '/'7'Z? .i'\.4..e;t'/"v , , . 5T. Legal Description Owner ;7;;h.VLE" TA^" r.!>/V Address /7#"7 ,I<-/?,# //Y C;:PFc..P. _ C:>7-? . ~~ Phone '57, 7l././~~ 74;;-///:::< Construction lender r Address UlSIGN TEAI1 (name) Phone (address) Primary Structural Electrical Mechanical CONTRACTORS (name) faddrf!ssl (1ir.~, \"10.' General ~J,.../VE/ii:' Plumbina .1A.."50..-v 4.c"'~Ar (//7,0/-__7) C.s:;,..".-" 7.) Electric'l~pC:R~S/vE -CC::::~C7 .(///'/9-;'~RA<<s~) ~1echanical PLUI1B I NG ELECTRICAL NO.1 ~ Each single fixture INFORlIATION UNl 726-3753 Sq. Ftg. '.Iain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. -Fence Demo Change/Use Other- - 0)) ~ {) (exoires) (ohane no. ~ ~ (pl(l);rpc:.\ (n,",onp no , MECHANICAL , FEE IJdjARGF Nn I I !'I.L'J:liARliE. Nn I Residence of furnace/burner to ?S~"'32- SQ. FT. BTU's .I='H" 'rl1ARG.E. I I I I I TOTAL CHARGES -3'.P.- ~ TOTAL CHARGES '::?-::?....,S7!/' TOTAL CHARGES ~ -t>o WHERE STATE L,'lj REQUIRES that the Electrical work be done by an..Electrical Contractor, the electrical portion of "this permit shall not be vali~.u~til the label has been signed by an Electrical Supervisor and returned to the Build~ng Division I HAVE CAREFUllY EXAMINED the completed application for permit. and do her~by certify that all information hereon is true and correct, and I further ~ertify 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 OCCUPArKY will be made of any structure without the permission of the Building Division. I further cert' J ~I,,"~ ~registration with the Builder's Board is in full force and effect as required by ons 701.055. that if exempt ba~" for e~emption is noted hereon, and that only subcontractors and employees who are in compliance with OP.S 7QI.055 . be ~sed on thjs project. /' ? "...- - SIGIlATURE _ . __j:~"::,;~__ OATE /-Z2-P'ff FOr. OFFICE USElorJf-r~ /' ~ /~ Zone c:::. c::.. Type/Canst. r")~# Units Sq. Ftg. fifth x Value Fire Zone Bedrooms Occy Load Sq. FtD. Access x Value Flood Plain Stories I Occy Group)f-r Sq. Ftg. Other HrT' ~Value ~c.s-'O #6Tc~E.J=~ ~jfj<C.~'?,~ L~~A' ~,;9/=p W/~TOTAlVAlUATION 7i?'~6o/'R,.:::::J:) p~t?i>/:r5". . BUilDING PWIIT 7"/ $~ Plan Ck. Conm/lnd ..c-:;. A~ Systems Development ;( / LJ Charges ant: _____~.:_____ 65%/Rldo P-,~!, Fpe VV..Vd Charqe (1.51,;)" ~.~ . Surcharges ~ C>~ Plan Ck. Res . ~~ G) 30%/Blda Per Fee .6::2 cs-6 I Fence --- ~:-';;--I DfIAlO ____f~_~JSjde...alk ;:?- -::?5' I A/C P~ving __--1~_~__J Curb C~t - "70 I Relocated building (new fix. additional) ~ New circuits alts. or~xt:;;s)&l's___~~ SERVICES 478' I S.F. Residence (1 bath) Duplex (1 bath) each Additional bath Temporary Construction Change in existing rp} i rtP!H~P multifamily. comm. or Tnrlllc;.t.r;ill ~Iater service Sewer Storm Sewer Of amps. COMl-I. /IND. FEEDERS I Install/alter/relocate rlic;.tr;n fpprlpl"<::: IOf I I I amps. NAr.IE(please print) D 'itU c.. T/Cl (\J '\t[) t.J PlU'~BING PERMIT Charges and Surcha rges ELECTRICAL PERlilT Charges and Surcharges ITotal Comb. I I TOTAL MECHANICAL PERMIT Charges and Surcharges Floor furnace and vent Recessed wall So~~P hpatpr ilnn vpnt /;.- I Appliance vent seoarntp Stationary evap. cooler Vent fan with sinale duct Vent system apart from heatino 01" AC. Mechanical exhaust hood nnd rlut't ~-- Wood stove/heater ISSUANCE OF PFR!lIT Permi t "2/?l ~ J 76C! c?S . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax Lot 100. lane County Map Reference 17 03 43 2. example- Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name. etc. of owner and construction lender D. . Energy Sources ~ ~_" . 1. examDle~ heat/electrical ceilinQ/or forced air Qas 2. examole- waterheater/electrica(/or solar E. Square footage or valuation. etc. ------ 1. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project. check new - if addition, check add, etc. f. Building pennit information: 1. exam~le - construct single family house with an attached garage 2. examEle - 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 jOb site - " correct ions, 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 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 e cl .' PERMIT VALIDATION . .' , , '. t-, "_'" , , " , ! /)g3 f ! -- l~ ~O <'& Q/ Pennit Cl erk . /ff"&U &hL/" . 'PROJECT CONDITIONS TO BE SATISF~EpBEFORE OCCUPANCY: V~/T ~ fr~ ~~v=-"25 ~O ~/,;.-/ CO~/~ ~ 6Ce::c=,,-~:..:,,~ ~o"..-& 6A?C9. Permit applicant exempt from registration with the Builderis' Board becaus~: Additional Project. Infonnation: . \ , PLANS REVIEWED BY: . signature /?.~ ~". /" ~ ./~/,.P/ __ -..;,f ~. date /--;:;J~' e & nam~ &8H-G~;-~G/f' '/ .r