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HomeMy WebLinkAboutPermit Building 1990-10-23 I INSPECTION LINE . 726-3769 Job Address /97t::> legal Description . CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT E!lERGY SOURCES: Heat I~ater Heater Range ValuE of Work: . INFOR/IATlDN LINt 726-3753 Sq. Ftg. 1.lain ~q. Ftg. Access. Sq. Ftg. Other flew Add A Iter Pep. --Fence Demo Change/Use -Other - - I ~ ~ \) '" /5C 1/?',,47 7>""-':::::' ~cn/ rp/"f !b-YHC /#/~~ ~ Address ~/~7~z, J plene BuilriinQ Permit Info: Describe Work(i,e" Build Single Familv nesidence With Attached Garaoe) ~f/.~dCr~~ ___ff'{.'{:AE' I ,.fZ6 ,/L' ~~ ?~","--",- /AI ~kt. fr~hr~. (lies. no.l fexoiresl (ohone no. ~#,A;:. '7L&:-/'5'~7 Construction. Leryler ,.,..... ~......:/."...c ?lo'";) - ~'7" ~ Address .z;;";:#~#A:'- 'I8~p:?:~6 c;> UI:.~lbN fi.{r'f- (name) ,/ (addressl Primary Structura 1 Electrical Mechanical CONTRACTORS General ~ ~ Plumbina (name) ~LvA'7~C7f'C, (address) (1ir:~_ nn.) (pxoirp<:ol (ohnl'lp nn , Electrical ~'echanical PLUI1BING ELECTRICAL MECHANICAL NO. FEF r:HARhF NO ~~~ r~~ NO ~~~ rl-l~ Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (] bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall ~n~rp hp~tpr ~nrl vpnt Storm Sewer Of amps. Appliance vent c;.poa ra tp Stationary evap. coolar Vent fan with sinole duct Vant system apart from heatino or A.C. Mechanical exhaust hood and durt Sewer Temporary Construction Change in existing res i ~~.nce multifamily. COn11l. or Industrial Water service CO~~./IND. FEEDERS Install/alter/relocate dic;.trih. fppdprc;. Wood stove/heater Of amps. TOTAL CHARGES WHERE STATE LAW REQUIRES shall not be valid until the TOTAL CHARGES ISSUANCE OF PFR!lIT TOTAL CHARGES that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit 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 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 IIOOCCUPAllCY 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 OP.S 701.055 will be used on this project. oC>ps ( SIGII^TUR~Ko~I"'" L. 14 I c.1<.""l> N FOR OFFICE USE Q;lLY Sq. Ftg. tiain Sq. Ftg. Access Sq. Ftg. Other Print)/?~ -----/..~~.1 Dm/O-.:n-90 NAI.1E (p 1 ease Zone Type/Const. Bedrooms Units Occy load Occy Group x Value Value Value Fi re Zone x Flood Plain Stories , TOT^L VALUATION PLUHBING PERMIT Charges and Surcharges Plan Ck. Comm/Ind 65$/Bldo P~r Fpp ------------ Plan Ck. Res 30%/BldQ Per Fee Fence Systems Development CharQe (!.5~) BUILDIrIG PER/lIT Charges and Surcharges ELECTRICAL PERI~IT Charges and Surcharges 11ECHANICAL PERMIT Charges and Surcharges Demo 'Sidewalk A/C Paving Total Comb. rermit~ Curb Cut TOTAL I;YO fre- . I. . ~ COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description 1. example~ Tax Lot 100, Lane County Map Reference -'\ ,- II oj 43 2. example- Lot I. Block 3, 2nd Addition to Sprlngtield Estates . C. Name. etc. of owner and construction lender D. Energy, Sources .' - ... 1.' examole- heat/electrical ceilinq/or forced'air Qas. 2. .~examOle- waterheater/electncalJor 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, cned:. add. etc. F. Building pennit information: 1. exame'e - construct single family house with an attached garage 2. example - remodel existing garage into family room 3. exam~le - 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 infonmation 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 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 Pennit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ~ennit applic~nt exempt from registration with the Builder's Board because: Additional Project Infonnation: PLANS REVIEWED BY: name / o;~/,:r--:<&"'?tsignature~~~ ;date ,vr - , ,; , /6 -2!:f"-<?C/