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HomeMy WebLinkAboutPermit Building 1989-9-20 'l'iNSPECTlON LINE . 716-3769 Job Address 14 d f) lUV I ~~ i#> 3~ I.egal Description \1) ():=).!{ I?)~\ I (')0 'l(,() CITY Of SPRINGfIELD COMBINATION APPLICATION/PERMIT E!lERGY SOURCES: Heat Ha ter Ilea tcr . INFORI1ATION LINt 726-3753 Sq. Ftg. Hain ~q. Ft~. Access. Sq. Ftg. Other flew Add Alter Pep. -Fence Demo Change/Use -Other- - )) e ..CJ JJ CJl Ranne ValU(~rto~ Buihiinoi5ermit Info: Oeser be l4ork(i-.e.. Build Single F~~l~Ctr/t A;tauh~dM~: ,~O Address UES I GN ltAf1 (name) Phone {address I !lies. no.l (exo; res) (ohone no. j Primary Structura 1 Electrical l1echani ca 1 CONTRACTORS tnamel {address' (lip- "9.) (p.xnire!i.) Generalr~('~. 15Lo{p {~~f(J\Cff)4D1 Plumbina '\::ct:$.~ \?~~ IOn C/)t-Lt n, Ei cDO-RP6 Electrieal~\,{\r.f\, ~b~, . rlechani~al f~~)~(\. -1'C\lp(o 0f\ht.Lll.Q f::'~Wo ~~oo llirn~ U 314:2q~ 843"5401 MECHANICAL 7:?tt/ 3:;:?..e. SQ. FT. furnace/burner to BTlI's I 1 Each Single fixture FFF CHARGF Nr,- Residence of "r 'J!AllG.E..lIJl. NO. Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence II bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall Sn~~p he~tpr nnrl vpnt amps, Appliance vent sel}aratp Stationary evap. cooler Vent fan wi th single duct Vent system apart from heatino or A.C. Mechanical exhaust hOl"\rl nnd rlurt Sewer Temporary Construction Change in existing res j rlJ'nr:~ multifamily, con1l1. or Inrlustrial ~/ater service Storm Sewer Of COMfI./IND. FEEDERS Install/alter/relocate distrib. fppders Wood stove/heater Of amps. TOTAL CHARGES WIIEnE STATE L'II REQUIRES shall not be vali:.! until the u~/:~/~~r 6;....;....~ ~ ~ /A-f/.;<j'/N' .~c-.=7. K~ff-/' ...-7:>.....": (7lEl .~. ISSUANCF OF PFRim ( .~. ~. -'" TOTAL CHARGES I TOTAL CIIARGES that tile Electrical work be done by an Electric,'ll Contractor. the electrical portion of this permit label has been signed by an Electrical 5upervisor and returned to the Building Division I HAVE CAREFUllY DAmNED the completed app 1 i ca t i on for permit. i\Od do hereby cert ify tha t a 11 informa t i on 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 Spri ngfi e 1 d and the Laws of the Sta te of Oreqon perta i n i ng to the work descri bed herei n. and tha t rw OCCUPAI~CY wi 11 be made of any structure without the permission of the Building Oivision. I further certify that my re8istration with the Builder1s 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 SUbconty\ractors and employees who are in eomolianee with OP.S 701.Q55 will be used on thi~Ojeet. IWIE(please pr ) l')AvloC> H-oLMt'::. SIGil^TURE~) DATE ')p.o/J'J _, I FOr. OFFICE USELOII\. Y , Zone C'- c.J TYDe/Const. :7--A/ Units So. Ft~. 11ain x Value Fire Zone / Bedrooms Ocey load Sq. FtI1. Access x Value Flood Plain' Stories / Occy Group 8-2. Sq. Ft;. Othe~1vr..~6>/<<",'.-c-~ Value q...;.::-~-- TOTAL VALOATlOtI BUILDING PERfIIT Charges and Surcha rges V' / a:-: Plan Ck. _ _ __ _L'l-_~~ _ 65%/Bldo /7 -:? Plan Ck. -< - -;:;(...J 30%/Blda ~& -=:0 Fenee ____~t.:J____ 1_ Sc:s D~mo Sidewalk Conm/Ind Per Fpp R-es Per Fee :::;>&9'3 Systems Development Charae (1.5~) #-4 PLUI~B I NG PERMIT Charges and Surcharges ~'l'tK~~-:-6S-.00 8~.c.ey~ '7,k.., 9'5' ELECTRICAL PERI:IT Charges and Surcharges ------,------ A/C Paving Tot~l Comb. rermit 11WIANICAL PERMIT Charges and Surcharges Curb Cut , jLJ7/b TOTAL . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address n. legal Description 1. ~xarnple- Tax Lot 100. lane County "lap Reference 17 03 4J 2. exa~le- lot I. Block 3, 2nd Addition to SprIngfield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. example- heat/electrical ceili~Q/or forced air qas 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - I. examole- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, checklnew - if addition. check. add. etc. F. Building penn it information: 1. example - construct Single family house with an attached gartlge 2. exam~le - remodel existing garage into family room 3. exarT.!Ple - 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 TEAfI AND CONTRACTOIlS To avoid design or conslt'uction d(~lays. Building Division Staff must be able to contact appropriate persons regarding design infonnation or job site corrections. etc. II. Abbreviated Plumbing, Mechanical. & Electrical Schedules A. Except ~Ihere blank spaces occur in the description portion of the r~echanical 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 ~ 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 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . PERMIT VALIDATION ~. ~ ~-W,<6~ 4Cf3t- Pennit Clerk_~ffJ1 ') . Permit applicant exempt from registration with the Builder's Board because: Additi ona 1 Project Infonnation: PLANS REVIEWED BY: name ~~ ;7}._-, .:...,..,.signature c ~~~ate /' p/ ..; //' '/' r, r ~/"5 &. ?