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HomeMy WebLinkAboutPermit Building 1984-9-21 CITY OF SPRINuFIElD ~ INfORllATIDN lINl COMBINATION APPlICATIONfPERMIT . 726-3753 E!lERGY SOURCES: Sq. Ftg. 1.la;n Heat ~q. Ftg. Access. Water Heater Sq. Ftg. Other flew Add Alter Rep. Range~____.___.=__ -Fence Demo Change/Use . Valu, of Hork: Other- - ~ ; /.:; .::JO~b1J:.A) a83S3b.5' io 1}{Jt),~ Address /J /- IJ 1_11 ""'1 / BuilciinQ Pennit Info: Describe I~ork(;.,e., Build Single "'7Q.;:;j, , t...-, . Y.i./ZflYtl.t. /Ol~- Familv nes;dence With Attached Garaoel ~)O"",(UII..~ J 1tJ4- /.:;'1/iL 10/HAndd ~ - ~f/__ f'.JAU Construction Lender ~ ...-:I!:r/ ..ru:ztfl --: _~ ~ / a ~A L I cu/ dl / -!' C?/ IA,rrL/.J?..., . flUs. no.) (Hoires) \J~~"""'?lE, "\"'\ffi\C,,\' E\'i(n~ '~\\.~\\.~ "\\.\'In1ft \tJ~. C\~ IIIISPECTIOII 1I11E 726.3769 Job Address J 9 Ci 0 (tJ! {,/ M j; (~ . I I legal Description Owner Address UlSluN flNl Primary Structural .~ Electrical Mechanical ..€lJNTRACTORS I~ Genera 1 Plumbina Electrical 11 ~'echan; ca 1 - ~ (name) {name} PlUllBIIIG \ Each single fixture IRelocated building (new fix. additional) Is.F. Residence II bathl IOuPlex (I bath) each IAdditional bath I~Jater service I Sewer lstorm Sewer I I I ~'~~"'U~~\:M-;: I - I I I I I TOTAL CHARGES \C).eo TOTAl CHARGES \ ~ ClO TOTAL CHARGES \C'I.cP 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~ until the 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 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 UO OCCUPAUCY 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 as's ?or exe~~n is noted hereon, and that only subcontractors and employees who are in comoliance with OP.S 7~1.055 wil u d 0 i ~ject. IIAllE(please princ:?t'J&8.777)/;9-JJ SIGIIATU Y# - - DATE9kh: FOP. OFFICE usf OIIL Y ./ /' Sq. Ftg. riain x Value Sq. Ft~. Access x Value Sq. Ftg. Other x Value (J. ~;1iJ./' l TOTAL VAlUATIOtl.Qf"YV....,-- "'2 -:2 t!O P/.,... if ISystems Development \".... ~ 7. _ Q fa PloCharoe (l.5~) ",1 t'll. . r I I I Zone CC_ Fi re Zone Flood Plain BUILDING PER~1lT Charges anC: Surcharges PlUIiBING PERMIT Charges and Surcha rges ELECTRICAl PER/lIT Charges and SUTcharges 11ECHANICAl PERMIT Charges and Surcharges - #/l..t Phone (address) iXj ~ -..S) <:) ~ ~, (ohone no. I (address) (1 it's. no.) (pxnirps) (ohnnp nn,) ElECTRICAL FEE rHARr.E Nn Residence of S.- SQ. FT. New circuits alts. \ or extensions SERVICES MECHANICAl <<c. J:IiARliE. NO ILELJ:IiARliE. furnace/burner to BTU's \s-:" Floor fu rnace and vent Recessed wall SOn;P hp~tpr ~nrl ~pnt ITemporary Construction IChange in existing rp~ i rleJlcP Imultifamily, comm. or Inrlllstri<ll IOf amps.1 ICOW1.fINO_ FEEDERS I IInstall/alter/relocate I rli<:.trih fppnpr<:. Appliance vent c;.poa rn te Stationary evap. cooler V.ent fan wi th sinole duct. Vent system apart from heatina or A.C. I Mechanical exhaust hnnrl <lnd rlUi.t. I Hood stove/heater ~\\.)7E~\\ I (~r;:."I~~\<"I\." I - 'J I I I I ~:- I I n- Of amps. I SSUAIICF OF PFRIIlT TyoefCons~~~ Bedrooms Stories \ . t::. f") - Plan Ck. Co""'fInd ____ilJ.'-_____~/B'rln Per Fpp f") C>'2. Plan Ck_ Res L. 30%fBI do Per Fee \~ Fence __ __ u...>~=-____ "0 .___~~~:____J S1dewalk . cc> I AlC Paving _____\Q:.~_J Curb Cut . ,",0 I _Units Occy Load Occy Group ~'l_ DtjII10 ITotal Comb. Permit I I TOTAl qo.~ . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Description I. example- Tax lot 100, lane County Map Reference 11 oj 43 2. example- lot I. Block 3, 2nd Addition to ~pringtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. exam~le- heat/electrical ceilinq/or forced air Qas 2. examyle~ waterheater/electrlcal/or solar E. Square footage or valuation, etc. ------ 1. examole- 1250 sq. foot house, 500 sq. foot garage 2. exam91e- if new project, check-new - if addition, check add, etc. F. Building permit information: 1. examele - construct single family house with an attached garage 2. examele - remodel existing garage into family room 3. exa~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 ANO CONTRACTORS To avoid design or construction delays. Building ~ivision 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 approp~iate 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. BOIlDING OIVISION STAFF WIll Fill OOT 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. --- 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 OSE ONLY PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY: , PERMIT VALIDATION '\ SJ & 30-0 ;JrY ~\? . + ~ Permit Clerk k . Permit applicant exempt from registration with the Builder's Board because: Additional Project Infonnation: ~~\~~'~_~\~'F. F_~'~""''I>~5') ~\C~ ~\ c..~ ~\.~ "t\~l_~~ ("'(X"\.\?~'ir~ PLANS REVIEWED BY: ---nam~~~ signaturE~::lu.r' ~'Q-'k.-I\r-'" da~eC\-C?_\-~4 .