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HomeMy WebLinkAboutPermit Building 1988-5-13 ... ~, " ..' '" ' J INSPECTION l..,_ _ CITY UF SPRINGFIELO 726-3769 COMBJlIATlON APPLICATION/PERMIT /) EIIERGY SOURCES: .. Job Address/~9 A-~ce"< r-A'R~A'Y' E~ Heat~ 1IV~ legal DescriPtion.a..."q'2':::_::?~ /9~.:2~ ":2/~ llater Heater~~ Ranqe I \ INFOR/IATlON l.Nt 726-3753 SQ. FtQ. "lain~7. Y 'P ~q. rtg. Access. SQ. FtQ. Other XI/ew Add Alter Rep. -Fence Demo Change/Use AOther~~-"-,,, ~' I ~ ~ I~ N ,Ownerlh.t:.L.h!?",p,N ~P6C?H'6S .j!fV' _ Address"" ~ / ...".., ~~/:':stG .7'-"'" AZ /~~Wk' IS. /-"'iC -~f',: ~~2> ,LP7? <9?:Z/? - " Construction Lender ValUE of Hark: 7~~ BUllrlinQ Permit Info: Describe Work(i~e.. Build Single Farnilv nesidence With Attached Garaae) ~~e-//.......&- ~F ~r:-Ar.J~ S~ ~ 7JijAlVEL ~ ~_Co/ Address Phone UI:.~lliN rI:.Af.' (name) (address) flies. no.) Cexoiresl Primary ~ h?~__-:-/V ?~~_ /'2:ZCl::>....v. ~j,#77€"'" ~;, ~A"~ Structura 1 Electrical Mechanical CONTRACTORS (name) (address) (1;('0:;. nn.) (pxnirp<:.\ General MC..f'<9Y2/<<;: ~..-..r:;r?~.-. ~~.~.,- Iv. ~~ G~~ PlumbinOr~( .P~.k-, 7dS"~ ItY: _7?2~1.. /, ~ / &..h:9,G ElectricaIL.R-g7'f~~~..' /.t!:JIN:::--u ~.~~ ~?tj;::~..",.7) ~lechanic'al /IA.'71JtE:'Y .{ ;?b/~~.. ~~ ~~;r;::r ~r I NO. "2 Each single fixture PlUllBING ELECTRICAL FrF rHARr.F NO (ohona no. ::?~'22S"4 (ohnt1p "n. 1 ~~7/~"r r.::R~44f/~ ?7'7-b(P~ 7~./~2/ MECHANICAL SQ. FT. / I furnace/burner to BTU' H-VN<- '..IA~ F1 oar furnace and vent 1G.,- <<F r'lARliE. ...lli' 7.S"~ ISat> Residence of Relocated building (new fix, additional) ~ New circuits a1t5. or extensions .~ -!Z <>R ~= SERVICES ~ Recessed wall So~rp np~tp~ ~nrl vpnt S.F. Residence (1 bath! Duplex (I bath) each Additional bath Water service Sewer Storm Sewer Appliance vent c:;aoaratp Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from heatina or A.C. Mechanical exhaust hood i'lnd durt Temporary Construction Change in existing I"P,;.i dJ'.nrp multifamily, corrm. or Industrial I I r;~t:' I'" I /PO amps. 2Z.$ ~...... COI~fl. II NO. FEEDERS Install/alter/relocate rlic:,tl"ih fpprlprc:; Wood stove/heater 6#5 P/.P/nz, <-- Type/Const.~~ ~Units ; Bedrooms Occy load Stories / Occy Group ::R-;Z Of Of ....... ISSUANCE OF PFR!lIT TOTAL CHARGES /!?-...... TOTAL CHARGES Y_'1. ""'" TOTAL CHARGES ..h0-,.y. /.<;;':"- WHERE STATE L\l/ REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit shall not be vali1 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 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 un OCCUPAI~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 ORS ZOl.055. that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 7Ql.055 will be used on this project. IIAf.1E{please print) \. s;,/.r-// ]/J~ SIGrlATURfL ~~1) FOr. O'rFICE USE orllV Sq, Ftg. 11ain ~;::>. ~lf1 > Sq. Ft~. Access x Sq. Ftg. Other x Zone LL Fire Zone Flood Plain BUILDING PERHlT Charges and Surcharges PLur~BING PERMIT Cha rges and Surcharges ELECTRICAL PERIHT Cha rges and Surcharges MECHANICAL PERMIT Charges and Surcharges : amps. TOTAL V AlUA Tl ON nAIF sh~,R, , Value Value Value 7~ CoO Plan Ck. Comm/Ind 65%/Rldo Ppr Fee Plan Ck. Res 30%/Bldo Per Fee ~//+,~.,":~'~ '/0 r=' syste. ms Development ..",...., ~ -r,.,,:,") Charoe (!,5~l?~ ~ -c. ,..,. ___JG~ 5"'"0 3'. 413 /c- t>C> Fence ___...LJ.J..=._____ -?S ~ ~ Sidewalk ___.:.'.U.:._____ "2, :zs- AIC Paving L5; """" ' I Curb Cut ---- ~-7.?-1 D~A10 Total Comb. Permit , ., I TOTAL /-:>C?, Gf!3,. . /$3.'/y " ~, ( i COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I, Applicant to furnish A, Job Address B. Legal Description I, example- Tax Lot 100, Lane County Map Reference II oj 43 2. examele- Lot 1. Block 3, 2nd Addition to sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources . 1. examole- heat/electrical teilinq/or forced air Qas 2. examole- waterneater/electrlcal/or solar E. Square footage or valuation. etc. ------ 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. example- 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. example - 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 . ,; per:sons:~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 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' '. ful" schedules C. BOILDING 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. If S-01 , . &q. S;-I'~- V. FOR OFFICE USE ONLY Permi t Cl erk ~(-' , ' PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name L6'Jli:NE Pc. f:"~ ~ signature 4...-e.-_~A~J? date _)..;.~ -'" , / -