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HomeMy WebLinkAboutPermit Building 1989-3-10 (2) r ~m~~mo,N LINE ., COMBlllm~NU~p~m~~\m~ERMIT . ~~ III"!PZJI' I A:717) / /112- E!lERGY SOURCES: ' Job Address -'-I-' ~ KI...tU../!.tU1L.-v WVI Heat Le~al Oe~cription /' t Hater Iieater /7-~'22.'2R azS"~ Range___ Owner ll--rSgjfi-emt!:- valU,'O?t,,:,g-O, ~D Addrcs's j//A-I-'\' .J..~t;JJf I. (-~ Phone/-(J3 Buil{iinQ'.tPennit info: Oeser be Workli..e.. Build Single I.f () () J..:JJ".1 ~/... CLJD. Familv l1esidence I'lith Jl..ttached Garaae' 4ft'{ YnE:/~ / Q12-,// O. j/ M""~~"AA/ constru~t'~ -L~der } ~) .~~ ~JC- Addro'. U~ bu,lcLwf),~) I'hoo",' '/)l1r&-n Aajjl DESIGN tl (name) -u..--- (address) L nics. no.) ~(exnires'1 INFUR/tAnON L,"t 726-3753 Sq. Ftg.. 1,1a I n ~q. Ftg. Access. Sq, Ftg, Other New Add Alter Rep, -Fence Demo Change/Use Dther"'- - ~I -Q P I~ .~ I (ohone no. I Primary Structura 1 Electrical f1echanical CONTRACTORS Plumbino If/JJe ~/ I~~OA/') _ _\.. v / (~J- S f~ J'?Ud/mJ/U (l ice;, no,l (exni res) (ohone no.) Genera 1 t,g 3 - /51& Electrical fo.1echanical PLUIIBING ELfCTRICAL MECHANICAL NO. FFF [HARGF Jj(l~ FFF rH~ -pO. ~H r1.1ARG.( Each single fixture Residence of SQ. FT, furnace/burner to BTU's each -1leWCircu~ts alts. or extenslons -:2 e>7? >'lh6Y<? (? I SfRVICfS I ~:?S'e I I I I Floor furnace and vent Relocated building (new fix. additional) IS. F. Res idence (I hath I I Duplex (1 hath) IAdditional bath I~rater service I Sewer I Storm Sewer Recessed wa 11 So~ce he~tpr ~~rl wpnt I -Ilj::z:o a-~r~ I . T .. I' I I I I I IS.~ ITemporary Construction Change in existing rpsioPJ1ce multifamily, COfl"f!1. or Inrlllc;;:t.r;.::l1 IOf IC0f111./lND, FEEDERS IInstall/alter/relocate I rli<;.t.rih. feeders amps.1 Appliance vent sp.oarittp Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from I heatiOQ or A.C. Mechanical exhaust hood ~nd l1urt Of amps. I I ~/ -",P N'Af L ,..?7 ~h';."'5I--1 :P~/'>>/7" ;;?F&J;??dP 'I' /fC I I Wood stove/heater TOTAL CHARGES WHERf STATE L~W REQUIRES shall not be vali1 until the L<:;: O>i:> TOTAL CHARGES that tile Electrical work be done by an label has been signed by an Electrical I I I ISSUANCF OF P<RI1lT ::2:2sz::.l TOTAL CHARGES Electrical Contractor. the electrical portion of this permit Supervisor and returned to the Building Division I liME CAREFULLY EXAt11NED Ule completed aprl.ication for [lermit, and do hereby certify that all information hereon is true and correct. and I further certify that any and all work nerformed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Orel)on pertaining to the work described herein. and that UO OCCUPArKY 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 reC]uired by Or..S 701.055, that if exempt the basis for exemption .is-noted-hereon. and that only subcontractors and employees who ~e in cO","liance with Or.S 701.055 '~jJsed on/hiS project, IjAIIE(please prlnt)K1c..t:::- -Pr1.::.t0~Of\J SIGlIATURE/lmmv Dm3-/(}-P.7 Zone c: r:::. Fi re Zone Flood Plain FOr. OFF I CE USE OIlLY( / Type/Const,_~~ . Units S~. Ftn, Hain Bedrooms Occy Load Sq, Ft~. Access / , B-2 Other mr. Stories . Occy Group Sq, Ftg, BUILDING PERI,IIT Charges an~ Surcharges . ':ZB2~' ~~~~R~~~ -----;~;S~ ~6~~B~~~ J;c-'~" Fence -----~:---_.- -;0- _ n_ ~::5::.~-' Sidewalk /./3IA!cpaVing COnlnll nd Ppr Fpe Res Per Fee 7:,-/0 ~'5q '33//1 0' c-, syste. ms Development \ <P / (l ...." Charqe (1.5~) x Value ..... x Value , ,T.""'h~~ Val~e:---5-q TOTAL VALUATION ';y:~ " PLU'1BING PERMIT Charges and Surcharges D~mo 1I.tfN',?jk.///s ......~~ .#r;>~~' 75!./3 I ITot~l Comb. r~rmit iTDTAL ~O? b6 , ELECTRICP,L PERI~IT Charges and Surcharges /lECHAN I CAL PERMIT Charges and Surcharges Curb Cut . t -~ . COMBINATION APPLICATION/PERMIT (CAP) ,.. , PERMIT VALIDATION I. Applicant to furnish A, Job Address B, Legal Oescription J, example- Tax Lot 100, Lane County Map Reference II UJ 43 2, examele- Lot 1, Block 3, 2nd Addition to , sprlngtield Estates C. Name, etc. of owner and construction lender D, Energy Sources 1.., example- heat/electrical ceiling/or forced air Qas 2. example- waterheater/electr;cal/or solar E. ~quare footage or valuation, etc. - I, example- 1250 sq, foot house, 500 sq. foot garage 2. exa~le- if new project, check new - if addition, check add, etc. F. Building permit information: 1. example - construct single family house with' an attached garage . 2. exam~le - 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 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, --- Ill, 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. I ) <-(0 7 3-(1~f f V, FOR OFFICE USE ONLY Permit 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 /~N'<f: ?l~~ signature ~ -pa~ ~ - '" /, r - ./ ...., date "3/'/-9''7