Loading...
HomeMy WebLinkAboutPermit Building 1984-6-27 ," ""~ ~.~, "' Legal De'scriPtion\'1 'q' ~S+rett ()~ '2.to rc. '-\ 0\ ~O\ CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT I EnERGY SOURCES; Heat \./ater Heater 1 INSPECTION LINE , 726-3769 Job Address c::9 J a Ranqe INFORllATION LlNE 726-3753 ' Sq. F tg. f.la i n ~q. !'"tg. Access. Sq. Ftg. Other Ne\~ Add Al ter Rep. --Fence Demo Change/Use --Other-- -- Ow,,, :6mN lr\ '<:-~QP Il.inl'J{ Address dl~ \~\ ~.' ,~ PhO~ , V':1JUf of I-Iork: cO 'It \ ,O()(\ . ' , Buildin~ Permit Info: Describe Work(i,e., Family Residence With Attached Garaqe) Build Single ~ ~ ~ Address DES I GN l1EAI.1 Cnamel Phone (address) C'~n.C\.f\CW, f"\,(\~ ~ (' f)MN~r (OJA"'\l\..(.lnU- V- - JJI.1'~CA.j) (lies. no.) (exoires) (ohone no.) Construction Lender Primary Structura I Electrical Mechanical CONTRACTORS (name) ~) (address) f.OOl I (exoires) (ohone no.) General Plumbinq (~ric.a-l' ) .~a";'-d~ PLUtlBItlG ELECTRICAL MECHANICAL NO. ' , FEE' CHARGE NO,' , FFF I rHARr,F NO.' 'FFF l rHARr,F Each single fixture Residence of SQ. FT. furnace/burner to BTU's /' . Re loca.ted buil ding (new fix. additional) \ New circuits alts. or extensions ,\(5 \O~ Floor furna'ce and vent IS.F. Residence' (I bath) IDup~ex (1 bath) each IAdditional bath 1~la ter servi ce Sewer SERVICES Recessed wall Soace he~ter ~nd vent ',' Storm Sewer I I I I :1 ITempOrary Construction IChange in existing residence multifamily, comm, or Industrial Appliance vent I seoarate Stationarv evao..'f I cooler. . I Vent fan with I , sinole duct I Vent system apart from I heating or A.C. I Mechanical .'exhaust I hood and duct I }Iood stove/heater I I I I Of amps.1 I COt~r,1. II NO. FEEDERS I I IInstall/alter/relocate I I distrib. feeders 10f amps.1 I I I. I I I I 1 I I ISSUANCE OF PFmlIT TOTAL CHARGES \D.CD 1 TOTAL CHARGES thatithe Electrical work be done by an Electrical Contractor, the electrical portionHof this permit laberl has been signed by an Electrical Supervisor and .returned to the Building Division I I ,I TOTAL CHARGES , WHERE STATE Ul~REQUIRES shall not be valid until the Zone '2? I HAVE CAREFULLY EXAMINED the icompleted application for permit, and do hereby certify that all information hereon is true and correct, and I further certif~ 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 NO OCCUPAIJCY will be made of any structure without the permi;ssion of the [luilding Division. I further certify that my registration ~Iith 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 ooly ,"btoot""o" "d "",ploy", .who '" '0 tom,it"" with oes 701.055 fibe ",~d2J/' ~". /1 .. . lJAt.1E(please print)2/6.A4'C,O B/<'AA/c// SIGNATU~W~~~2!~/~~/~E&-U-8f? FOr; OFFICE USCOflLY pr So. Ftg. t1ain Sq. Ftg. Access Sq. Ftg. Other Tyoe/Cons t. \. ~- \.. ') Units \. Occy Load Occy Grou~- f2.- x Value Value Value Fire Zone - Bedrooms x Flood Plain ---- Stori es x TOTAL VALUATION \ ,(,"(")- BUILDING PERf'lIT Charges and Surcharges Plan Ck. Comm/Ind 65%/~lda Per Fpe PI an Ck. Res - 30%/Bldq Per Fee Fence ------ ----- ~I D@mo ____jO 00 I Sidewalk . .. \..\D I A/C Paving _____'WL~-Jcurb Cut 'I . I ' ____~O:,~_- . ,:\...\() ISystems~ Development Charqe (1.5%) " I I I I \\ ~ , PLUNB ING PERMIT Charges and Surcharges ELECTRICAL PERr~IT Cha rges and Surcharges Total Comb. Permit j MECHANICAL PERMIT Charges and Surcharges I TOTAL () tb LO. " ~: , COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. 'Legal Description 1. exam~le- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot 1. Block 3, 2nd Addition to Springfielq ,Estat~s , C. Name; etc. 'of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinq/o~ forced air qas 2. examole- waterheater/electricalior solar E. Square footage or valuation, etc. 1. example~ 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. example - 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 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 ~he 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 f PROJECT CONDITIONS TO BE SATISF1ED BEFORE OCCUPANCY: I Permit Clerk PERMIT VAll DATION ~3J3 Co . Ifl- 76- ~V .~~ Permit applicant exempt from registration with the Builder's Board because~ Additional Project Information: PLANS REVIEWED BY: nam~~\6~G\.)\ Signat:reV"--C-\ ~_" ,dateb- 9'1 ~8'-l