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HomeMy WebLinkAboutPermit Building 1990-11-7 I INSPECTION LINE 4IIIJ CITY OF SPRINGFIELD 726-3769 COMBItlATION APPLICATION/PERMIT Job Address \ ~ 50 ffi.t f\b)h ') \ lX \ oe.. ~~;~GY SOURCES: Legal De5Cription l f I ()~~ r)"::l'\4 nf::J1 n()Q / \iater Meater - , I Range Owner Q_('\~'f\ 'f\()\f) \ ~\\Cl O~9-Id(JI~ valu'r\f)ktfJ0,uJ Address, \ Clr-!-{'~~ 1 ^ ' . "\ i'\ ,""",ooJ Bui1liino P~niit Info: Descrlbe \iork(i-.e" Build Single --- 0(1) f'( \ , f .... J.-) )I \- n.. Faml1v l1esldence 1~1th Attached Garaop) ~\ 'n 7 ~ C{/.1l7 1\ 0 l\ IYj 1- \ q\0,h\ \\m Q (\ t '_ constr~~t~~ Lender - 1 ll.l"\\ 'rt (\\ Address Phone l DESIGN It::Ar~ (name) (address) flies. no.) (exoiresl (ohone no.' '. INFORltATION LINt 726-3753 Sq, Ftg, 1,1ain ~q. Ftg. Access. Sq, Ftg, Other Ilew Add Alter Pep, --Fence Demo Change/Use -Other - - d:) o ---. 0J ~ Primary Structural Electrical Mechanical ::::::~Ttt) ~ f~ y~ i\~ ~\c-\TG~~~ ~'f ,G lli1d)\L\rl Plumbina (pxpi rp\' -<\[<::\\ (P"{l"P !''In. ) ,~~\4\~_ Electrical ~'echanical PLUJ,IBING ELECTRICAL rrLIJ:I!AllG.E.I Nn MECHANICAL NO. FEF rHAPGF Nn~ rrr <:HAR!iL Each single fixture Residence of SQ, FT, furnace/burner to BTU.s Relocated building (new fix, additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence 11 bath \ Duplex (1 bath) each SERVICES Recessed wall ~n~rp hp~tpr ~nrl vpnt Water service Temporary Construction Change in existing rp~ j nj',nrp Imultifamily, comm. or Innuc;.trial IOf amps, I COI~'1. /lND, FEEDERS I Install/alter/relocate ,dic;.trib. fppdprc;. [Of amps. I I I Appliance vent $~oaratp Stationary evap. cooler Vent fan with sinole duct Vent system apart from heatino or A.C. Mechanical exhaust hood and durt Additional bath Sewer Storm Sewer Wood stove/heater ISSUANC, OF PFR!11T TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L'\~ 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 EXM1INED the completed aprlication 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 rm -OCCUPAIlCY 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 basis for exemption is noted hereon, and that :::,:(:~::::t:::~aop~~e: ~:o ar~:~o:ance with :~:'u::~~:55 CJ used/~th~:'r DATE l\-~- ~o '!. FOP. OFFICE USE OiIL Y Sq, Ftg, rlain Sq, ft9, Access Sq, Ftg, Other Zone Type/Const, Bedrooms Units Occy Load Occy Group , Value Value Value Fire Zone , Flood Plain Stories x TOTAL VALUATION BUILDING PERflIT Charges an~ Surcharges _QJ_L~._~_ ~~~~~~~; ~~~~~~d '\" -10 Plan Ck, Pes I J, IT") 30%/Bl do Per Fee Fence Systems Development Charoe (1.5~) PLur1BING PERMIT Charges and Surcha rges Demo ELECTRICAL PERmT Cha rges and Surcharges MECHANICAL PERMIT Charges and Surcharges Sidewalk A/C Paving Total Comb, Permit TOTAL c9JIo,~'6 Curb Cut . . , a . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I, Applicant to furnish A, Job Address B, Legal Description 1. example- Tax Lot 100, lane County Map Reference II oj 43 2, examEle- Lot I, Block 3, 2nd Addition to sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. exam21e- heat/electrical ce;lin~/or forced air Qas 2. example- waterheater/electrlcal/or solar E. Square footage or valuation, etc. ----- I. examp1e- 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. 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 AND CONTRACTORS To avoid design or construction delays. Building Division Staff must be able to contact appropriate persons regarding design information or jab 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 0, 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. ~ ~' . V. FOR OFFICE USE ONLY Permit Clerk ) - ~\~ . . 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 signature ~~