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HomeMy WebLinkAboutPermit Building 1997-1-1 1111SPECTIOII LIIIE 726-3769 . . INFORlIATION LW, II 726-3753 ~ So. Ftq. '-lain ~: Ftg, Access. (,,<I-"; Sq, Ftg. Other lIew Add A Her Rep. --Fence Demo ChangelUse Other -- -- ~ ~ I~ I, CiH UF SPRUiGFIELD CmlBlIlATION APPLICATIOu/PERMrT -+- E!IERr,y SOURCES: 'Job Address I ZS'~ PIf/P5PAl ( Heat \ ,- Legal Dmription 1.,ot -l'LBI,')(I,1! _, . NOR.#l(:AAtr.? \'Iater Heater ". ...... _Fii>--::f fr:Idtn6A.J in ,~#I. {}1?~ 1<6 R; r3 ~:~~: of Hark: 00 -Owner -....//I/I1f7S r z:Iz6RA- !leJJ!~ G::" 080. - Address IC)SC/ P/~l'!sP.WI- Phone7<fI-iJ$/ ~~~l1:~nRe~;~~~~eInf~h SDRf(..y.?,f7<,~tI /)R., I . _ - Constructlon lender AIoIJIl... 17<177 VDe.+Ftc.l?d Describe Work(i.e'f Build Single Attached GaraQe) aFtPA~~ ./ Address U,,!(;ll lOA11 Structural rhlJhq ..../ Phone (address) C' ....'p.fl:te (1 ics. no.) (end res) (ohane no.l (name> ./" - Primary -...J IfMeS Electrical t1echanical CONTRACTORS (name) General JI7IV!~ If~N 4'l-/ ---' (address) C o-JlIlI1e. (l ;r.s. no.) (pxnired (ohonp nn 1 Plumbino 'Electrical ~MI'S lIelJ/-ey f.lechan; ca 1 <' 011111,,', PLUIlBUIG ELECTRICAL MECHANICAL FEE CHAPr,E fin ~F rl-IARr.F t.JO. FFF rHARr.~ Residence of furnace/burner to SQ, FT, BTU's New circuits alts. Floor furnace or extensions and vent I SERV ICES - 1,.,.-0 , 1,:-' Recessed wall -.. SD~CP h~~tpr ~nd vpnt ... I cO .......,.....~. r10. Each single fixture IRelocated buildino (new fix. additional) Is.F. Residence (] bath) Duplex (1 bath) each Hater service I Sewer I Storm Sewer Of amps. Appliance vent seoarate Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from I heatino or A.C. Mechanical exhaust hood .lnd duct Additional bath Temporary Construction Change in existing res.i dpnce multifamily, COrml. or TndlJ,,-tri.ll COlj/.L/IIID, FEEDERS Install/alter/relocate distrih. fpprlprs Wood stove/heater Of amps. TOTAL CHARGES HHERE STATE L~H REOUIRES shall not be vali] until the ~ TOTAL CHARGES 'r- I I I ISSUANCE OF PFR!IIT / c-~'.J I _', _ TOTAL CHARGES -." .... ''J - that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAHHlED the completed aprlication for ~ermit, 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 50ringfield and the Laws of the State of Orel]on pertaining to the.\oJork described herein, and that 1m 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 exemot the basis for exemption is noted hereon. and that only subcontractors and emrloyees who are in compliance with ORS 701.055 will be used on this project. IlAI-lE(please print) Zone j"=\ Tyoe/Const. \1,\1 Fire Zone Bedrooms Flood Plain - Stories \ - Units Occy Load S 1r,IIATURE FO~ OFFICE USE OIIL Y Sq. Ftg. /lain SQ, Ftg, Access (_.4(, SQ, Ft9, Other DATE Occy Group \ I I x Value , qs"O value'! t,,,go, ,,<;0 x Va 1 ue BUILDING PERI.IIT Charges anc Surcharges 4'() 00 I Plan Ck. . . -- 65%/Rldn -------0---- {fo ~ I ~6~~Bi~~ _____~.:__---_I Fence I Demo J5:00. Sidewalk -- --.------- , ,~.9 AIC 'Pavi ng COIM1II nd Ppr F~e Res Per Fee TOTAL VALUATlOIi I '1"'~<J'''iO Syste~s Development .M-<'u-p -.JI" Charoe (I. sn .:pI'), DE' ,;,#?-'S< I QRLtLW)(,6 ro4 I I PLU'~BING PERMIT Cha rges and Surcharges ELECTRIC~.L PERI:IT Cha rges and Surcharges ITotal Comb. Permit .1=)'740 II ,..b.- ';'S7-.ro 11ECHAIHCAL PERMIT Charges and Surcharges Curb Cut I I TOTAL . , III. . . oJ . COMBINATION APPLICATION/PERMIT (CAP) I. PERMIT VALIDATION II. Applicant to furnish A, Job Address B, Legal Description 1. example- Tax Lot 100, Lane County Map Reference II 03 43 2. example- Lot I, Block 3. 2nd Addition to >prlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinq/or forced air qas 2. examole- waterheater/electrical/or solar E. Square footage or valuation, etc. ------ I. 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. example - construct single family house w ~a( attached garage 2. exam~le - remodel existing garage into far 3. examole - convert single family residence (' restaurant (change of use) G. Value of work as defined in Section 303 (a) 01 Structural Specialty Code H, DES I G;I TEM,' AND COIITRACTORS To avoid design or construction delays, Build; Division Staff must be able to contact appropr persons regarding design information or job si corrections, etc. 'd F " ",e' Rec. rom Abbreviated Plumbing, Mechanical, & Electrical 5ch ~ A. Except where blank spaces occur in the descrip portion of the Mechanical and Electrical Sched the applicant need fill-in only the No. Boxes, to the aopropriate item(s) to be installed ( B. Full Plumbing, Mechanical. and Electrical Schel are available at the Building Division 1. To conserve space on the permit form the s< have been abbreviated ( 2. If the item(s) to be installed are not COVE the abbreviated schedules you should consul full schedules C. BUiLDIi;G DIVISION STAFF WILL FILL OUT ALL FEES CHARGES ON THE SCHEDULES O. As noted on the CAP, the label must electrical contractor for signature supervisor. The general contractor to sign the electrical label. Applicant to sign and date Whenever possible, the initial application will be I a ~'Iorksheet only. Where possible, Building DivisiOl (ell will prepare a type written copy and return it to tl appl i'cant at the time the actual 'permit is issued f( Signature. Fees and Charges ( Plan check rees are due and payable at the time of t appli'cation, and no plans ~.1i11 be processed until th fees are paid. All other fees and charges are due a payable when the permit is' issued. , I . ,- " CITY (I SPRINGfiELD Of City Hall Springfield, Oregon Department of Public Works OFFICIAL RECEIPT o No. B r:::t"~7~ u 4 ( i ..; (D Date 1/' 19, i. (~ , / , CD ,(j) ,<11 IS , .\r:/. G ( ( ( Address J /~' .:-, '., ,-.' - . -. ~ ; ! ", Received For: '- '. " , ~;-, ."j' ~ .f " c - .-, I ';:> to 0 </ 4oDO IreD be delivere by his elec is ~ auth '_ F-'I' , , i'" .- .. .~, . ,',. . " l' :....,-. ,r -/ " .1 , ' IV. V, ( A~~~~ Received';' .- '" ... ,../ . FOR OFFICE USE ON,Y PROJECT CONDITIONS TO BE SATISFIED BEFORE ( .. BY _ ~: ~ c'--; t 1/ :-1 AUTHOlll1:E;O 5IGN...TURE ....~LTON.TU......ULL ..."..t.... LUC'U.t"" .~.O' ,.",.. C- ( 1-, Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name I 1/ '/ slgnature - /' .', ",',.1,".\' ' - ---~"'" ", , ~ ......~ 1-;-"''''') date " 'r_7.'- f> .t.(