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HomeMy WebLinkAboutPermit Building 1981-8-4 l INSPECTION LINE 726-3769 CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT INFORMATION LINE 726-3753 Job Address 456 3 - .4~<; 'T.t!:: P sr ENERGY SOURCES: Heat Water Heater Ra nge Value of Work: Sq. Ftg. Main Sq. Ftg. Access. Sq. Hg. Other _New_Add_Alter_Rep. _Fence_Demo_Change/ Use _Other \) ~ ~ Legal Description Owner flevrf/d/eAJE" P'}"j 'IL /r ~ Address (>G,.,1L/.tJ... l) J r: ..:5P,(2/~GP;~L-D CJ..e ,/ Phon7.2~-75qt. 0477 Building Permit Info: Describe Work (i.e" Build Single Family Residence With Attached Garage) Construction Lender Address ) Phane DESIGN TEAM (name) (address) (Iics. no.) (expires) (phone no.) Primary Structural Electrical Mechanical CONTRACTORS (name) (address) (lics. no.) (expires) (phone no.) Plumbing / /I/O / General Electrical Mechanical , PLUMBING ELECTRICAL MECHANICAL NO, FEE CHARGE NO. FEE CHARGE NO. FEE CHARGE SERVICES ';../ /" furnace/ burner to I\TU's Appliance vent separate Stationary evap, cooler Vent fan with single duct Vent system apart from heating or A.C. Mechanical exhaust hood and duct Residence of Each single fixture Relocated building (new fix. additional) S.F. Residence (1 bath) .". ft. New circuits, alterations or extensions Duplex (1 bath) each T,e;';porary c~i1sJ!uction ~~. ~,,-' Additional bath Amps. ~~~, ) .: ./ .\W\ '/\n .,::'". --.~~~~;;. ____."; ~~:'J~ ~~'_.__ ___ Wood stove/heater Water service ", '''-''/ Sewer " I ,!.~ I "," Storm Sewer FEEDERS Heat Pump Air handler to 10,000 CFM Air handler over 10,000 CFM ~i. . Amps. -'\ ,', l ~ . i ISSUANCE OF PERMIT TOT AL CHARGES . I I )(/OM~ TOT AL CHARGES' TOTAL CHARGES WHERE STATE lAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall not be valid until a label, has been signed by an Electrical Contractor and attached to the electrical panel. I HA VE 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 performed 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 describ~d herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building ,Division. I further certlfy that my registration with, the Builder's Board is in full force and effect a s required by ORS 701.055, that if exempt the basis for exemption is noted heron, and that, only subcontractors and employees who are in compliance with ORS 701.055 will be used on this proje,ct. Basis for Builder's Board exemption: .NAME (pl,ease print) !foh~;o1'- D I/@ '1 f h (Jr~ p SIGNATURE ,~ DATE Wft7 / / FOR OFFICE USE ONLY ..Zon" Fire Zone Flood Plain Type/ Const. Bedrooms C::.toriOt Units Occy Load 0ccy Group <;q. Ftg. Moin <;q. Ftg. Access <;q. Ftg. Other 'I( Value Valul' Value x x TOTAL VALUATION BUILDING PERMIT Charges and Surch~rges Plan Ck. Comm/lnd 65%/ Bldg Per Fee Plan Ck. Res 30%/ Bldg Per Fee Systems Development Char!'!e (1.5%) PLUMBING PERMIT Charges and Surcharges, Fence Demo I Total Comb. Permit ELECTRICAL PERMIT Charges and Surcharges Sidewalk A/C Pavin!,! MECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL .-, COMBINATION APPLlCA TION!.PERMlf (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example-tax lot 100, Lane County Map Reference 17 03 43 2. example-Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example-heat/electrical ceiling/or forced air gas 2. example-water heater/electrical/or .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 informa.tion: 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 abbrevi- ated sohedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES 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 typewritten 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 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: PLANS REVIEWED BY: namE" c;ignaturp IERMIT VALIDATION Permit CierI<- -latE'