The URL can be used to link to this page

Home My WebLink AboutPermit Fence 1986-9-4 INSPECTION LINE 726-3769 Job Address legal Description 4i3...L"! (I A,A,1 ELLI If Owner ~'/vA/?~ [)_ rlre.;:::;-I\J Address L/- /30 C--A Ail e: LI __ 1 A ~F /) /)P... q 7c.j7 7 Construction lender Address DESIGN TEAM Primary Structural Electrical Mechanical CONTRACTORS General Plumbing Electrical Mechanical NO'1 Each single fixture Relocated building (new fix. additional) S.F. Residence (1 bath) Duplex (1 bath) each Additional bath Water service Sewer Storm Sewer TOTAL CHARGES (name) (name) r.:n..u IV ElL PLUMBING FEE CHARGE CITY OF SPRINGFIELD COMBINATION APPlICATIONlpERMIT Phone 7Lf-7-29D'7 Phone (address) (address) NO. Residence of ENERGY SOURCES: Heat Water Heater Ra nge Value of Work: INFORMATION LINE 726-3753 Sq. Ftg. Main Sq. Ftg. Access. Sq. Ftg. Other _New_Add_Alter _Rep. _Fence_Demo_Change/ Use _Other \x::) .......... ~ ~ "" ~ Building Permit Info: Describe Work (i.e., Build Single Famil'( Residence With Attached Garage) J.~41i rL hAffP/ b ELECTRICAL FEE ..,. ft. New circuits, alterations or extensions (lies. no.) (expires) (phone no.) SERVICES Temporary Construction Amps. FEEDERS Amps. TOTAL CHARGES (lies. no.) (expires) (p!'Ione no.) MECHANICAL CHARGE I CHARGE I I NO. FEE furnace/ burner to BTU's Appliance vent separate Stationary evap. cooler Vent fan with single duct Vent system aport from heating Or A.C. Mechanical exhaust hood and duct .~: - Wood stove/heater Heat Pump I Air handler to 10,000 CFM I Air handler over 10,000 CFM I I I ISSUANCE OF PERMIT I TOTAL CHARGES WHERE STATE lAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of Ihis permit shall not be valid until a label has been signed by an Electrical Contractor and attached to the electrical panel. I HAVE CAREFULLY EXAMINED the completed applicatian 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 described herin, and that NO OCCUPANtCY will be made of any structure without the permission of the Building ,Division. I further certIfy that my registration witt> the Builder's Board is in full force and e'ffect 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 project. Basis for Builder's Board e~;mption: NAME (please print) III/, !- AA :"~ Zon.. fire Zon.. Flood Plain BUilDING PERMIT Charges and Surcharges PLUMBING PERMIT Charges and Surcharges ELECTRICAL PERMIT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges j, -f/,{ q ~ ./1/' .' ~IGNATURE 11./ :JZ4fi..#\/ ~...4 ~ (/' tl'/' DATE ?-y:- ~ ( Typel Const Bedrooms ~tori"'lt I I I I ---------1 FOR OFFICE USE ONLY 'Inits Occy load ('lecy Group Plan Ck. Comm/lnd 65%/ Bldg Per Fee Plan Ck. Res 30%/ Bldg Per Fee Fence Demo Sidewalk AI C Pavina Curb Cut ~q. Ftg. Main <;q. Ftg. Access Sq. Ftg. Other ~ /8. tJO x Value Value Value x x TOTAL VALUATION Systems Development Charqe (1.5%) I Tolal Comb. Permit I I I I TOTAL 1/1 f. (}-(J COMBINATION APPLICATION/PERM., (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example-tax lot 100, Lane County Map Reference 2. example-Lot 1. Block 3, 2nd Addition to Springfiell 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, ChE add, etc. F. Building permit information: 1. example-construct single family house with an att garage 2. example-remodel existing garage into family roor 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 Divi: Staff must be able to contact appropriate persons re~ design information or job site corrections, etc. II. Abbreviated Plumbing, Mechanical & Electrical Schedule A. Except where blank spaces occur in the description p of the Mechanical and Electrical Schedules, the appli, need fill-in only the No. Boxes adjacent to the appro 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 schedul ( have been abbreviated 2. If the item(s) to be installed are not covered on th ated schedules you should consult the full schedul ( C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ~ ~ CHARGES ON THE SCHEDULES ~ ~ I I I V r ~ r K I I~ U r I I: L LI City Hall Springfield. Oregon Department of Public Works OFFICIAL RECEIPT ..., . (' 1 No. B Date 4(,-, ,-;t L/ 19 g / Rec'd Fromi ;// ...In1./.Vt_dJ J'd.. aL41 -" -; I Address 'I, / 3 {, (PA.dJloM~-, I C::~?0"3 v I ~L( ! ~ Received For: 1I..1,1-1'_1.j IJ) h /VVlJ-t:. $j If. 1M ( ( (, j' ~~_i~ ( ( #I/o 1'1.) ;{,UZ; Amount Received BY J/v (I AUTHORIZED SIGNATURE SHEl.TON-TURNBULL PRINTERS' EUGENE. OR 97401 58511-8 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 Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: PLANS REVIEWED BY: namp 'iignatur'" rJate