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Home My WebLink AboutPermit Building 1983-8-4 j j1NSPECTION LIrlE 1726-3769 . CITY OF SPRINGFIEeD COMBIIIATION APPLICATION/PERMIT EIIERGY SOURCES: Heat t~ater Heater . INFOfU1ATION liNt. 726-3753 Sq. Ftq. 1.lain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. --Fence Demo Change/Use Other- - 0<.) UJ ...D :)J ()l !70<J S, )/ ...:7' I eegal oescription" \, ()~~c, <:\\ \~('rO r I I. Job Address ~- Range ValuE of Hark: d 19'1 ~ Bui16inq Penmit Info: Family nes;dence With Descrlbe Work(i.e.. Build Single ,lI..ttached Garaqe) Owner U/~ dA!'--7(AArl1 ~#_~ )i.-f~ Address <; A- M P 7 471}4J ~one Construction lender , (~U'-4'o..d~ ,7 ~. ~~~--A-~ p '7:20 II/M. ;:>-tt..-f' A'fA- ~~A"A A. Address Ut~ltiN I tAl,' {name) Phone (address) flies. no.) (exo; res) (ohane nO.'J Primary Structural Electrical t1echanical CONTRACTORS (name) Genera 1 ArYl=! A eJI7P//f)i:- /A//', (address) (lies. no.) .2 9;'/') '7 A-t"/ft?tv/l 11 ).tf /9"0 or; ~c.e- 'f74C>;L / (pxnirpc:,) /14/&'5- (ohnnp no. ) -p...If/{O'zt '7 Plumb;na Electrical ~lechani ca 1 PeUI1BING ELECTRICAe MECHANICAL NO. F,E CHARGE Nn Ieee n-lARr,F NO. I FFF ~ n-lARhF I I I I I I Each single fixture Residence of SQ. FT. furnace/burner to BTU's / Relocated building (new fix. additional) $.F. Residence (] bath) Duplex (1 bath) each New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wa 11 Sn~~p hp~tpr ~nrl vpnt ~Iater service ITempOrary Construction IChange in existing rpo:;; rlJ.nre " Imultifamily, comm, or TnrllJ<;tr;~l IOf amps.1 ICOMM./INO. FEEDERS I I~~~;~~~~a~;:~~~:locate I IOf amps.1 Appliance vent seoarate Stationary evap. cooler Vent fan with sinale duct Vent system apart from I heatinq or A.C. Mechanical exhaust hnnrl ~nd rluct Additional bath Sewer Storm Sewer Wood stove/heater ISSUANC, OF PFRtHT TOTAe CHARGES TOTAL CHARGES TOTAe CMARGES WHERE STATE LAW REQUIRES that tile Electrical work be done by an "Electrical Contractor, the electrical portion of this permit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXM1INED 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 oerformed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Ore~lOn pertaining to the work described herein, and that NO OCCUPAIlCY will be made of any structure without the permission of the Building Division, I further certify that my registration with the Bu;lder1s 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 only subcontractors and employees who are in compliance with OP.S 7Ql.055 will be used on this project. UAI.IE(please print) N/C.H/I~ /fOr' ~/)~ SIGIIATURE ~.-r:"~#./ /rA-G//.;II'"~ FO~ OFFICE USE OrlLY So. Ft9. liain Sq, Ftg. Access Sq. Ftg. Other OATE fr'/~/ 9"5 Zone Fire Zone Flood Plain Tyoe/Const. Bedrooms Stories Units Occy Load Occy Group x Value Value Value x x TOTAL VAeUATlON BUILDING PERflIT _____3'-=-9;>_ Plan Ck. Comm/ I nd Charges and 65%/Bldo Ppr Fe€' Surcharges I.a Plan Ck. Res 30%/Bldo Per Fee PLU'~BING PERMIT Fence Charges and ------------ Surcharges Dr;mo ELECTRICAe PERI~IT 'Sidewal k Charges and ------------ Surcharges Ale Paving MECMANICAe PERMIT Curb Cut Charges and ------------ Surcharges syste.ms Development CharQo (1.5%) Total Comb. Permit TOTAL I $ 33 Z 8" I ' ~ . . . , , ~ COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I I. Applicant to furnish A. Job Address B. legal Description 1. examole- Tax lot 100. Lane County Map Reference 1/ U3 43 2. example- Lot I. Block 3. 2nd Addition to ~pr'ngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1, example- heat/electrical ceilinq/or forced air qas 2. examole- waterheater/eJectricalfor solar E. Square footage or valuation. etc. ----- 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. exam21e- if new project, check-new - if addition, cneck add, etc. F. Building permit information: 1, example - construct single family house with an attached gar~ge 2. example - remodel existing garage into family room 3. exam21e - 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 TEM4 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 the 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 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 date .