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Home My WebLink AboutPermit Building 1980-2-11 .~ r .. . . 1 IrISPECTIOII LIIIE 726-3769 CITY Uf SPRINGFIELD COIIBIIIATIDN APPLICATION/PERMIT EIIERGY SOURCES: Heat Ha ter Hea ter Job Address d,,<)() N. A" t(:;frN 'b Legal Description .z. 7 DO J 7D"3"35 '5'2.. Owner SD!:2I~iG--F)u.D O-f..; /, '.j..,. Address ~ ~~& IN.A" S'fr...::t C' I / ,'l~IVJM:/~tb: O[>QMJN Construction lender Range INFDRlIATIDN urlt 726-3753 Sq. Ftg. f.la;n ~CJ. Ftg. Access. Sq. Ftg. Other fle\v Add Alter Rep. -Fence Demo Change/Use -Other - - /ivalU€ of H~<\: ROARd ,,?, Q(J/Y- Phone~JI \JU .....Builci;nq Permit Info: Oeser be Hork{Le., /76"Ol~ 'Family ~esidence \~;th /l,ttached GaraQe) Build Single ~ 10 G c b Air/' u.Jr.J L -6n L<:fu)} Nei.(J --- rJ'~Jlj., rtViIV1 1,,1__jM~-F-, e/ff-lI/I<:'/Octl/..t"3 -RJy Address UI:.SHifl II:.Ar.' COl)1.a..l 'f:..:J 1/-- (l ics. no.) \ \.. (name) Phone (address) Primary Structural Electrical i1echanical CDNTRACTDRS (address) (1 iC5. no_) f?O J4. d.1~ ~ st s...f1d ;::).{,7S''7 3-1- 8'0 (name) Genera 1 C. Lu~, ('''n~-Irt.et;'G~ Plumbinq Electrical Mr_ Ph -ee~.ts ,.?7'1t;, .cfr.u"I::.I,~ IleChanicalChrl~.t.AIU Rln){h~".s- 3"867'-"1 PLUIIBIIIG ELECTRICAL FEE rHARr,F 'In F<' n~ARr,~ 'In Residence of SQ. FT. ./ New circuits alts. 115.."" or extensions ~ dOP /IA__~ ISERVICES I I I I Temporary Construction I IChange in existing rp<:; i rJpnce multifamily, comm. or InrJu<:;t.ri<ll Of amps. COMM./IND. FEEDERS Install/alter/relocate I ni<:;trih. feerJprs ..-/ Df ,~__ ~mp~ lIP"'" ND. Each single fixture Relocated building (new fix. additional) S. F. Res i dence (1 bath) Duplex (1 bath) each Additional bath ~Jater servi ce Sewer Storm Sewer .(exoires) (ohone no. (exoi res) (ohane no.) 7~"-S"I;Xq l../-I - 3' 0 ?....(.;- '?(, 4.j 9 ?;)6-0d.-1-J C. MECHANICAL furnace/burner to :ot.-.J.- BTU's , Floor furnace and vent Recessed wall Sn<lr.p hp~tpr nnn vpnt Appliance vent seo.arate Stationarv evan. cooler" , Vent fan wi th sinole duct Vent. system apart from heatinq or A.C. Mechanical exhaust hood and rluct Wood stove/heater TOTAL CHARGES WHERE STATE LAW REQUIRES shall not be valij until the TDTAL CHARGES that the Electrical work be done by an label has been signed by an Electrical ISSUANCE OF PFR'llT ':2 S:-. TOTAL CHARGES Electrical Contractor. the electrical portion of Supervisor and returned to the Building Division I ~~~ I r~AR(:~ 16.- I I I I I I I /0.... I€;',- thi s permit I HAVE CAREFULLY EXMlINED 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 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 herein, and that rw OCCUPAllCY 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 ORS 701.055. that if exempt the basis for exemption is noted hereon. and that only subcontractors and employees who are in compliance with Or,S 701.055 will be used on this project. ~ ~ Dm;;?-!l-;;r~ NAf.IE(please print)~f A. Pd::erl~)(_ S IGij^TU~O.J7JU'" 0. .t?Jkf?~""u? FO~ OFFICE USE GilLY 'V ./ Zone c:::.-'3 Fire Zone :n::. Flood Plain Tyoe/Const. ;z;"-J H;ti!. Bedrooms Stories Units Dccy load Dccy Group Sq. Ftg. riain Sq. Ft~. Access Sq. Ftg. Other x x x Value Value Value Comm/lnd Ppr Fee Res Per Fee TOTAL VALUATION '7-1- $(0 I/'Jq /-D ,..-.-, Iq .l.Syste. ms Development I M A t-.<o "J~ :t!iharqe (1.5') ,f~,n, I BUILDING PER~IIT -;;z <1, 00 I Plan Ck. Charges an': 7 65%/B1da Surcharges ..aI;-=--------~-PTan Ck. .,....,-, r:7 ,'<IP 30%/Bldo PLUMBING PERMIT Fence Charges and ---~-{,~ . O-mo Surcharges I}'" 'i t>o ELECTRIUL PERI:IT '25", - I Sidewalk ~~~~~:~g:~d ~1';~----1-.-.;p-1 A/C Paving 11ECHANICAL PERMIT I~. e'" I Curb Cut Charges and Surcharges -------~~~-I Total Comb. rermit I I TOTAL I :867. €O I . . . , . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax lot 100. Lane County Map Reference 17 03 43 2. exam~le- lot 1. Block 3. 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical cei1;nQ/or forced air qas 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. examp 1 e- if new proj ec t. check new - if add it i on, check add. etc. F. Building permit information: 1. example - construct single family house with an attached garage 2. example - remodel existing garage into family room 3. examjle - 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 TEA/.l 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 fu 11 schedu 1 es 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 siqn 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 /,RN&1. ~~<!5i;,' signature ~~,?~-~ .. ,. - . date 2-11. Se> .