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Home My WebLink AboutPermit Building 1987-7-15 -1 '. I IrISPECTIOII LlIIE . 726-3769 / Job Address .3(');:5 I.egal Description . CITY OF SPRINGFIELD CDr1BIiIATlON APPLlCATlON/PERMrT EIIERGY SOURCES: Heat Hater Heater . INFORf1ATION UNt 726-3753 Sq. Ftq. 1.lain :q. Ftg. Access. Sq. Ftq. Other Ilew Add Alter Pep. -Fence Demo Change/Use Other - - Owner C/?"4r' r:JF :5p'p//,/c::,F/€c. 2:) Address 22'5' NoRr.h' /)"T.o s;r. Phone /)P,8/M::-./,/,cLL:> OX. (#~/;;~) Valwof ~'ork: WJ7. /?~" Builciinq'Permit Info: Describe Work(i.e.. Family nesidence Hith Jl..ttached Garaae) Build Single ~ ~ ~ ~ /y",prN ';4': -::;r. I Ranqe~ Address UDIGN nAi~ (name I Phone (address) k-6T~"t: )'/1s"D/.F/E.D ~/ TUh?Eh- M..G'h?";;>~~& .~6r ~5E/"77ZS.t. ~ 08 C/7'''r' ,6:)Jy/yEL> a.../L/.:>/~. flies. no.) (exoiresl lohoneno.J Construction Lender , Primary Structural (j")< ("'100 \J- I /') , 16' ' ( , \,., Electrical Hechanical CONTRACTORS Iname) ~Pfl.l<#1'~R' "-A-'?,.<r"" 6.GA:4 General 6~~L D/~r p/'9 (addres~' (lir~ ~n' /W~/#~h#/.Y""''''' "" F'-?~ /s:!IC?.", AI'-'!1 ~::;>~C>~7. (PXO; rpo;) rohnnp no_) 726.327S Plumbino Electrical 'lechanical -;;;;71'R~ ~l'Y.//Th' 5#~ pe/"A'C PLUI1BING ELECTRICAL MECHANICAL furnace/burner to BTU's J:'J:'r p.IAIH~r ~ NO. Each single fixture FH C':HARGE Nn I I Res i dence of SQ. FT. INew circuits alts. or extensions I SERVICES J:'J:'J:' r~AR~r NO Relocated building (new fix. additional) Floor fu rnace and vent S.F. Residence (I bathl Duplex (I bath) each Recessed wal1 SOi'lrp hp~tp.. ;Inri \/pont Storm Sewer Of amps.1 Appl lance vent sena ra tp Stationary evan. cooler ~ , Vent fan wi th sinale duct Vent system apart from heatinq or A.C- I ~lechanical exhaust hood nod duct I I'ioad stove/heater Additional bath ~!ater servi ce Temporary Construction Change in existing rpc;idJ'.ncp multifamily, COITm. or Tnrlllc;trial Sewer COMM./IND. FEEDERS Install/alter/relocate rli<;trih. fpprlpr<; IOf amp~ I I I ISSUANCf OF PFRIIIT TOTAL CHARGES I TOTAL CHARGES , TOTAL CHARGES .WHERE STATE L'U~ REQUIRES that the Electrical work be done by an.-Electrical Contractor. the electrical portion of this permit shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE 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 described herein, and that 1m OCCUPArKY 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 OP.S 7Dl.055 will be used on this project. Zone Fire Zone Flood Plain Tvpe/Const. Bedrooms Stories Units Occy load Occy Group SIf;iJATlJRE FOr. OFFICE USE OiIL'V Sq. Ftg. f1ain Sq. Ft~. Access Sq. Ft9. Other OL f/ :1- /M f/ DP.TE ? - l'r/ir 7 rWIE(please print) x x x ValuE." Value Value TOTAL VALUATION BUILDING PERI.IIT Charges anc Surcharges I ~ I Plan Ck. CorrmlInd .IY~_./_~___ 65%/Bldo Per Fee Plan Ck. Res 30%/Bldo Per Fee Fence ISystems Development ,-- Charoe (1.5%) PLUI~BING PERMIT Char.ges and Surcharges D~mo ELECTRICAL PERI~IT Cha rges and Surcharges Sidewalk AIC Paving ITotal Comb. rermit 11ECHANICAL PERMIT Charges and Surcharges Curb Cut I I TOTAL ;10 fiE I . . l \ COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION 1. Applicant to furnish A. Job Address B. legal Description 1. e~a~ple- Tax Lot 100, lane County Map Reference 11 Uj 4J 2. examp]e- Lot 1. Block 3. 2nd Addition to Springtield Estates. . C. Name, etc. of owner and construction lender O. Energy Sources . 1. exalT1ple- heat/electrical ceiling/or forced air Qas 2. example- waterheater/electrlcal/or solar . E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. example- Tflnew project. check-new - if addition, 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. examyle - 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 abbreviated schedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES o. 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 signa ture. 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 J 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 .