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Home My WebLink AboutPermit Building 1990-11-2 --~-- I INSPECTION LINE 726-3769 -----.. CITY OF SPRINGFIElD CDr1BINATION APPlICATION/PERMIT .. INFDRIIATIDN UNc 726-3753 Sq. Ftq. 1.lain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. -Fence Demo Change/Use -Other- - ~ ~ ~ Job Address 'i/7 #~ ,#"'5/ EilERGY SOURCES: Heat \4ater Heater Range Valys~ ~ ~ ~j Bu,idina Permit Info: Describe Work(i.e., Build Single Family nesidence With Attached Garaae) $EC~/?>7 ;zj'P=-/ ~~~ ~~.", ;9,7/~ bP (::"'t?fi'7~~~pG.-~"t>I'~ (lics. no.) (exn;res) (ohone no. J legal Description Il-(j'J'3-5'.."'!J~. o5"~~ h# ~p-~.:> Address 7?~~ ~ ~;),A'-:D - z1?f- Constructi;n Lender /. : Owner Phone 7c.17 -&>7:2'7 . Address Ut~lliNI tAf1 (name) Phone (address) Primary ~W'#6Z? . Structural Electrical Mechanical CONTRACTORS Iname) Genera 1 ~At/.6j #/~ {address} (1 ics. no.) I :-) :::s4. n (pxoir~~) (ohon~ no.) '7 /1~!q1 Plumbina , Electrical ~1~chanical PlUlIBING ElECTRICAl MECHANICAl -1J!l- FFF' rHAR~F Nn r:r:r: r~ARG.E.. ..lill......... r:rr r~;RG.L SQ. FT. furnace/burner to BTU's Each single fixture Residence of Relocated builaing (new fix. additional)' " New circuits alts. or extensions Floor furnace and vent S.F. Residence II bath) Duplex (1 bath) each SERVICES Recessed wall Soac~ herttpr rtnd vpnt Storm Sewer Of amps. Appliance vent "eo~rate Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from heat;no or A.C. Mechanical exhaust hond and dud Additional bath Sewer Temporary Construction Change in existing rp~ j dJ.ncp multifamily, comm. or Tnduc;tr;al ~Iater servi ce COMM./INO_ FEEDERS Install/alter/relocate d;strib. feederc; Wood stove/heater Of amps. .... -... . , ISSUANCE OF PFRtIlT TOTAl CHARGES J TOTAl CHARGES WHERE STATE l,'I/ REQUIRES that the Electrical work be done by an shall not be valid until the label has been signed by an Electrical I TOTAL CHARGES Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFULLY EXMlINED 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 UO .OCCUPAUCY 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 701.055 will be used on this project. NAI.1E(please print) Zone &::. C Fire Zone Flood Plain Type/Canst. Bedrooms Stories Uni ts Occy Load Occy Group SIGNATURE FO~ OFF I CE USE QiJl Y Sq. Ftg. Sq. Ftg. Sq. Ftg. DATE I t1ain x Value Access_ x Value Other~e'pA".o;o,..7 Value~~- TOTAl VAlUATION BUilDING PERIHT Charges an~ Surcharges '~.A ' Plan Ck. COlTllllInd ___~~~__ 65%1BldQ Per ~pp ~ Plan Ck. Res ~~ -J 30%/Blda Per Fee Fence ~2~ 'Systems Development ' Charae t1.5n . PlU!1BING PERMIT Charges and Surcha rges D~mo ElECTRICAL PERI~IT Cha rges and Surcharges Sidewalk A/C Paving Total Comb. rermit IIECHANICAl PERMIT Charges and Surcharges Curb Cut TOTAl ~.&;; . . . COMBINATION APPLICATION/PERMIT (CAP) " PERMIT VAl:lDA:qON I. Applicant to furnish A. Job Address B. legal Description . ." 1. example- Tax Lot 100, lane County Map Reference 17 03 43 2. examole- Lot 1. Block 3, 2nd Addition ~o " sprlngtield Estates ~ ... C.' Name. etc. of owner and construction lender~ O. Energy Sourc~s ~ '. '. ~ .. '. . 1. examDle~~heat/electrical ceilinq/or fo~ced air qas 2. exa~le- waterheater/eleCtr;cal/o~ solar '. ~E;: "'Squa',re-'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. B ilding permit information: examole - construct single family house with an attached garage 2. examole - 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. OESIGN 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 OIVISION STAFF WILL FILL OUT ALL FEES ANO CHARGES ON THE SCHEOULES 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. !fc/,,/ /~b~ 1/~-2"'7e> ~ - ..... . .. ..... . ~$6 ~1I /7~~ 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 Projec~'Jnforma~ion: .' PLANS REVIEWED BY: . name ~~E R-~~ signature . . _~_? date //'-;?-"'5fiI.:::> "