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Home My WebLink AboutPermit Building 1984-10-3 I INSPECTION L1IIE 726- 37 69 . " f . INFORrlATION liNt 726-3753 Sq. Ftg. I.lain :q. Ftg. Access. Sq. Ftg. Other r~ew Add Alter Rep. --Fence Demo Change/Use -Other- - .,.,,- Phone Ran~e ValuE of flor.: of!!) Arm. BUildinQ-ftler.mit-, Info: Descr.be Work{Le.. Familv Residence Witr Attached Garaae) Build Single I ~ Q) IV IOJ v---' ~ Job Address ;Y~S~lm _ '..A/ ",J.it:; Legal Descripti~n\'7 O~ ~7\ ~2 ~ ~'I(-() ) n 1 <'\~ . 04ry.~ a_ - - 114 In- 'lfjdo CITY UF SPRINGFIELD CDMBIIIATION APPLICATION/PERMIT EnERGY SOURCES: Heat t.Jater Heater (namel Phone (address) .~rv n 9-... o flies. t l"'n~Qj)fll J)o Constru ti n Address UESIGN TEAr.., no. , (eXD; res) (ohone nO.l Primary Structural Electrical Mechanical CONTRACTO,S, [name V , General_ r~ ~t )~ ~{\ t(lt t-l") Plumbino (address) \'f:>If\ \:i. ,--. 45f\ ~- (lic<:. no. \ (exnirps,- Jl:!.hnnf'l nn.' <[~n . ID-3-84- ~' ~.,\~-QJ1Q 8u l\ ~~'llLnl () ~ Electrical "'echan; ca 1 PLUllBING ELECTRICAL MECHANICAL NO. FEF r.HARr.F ~n ~~~ r411.Rr.I='Nn 1='1='1= r4ARr.r: SQ. FT. furnace/burner to BTU's ,. Each single fixture Residence of Relocated building (new fix. additional) S.F. Residence (l bath) Duplex (1 bath) each Additional bath New circuits a1ts. or extensions Floor furnace and vent SERVICES Recessed wall ~n~~~ h~~tpr ~nd vent COMM./IND. FEEDERS \ Install/alter/relocate _l.oi c:;trib. fe€>dPrC:; /' I -I. Appl iance vent seoarate Stationaryevap. cooler Vent fan with sinale dllct Vent system apart from heatina or A.C. Mechanical exhaust hood and oud Wood stove/heater ~!ater service Temporary Construction Change in existing rps i d.p'n~p multifamily, COJlll1. or tnrllJ<:.tri~l Sewer Storm Sewer Of amps. ~, Of amps. ISSUANCE OF PERmT TOTAL CHARGES ~ TOTAL CHARGES I TOTAL CHARGES WHERE STATE LA\/ REQUIRES tbat 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.Surervisor and returned to the BUilding Division I HAVE CAREFULLY EXAMINED 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 oerformed 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 NO OCCUPAHCY 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. Zone r r Fire Zone Flood Plain Tyoe/Const. ~ \.) Bedrooms Stories Units Occy load Occ'y Group~-4 SIGNATURE FOP. OFFICE USE DIlLY / Sq. Ftg. f1ain Sq. Ftg. Access,\" rz_~ Sq, Ftg. Other (j)d rR~ OATE IlAI.IE(please print) x x Value Value Value x TOTAL VALUATION BUILDING PERHIT l\ W. 00 Plan C.. Comm/Ind Charges anc 65%/Blda Per Fpp Surcharges -----\~~~- Plan Ck. Res 30%/Bldo Per Fee PLUMBING PERMIT - Fence Charges and ------------ Surcharges D~mo ELECTRICAL PERI:IT Sidewalk Cha rges and ---=-=-------- Surcharges A/C Paving MECHANICAL PERMIT Curb Cut Cha rges and ------------ Surcharges --- '(J~ 1_I'\~Yste.ms Development ,~ ). harQe (1.5%) . 11- 'V,,- - - l-.1d2fYY) \ 70- 0= Total Comb. Permit TOTAL ! \ W~:~ . : ~, . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. , Applicant to furnish .A. Job Address B. legal Description 1. example- Tax Lot lOa, Lane County Map Reference 1I 03 43 2. example- Lot 1. Block 3, 2nd Addition to sprlngtield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. example-lheat/electr;cal ceiling/or forced air oas 2. exa~le- waterheater/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, check add, etc. . F. Building pennit 'information: 1. example - construct single family house with an attached garllge 2. example - 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. 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. 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 Z. 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. --- 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. 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. ~~J~~ Lo'd-OJ7 ~f:- II. I I I. IV. V. FOR OFFICE USE ONLY Pennit Clerk ctf~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY; ~'-- '\ \. \.. Y'\. ~\'\ ~ Ccr~'\~'-k~\ ~ C'~~\:€'r\.. ~~~ \ - - Permit appl icant exempt, from registration with the Builder's Board because: Additional Project Information: . PLANS REVIEWED BY: nam~\\\'~-<~M\6-"" Signatus;::J.-ljA~-A Y (j'a ~e \\--\ ~<t:\ .