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Home My WebLink AboutPermit Building 1984-3-18 JNFORllATION u.,E i~li\1 726-3753 _ " Sq, Ftq, 1"lain ~q. Ftg. Access. Sq. Ftg, Ot~er ~ew Add Alter Reo. -Fence Demo Change/Use r n ; ValuE of work:~O"6'~ Ot~er- - ~ 1 BuilGina Permit Info: Oescrlbe Work(l.e.. Build Single li'-> Family P..esidence Hith ~ttached l1araoe) ~;t~"- ~D""" - S, b 'iuJtt"~K ON Sc. ~ ; I.JNb~MJt ~ lA.-r~H ~'AI-.tJ.UT~/t'A-/~rk'''1 ,*,.M.y ~eJkl.( f ~ WAx'Wt 5~Ph. So' ~lff {addressl (lies. no.l (exo;res) (ohane no. I r -6{. ~ ic.I ~ &,;. L.- A! ANA-It R tJ . j IrlSPECTION LJrlE 726-3769 . legal Oe5cription Sf). :". . / A /t.~QOt 1'7-6~' 3S- ''2.. Fi.~~ 0 CITY uF SPRINGFIELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat !~ater Heater RanQe IOf / ~R:>~'7"O;r:-A2' s:'>P'P", ..,. ttJ."~ / I.#~~? ~, - ISSUANCE OF PFR'1lT 5::>":..... I TOTAL CHMGES 2t:Zl. .,." I TOTAL CHARGES J that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit I label has been signed by an Electrical Supervisor and returned to the Building Division Job Address If I Owner .4A-i'1i "f ~L.,q.~ 1M P.!)/L:'-J. AN I':. Address Construction Lender Address Ut~lljrj fEAr., (name) Pri ma ry Structural K/tA1 "." ''''I b Electrical Mechani ca 1 CONTRACTORS {name} A . I ,+sP;.h,..L." 5.4H'L '5,411 t- ~,tH ~ Genera 1 PlumbinQ Electrical ~'echanical PLU11BING NO" FfF r~AQ~~ Nn Each single fixture Relocated building (new fix. additional) S.F. Residence (1 bath) Duplex (1 bat~) eac~ Additional bath / Ilater service /~. ~ / Sewer 5~l'yic:e:: It:'. ~., 92' Storm Sewer 25:.... I 7JM~~Rs-' q9'l<k" ~~p ~WM ..f ~; c=x; IP,- TOTAL CHARGES WHERE STATE L~W REQUIRES shall nOt be vali1 until the .. '.1~ne.... Lll _,,,,,6-,__ Phone faddrpc;.c;.) (1 icc;._ no.) (pxoi rpc;) (ohnnp no: /JlBw ~ (.,.L '! ELECTRICAL MECHANICAL r:r:r: rI-lARr.r: ~m r:r:r: rU.dRr.r: Residence of furnace/burner to BTU's SQ" FT. New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall ~n~rp hp~tp~ ~"rl VP"t Temporary Construction Change in existing rp<;ir'Lpnl"'e. multifamily. comm. or Tnrfustrii'll Appliance vent seoaratp Stationary evap. cooler I Vent fan with sinole duct I Vent system apart heatino or A.C. I Mechanical exhaust honrf and duct Wood stove/heater from , Of amps. COMM./IND. FEEDERS Install/alter/relocate rli<;trih_ fpprfpr<; amps. i I , J I HAVE CAREFULLY EXM11NED the completed aprlication for permit. and do hereby certify that all information hereon is true and corfect, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Soringfield and the Laws of the State of Oregon pertaining to the work described herein, and that UO OCCUPAr~cy will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Board lS In full farce and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and emrlOYees__lw~: ;r~_i::oliance with OP.S 7~!'Or-1 ~Lh'Or.ojI01t)~\\.LLl'J( IW1E(p1ease print) 6,o,e/f f'#r~<f/I<- SIr.11ATURL ~~ OATE ~ - /J V- J FOP. OFFICE USE OIlLY Sq. Ftg. f1ain Sq. FtlJ. Access Sq. Ftg, Ot~er~<S J Zone C C Fire Zone Flood Plain TYDe/const,fj"A( r.~Units Bedrooms Occy Load Stories / Occy Group 15'-2 x Value x Value f! .t1,f'.9/~a1ue--"'................ .... TOTAL VALUATION BUILDING PERfllT Charges an~ Surcharges I Plan Ck. Conm/Ind 65%/Blda P"r Fpe ------------ Plan Ck. Res 30%/Bldo Per Fee 90.<><> PLur1BING PERMIT Charges and Surcharges ____.2.)".",,:> 2 .;Z~ - ----~~.- ~~- SO ELECTRICAL PERI~IT Cha rges and Surcharges 11ECHANICAL PERMIT Charges and Surchafges '-LJU40 ~ 'Systems Development' :Y. -) Charoe (!'5n &\'P>-P\ ({4~1 n Fence Delllo Sidewalk A/C Pavi n9 /9.68 ~. e>c:. '_/ij. r't:> I TOTAL 16'1 ' -I Total Comb. rermit /l/B,~ r" "- . 238.L'8 Curb Cut Ztl:> . . '. COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION , I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax lot 100. lane County Map Reference 17 03 43 2. example- lot 1. Block 3, 2nd Addition ,\0. Sprlngtield Estates C. Name. etc. of owner and construction. lender D. Energy Sources ' 1. example- heat/electrical ce;lin~/or forced air Qas '2. examole- waterheater/electr1cal/or solar E. Square footage or valuation, etc. - 1. examole- 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 garage 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 TEAfl ANO 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. Exce~t 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 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 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. or#- 0</</1 ~ fJ ?/8 o/'of~ V, FOR OFFICE USE ONLY Permit Cl erk lMi J PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: 7#.e" .,I7'7l?t:JIUH. r&.A" n~ --- 7F~A:::>n#/5" y OrF/CE s5'#-#:C L ::Be- C;O"Rr/;&:C.r 7i? ~ ,?'.AZ>Y/5/C>JY5 &'F ~C7/4"A7 /7'tP9 .4-3 I"'5F .(#-~ 57??//Y~/,e:::C'7:> :;:'6h/N6. ~&>D~. ""'-"-'Ps-' .4I;77~-=,Z:). Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: nameL.:)KNcn~~ Signatur~--?~ ~ ,., ..,./ date :?...?~-~ .