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Home My WebLink AboutPermit Building 1985-8-14 IIIlSPECTION LINE 726-3769 . Owner !J!J/Yl ikhr Phone INFORlIATION liNt 726-3753 Sq. Ftq. 1.lain ~q. !='tg. Access. Sq. Ftg. Other flew Add A Her ~ep. Ranqe______ --Fence Demo Change/Use ValuE of 'k'/35V, Other-- BuilC:lno P"ermit Info: Describe \~orkl;-.e., Build Single F/J~;Z;ttaCh~;/JA1 0 ~ ~ ~'"'"T' ./ a . Job Address 1505 s;- Legal Description /7-0 3-3(r 32.- 0700 I 19 )( CITY OF SPRIIlGFIELD COMBllIATION APPLICATION/PERlln EIIERGY SOURCES: Heat l~ater Heater ()(j ~ U'\ C}J 00 Address Construction lender Address UDlliN a.At.' {name) Phone (address) (1 ics. no.) (exo; res) (ohane nn.) Primary Structural Electrical 11echan; ca 1 CONTRACTORS Inamel fl.1 ./1_1 II . General J<'I- iJ..,{tI-UJ L_(Q..J .141 f') (address) 5.T-I M (1ir:~.no.) (pxn;rpc;,) (ohnnp nn. ) Plumbina Electrical ~lechanical PLUIIB I NG ELECTRICAL MECHANICAL NO. FEE CHARGF NO I ~F~ r~AR~F Nn_ FFl=' rI-lARr,r: Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) S.F. Residence (J bath) Duplex (1 bath) each New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall ~nacp hp~tpr and vpnt Storm Sewer Of amps. Appliance vent seoarate Stationary evap. cooler Vent fan with sinole duct Vent system apart from heatina or A.C. Mechanica 1 exhaust hood and duct Wood stove/heater Additional bath ~Iater servi ce Temporary Construction Change in existing res j q~nce multifamily, comm. or Imhistr;al Sewer COMI-I./!ND. FEEDERS Install/alter/relocate d;strih. fppdpro; Of amps. ISSUANCf OF PFR!IIT TOTAL CHARGES I TOTAL CHARGES WHERE STATE L\IJ REQUIRES that tile Electrical work be done by an Electrical shall not be valij until the label has been signed by an Electrical Supervisor I TOTAL CHARGES Contractor, the electrical rortion of this permit and returned to the Building Division I HAVE CAREFULLY EXNlINED the completed application for permit, and do hereby certify that all infonnation hereon is true and correct, and I further certify that any and all work oerfonned 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 flO OCCUPAr~CY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s 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 ORS 701.055 will be used on this project. flAf.1E(please print) N"",,'C.'1 l>EAN- COe.'NO S I GrlATURE It - .. Fan OFFICE USE DilLY Zone Tyoe/Const. !Jnits Sq, Ftg. t1ain Fire Zone Bedrooms Occy Load Sq. Ftg. Access nood Phi n Stori es Occ,v Group Sq. Ftg. Other /J..u......- ~ DATE ~ /'-1191." x Value x Value x Value TOTAL VALUATION BUILDING PERflIT ' ) if . Plan Ck. Conm/! nd Charges and ________:...Q(:L 65%/Rl no Ppr Fpp Surcharges .~ Plan Ck, R.es 30%/Bldo Per Fee PLur~BING PERMIT I Fence Charges and ------------ Surcharges D(jRlo ELECTRICAL PERI~IT Sldewal k Charges and ------------ Surcha rges A/C Paving MECHANICAL PERMIT Curb Cut Charges and ------------ Surcharges ---- Systems Development I Charo. O.5~) Total Comb. rermit I I TOTAL /(t~. , . . COMBINATION APPLICATION/PERMIT (CAP) 1. Applicant to furnish A. Job Address B. Legal Description 1. ~xample- Tax Lot 100. lane County Map Reference 17 03 43 2. example- lot 1. Block 3, 2nd Addition to sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinQ/or forced air Qas 2. examDre~ waterheater/electrlcal/or solar E. Square footage or valuation~ etc. ----- 1. example- 1250 sq. foot house, 500 sq. foot garage 2. examp'le~ if new project. check-new - if addition, check add. etc. F. Building penn'it information: 1. example - construct single family house with an attached garage 2. examole - remodel existing garage into family room 3. examOle - 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 TEAl.' AlIO 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 8. 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 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . .. Ii PERMIT VALIDATION t.P5J(;)5: ~ /qr1qgr ~, ~U1flJ6 14.00 /;;h ~ Ic.f. s1P Permit Clerk f?tAJdU/ Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name 5 i gna ture date