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Home My WebLink AboutPermit Building 1982-12-9 'I HiSPECTIOtl L1IIE, )726-3769 Job Address legal Description Owner Address Construction Lender Address UI:.~lGN II:.Nl Primary Structural Electrical f~echanical . CONTRACTORS . . CITY OF SPRlI1GFIELO CmlBItlATION APPLICATION/PERMIT EilERGY SOURCES: Heat ('later Heater Ranqe INFORflATION Ufil:. '1 726-3753 5q, Ftq, 1,Iain :q. Ftg. Access. Sq, Ftq, Other tlew AddX Alter Rep, --Fence Demo Change/Use -Other- - co N N ..... o 1O 223 North "A". Sui te A Electrical City Vi ew El ectri c Springfield Utility 2S0 ~J.A, lname) (name) PLUIIBING NO,I ' FEF 'CHARGF lEach single fixture IRelocated building (new fix. additional) IS.F. Residence 11 bath \ louplex (1 bath) each lAdditional bath I Water servi ce Sewer Tyoe/Const. exi st. Bedrooms Stories Board ValUE of Hark: $900.00 Bul1riinQ Permit Info: Describe Work(i.e.. Familv nesidence With Attached Garaoe' Build Single Pho1J,e~'B.~~c..,1 Install Door, Alter Electrical change swing on one door. circuit, I I (ohone no:\ Phone (addressl (lies. no. 1 (exoiresl Plumbina Vanguard Construction Co. (address) (1 ire:;. no. \ (ohonp no. , Genera 1 ~lechanical Storm Sewer (pxoirpe:;) ELECTRICAL MECHANICAL Nn . r:r:c I nlllR(.:r: ~Jn I cr:r: I fI.-lllRr::r: Residence of furnace/burner to sru's SQ, FT. New circuits alts. or extensions Floor furnace and vent ISERVICES I ITempOrary Construction I'change in existing , rpS; rtpnrp Imultifamily, corrrn. or TnrflJe:;tri~l IOf amps. ICOMM,/IND, FEEDERS I Install/alter/relocate rtic:.trih. fpprfPrc:. Recessed wall Sn~rp hp~tpr ~nrt vpnt Appliance vent c;poarate Stationary evap. cooler Vent fan wi th ,;nole duct Vent sys tern apa rt from I heat;na or A.C. Mechanical exhaust hood ilnd rfurt Wood stove/heater IOf I I I amps. ISSUANCE OF PFR11IT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L~W REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXN1INED 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 Derformed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Ore!}on pertaining to the work described herein, and that rw OCCUPAIKY 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 ORS 701.055 will be used on this project. IlAHE(please print\; SIGII^TU~ OAT} / '\ FO~ OFFICE USE OIIL Y , \ Zone CC Fi re Zone Flood Plain BUILOIlIG PER~1lT Charges anc Surcharges PLUI1B IrIG PERMIT Charges and Surcha rges ELECTRIU.L PERI:IT Charges and Surcharges HECHAtl I CAL PERl1IT Charges and Surcharges Units Occy Load Occy Group B-2 Value Value Value Sq. Ftg. r1ain Sq. Ftg. Access Sq, Ft9, Other x x x TOT^L VALUATIOII $900.00 $5.85 Systems Development Charoe (1.5%) Plan Ck. Comm/lnd ____J2,,9.9____ 65%/Bldo Ppr Fpp .36 Plan Ck, Res 30%/Bldo Per Fee Fence Demo $10.00 Sidewalk ------------ .40 A/C Pavi n9 Curb Cut Total Comb. rermit :1 ~.j ~ TOTAL $25.61 . . , .. . " COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION II. I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax Lot 100. Lane County Map Reference 11 Uj 4j 2. examole- Lot 1. Slock 3. 2nd Addition to sprlngtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. exarnole- heat/electrical ceiling/or forced air qas 2. examyle- waterheater/electrlcal/or SOlar E. Square footage or valuation, etc. 1. examDle- 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. examele - remodel existing garage into family room 3. exam~le - 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 TEM1 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 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 AND CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must electrical contractor for signature supervisor. The general contractor 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 signa ture. 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. lo row a \)~ (3,V ~ be delivered to the by his electrical is.not authorized III. IV. V. FOR OFFICE USE ONLY Permit Clerk (l J l~rLl-V 1.. PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Verify if the wall at door 2 is a bearing wall. and install header to suit. Permit applicant exempt from registration with the Builder's Board because: I I I I . Additional Project Information: I PLANS REVIEWED BY: QJ\. ~D r:J name I nrnp Plpnpr Signatur~ nQ > \.V ~ OQ.iJU date,:, \:.. ~2 ':~-':.':::::::-"'='=':::__..._._ ,_ ~ .~_~.-:. 7-::: :'_'.-=--::::..:::~:::':-':::;:._ -:- .;-..-"::'".:--::~~ ~:- .-::':~:;-:-= ~ _. _A":. :~._,:.:",-_.;::-~_=..p.:.7_'C::";~==~-::=':""" -'-:;---~:".;.._.:.- - ;