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Home My WebLink AboutPermit Building 1987-7-9 BuiltiinQ Permit Info: Describe Work(i.e.. Build Single Far:1i 1 v l'l.es i dence I-lith J1.t tached...Garaqe) ~~_ ':3~ Lt/0.J'/n.J "" Ii JJJ..f./ / - '0/ . (iies. no.l (exoires) ..L)C;J7/''-'-- !IrISPECTlON LINE /{., / _ -,., CITY 01 SPRINGIIELD 726-3769 .1.1. :'-:!_':".' ~,l5 COIIBIIIATION APPLICATION/PERMlT J b Add 7T'/~ 6l::-m ~-~, 7~, ;/.l! ErIERGY SOURCES: o ress ~-'^-1 . r- - / ^- ,. /~~ _ ,-/( ,....../~{1d-Heat Le.ga~ Description 174 0~ ~- , t'Jater Heater ! l'iztri~ JJ ~CJA J >' ~:~~:~:I~:k: . 'owner [();.R/;/C; /H1!?Ge- 000" /y.L( !AI n- Address (' "--- Phone Construction lender ---- Address UESIGN ItAr~ ~name) i.O/-J,e/j'V'q I Phone (address 1 /J-?/b[G/L Primary Structural Electrical /1echan; ca 1 --- - - . INFORIIATION UNt 726-3753 Sq. Ftq_ 1.lain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. --Fence Demo Change/Use -~Other - - - '\ (ohone no. J '" "/I~ == \:xv ~ ~ ""-l I~ ::::::~TORCrT4;'/65 ffl i-c:-Gd:d/&.6t;?~ rrr1h(I~;O \ IfIF/:; /M Plumbinq ((tf!'C($ ~ /TH' /?a/Z1/SJA/G Electrical /7P!-//V9 7ZJ~./50B (phonp nQ.) j/.(J8JY7 {"tf6S7f7 (/,JI? It/;S r ~lechan; ca 1 PLUI1BING ELECTRICAL MECHANICAL SQ. FT. ~~~ r~ARr,F NO. furnace/burner to BTU's ~jO . FEF r.HARGE tJn Each single fixture Residence of Relocated building (new fix. additional) S. F. Res; dence (I bath) Duplex (1 bath) each Add it i ona 1 ba th New circuits alts. or extensions ISERVICES Temporary Construction Change in existing rf'C; i q~.nce multifamily, corrm. or Industrial ~Iater service Sewer Storm Sewer Of amps. '.'1 ' Pl ~t'i/ ).'7, "0- COMM./IND. FEEDERS Install/alter/relocate rlic;t.rih. fppdprs Of amps. Floor furnace and vent Recessed wall SOArp hPntpr nnd vpnt Appliance vent SPDgrate Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from heatina or A.C. Mechanical exhaust hood and durt. Wood stove/heater ISSUANCF OF PFR/IIT ~FF f.HAR(;F TOTAL CHARGES , TOTAL CHARGES ,WHERE STATE LA\~ REQUIRES that the Electrical work be done by an shall not be valiJ until the label has been signed by an Electrical , TOTAL CHARGES Electrical Contractor. the electrical portion of this permit Surervisor and returned to the Building Division , I HAVE CAREFULLY EXAMINED the completed apr1ication 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 rw OCCUPArKY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Goard 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 comoliance with OP..S 701.05(:%.1 b used on this Droject. . I' IJArIE(please print) 0. ha..(' \ e.S 1= l) l \ -e.r SIGIIATURE 1~~LIL ) D~TOC;- ~ 7 FO~ OfFICE USE miL Y Sq. Ftg. t1ain x Value Sq. Ftq. Access x Value Sq. Ftg. Other x Value TOTAL VALUATIOII Ishstems Development , C arqe (1.51,) Zone Fi re Zone Flood Plain Type/Canst. Bedrooms Stori es Units Occy Load Occy Group BUILDING PERfl1T Charges anc ~ Surcharges ~ l5 00 I Plan Ck. !' 65%/Rlda -------~-15 ~6~~B;~~ ----3i~- ::::e ;)~.SO I Sidewalk ------Tlz=.-I A/C Paving I Curb Cut I Comm/l nd Ppr Fee Res Per Fee PLU!1BING PERMIT Char..ges and ( . Surcharges ? ELECTRICP.L PERI~IT Charges and U. Surcharges -, 11ECHANICAL PERMIT Cha rges and Surcharges Total Comb. Permit TOTAL J 1~ 71 , . . 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 II 03 43 2. example- Lot 1. Block 3. 2nd Addition to sprlngt;eld Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceiling/or forced air Qas 2. examyJe- waterheater/efectrlcal/or solar E. Square footage or valuation, etc. - 1. exam~le- 1250 sq. foot house, 500 sq. foot garage 2. examrle- if new project. check new - if addition, check add, etc. F. Building permit information: 1. exam~le - construct single family house with an a ttached garage 2. examele - remodel existing garage into family room 3. examale - 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. 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 DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES D. As noted on the CAP. the labe1 must be de1ivered 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. ~ 0~51 ' 1~ /~1 ! V. FOR OFFICE USE ONLY Permit Clerk tC/ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: . PLANS REVIEWED BY: name signature date .