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Home My WebLink AboutPermit Building 1986-1-21 , ?;t11Nh@ {WI-' pL . I INSPECTION LINE 726- 37 69 . Job Address 3-9S W, C eN TE/Y/Y /AL Legal DescriptionI7'(;)'j.2 ?-~i./, 2~t::'c:>1- ~.-...,c.,1 , . CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT ErlERGY SOURCES: Heat Hater Heater Range INFORllATION UNc. 726-3753 Sq. Ftg. f.lain ~q. Ftg. Access. Sq. Ftg. Other Ne\~ Add Alter P,ep. --Fence Demo Change/Use --Other-- -- 00 ~ ~ ~ ~ ~ Owner (VU,ut<-k ~ YUu/y Address '395' Wl/~;~'Ac.. -5?~a>. _ ~ "7? Y/;; Construction Lender~ Phone ValUE of Hork: <.~SO~.~- Buildinq Permit Info: Family Residence With Describe Work(i,e., Build Single ,n,ttached Garage) Address DES I GN TEAt'1 (name) Phone , (address) % VEAHe:>,N C~~r-IF~ ~N5TRO<tC r W:/'~Z? .P?J..#.h:?G'b :/ L;,R7?U6A7~ 7Y~&:. G9 ~ 1?~R ~TR~' ~h"~r>~. (lics. no.) (exoires) (phone no.) 7f7- 95;;r / CjA? ::t#/~~ I5::ZUf!::, -. - . Primary ~ IIV'" #' E~ Structural , El ectri ca 1 : f1echan1ca 1 : CONTRACTORS (name) (address) (] ics. no:) (exoires) (ohone no.) . Genera 1 eO., I ; Pl umbi ng : Electrical d)W#e--~ i ~lechani ca 1 PLUflBING ELECTRICAL MECHANICAL ,-'I NO.1 FEE CHARGE NO, , FFF rHARGF NO. FFF rHARGF Each single fixture Residence of furnace/burner to SQ. FT. BTlI's Relocated building New circuits alts. Floor furnace (new fix. additional) or extensions and vent Is.F. Residence SERVICES Recessed wall (1 bath) Soace heater and vent, I Duplex (1 bath) each I - IAdditional bath Temporary Construction: I I Appl iance v.ent I seoarate ' ~later service IChange in existing I I [ Stationary evap. residence cooler , Sewer [ [mUlt ifamily, comm. or [ I [ Vent fan wi th Industrial sinale duct [ [Of amps.[ I, I Vent system apart from Storm Sewer heatinq or A.C. [ I Cm~r'LIIND. FEEDERS I I I Mechan i ca 1 exhaust I hood and duct [ I Install/alter/relocate I [ I \'Jood stove/heater '[ ; , distrib. feeders I 10f I I ------ amps. I [ I [ I I 'I I I I I ISSUANCE OF PFRrlIT TOTAL CHARGES . TOTAL CHARGES ~ TOTAL CHARGES 11HERE STATEL'\H REQUIRES that tile 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 Supervisor ana returned to the Building Division I HAVE CAREFULLY EXAf1INED 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 performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon oertair1ing to the work described herein, and that NO OCCUPAf~CY \1ill 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 exemotion is noted hereon, and that only subcontractors and employees who are in compliance with ORS701.055 will be used on this project. NAME(please print) SIGNATURE_,_ _ FOR OFFICE USE ONLY Dim 1-2/.e~ Zone~ l., ~ e,.}p Type/Const. S--N Fire Zon~ Bedrooms FloodPlain Stories I , Uni ts Sq. Ftc]. ~1a i n Occy Load Sq. Ft']. Access Occy Groupfi-'L Sq. Ftg. Other x x 'Val ue Value Val ue ..~Ifk!J. aD x TOTAL VALUATION BUILDING PER~1IT Charges and Surcharges _-_-L~._~___ . yo Plan Ck. 65%/Blda Plan Ck. , 30%/Bl dq I Fence I D!;lmo Sidewalk Comm/Ind Per Fee Res Per Fee Systems Development Charge (1.5%) PLW~BING PERMIT Charges and Surcha rges I [ ELECTRICAL PERrHT Charges and Surcharges A/C Paving < I Curb Cut ------------1 Total Comb. Permit MECHANICAL PERMIT Charges and Surcharges / TOTAL I~. YO I ~ - COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. examp I e- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinq/or forced air qas 2. example- waterheater/electricalior solar E'. Square {ootage or valuation, etc. 1. example- 1250 sq. foot house, 500 sq. foot garage 2. .. example- if new project, checknew - if, addition, check add, etc. F. Building permit informat'ion: 1. example - construct single family house ~ith 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 TEA~1 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 Sc~edules, 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 UN THE SCHEDULES D. As noted on the CAP, the label must electrical contractor for signature supervisor. The general contractor 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 wil'l prepa re a type, written copy and return it to the appl icant 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. be delivered to the by his electrical is not authorized V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: , . ~ 1 -;: PERMIT VALIDATION " ~ 'I! ~ ~ i i ~ ~ ~ ~ I i .. ~ ~ ! .~ ~ ; ii i" ~ ~ ~ ~ ':'i 'I . " j " ~ . . ~ ~ ~ : Permit Clerk J Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name Lt::J~NtE ~~~~signature ~~~e.PJ , '/' date /"':< <-&i"6