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Home My WebLink AboutPermit Building 1953-2-1 "1 INSPECTION LINE. 1726-3769 Job Address ','" , \ - .- C !TY-OF SPRIi~GF I ELD ' COMBINATION APPLICATION/PERMIT E!lERGY SOURCES: Hea t t!::LL-"'G 7 loJ P. \'Jater HeaterpLcC7. Range " - EL-cC~ INFORrlATION UN!: 726-3753 Sq. F tg. f'la i n :q. Ftg. Access. Sq. Ftg. Other ,~d) New XAdd Alter Rep. -Fence _Demo_Change/Use -Other "jJ . 6 r - JQ ~' 5""4 LJ,l1. Lr:MTt;IJj.JI^'~ i':SLU[.). Legal Description 17-03-2?- "'3 0 ~800 , I~AUt= H-kt0()SA~8R '54/ LJ, ~=,..;;7E1-.J)JIN_ P.,u;O <;Pt2..'NUf=IEU). OR. q)<17i Construction lender ,I ~ot..!F.. Owner' Address Address DESIGN TEAr1 Phone '7z..~ <,'<I,f, (name) V A~ \IOOr;Lt~'t5s Phone (address) /I~s LOO.n\vEr...J <sP ,":'() P6 '17 r=t 14/ -/co ~ Primary Structural II Electrical " . l1echani ca 1 CONTRACTORS (name) " I. (address) Plumbinq OCUU6-rL ~'~~J-Jil\. DC\. '( Q L ELECTRICAL FEE CHARGE NO Residence of s:- )t).- SQ. FT. ,,/ New circuits alts. or extensions ~ '2 .:a~ ,N/6r? I I I ITempOrary Construction I IChange in existing residence ' I ImultifamilY, comm. or Industrial I 10f I ICOMM./IND. FEEDERS I I Install/alter/relocate I distrih. feeders I 10f amps.! I I I ~)(Tt.). t:;t.-72.0. ,I I I I kOe&VJl7e.. I I I I I I I ISSUANCE OF PFRfiIT It:::>. -- ~~ ~ I TOTAL CHARGES 1.5:'0-=-1 TOTAL CHARGES "2 <"..... that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit label :has been signed by an Electrical Supervisor and returned to the Building Division , Genera 1 Electrical ~lechani ca 1 tJ 0 1-J fF_ PLU11B I NG NO. s Each single fixture Relocated building (new fix. additional) IS.F. Residence (] bath) IDuPlex (1 bath) each IAdditional bath IHater service I Sewer Istorm Sewer I I I I I I TOTAL CHARGES , WHERE STATE L~W REQUIRES shall not be valid until the SERVICES ValuE. of Hork: ,Ii c.c.:J ~,.f;; oeo'~ , \ Builc;inq Permit Info: Describe Work(i'.e., Family nesidence With Attached Garaqe) Build Single A/')D bOO t6 10 I Il.G<;. Tf4. ~A}J T. OGGuPMJGY TO BE IkLIJ CaYls 7/?nv7 (lies. no.) (exnires) (phone no.) (] ics. no.) (exoires) (ohone no.) I~ MECHANICAL FFF I rHAR(.;F NO. """ rHAR(.;F furnace/burner to BTU's IS:~ I I I I I Floor furnace and vent I Recessed wall Snace hp~tpr norl vpnt .,_ > ,. _. h . . I I I I I 1'3: oe /t:. oa. I I I 16.00 I I amps. I App 1 i ance vent seDarate ' I Stationary evap. cooler Z I Vent fan with sinale duct ,. Vent system apa rt from I heatinq or A.C., ,. Mechanical exhau'st I hood and duct I Hood stove/heater I .r I"'VI!f.PJ c>R' C:.k~~ ~C""WC:SR"" I I I I I I HAVE CAREFULLY EXA/1INED 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 oertaining to the work described herein, and that NO OCCUPAHCY will be made ~of any structure without the permission of the Building Division. I further certify that my registration with the Builder's lBoard is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that lonly subcontractors and employees who are in compliance with ORS 70.1.055 will be used on this project. j < SIGrJ^TURE~~"'_<~0~_~-AL__ DATE~.L (' /?~~ FOR OFFICE USE ONLY So. Ftg. f1a in. x Va 1 ue Sq. Ftn. Access x. Value Sq. Ft;. Other~M...c>.( $"C x ,~~ 'rp Va 1 ue ~(/).- ~r:-~c;:- ,);tQ1-~.r TOTAL VALUATION rW1E(please print)P"?v/~ C) ///?/Yd<.-?,R.--':/L Zone G ~ Fire Zone Flood Plain Type/Const. ~-/ #fi? ~. Bedrooms Occy Load Stories I Occy Group '17 71...;2.. -:z~ ~- Plan Ck. Comm/!nd ,;? ~. 65%/Blda Per Fee ----- -1----- Plan Ck. Res . ,:?S 30%/Bldq Per Fee ~&> .0_1 Fence ------ 1~6(,-1 Demo _____L').oO I Sidewalk . &0 I A/C Paving 2:< . -.. I Curb Cut --------:g.:1 BUILDING PERr-HT Charges anG Surcharges PLUI1BING PERMIT Charges and Surcha rges' ELECTR I CAL PERr~IT Cha rges and Surcharges MECHANICAL PERMIT Charges and Surcharges L_ rrr r,J..:l"o\) ~' , I Systems Development I 'j{l).1' 1 ) ~ \ Yl-LCharge (1.5%) V:O:3 < () ~,-J-~ :9J~ I , I I / I I l',/ ,I I ITotal Comb. Permit TOTAL 1/";3. "3~ ~ q M -. COMBINATION APPLICATION/PERMIT (CAP) 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 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/electrical!or solar E. Square footage or valuation, etc. 1. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check-new - if 'addition, check add, etc. ' - F. Building permit 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 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"(::,c;,.,, '" .' D. As noted on the CAP, therabel 'rifG's'f 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 sPpy and':r;,gturn it to the. applicant at the time the actGal permit is is~ued 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. V. FOR OFFICE USE ONLY PROJECT CONDITION'S TO BE SATISFIED BEFORE OCCUPANCY : ) I, -. PERMIT VALIDATION L. f\_' 'oDS '\l4. cJ I ~. tt .J)J\J 1'O-Lv-b ~ I ;~ i1 i~ \~ :1 Permit ---- ,"'---, Cler r+!' ~ _) L-:~\V) _ Permit applicant exempt from registration with the Builder's Board because: ~ ~ I Additi ona 1 Project Informati on: ~ i ~ '~ 1 . ~ 1.__PLANS REVIEWED BY: . name (C/iN~ .:...... ". ~L " ~ Signature~ ?~~- t..~~ date <-/&'''"18 :3 I 7::~~:~.;.;::.L....., '~':'_V<",; .'-';"';' '.....;.....~.':~::..;.::~._.. _.,_.'.~" ....~~:.:.:~-::::.::-:-.c:::~,-_:-~.~-=.::~'::::.:.~:..;;:=:!::~::.:;:::::;::~.~ -::;~;:.-'::-__,~....;.,;,..;.:.~~::':":":.:;.:,~~~...w,._..;;.' _':'=-~:...(~-::::::~~.~:__;z._::.:';,;~;;~i.:':-c.::: ,:,_'.':: .....,.<-..