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Home My WebLink AboutPermit Building 1983-8-4 Job Address ?{2,/{--fl[Z,; A/ ,A..-{A'. _ LegalOescription \l h?"o,~ . (')T1rr: ~-. ,:fr'.( f'INSPECTION LIrlE 726-3769 Owner M...<rA ' Address '$3' Z r; Construction Lender Address U~~JliN II:.AH Primary Structura 1 Electrical Mechanical CONIRACTORS General /foe Plumbina Electrical "'1~ch"ni~al NO. . I JIo\4 q~ . CITY OF SPRINGFIELD COHBIIIATION APPLICAHON/PERMlT EIIERGY SOURCES: Heat t1ater Heater INFORl1ATION ll"t 726-3753 Sq. Ftg. /.lain :q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. --Fence Demo Change/Use Other- -- I D<J ()J -D uJ ..r:.-. Range ~~..-( " / 1A/....r.At,/-""',~ ValuE of Hark: ./J. 30/7'.2. ~ BUllriinQ Permit Info: Describe Workli~e., Familv ~es;dence With Attached Garaqe) Build Single cr, Phone ~ ""'f77'c. ( 'r ---€.d~ ~ ../ 4'P.A- ~ OU~r ffi,U:-p -;;:zO LC)/'( v ('~ A (namel Phone (address) (exo; res) (ohone no.') (lies. no. J (namel (address) "7"-'t"?- C--J(O/'p .If I! ~-MU ~4--+(?..2,6 '7' l1;r:~.no.) /0:7~ (nhnn~ nn.) .'/:::/'/'10 "? fiC/7PYA/,? ::?Q-()7 A PLUI1BIrlG ELECTRICAL MECHANICAL I FEF CHARGE NO ~~~ r~ARr,~ Nn. I=H" r~ARr.;r I Residence of furnace/burner to BTU's Each single fixture SQ. FT. I Relocated building (new fix. additional) IS.F. Residence 11 hath \ louPlex (1 bathl each IAdditional bath I ~Iater service I Sewer IStorm Sewer New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall ~n~~p hp~tpr ~nrl vpnt I I I I I I I !TempOrary Construction IChange in existing rp".i dpncp, Imultifamily. COrml. or Tnrlll<;.trial 10f amps.1 !COffi1./IND. FEEDERS I IInstall/alter/relocate I r1i<;.trih. fppdprc; jOf amp~ I I Appl iance vent seoarate I Stationary evap. cooler I Vent fan with sinole duct I Vent system apart from I heatino or A.C. I Meehan i ca 1 exhaus t hood and duct. I ~1ood stove/heater ISSUANCF OF PFRIHT TOTAL CHARGES TOTAL CHARGES WHERE STATE L.\H REQUIRES that the Electrical work be done by an 'Electrical shall not'be valiJ until the label has been signed by an Electrical Supervisor TOTAL CHARGES Contractor, the electrical portion Of-this permit and returned to the Building Division I HAVE CAREFUllY EXAMINED 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 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 OP.S 7~1.055 will be used on this project. Tvpe/Const. Bedrooms Stories SIGNA~~""...-/" ./~~ FO~ OFF I CE USE 0111. Y Sq. Ftg. t1ain x Sq. Ftn. Access x Sq. Ftg. Other x Value Val ue Value IIAlIE(please printlk-/l:#kEL )((j V ./t() E OATEff).,.J.G--,;. Zone Fire Zone Flood Plain BUILOING PERI.IIT Charges anG Surcharges PLOllBING PERMIT Charges and Surcharges EI.ECTR I CAI. PERI~IT Cha rges and Surcharges rlECHANICAL PERMIT Charges and Surcharges Units Occy load Occy Group TOT^L VALUATION _____Z-~~oo_ 110 Plan Ck. Comm/lnd 65%/Bld(l Pf>r Ff>e Plan Ck. Res 30%lBl dQ Per Fee Fence Systems Development CharQe (!.5~) I Demo _ ___ __ ___ __-'Sidewalk I A/C Paving ____________1 Curb Cut I Total Comb. rermit I I TOTAL $Zq.IZ J . . './ ('., 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 17 03 43 2. example- lot 1. BlocK 3. 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilin~/or forced air qas 2. examole- waterheater/electrlcal/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 pennit 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. OESIGN TEAM ANO 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 OIVISION STAFF WILL FILL OUT ALL FEES ANO 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 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. il/r) €/~ ) ~ V. FOR OFFICE USE ONLY Permit Clerk (tV 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 .