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Home My WebLink AboutPermit Building 1985-1-7 i. .. 'j' nJSPECTlON LINE , 726-3769 Job Address e CITY UF SPRINGFIELD COMBIIIATlON APPLICATION/PERMIT tt INFORl1ATlON UNt 726-3753 Sq. Ftq. I"a;n ~q. ~tg. Access. Sq. Ftg. Other New Add Alter ~ep. --Fence Demo Change/Use Other- - Owner ~t>R""'_;Y *Y~J":. &::;;'H~;Z>. - - - Address ~C>~ #~~__'5:r. ~~-;:;? 5?~.z>.,~. "3.7 Y:::>? Construction lender / Build Single ~ I! B~? /V~)(1' ?/. E!lERGY SOURCES: Heat Hater Heater Range Val~ Harle ;;:> ............. - Builcilna Pennit Info: Describe Work( i-.e., Familv nesidence With Attached Garaae) legal Description ~ 4'H.5:rR~ E." <=Y"'-~~ ~7':aIJ-./? "~~~~/t:.. Address DeSIGN rtAM (namel Primary rfA? Ll~~_ Structural P,",one (addressl 7~(tJ'.....,.. - {lies. no.) {exoiresl (ohone no. J Electrical Mechanical CONTRACTORS (name) (addr~ss ) (1 ;~S_ no. \ (pxn;n>s) (ohnnp no_ \ Genera 1 Plumbino Electrical ~'echanical PLUMBING ELECTRICAL MECHANICAL NO. ~FF rH/\,R~F Nn I ~~~ rHARr::~ ~IO FFF n~ARr::F SQ. FT. furnace/burner to BTU's Each single fixture Residence of Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (] bath) Duplex (1 bath) each SERVICES Recessed wa 11 Sn~cp hPntpr nnrl vpnt Storm Sewer Of amps. Appliance vent seDarate Stationary evap. coolpr Vent - fan with sinole duct Vent system apart from heatina or A.C. Mechanical exhaust hnnn nnd rllJrt Additional bath Sewer Temporary Construction Change in existing rps i rlJ'ncf' multifamily. comm. or TnnlJ<;.tri~l ~Iater servi ce COMI'1- /I NO. FEEDERS Install/alter/relocate rli<;.trih_ fPPrlpr<;. Wood stove/heater Of amps. ISSUANCf OF PFRtllT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE lAl~ REQUIRES that the Electrical work be done by an..Electrical Contractor, the electrical portion of this permit shall nOt be valij until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAmNED 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 oerformed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Drel)on pertaining to the work described herein, and that UO OCCUPAIlCY will be made of any structure without the permission of the Building Oivision. 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 comoliance with ORS 701.055 will be used on this project. SIGNATURE~ ~f/a 11 FOP. orFICE usO'ffiiLY ~ V Sq. Ftg. Sq. Ft~. Sq. Ftg. NAI'lE(please print)~<Il."'~'1? CLDS'::: .Jlt DATE .1:::Z::}/ S- Zone Fi re Zone Tyoe/Const. Bedrooms Stories Units Occy Load Occy Group r1ain Access Otherc..a-. , , x Value _ x Value :............/11> Value TOTAL V ALUA TI ON ,~~- Flood Plain BUILDING PERIIIT Charges and Surcharges r /0 __ r Plan Ck, ___I-:'_~_____ 65VBlda ~~ Plan Ck. . 1" 3D%/Bldo Fence Conm/lnd Ppr Fee Res Per Fee ISystems Development I Charoe tl.s~) PLU'1BING PERMIT Charges and Surcharges D~R1o ELECTRICP,L PERI~IT Charges and Surcha rges 'Sidewalk A/C Pavi ng Curb Cut Total Comb. rermit MECHANICAL PERMIT Charges and Surcharges TOTAL /C>.'1tt> 1 . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax Lot 100. Lane County Map Reference t. 11 oj 43 2. examele- lot 1. Block 3, 2nd Addition to 'sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy.Sources 1. exame'e- heat/electrical ceilinq/of forced air \ 2. examoJe- waterheater/electrlcal/or solar E. Square 'footage or valuation, etc. - ( 1. examDle- 1250 sq. foot house. 500 sQ. foot gara~ 2. example- if new project, check new - if additior check add. etc. F. Building permit information: ( 1. example - construct single family house with an '. attached gar~ge 2. exam~le - remodel existing garage into family fa 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 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 adjacer ( to the appropriate item(s) to be installed B. Full Plumbing. Mechanical. and Electrical Schedules are available at the Building Division 1. To conser\le space on the permit form the schedule ( have been abbreviated 2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the fu 11 schedul es C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEOULES 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 signature. 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. II. be delivered to the' by his electrical is ,~ authorized lII. IV. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: c e-V OF SPRINGFIELD City Hon Springfield. Oregon Department of Public Worka OFFICIAL RECEIPT No. B 64077 Date c! ~~ ~- 19~ Rec'dFrom~ ~#~ M~c::A'!i#'~YT 'l ( - ( Address 11 -:7 .tY~ , )4. ~.. Received For: JeW*" ~/,~ ~p ~6_ ILS~~ v qe> '""" I.l:. - ( ~,--/tP. o/'t!> , . ( ~~I.rI&:2~ "Amount Receiv~7 /e:>- ~O ~OR~~~a;,,~ .,"" t- ( ", BY ,I ~\. "'1I.,tler BUSINESS FO~MS. INC. 15031342-81.' 635< Permit Clerk Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name L t9?#E~~~ -""signatur~~~da~e /-?~~ .