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Home My WebLink AboutPermit Building 1982-12-20 :J" G, . 1 IrlSPECTIDrl LINE. 726-3769 Job Address /65"6 L€N7~h~L "jJ(.YD Legal Description/?-c~.~S.?J'I. d:>3~C , CITY OF SPRINGFIELD COt1BlIJATION APPLICATION/PERMIT ErlERGY SOURCES: Heat l'Jater Heater Range I NFORtlATION U Nt 726-3753 Sq. Ftq. f'lain ~q. ~tg. Access. Sq., Ftg. Other Ne\~ Add Alter Rep. --Fence Demo Change/Use --Other -- -- ~ IV ~l ~ ~ Address DES I GN TEAr-I (name) Phone (address) S~/B~Rr AU. r, , ValUE Of l'Jork: -::</I~'oo I Builei'nq Permit Info: Describe l~ork( Le., Build Single ~ ::glj Family Residence IVith /l,ttached Garaae) /Aoc::-R~ ...if~De~/ ~A.T~ ~~ ~'/ ~e-t..~r~ '1-' , 7i ~E :;fe:~/4'~/C;;,;.~ ~~~ , ((ics. no.) lexoires) (phone no.') 4/~~~~a?1. . , Address M/9c.rrA-/73 M~k~S IS CO~ GJ'R<:;;' ~. E~..:::;.) E".., c:-,~. e;;?tf~ / , Owner Construction Lender , Primary WI'- <./ A-M Structural . Electrical , r1echanical lIeJ$M#/Y/V r-.. ~ t.A.M/J'f'#Z>A~ ~A ('7~y) ~CY-6"Y~' , CONTRACTORS (name) , '(address? nics. no.) (exoir'es) (ohone no.) 'General )';f~d<. .M~<E"7"5(8<.~ 57J,..J~;YA-rh}' ' , 'IiSS;"':2.8// Plumbinq .j(JD~~i#oI~ /AV~. ~' ~~€~ c;:..H. (~)/~~7T 6024Z) '36'3-'-11'1/ Electrical fI-(7f €t:../~"c.r. (~~ S-~E~I(..))/ 8~<;~. 68?--:</~ , ~'echanical ~)J]'/f"'S 7fE;::::::y,/ttZ~)';;~'. ~&:r ~ , . , PLUflBING ELECTRICAL MECHANICAL,' NO. FEE CHARGE NO, FEF . CHARGF NO. FEE CHARGE: SQ. FT. furnace/burner to BTU's /2. Each singl.e fixture ~~--' Residence of Relocated buildfng (new fix. ftdditional) New circuits alts. or extensions Fl oar furnace and vent I each I I 1~later service I ~8C' Sewer /~~C) ~.~. I I .1 I I I I I IS.F. Residence (1 bath) I Duplex (1 bath) IAdditional bath I SERVICES I' Rece~sed wall Soace heater and vent ~.PRc::p~ .,~.s Appliance vent seoarate Stationarv evao. cooler" " Vent fan with sinole duct Vent system apart from heating or A.C. Mechanical exhaust hood and duct Wood stove/heater ~ .to ~-= Do VIP- I ~.~ Temporary Construction Change in existing residence Imultifamily, comm. or Industrial 10L ICOMM,/IND. FEEDERS II~sta~l/alter/relocate dlstnb. feeders ' IOf I amps.1 I I I I I I I I I I I / .,. .. Storm Sewer 6C:C I I /0.--: IIS06 ~ , ~JHERE STATE LAH REQUIRES that tile Electrical work be done by an Electrical Contractor, the electrical portion of this permit f shall not be vali'J until the label has been signed by an Electrical Superv,isor and returned to the Building Division amps. I ~~NSE)j'4/j,. I I ISSUANCE OF PFRrHT TOTAL CHARGES /ii:A. -.0 TOTAL CHARGES TOTAL CHARGES I HAVE CAREFULLY EXAmNED the completed appl ication 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, ~nd that ~O OCCUPA~CY will be made ,of any structure without the permission af the Building Division. I further certify that my registration with the Builder's Board is in full force and effect as requiredbyORS 701.055, that if exempt the basis for exe ption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on thiproject. , ~' , NAt.1E(please print) B~L c..f;~c;.b?/-<J-),-ff SIGiU\TUREffi//./ ~C, ,(/-'.'.,~ Dfl'T~~~t; FOR OFFICE USE O~LY -- So. Ftc]. r1a in Sq. Ftg. Access Sq. Ftg. Other Zone Type/Canst. Bedrooms Units Occy Load Occy Graup x Value Value Value Fire Zone 'x Fload Plain Stori es x TOTAL VALUATION BUILDING PERf.1!T Charges and Surcharges ----~~- ~~Cf ~oo Fence ------.7~:2o~1 D~mo I S i dewa 1 k I A/C Paving Plan Ck. 65%/Bldo Pl anck. 30%/Bldq CommlInd Pf:'r Ff:'f:' Res Pe r Fee ~2. 'ID PlJn--a .t'r..~,~:~o#I ,,: /?,J . Sys terns Deve, lopment Charqe (1.5%) , Plur~B ING PERMIT Charges and Surcharges ELECTRICAL PER~IT Cha rges and Surcharges MECHANICAL PERMIT Charges and . SUrcharges ____1{~'-~_ Curb Cut ,~ . ({;.o. ITotal Comb. rermit I I TOTAL -:;<7:< . ~ I.f I I 30=<.6~ Additional Project Information: ~~_~I'7"'" hZ'/.T/Jf>.N'~C-~ C<~~~ ;r:-~~~_ h~??'~r- ~.u~c. S:::?t!!!P:S i ~77'A;; ", ~S'~~ ..#~~~'~/'~~E~/':: ~ ~~ ~E}!:). S-~~/~ ~_.'Y~/ ~r ~/~€b PLANS REVIEWED BY: , / ~ name ~i'!J~~""'. ~Signa_tu~::?~~.~~ .t~~::,.::':- ~'":'"~;::~:~;:::-:-.::..:.~.::::~::.~:.-.--:..::::::;_::.-:,'.__:;:=::.::.._:':::~;. ~:'._:':::: ::~~ :..::z.:.:"~:::':':::.':::':::::;~2-::~'>-:),~:,.~ ~~..;';...i_ ...;:~.&;.,:.; ~;;,~:,_.~~.;..Z...,-...~~~.i.:.:..~;i~;:',;.';""~~' . I I i i ~ ,j . I, J ~ ! j ~ j fI L COMBINATION APPLICATION/PERmT (CAP) PERMIT VALIDATION I. Applicant to furnish A: Job Address B. Legal Descriptian 1. examp 1 e-: Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot 1. dlock 3~ 2nd Addition to Springfield Estates C. Name, etc. of awner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinq/or forced air qas 2. examole- waterheater/electrical/or solar E. Square footage or valuatian, 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 infarmation: < 1. example - construct single family house with an attached garage 2. example - remodel existing garage into family room 3. examole - convert single family residence into restaurant (change af use) G. Value of work as defined in Section 303 (a) of the Structural Specialty Code H. - DES I GN 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 descriptian portion of the Mechanical and Electrical Schedules~ the applicant need fill-in anly the No. Baxes 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 farm the schedules have been abbreviated 2. If the item(s) to be installed are nat covered on the abbreviated schedules you should consult the full schedul es C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND 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.. --- Applicant to. sign and date Whenever possible, ,the initial applicatian will be used as a worksheet only. Where possible, Building Dlvisian 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. ) (a 0 /4/ :1 ..~" ~ .,OGY . \~ ;I III. ...... IV. -~. ~~~ V. FOR OFFICE USE ONLY Permit Clerk 1I11~IIi,l;. ...illi'I"J".;L~''''~-'IIJ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: date /~-~8 ":L. ~,~~"-~'~":~....,:","...:.:_,;;~~..~~:~?';:~?::,(--:,"'-