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Home My WebLink AboutPermit Building 1983-12-20 'J- INSPECTION LIIIE 725.3769 Job Address I '70 \ C .Q..X\-h ~ \J Legal Omnptlon \iD"7).Qc::::;'?:J,...\ CITY UF SPRINGFIELD COImI ,IATI DN APPLI CATION/PERM IT E'IERGY SOURCES Heat Ilater Hea ter ~n\ Ranqe INFURIIATIDN UNt 726,3753 So Ftq Ilaln :q t'tg Access So Ftq Other f~ew_Add_Alter _oep -Fence Demo Change/Use -Other - - Phone Val ~ of \lor, OD l?; DO. BUllclnq Perm,t Info Farnlv Resldence I~'th ( J",(')f-, -f--:ru {}-- MY! -- 6r t YI ~ '---~l1\J! oYi (j J(}j)) I Descnbe \~orkt 1 .Attached Garaoe) e , BUlld S,ngle D\) ()J C0 Q;l D Address -Sfilc1 :3,,, vYU ~ Owner Constructlon Lender Address UI:.SIGN TEAf1 (name) Phone (address) (11CS no 1 (pxmrp<; ) I ll)hone no Pnmary Structura 1 Electncal Mecham ca 1 CONTRACTORS (J (name 1 (.!.; k'J ",I'll L f address) 6)wV\o.Y' (11cs no) (eXOlres) (ohonp no ) Genera 1 Plumblna Electncal ~lechanlcal PLUIIBING ELECTRICAL MECHANICAL NO I I FEE I rHAR(;F Each 51ngle flxture Nn , I Resldence of SO INew ClrCUlts alts or extens lOns I i="i="i=" n.I/!.lu::i=" NO I Ii="i="i=" r~AQhi=" FT furnace/burner to BTU's Relocated bU1ld1ng (new f1X add1t1onal) Floor fu rnace and vent S F Pes1dence (] bath] Duplex (1 bath) each SERVICES Recessed wall SOilCP hpiltpr ilnn \/pnt Add1t1onal bath ITemporary Constructlon I;~~~~:n~~ eX1st1ng Imult1fam1ly, comm or InnlJ<:;tnill IOf amps C0I111 (I NO FEEDERS Install/alter/relocate (11 d_n h fppr!prc; Apel1ance vent seo.aratp Stat10nary evap cooler Vent fan W1 th S1nale duct Vent systeM apart from heat1na or A C 1 MechanlCal exhaust hood and duct I ~Jood stove/heater ~Iater serV1ce Sewer Storm Sewer Of amps. ISSUANcr OF PFPtllT TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES WHERE STATE L \H REQUIRES that the Electrlcal work be done by an Electrlcal Contractor. the electrlcal portlOn of thlS permlt shall not be val1j unt1l the label has been s1gned by an Electr1cal Superv1sor and returned to the BU1ld1ng 01v1S1on I HAVE CAREFULLY EXM1TNED t1e completed apn11catlon for oermlt. and do hereby cert1fy that all 1nforrrJat1on hereon 1S true and correct, and I further cert1fy that any and all work eerformed shall be done 1n accordance w1th the Ord1nances of the C1ty of Spnngfleld and the laws of the State of Oregon oerta1mng to the work descnbed here1n, and that rw OCCUPAIKY Wll1 be made of any structure w1thout the perm1SSlon of the BU1ldlng 01v1slon I further cert1fy that my req1strat1on w1th the BUllder's Board 1S 1n full force and effect as requ1red by ORS 701 055, that 1f exempt the basls for exempt10n 1S noted hereon, and that only subcontractors and employees \'1ho are 1n comollance w1th OPS 7nl 055 \1111 be used on th1S proJect 11Al1E(please prlnt) Fl (") /1/ (J c. J( 0 /' __'_'~~A~UR~ a .v Jijrk FO" OFFICE USE OIIL Y DATEl.,0(f J.;; I / i Zone Fl re Zone Flood Pla1n Tyee/Canst Bedrooms Stones Um ts Occy Load Occy Group So Ftg r1aln Sq Ftg Access So Ftg Other x x Value Value Value x TOTAL VALUATION BUILDING PERMIT __ __ lQ._06 I Plan Ck Comm/lnd Charges an'::: ",VBl do Ppr Fee Surcharges ,1,--/0 1 Plan Ck Res 30%/BldQ Per Fee PLUMBING PERMIT 1 Fence Charges and ------------ Surcharges D~mo ELECTRICPL PERI:IT Sldewalk Charges and ------------ 1 A/C PaVlng Surcharges tlECHAN I CAL PERMIT Curb Cut Charges and ------------ Surcharges Systens Development I Cha roe (I 51) Total Co~b rerm1t TOTAL Ji/o 4-0 ......_-,. . ~ , '~ COMBINATION APPLICATION/PERMIT (CAP) Appllcant to furnlsh A Job Address B legal Descrlptlon 1 example- Tax Lot 100, Lane County Map Reference 17 0'3 43 2 example- Lot 1 Block 3, 2nd Add,tlon to springtleld Estates C Name, etc of owner and constructlon lender o Energy Sources 1 exam~le- heat/electrlcal celllnqlor forced dlr qas 2 examole- waterheater/electrlcal/or solar E Square footage or valuatlon, etc ----- 1 examole- 1250 sq foot house, 500 sq foot garage 2 example- lflnew proJect. check-n€w - If addltlon, check add, etc F BUlldlng permlt lnformatlon 1 example - construct slngle famlly house wlth an attached garage 2 examole - remodel eXlstlng garage lnto famlly room 3 example - convert 51ngle famlly resldence lnto restaurant (change of use) G Value of work as def1ned 1n Sect10n 303 (a) of the Structural Speclalty Code H OESIGN TEAM AND CONTRACTORS To avo1d des1gn or construct1on delays, BU1ld1ng Olvlslon Staff must be able to contact appropr1ate persons regard1ng deslgn 1nformat1on or Job slte correctlons, etc II Abbrevlated Plumb1ng, Mechan1cal, & Electr1cal Schedules A Except where blank spaces occur 1n the descrlptlon port1on of the Mechanlcal and Electr1cal Schedules, the appl1cant need f1ll-ln only the No Boxes adJacent to the approprlate ltem(s) to be lnstalled B Full Plumb1ng, Mechanlcal, and Electr1cal Schedules are ava1lable at the BUlld1ng Olv1s1on 1 To conserve space on the permlt form the schedules have been abbrev1ated 2 If the ltem(s) to be lnstalled are not covered on the abbrev1ated schedules you should consult the full schedules C BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES o As noted on the CAP, the label must be del1vered to the electr1cal contractor for slgnature by hlS electr1cal superV1sor The general contractor 15 not authorlzed to slgn the electrlcal label III Appl1cant to slgn and date Whenever posslble, the lnltlal appl1cat1on wl1l be used as a worksheet only Where posslble, BU1ldlng D1vls1on Staff w1ll prepare a type wr1tten copy and return 1t to the appl1cant at the tlme the actual permlt 1S lssued for h1S slgnature IV Fees and Charges Plan check fees are due and payable at the tlme of the appllcatlon, and no plans wlll be processed unt1l these fees are pa1d All other fees and charges are due and payable when the perm1t lS 1ssued V FOR OFFICE USE ONLY 1 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY " . PERMIT VALIDATION . . /J ~ , j Perm t Cl erk J Permlt appllcant exempt from reglstratlon wlth the BUllder's Board because Addltlonal Project Informatlon PLANS REVIEWED BY name slgnature date 0:J-14(P (lAf1Ii,)..i..J ~ .