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Home My WebLink AboutPermit Building 1991-2-1 \ 'j IrISPECTIOII LIIIE 726-3769 Job Address J~m ca..;;m}~)~_ legal De'crlptlOn /JO,{ ?~-(' /)'Z.,7/T'7) CITY 01 SURIIIGFIELD COIlBldAT Of! ~PPLICATION/PERIHT \ INFORlIATION llNt -[ 726-3753 So Ftq IIa10 ~q !:'tg Access Sq Ftq Other r~e\~ Add Alter Qep --Fence Demo Change/Use Other - - E"ERrV SOURCES Heat 'later heater Ranqe Owner ;5'7?l;r.?,1kA J,{J'(;. (2,;, M})O"/..A;.l.A Address Phone Valu' of7~irv BUll(llna Penmt Info Descnbe Hork(l Farnlv n.esldence lhth Attached Garaoe) e . BU11d Slngle \ ~I li\' ~ ~-, Constructlon Lender &.p3r J~ ;P/'1f'!e:d..e Urr Address OESIGN rEAlI (name) Phone {address 1 (l1c5 no) (exnlrpc:;) (ohon~ nn Pn ma ry Structural Electncal Mechanlcal CONTRACTORS Inamel General /J;1M,~E~. I..I/t), (address) \ (1,c<:, no) NO' b//,,,{/b} ~ 7'-' ",,'" I (~Xl)l rpc;.) lnhol"lp nn , ~kJq..! c:.~-V'~ Plumblna Electrlcal ~lechanl ca 1 PLUllBlNG ELECTRIC~L MECHANICAL NO FFF CHARCF Nn FFF fI-lAR(.';F NO Each slngle flxture ReSldence of SO FT I 1/ I I / I I I or I furnace/burner to BTU's ~n I rHARr,~ I /1 I I I I I / 1/ 1/ 11 Ii / I I I / '--t I I I I TOTAL CHARGES I TOTAL CHARGES TOTAL CHARGES WHERE STATE L 'I~ REQUIRES that tile Electncal work be done by an Electncal Contrac or, the electncal portlOn of thlS permlt shall not be vallJ untll the label has been slgned by an Electr1calrSupervlsor and returned to the BU1ldlng Dlvls10n ~ ; ...., - ~" ~ I HAVE CAREFULLY EXM1INED t1e completed apnl1cat1on for perm1t, and do hereby cert1fy that all lnformat1on hereon 1S true and correct. and I further cert1fy that any and all'work oer(ormed shall be "done 1n accordance w1th the Ordlnances of tne C1ty of Spnngfleld and the Laws of the State of Oregon oerta1nlng to the work descnbed hereln, and that 1m OCCUPAlKY w1ll be made of any structure w1thout the perm1SS1on of the BU1ldlng D1v1s1on I further cert1fy that my reqlstrat10n w1th the BUllder's Board 1S 1n full force and~effect as requ1red~by ORS 701 055, that 1f exempt the bas1s for exemDtlon lS noted hereon, and that only subcontractors and e~ployees who are 1n comol1ance wlth OPS 7nl 055 wlll be used on th1S proJect I Relocated bU1ld1ng (new f1X add1tlonal) Is F Pes1dence (] bath] IDuPlex (1 bath) each / INew Clrcu1ts alts or extens10ns ISERVICES I Floor furnace and vent Add1t1ona1 bath ITempOrary construcy(on Change 1n eX1st1~ rps 1 dpnCI? /- mult1fam1ly. cofum Tncluc;t.rlal / I amps I Recessed wa 11 / ~naLP hpatpr anrl vp~t/ II Apollance vent / sp.oarate StatlOnarv ev cooler - Vent fan Wl h s1nole due: Vent sys e~ apart from heat1n or A C Mecha lcal exhaust han i'l.nr! dULt I \J d stove/heater I ~Iater serV1ce I Sewer !Storm Sewer IOf I COl111 II NY FEEDERS I InstalY7alter/relocate d1strib fpprlprs 10f/ 1/ amps. ISSUANCf OF PFRIIIT , ,- SICIIATURF uJ~ A QO , om--=-/l \ 'I \ NAIIE(please pnnt) u.J" .,....'" 'Yo ~ '" SO" Zone Flre Zone Flood Plaln Tyoe/Const Bedrooms Ston es For OFFICE USE O,IL Y Um ts So Fto Haln Occy Load Sq Ftq Access Occy Group Sq Ftg Other x x Value Value Value x TOTAL VALUATION BUILDIIIG PERlllT Charges anc Surcharges -f----___ Plan Ck 65%/Bldo Plan Ck 3D%/Bldq I Fence I D~mo Sidewalk CommlI nd Ppr Fee Res Per Fee 4000 ISystens Development Cha roe (J 5') lL.2.z :5 S- I I I I PLU'1BING PERMIT Charges and Surcharges ELECTR I CPL PERI'IT Cha rges and Surcharges A/C Pavl ng I Curb Cut ------------1 14-: 5P ITotal, Comb I TOTAL Permlt IIECHAf!ICAL PERMIT Charges and Surcharges ~11,B~ 1 ( ) , .. . __, - ..'_"0." __ ..~.. _ II _.. I " COMBINATION APPLICATION/PERMIT (CAP) PERMiT VALIDATION Appl1cant to furnlsh A Job Address B legal Descrlptlon 1 example. Tax Lot lOa, Lane County Map Reference II 03 43 2 example- lot 1 Block 3. 2nd Addltlon to - sprlngtleld Estates C Name. etc of owner and 'constructlon lender o Energy Sources 1 example- heatlelectrlcal celllnq!or forced alr QdS 2 examole- waterheater/electrlcal/or solar E Square footage or valuatlon, etc ------ 1 example- 1250 sq foot house, 500 sq foot garage 2 example- If new proJect. check new - ,f add,tlon. check add, etc F BU11dlng permlt lnformatlon 1 example - construct slngle famlly house wlth an attached garll:ge 2 exam~le - remodel eXlstlng garage lnto faml1y room 3 example - convert slngle famlly resldence lnto restaurant (change of use) G Value of work as deflned 1n Sectlon 303 (a) of the Structural Speclalty Code H OESIGN TEAll AND CONTRACTORS To avold deslgn or constructlon delays. BUlldlng Olvlslon Staff must be able to contact approprlate persons regardlng deslgn lnformatlon or Job slte correctlons. etc II Abbrevlated Plumblng, Mechanlcal, & Electrlcal Schedules A Except where blank spaces occur In the descrlptlon portlon of the Mechanlcal and Electrlcal Schedules. the appllcant need flll-1n only the No Boxes adJacent to the approprlate ltem(s) to be lnstalled B Full Plumblng. Mechanlcal, and Electrlcal Schedules are avallable at the BU1ldlng OlV1Slon 1 To conserve space on the permlt form the schedules have been abbrevlated 2 If the ltem(s) to be lnstalled are not covered on the abbrevlated schedules you should consult the full schedules C BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANO CHARGES ON THE SCHEDULES D As noted on the CAP, the label must be dellvered to the electrlcal contractor for slgnature by hlS electrlcal supervlsor The general contractor 15 not authorlzed to 51gn the electrlcal label III Appllcant to 51gn and date Whenever posslble. the lnltlal appllcatlon wlll be used as a worksheet only Where posslble. BUlldlng Olvlslon Staff wlll prepare a type wrltten copy and return lt to the appllcant at the tlme the actual permlt lS 15sued for hlS slgnature IV Fees and Charges Plan check fees are due and payable at the tlme of the appllcatlon. and no plans wlll be processed untll these fees are pald All other fees and charges are due and payable when the permlt lS lssued " -"". t/#~ ( -----~- --- \ q I~ ~\ Jill fq//G- { { '~~ VI V FOR OFFICE USE ONLY ~(;WZ Permlt Clerk J PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY !/-Al-ill."i~,c .7HE ~1,,:fJfA,,~ NL-'?\ ~,s(7l1fG ArJ ~4t'~ ),MC;;,--r 'R~ -q, /O~L jJtm-f( nI~ kl l' "!',r fi~JT'I"'R M~ -'Y,/ ~ 51 I~D (~) l:J,F Jlt'E C/~~..mAJ,1 Cb;)F Permlt appllcant exempt from reglstratlon wlth the BUllder's Board because I,,) ~1'k)1'Z, w/ ~ :V,I:7C (2.) ( I / I kT' I- ~r .!2fN~6 IV A?r/~/~ Addltlonal Project Informatlon , . .'~ \ , \. \ ': PLANS REVIEWED BY name M~~ , \ I " - ' \.' ~ ~-; , \ -... . slgnature date ~/;J.0/ . ~ , - ~ . \ -.