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Home My WebLink AboutPermit Building 1983-9-21 , .. " '1 IrISPECTIOrl LIIIE 'II CITY Uf SPRIrlGFIElD IrlFDRlIATIDrI L1r1E 1726,3769 cormIllATION APPLICATIDrI/PERMIT 726,37S3 Job Address \'\t)\ \' () ~~(\ ~ 1.[\ Cb. -, ~~~~RCES ~q ~~~:ss Legal De<;cnptlon \ IJh-:=l...Q S ~ ~ 8) L I 'later Heater_____ -_____ Sqfle~tqAdd her ter Pep i Ranqe -Fence Demo ange/Use J Val\'a\ I~ro~ Other- - --....... BUlllllnQ JeY11i1t info Descnbe llork(l e , BUlld Slngle Farnlv ~es,dence \hth Attached Garaoe) \ '-.O-).N') 1.. (\N1\ffi- I ~('\ t)., L'J I (\- , , Owner f ~ J::\ rf.rrl -0 Q.....- :lLr9 14 ~ Addms {f\~ \b~ ~~\\\-~He con~~t~der j (~, ~ '14'1 'I Il~ C>\) ~ Co --J '-.J Address DES j GrI TEAll (name) Phone (address) (llCS no) (eXOl res) (ohane no ) Pnmary Structural El ectn ca 1 /1echanl ca 1 CONTRACTORS (name) ", ("'cfrlress) General 'i'S\..\\\::) "---\ .\'~ X\() ~l \\...J.. ')\ t::Q~ Plumblna l\ l) ('J (11r~ ~O) (exolres) (ohonp no \Cl~\\,~Ct: . ~4I,~\c'\\ Electncal ~1echanlcal PlUrmIrIG ElECTRICAl MECHArllCAl riD ' I FFF I CHARCiF Nn I I ~FF I rHARr::F. NO I H"F I rI-~ARr,J:" Each slngle flxture Resldence of SQ FT furnace/burner to BTll's Relocated bUlldlng (new flX addlt,onal) INew clrCUlts alts or extenslons I SERVICES I Floor furnace and vent 5 F Pesldence (l bath) Duplex (1 bath) each 1 Recessed wall I Snn~P hPntpr nnrl vpnt I Storm Sewer Of 1 COl111 IIND FEEDERS I Install/alter/relocate dl~trlh. fPPdprs 10f I 1 I amps 1 Apol lance vent 5eoarate 1 Statlonary evao cooler I Vent fan wlth slnole duct Vent syste~ apart heat1na or A C Mechan1cal exhaust hood and duct I ~Jood stove/heater from Addltlonal bath ~ra ter serVl ce Temporary Constructlon Change 1n eX1st1ng rp~ 1 derlee mult1fam1ly, comm or Tnrl\J~trlnl Sewer amps TOTAl CHARGES J TOTAl CHARGES WHERE STATE l\W REQUIRES that the Electncal work be done by an shall not be val1J unt11 the label has been s1gned by an Electr1cal ISSUANC, OF PFRt1lT I TOTAl CHARGES Electrlcal Contractor, the electrlcal portlon of thlS permlt Supervlsor and returned to the BU1ld1ng Olv151on I HAVE CAREFULLY EXN11NED tie completed appl1catlon for permlt, and do hereby certlfy that all lnformatlon hereon lS true and correct, and I further certlfy that any and all work oerformed shall be done ln accordance wlth the Ordlnances of the Clty of Spnngfleld and the Laws of the State of Oregon oerta1nlng to the work descnbed hereln. and that rw OCCUPAllCY wlll be made of any structure wlthout the permlss10n of the BU11d1ng 01v151on I further cert1fy that my req1strat1on wlth the BUllderls Board 15 1n full force and effect as requlred by O~S 701 055. that If exempt the bas1s for exempt10n lS noted hereon, and that only subcontractors and employees who are 1n comol1ance w1th ORS 7nl 055 Inll be used on th1S project IIAlIE(please pr~~-.Eu I....l~ / l.Q..U)lS- FDn SIC"IATllR, R~ L'~ OFFICE USF OIIL Y So Ftg f1aln Sq Ftg Access Sq Ftg Other DPTE 1/:J I J'l.3- Zone Fl re Zone Flood Plaln Tvoe/Const Bedrooms Unlts Occy load OCCy Group x x Value Value Value Stones x TOTAl VAlUATION BUllDlrIG PERI1lT Charges an~ Surcharges q Ie.. LX::? ~~~~B~~O ----~-l;~- ~6~~B~~O j'Fence CorrmlI nd Per Fee Res Per Fee Systens Development Charoe (l Sn PlU'1BIrlG PERMIT Charges and Surcha rges D~mo ElECTRICAl PERI'IT Charges and Surcha rges Sidewalk 1 A/C Pavl ng Curb Cut Total Co~b rerm1t IIECHArlICAl PEPI1IT Charges and Surcharges I TOT"l ~s,~<o ~ , _.. _ _ n___",.."__.. ~ , . --' COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION II Appllcant to furnlsh A Job Address B Legal Descrlptlon 1 examDle- Tax Lot 100, lane County Map Reference 'II U3 43 2 example- lot 1 Block 3, 2nd Add,tlon to 5prlngtleld Estates C Name, etc of owner and constructlon lender D Energy Sources 1 example- heat/electrlcal celll~q/or forced alr qas 2 example- waterheater/electrlcal/or solar E Square footage or valuatlon, etc ----- 1 example- 1250 sq foot house, 500 sq foot garage 2 example- 1fInew proJect. check-new - If addltlon, check add. etc F BUlldlng permlt lnformatlon 1 example - construct slngle farolly house wlth an attached garage 2 examgle - remodel eXlst1ng garage lnto farolly room 3 example - convert slngle farolly resldence lnto restaurant (change of use) G Value of work as def1ned 1n Sect10n 303 (a) of the Structural Speclalty Code H DES I GN TEArl AIID CONTRACTORS To avold des1gn or construct10n delays, BU1ld1ng Dlv1s10n Staff must be able to contact appropr1ate persons regard1ng des1gn 1nformat1on or Job s1te correct1ons, etc Abbrev1ated Plumb1ng, Mechan1cal, & Electr1cal Schedules A Except where blank spaces occur 1n the descr1pt10n port1on of the Mechan1cal and Electr1cal Schedules. the appl1cant need f1ll~1n only the No Boxes adJacent to the appropr1ate 1tem(s) to be 1nstalled B Full Plumb1ng, Mechan1cal, and Electr1cal Schedules are ava1lable at the BU1ld1ng 01v1s1on 1 To conserve space on the perm1t form the schedules have been abbrev1ated 2 If the 1tem(s) to be 1nstalled are not covered on the abbrev1ated schedules you should consult the full schedules C BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANO CHARGES ON THE SCHEDULES o As noted on the CAP, the label must be del1vered to the electrlcal contractor for s1gnature by h1S electr1cal superv1sor The general contractor 1S not author1zed to slgn the electrlcal label - Appl1cant to Slgn and date Whenever posslble, the 1n1t1al appl1cat1on w1ll be used as a worksheet only Where poss1ble, BU1ld1ng 01v1s1on Staff w1ll prepare a type wr1tten copy and return 1t to the appl1cant at the t1me the actual perm1t 15 1ssued for h1S slgnature Fees and Charges Plan check fees are due and payable at the t1me of the appl1cat1on, and no plans w1ll be processed unt1l these fees are pa1d All other fees and charges are due and payable when the perm1t 1S 1ssued ~~ ~ lo \ 1tq III ~~/D IV '- V FOR OFFICE USE ONLY Permlt Clerk . I ~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY " Permlt appllcant exempt from reglstratlon wlth the BUllder's Board because Addltlonal ProJect Informatlon " j ,- PLANS REVIEWED BY name slgnature date .., .,..."..",....1-