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Home My WebLink AboutPermit Building 1980-8-13 Hater Heater Range ValuE of Hork: 25,168.00 Buil~;inQ Permit Info: Descrlbe Work(i'.e., Build Single Familv Residence With Attached GaraQe) I. INSPECTION LINE 726-3769 ~- .... .. . CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT I ErIERGY[s-PM~SBaseboard Heat ... Job Address 5293 Cynthi a Court Legal Description Lot 8, Danielle Park Owner C.M. 'Beagley Address 5293 Cynthia Court Springfield,Oregon Construction Lender Phone " INFORl1ATION UNt 726-3753 Sq. Ftg. I.lain ~q. Ftg. Access. 880 Sq. Ftg. Other New Add Alter Rep. -Fence Demo Change/Use -Other- - co o o '-l '-l N 746-4336 Addition to mobile home 97477 Address DES I GN TEAf~ Phone (address) (name) (lics. no.) Primary Structural Electrical t1echani ca 1 CONTRACTORS General (name) Owner (address) (lics. no.) PlumbinQ Electrical ~1echanical PLUfm I NG ELECTRICAL NO. . FEE CHARGE. NO_ - FFF rHARGF NO. Each single fixture Residence of SQ. FT. Relocated building (new fix. additional) New circuits alts. or extensions S.F. Residence (l bath) Duplex (1 bath) each Additional bath SERVICES Temporary Construction Change in existing residence multifamily, comm. or Industrial I 125.00 I 1 I I I I 25.00 Iola ter servi ce Sewer Storm Sewer 1 Of amps. ?nn COMM./IND. FEEDERS Install/alter/relocate distrib. feeders Of amps. (exoires) . (ohone no.) (exoires) (ohone no. \ ,. MECHANICAL -.. FFF rHARGF, furnace/burner to BTlI's Floor furnace and vent Recessed wall Soace heater and vent Appliance vent seoarate Stationary evap. cooler Vent fan with sinole duct Vent system apart heating or A.C. Mechanical exhaust hood and duct Wood stove/heater from ISSUANCE OF PFRf1IT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L'\\~ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAI1INED the completed application for permit, and do hereby certify that all infnrmation 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 pertaining to the work described herein, and that NO OCCUPArlCY will be made of any structure without the permission of the Building Division. 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 compliance with ORS 7nl.055 will be used on this project. NAME(please print) SIGNIITURE e FOR OFFICE USE ONLY 1 Sq. Ftg. Sq. Ft!J. Sq. Ftg. LM. Beaalev Zone R-1 Fire Zone Flood Plain NO Type/Const. V-N Bedrooms Units Occy Load Occy Group f1ain Access 880 Other 1 K-J Stori es BUILDING PER~1IT ___lJ.?.:.QO_____ Plan Ck. Comm/Ind Charges and 65%/Bldo Per Fee Surcharges Plan Ck. Res 4.60 30%/BldQ Per Fee PLur1BING PERMIT Fence Charges and ------------ Surcharges D~mo ELECTRICJl,L PERrm 25.00 Sidewalk Cha rges and ------------ Surcharges 1. 00 A/C Paving MECHANICAL PERMIT Curb Cut Charges and ------------ Surcharges e~D/l.TE?t?~J-(;~ r x Value x 28.60 Value Lo,lb~.UU x Value -- 1-9-A., TOTAL VALUATION- L:J, 60. uu I Sys tems Deve 1 opmen t I Charge (1.5%) . 34.50 PD 8-12.;.1:0 REC#54285 I I ITotal Comb. Permit I I TOTAL 145.60 II 145.60 I fill .' -. COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. examp1e- Tax Lot 100, Lane County Map Reference 17 03 43 2. examp1e- Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. examp1e- heat/electrical ceiling/or forced air gas 2. example- waterheater/e1ectrical/or solar E. Square footage or valuation, etc. 1. examp1e- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check new - if addition, check add, etc. F. Building permit information: 1. example - construct single family house with an a ttached garage 2. example - remodel existing garage into family room 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. DESIGN 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.P1umbing, 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 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 form the schedules have been abbreviated 2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the full schedules . 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. --- III. 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. IV. 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. V. FOR OFFICE USE ONLY tift PERMIT VALIDATION 4 5 '-1302 ~-'3-~O " , Permit Clerk (1n I PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name DAN SMITH signature ,,~ '- . .JI date 8-13-80 v