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Home My WebLink AboutPermit Building 1984-5-18 .' .'. . :- . I INSPECTION LINE 726-3769 ' " CITY OF SPRINGFIELD ' CQtlBINATlON APPLICATION/PERMIT ErlERGY SOURCES: Heat ,l~ater Heater RanC)e_____:..__'~_,_____,.,_ _" , . , . . ....... "..... ".-- ... ........, ValuE ~Hork: '__ Owner 'p/9t! /HC J?:#1 ~J-.da,{)Dds-..:&(!, ~~~htO:'3{?t-:..-. , , Bui1riino Permlt Info: Describe Work(i,e., Build Single Address <.:?..?:<;;:? ~n-t-e.J.- C I "PI Phone?v?_BJ9; Familv nesidence With Attached Garaoe) ,V?".;r::: /d ~~r"p .M~~:U.Jc:..A~ ~~F/C:~ Construction Lender }?"/'-P/......A::"'". -I A:5'50~/4T~ &V/hG_ - - , &dP ~T~ /M;e>fl?OV~ME"",~. (lics. no.) (exllires) (ohone no. J INFORtlATlON UNt . 726-3753 Sq. Ftg. r'lain ~q. Ftg; Access. Sq. Ftg. Other ~_New_Add_A1ter ~qep. , Fence Demo Change/Use -Other - - ~ l ,~ "\l Job Address ?tJO,;Ai. (?;;( # S""~LC~ Legal Description /7."2-3/-::Z1 ~ ~t:.. ~~ , Address DES I GN TEAr1 (name) Phone (address) I Primary Structura" , Electrical Mechanical CONTRACTORS (name) General JJlod tI //7/Ir-e '/t')'B/j- r./:Je. EN tVr It/'?)1-(S' ' S- ~p ~ ~M fl>C!.i-;..I(l (~~r;!rF'~~ ) ..,&' (lies. no.) (exoires) o.e~(W" Ct 'b '77(#S- (ohone no. ) ,'~.5-60~O P1umbino Electrical Evye/lc3 TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be valid until the '*?S. Dc TOTAL CHARGES ~. - TOTAL CHARGES that the Electrical work be done by an. Electrical Contractor, the electrical portion of this permit label has been signed by an Electrical Supervisor and returned to the Building Division BUILDING PER~1IT Charges and ~r;:;rpes PLUt1BING PERMIT Charges and Surcharges I HAVE CAREFULLY EXAMINED the completed application 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 pertaining to the work described herein, and that NO OCCUPAIlCY 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 "'y "bo"t"ot", ,'d "",y", wh, '" ;, oom,l;"o, with OR' 701.055 wfl1 bo '~hf' ,"j,ot. __ . NAI-1E(please print) ttJ/?/~N, D. /9 SIGNATURE ~ ~ DATE..s' -/8-8r FO~ OFFICE USE ONLY I So. Ftg. 11ain ~F,IC/~~(U~a1ue~~.-' Sq. Ftg. Access x Value ' Sq. Ftg. Other./'.AY/h6. x ' Val~e ~~r~<,.- r~ 5Pc:::. ?ul'/~~ TOTAL VALUATION3~S"~. - , ./ e:" OD Plan Ck. COIllll1/Ind ~ d 7'L- Systems Development ~4~. ~.- ~ ~~ 65%/B1do Per Ff'P co C7' i7 Charqe (1.5%) , , ~, co ;7f..o-' --- - ------ PlanCk. Res ,- 30%/B1 do Per Fee ____'95= - I Fence :3. S~ I D~R1o 2~. -0 I Sidewalk -------~ 80 -, A/C pavingc11fS~.1 I Curb Cut I I I Zone M.# Fire Zone Type/Const. ~?IV Bedrooms Flood Plain Stories I Units Occy Load Occy Group~--~ ELECTRICAL PERlm Cha rges and Surcharges 3:Z.~ Total Comb. Permit 2/6 60 , . MECHANICAL PERMIT Charges and Surcharges --_._-------- TOTAL $37.85 . " ....;:. '.' .'. . . ~ . ,COMBINATION APPLICATION/PERMIT (CAP),' II. I. Applicant to 'furnish A.JobAddress B'. Legal Description ,1. examp 1 e- Tax Lot 100, Lane County Map Reference , 17 03 43 2. example- Lot 1. Block 3, 2nd Addition to Springfield Estates, C. Name, etc. of owner and construction lender D.' Energy Sources ,1. example- heat/electrical ceilinq/or' forced air qas 2.' example- waterheater/electrical/or solar" E. Square footage or valuation, 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 information: 1. example - construct single family house with an attached garage ' , ' 2. example - remodel existing garageintb 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. Abbreviated Plumbing, 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. - 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 signatvre. 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. .,-:. PERMIT VAll DATION wJ qsg ~ '. III. IV. V. FOR OFFICE USE ONLY Permit Clerk (}0 - ,J:::.- ~ ,<. - tf 1- ,'.' ~t!:~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: r~R;rec:r/~~ ~.~~~--~ ?" <1N . ;;. ~~L"........ -- Permit applicant exempt from registration with the Builder's Board because': " Additional Project Information: ..~ .. . , ' PLANS REVIEWED BY: name ~H.r:7>~-LSignature~~...~~ date ~-2 :J--8 Y , "