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Home My WebLink AboutPermit Building 1984-7-6 . .. HISPECTIOtI LlIIE 726-3769 Job Address CITY OF SPRIIIGFIELD cOtmIllATION APPLlCATIOII/PERMrr E!lERGY SOURCES: Heat Hater Heater II ,,\e INFORllATION UNt /I 726-3753 Sq. Ftg, l-Iaio ~q. ftg. Access. Sq, Ftg, Other ." lIew Add A 1t~~ep. Ranl'}e Fence_Demo~anl]e1Use Valu, of ~:f")q~~.. _Other BUilGinq Permit Info: Describe Work(i.e., Build Single Familv nesidence With Attached Garaael JO -.u:ot) ~ i~ :1 legal Description Address ut:~lljr. II:Al.' (name) Phone (address 1 (lies. no.) (exo;res) \ (ohone no.l Primary Structura t Electrical Mechanical CONTRACTORSA (oame 1 ~ GeOeral\C1n...l)... ~lM Plumbino -~\ (addrp<;o;; ) q4\ n J exoJ res 1 (I}h!'np no. 1 , ~-Uif Electrical Mechanical PLUllBIrIG ELECTRICAL . <<< 'r~'_Nn MECHANICAL NO. I I Frr I ~4ARr;r NO SQ. FT. furnace/burner to BTU's . t"~t" rL.lJiRG.E. Each single fixture Residence of Relocated building (new fix, additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence 11 bath 1 Duplex (1 bath) each IAdditional bath I Temporary Construction I' ~Iater servi ce" ,'Change in ex is ti n9 I rp~ i dJmr:p . I Sewer I Imultifamily, COnln. or I Induc;.tri,:l1 I Storm Sewer I IOf amps.1 I I I I COI-1f1.I!ND, FEEDERS I I .1 l'Install/alter/relocate I I rli"trih fpprlp,." I I IOf amp~1 I I I I I I I I I I ISSUANCf OF PFRI1IT TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES WHERE STATE L'l~ REQUIRES that the Electrical work be done by an"Electrical Contractor, the electrical portIon of this permit shall not be va1ij until the label has been signed by an Electrical Supervisor and returned to the Building Division SERVICES Recessed wall So~rp hp~tpr ~nd vpnt I Appl iance vent ~pn;jrat~ I S~tationary evap. cool~r I Vent fan with sinole duct I Vent system apart from heatino or A.C. I Mechanical exhaust hood find durt I \-lood stove/heater I I I Fire Zone Flood Plain I HAVE CAREFULLY EXAMINED the completed aprlication 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 OreC]on pertaining to the work described herein, and that rw OCCUPAIICY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Bui1der1s Board is in full force and effect as required by ons 701.055. that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with OP.S 7Ql.055 will be used on this project. IlAl-IE(please print)~"4_~ ~ ~..:- SIGrlATURE;t!.. ..,,--..11. ~ FOr. OFFICE USE 0I1L Y So, Ftg. riain Sq. Ftg. Access Sq. Ftg, Other DATE '1~- ~~ Zone Tvpe/Cons t. Bedrooms Units , Value Value Value Stories Occy Load Occy Group x , TOTAL VALUATION BUILDlIIG PERI-1IT Charges an~ Surcharges Ul _ rY'\ 1 Plan Ck, __~~\..A.J 65't/Bldo I A ^ I Plan Ck. -,.'-\ 30%/Bldo ____________1 Fence I Demo I S1dewalk I A/C Paving COnlnl! nd Ppr Fpp Res Per Fee Isystems Development Charoe (1,5~) " I I I I II ITota1 Comb. rermit I , PLUtlBING PERMIT Charges and Surcharges ELECTRICP,L PERr:IT Charges and Surcharges 11ECHANICAL PERMIT Charges and Surcharges Curb Cut 1- I'OTAL 3'1.41 . , COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION rotA. f1~1o Lo,?\11 ~ I. Applicant to furnish A, Job Address B. Legal Description 1. example- Tax lot 100. lane County Map Reference II 03 43 2, examele- Lot I, Block 3. 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. examele- heat/electrical ceiling/or forced air oas 2. exa~le- waterheater/electrlcal/or ~ E. Square footage or valuation, etc. 1. examole- 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. examole - 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 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 fu 11 schedu 1 es C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEOULES O. 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. --- Ill. 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 Cl"fh~ Permi t , PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: J name signature date I ., . ~~~@@@@@@@@@@@@@@@@@@@@~@@~~~0~~~~~~@@~@@@@~~ Q @ ~ @ ~ '1tertificate of QE)ccupanc11 ~ @1 e @ m CITY OF SPRINGFIELD ~ $, BUILDING DEPARTMENT ~ @ @ @ This Certificate issued pursuant to tile require/l1e11ts of Section 306 of the Uniform Building ~ @ Code certifying that at the time of issuance tllis stmcture was in compliance with the various ~I ~ ~i @ ordinances of tIle City regulating building construction or use. For tile following: ~i @ ~: ~ ~, ~l ~. @l Dee, Group B-I/B-2Type Construction V-N Fire Zone 11 Use Zone B-I/B-2 ~i @ ~I ~, J '1 Wh t 9415 j"1'lsh1're Boulevard '~::;. ~ Owner of Buildin: erome l'. i e Address Y ~ ~. @. Building Addro.. 1040 Gateway Loop ~Idg, Permit No NOll77 ~- @: ;J~' ~; / ) ~ ~ ~, By:, ft {4/1 L1~L ~ @ @ ~ ---l/d:IkL Doto. Cf,~~o:;'/I Jq Jtf7t:J ~ ~ 8u;Jd',. Off'dal {I ../" ';' ~ POST IN A CONSPICUOUS PLACE ~ ~ ~@~~~~~~~~@~@@@~~~~~~@~~~~~~@@@~~@~~~~~