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Home My WebLink AboutPermit Building 1986-7-28 ~ I IrISPECTJON LINE 726-3769 . Job Address /O./f 5' (; c::r:t:i4c/ ~ ,/ I. Leg.l Oescription /7-o~'Z2'20 a-::fhr~ I , - I / ~ I I Owner Ikw-/JI../aicl ;(mL~ /.t;4CtfZ1/ Address I () Y'? C, o:l~~o ~~ Phon.j tf rf -~ IO~rAJ . CITY Of 5PRII/GFIELO .. . INFORllATlON liNt I' COMBIIIATION APPLICATION/PERMIT. 726-3753 ErIERGY SOURCES: Sq. F tq. ,.1. i n Heat ~Q. Hg. Access. ll.ter He.ter Sq. FIg. Other lIew Add Alter ~ep. Ranqe Fence_Oemo_Change/Use V.1UErt~ ,_Other Builrifno Penmit Info: Describe Work(l.e., Build Single Fami1 tlesidence \~ith ,lI.ttached l'iaraaet ryA(1F{JM JI}.J., ~ aA t!....- tJM..ritnJ I IJ Constructinn Lender ~ ~ Z Address Dl5tGU TEAl' lname) , Phone (address) (lies. no.l (exniresl (ohane nO.1 . Primary Structural Electrical Hechanical CONTRACTORS in.mel Gener.l rn ILLUOU~I\.J (address) l~o / (lies. no.) (pxoirp,,) (ohnn"" nn.) Cf - /3 -RIo I);:] L, - ::5P?; Plumbina Electrical f..lechanical PLU'IBlNG ELECTRICAL MECUANICAL ..J!Q.." '..nL1 CHARGE E.ch Single fixture I IRelocated building I (new fix.....ddition.l) IS,F. Residence I (J b.th) IOuPlex (1 b.th) e.ch I IAddition.1 b.th I -I\-later service , I Sewer I or I I Storm Sewer I Of amps.1 I -I . I r COI~'1./lNO. FEEOERS I I I I I Install/alter/relocate I ,dis.trih. fppders. I I I Of amps.1 I -I I ,- I I I I I I I I I I I / ISSUANCf OF PFR!I1T TOTAL CHARGES I TOTAL CHARGES .1 TOTAL CHARGES WHERE STATE LAII REQUIRES th.t the Electric.l work be done by .n Electric.l Contr.ctor, the electric.l portion of this pemit shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the BUilding Division ~ Residence of I SQ. FT. INew circu!ts alts. or extenslOns I SERVICES I Floor furnace and vent 1..f.ELI.J:IJAB.IiE'-1lll......1 furnace/burner to BTU's 1.llL...1 I Recessed wall Sn~~p hp~tpr ~nrl I \11""" I ITemporary Construction ~Change in existing I rP'ljOY.I1f"P Imultifamily. camm. , tnrlll<;.trii'll Appliance vent c:eoaratp Stationary evap. cooler I Vent fan wi th sinolt=> duct I Vent system apart from I heatino or A.C. . Mechanical exhaust hood i'Ind durt WOOd stove/heater I HAVE CAREFULLY EXN1INED the completed application for ~ermit, and do hereby certify that all information hereon is true and correct. and I further certify that any and all work oerformed 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 rlO OCCUPArKY 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 OP.S 701.055 will be used on this project. IlAHE(ple.se print) M/J.t.NDUF# 6F;V, (o;J fA 5IGr1ATuR~g ", -iZxt tJt.t: /',eprf' ,. .......--. .." 5"._ FO~ OrFICE USE Q;ILY 50. FIg. Sq. Ftg. Sq. ftg. riain Access Other~ x J OATE~ ..1)5, y~ , / , Zone C;L. Tyoe/Const.GX'/S-r- Bedrooms Stories / Units Occy Lo.d Occy Group /f'- Z x Value Value Value /~~ Fire Zone Flood Pl.in BUILOII/G PWlIT Charges anC: Surcharges C::6P~ H' 8'2 <I . ___j2:~~__ . ?t:> Plan Ck. Comm/lnd 65%/Bldo ~~r Fee Plan Ck, Res 30%/Bldo Per Fee I Fence I Oemo I Sidew.l k lAIC P.ving I Curb Cut I ~ /1 :30 -;:,. I <l'1 tllsystems Development , ~ ~V>I:> '/ Ch.rQe (I.S~) -I I I I ITotal Comb. Permit I I TOTAL Jv1~F TOTAL VALUATION 11-;,4. PLU'~BING PERMIT Charges and Surcharges ELECTRICAL PER'~IT Cha rges and Surcharges /8.<'0 /8.20 I MECHANICAL PERMIT Charges and Surcharges ,-- . .-- , ~ ~ COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION t. Applicant to furnish A. Job Address B. legal Description 1. examole- Tax Lot -IOO? lane County Map Reference II OJ 43 2. example- lot 1. Block 3, 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender ~. Energy Sources 1. examole- heat/electrical ceilinq/or forced air Qas 2. examole- waterheater/electrical/or SOlar E. Square footage or valuation. etc. - 1. examole- 12S0 sq. foot house, SOO sq. foot garage 2. examp.le- 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. examEle - 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 TEN~ 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 full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES 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 ~ivision Staff will prepare a type written copy and return it to the applicant at the time the actual permit is issued for his signa ture. 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. ~~~~\O~~ C{;/0 V. FOR OFFICE USE ONLY Permit Clerk CV/ 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.Lo..e<i'€~~~ signatur4_-~,." date 7"29-:fl(f; .