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Home My WebLink AboutPermit Building 1984-11-19 n. lINSPECTION LItlE . CITY OF SPRINoFIELO . INFOR11ATION UNt 726-3769 COMBINATION APPLICATION/PERMIT 726-3753 ~_ EIIERGY SOURCES: Sq. Ftq. I'lain Job Address 3&'),2 '/f;4TIR YN .-' Heat ~q, Ftg. Access. Legal Descriptionl.".d.... ""_,_, ~""'co Hater Heater Sq. Ft9. Other ~. ..~., ~ , ..~' New Add Alter Rep. , Range -Fence Demo Change/Use Va~ of Hork: -Other- - Owner M~_...W~ !/AutE~ ~CL V~$ ,/''''J/t:>e>. .- NJrNE ~L~ Address ......"""....., I/~_,.. C_. ...1>0.. -.....",u Bui'riinQ Permit Info: Describe \~ork(i.e.. Build Single .JZJ~ ... -'\AI'I.-"'~ JY~~3'F Familv ~es;dence Hith /l.ttached Garaoe) ?rt.P~~. '9~t'~") /~(. :hJlfJ~~~AK~r~ Construction Lender 1 '!5'~T~ .k 5"~.s7~ ~~ l?(.vc.~'~"6)., flies. no.) (exoires) ~ ~ 6\ 'tl ~ Address Ut~loN TtAf1 (name) Phone (address) (nhone no.) Primary Mechanical -C:ONTRACTORS Inamel General JNV nM!. ~;J/...~/~>, Plumbina (addrpss) f1 ;r:!', no.) * (pxni rps' . (ohonp no. \ Structural Electrical .Y~E/;--",;~.~~. ~~4bY Electrical ~'echan;cal PLUI1BING ELECTRICAL MECHANICAL SQ. FT. furnace/burner to BTU's ,:,:,: fl../llQ(::': ~ NO, FEE l":HARr.F Nn ~ ~~~ r~4Rr.~ NO, Each Single fixture Residence of Relocated building (new fix. additional) S.F. Residence (1 bath) Duplex (1 bath) each Additional bath 1~later service I Sewer IStorm Sewer New circuits alts. or extensions Floor furnace and vent I SERVICES I l:emporary Construction IChange in existing rF!<;.jqf'nr:p Imultifamily. comm. or Indll<;.tr;al 10f amps.1 ICOMH./IND, FEEDERS I Install/alter/relocate ni,t.rih_ fppnpr, 10f amp~1 Recessed wall ~oaCF! hpat.pr ann vpnt Appliance vent seoarate Stationary evap. cooler Vent fan wi th sinale durt I'Vent system apart from heatinq or A_C. I Mechanical exhaust hoon and duct I I'lood stove/heater I I I TOTAL CHARGES HHERE STATE L~H REQUIRES shall not be valiJ until the ISSUANCE OF PFR'1IT TOTAL CHARGES TOTAL CHARGES that the Electrical work be done by an.'Electrical Contractor. the electrical portion of this label has been signed by an Electrical Supervisor and returned to the Building Division . perr.lit 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 oerformed shall be done in accordance with the Ordinances of the City of Spri ngfi e 1 d and the laws of the Sta te of Oregon perta i ning to the work descri bed herei n, and tha t NO OCCUPAHCY will be made of .any structure without the permission of the Building Division. I further certify that my registration ~Iith the Builder's 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 7nl.055 will be used on this project. IWIE(please print) SIGIIATURE FOP. OFFICE US'fOrILY Sq. Ftg. r1ain Sq. Ft9. Access Sq. Ftg. Other ph' D~.TE Zone-MN Fire Zone Flood Plain Tyoe/Const.~r . Bedrooms Stories Units Occy Load Occy Group x Value x Value ~~/~,.. Va1ue~~- TOTAL VALUATION BUILDING PERflIT 7~.- Plan Ck. COlllll/lnd Shstems Development #.A Charges and ____ -=-____ 65'URldo Ppr Fee C aroe (1.5~) . Surcharges '3. e> C( Plan Ck. Res 30%/B1da Per Fee PLur1BING PERMIT I Fence I Charges and ------------ Surcha rges I D~lno I ELECTRICAL PERI:IT I Sidewalk Charges and ------------, AIC Paving Surcharges Total Comb. Permit f1ECHANICAL PERMIT I Curb Cut Charges and ------------ ?., d~ Surcharges I I TOTAL . COMBINATION APPLICATION/PERMIT (CAP) I, Applicant to furnish A. Job Address B. .''legal Descript'ion ... 1. example- Tax lot 100. Lane County Map Reference 1/ oj 43 2. examp]e- Lot 1. Block 3, 2nd Addition to .'~pr1ngtield Estates C. Name, etc. 'of owner and construction lender D. Energy Sources . . '1. examf!le-" heat/electrical ceilinq/or~\forced air Qas 2. example- waterheater/electrical/or solar 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 pennit information: 1. example - construct single family house with an at,tached garc!lge 2. example - remodel existing garage into family room 3. exa~le - convert single family residence into restaurant (change of use) G. Value of work as defined in Section 303 (a) of the .'Structura 1 Spec i a lty 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 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. --- III, Applicant to sign and date Whenever possible, the initial application will b~ 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 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 penmit is issued. V. FOR OFFICE USE ONLY . .PERMIT VALIDATION ,'. .' st~ rff/~ \\1 \JIfP'\ Permit Cler~W PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: S'rfSTG7Jj C;;;-AJip""" ~ T~>~ .j ~~.--..ROVE'2) ~#j; 47".- h RtE' ~~YC~o.v ~i:.E:.Pc;... . -.. .. Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: . PLANS REVIEWED BY: name~ Jt.~~_Signature~_... (~_'-? date //-/9-BY '"