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Home My WebLink AboutPermit Building 1983-8-11 CITY OF SPRBlGFIELO INfOR/IATION LINe COIIBIilATION APPLlCATION/PERMlT 726-3753 EilERGY SOURCES: Sq. ftg. I.laln Heat ~q. Ftg. Access. 1;18 Hater Heater Sq. Ftg. Other ~w Add Alter Rep. Ranqe -Fence Demo Change/Use ValUE 4~ , Other- - BuilGlna Rermlt Info: Describe Work{i~e.1 Build Single ;\rtn~dl~~~tt~c~~at(fuf 0 , PhOr":ddreSS) \ s\[) ~-~ro'.)~~:r~ . . I INSPECTION LINE 726-3769 Job Addressr\).5f\r:...., ('\\\...\0 H 'n ~ v Legal Oe5criPtlon /7-0~~;;:':z:..OO. C::i:. ~ Owner \, \~C) ~) \i T "- ~A:::5:)n0_ , Address \?{"b "?\\(\~\ ,p .l\ldYhhne ~Q CIft\ C\ , \ \. rl J)~\ '~~ Construction Lender j C\~ \() I Address UlSIG,j leA'" Primary Structural E1 ectri ca 1 Hechanical CONTRACTORS Genera 1 Pl umbi no Electrical ~lechanica' NO. I (namel (name) (addrpss\ . rjJ ()J 15 ~ I " (ahoM no.) (11c5. !'In. l (P1(O;rpe:;' (nhn"",:) ","I , ~'\\i\Q~~ '\\\fSt N ~t.~';\ \,,\\~\\Q c\ (\1 ~J\~,f\ '----.x~_' . PLWIBItlG ELECTRICAL MECHANICAL Each single fixture I HI=' I rHARr.F" ~1O . ~ '..QiAJlliE. -.ill' Residence of furnace/burner to SQ. fT. BTU's 't'['[' 'C~ // Relocated building .".., New circu~ts alts. (new fix. additional) or extenslons ~ I'~~ '2 4.1< JWI&1I1"J= l's.F. Residence I (1 bath) SERVICES I Duplex (1 bath) each I IAdditional bath jremporary Construction I 1~later service IChange in e~istin9 I ,rpc;.jqr.ncp I'sewer Imultifamily, COO1!l. or I lnrluc;.trial I Storm Sewer IOf amps.1 I I ICOMH./lNO. fEEDERS I I IInsta1l/alter/relocate I I r1;~tr;h_ fpprlpr~ I 10f amps.1 I I I I I I I I I I I ISSUANCf Of PfRmT TOTAL CHARGES I TOTAL CHARGES IS'. 00 I TOTAL CHARGES WHERE STATE L\ll REQUIRES that the Electrical work bo done by an Electrical Contractor. the electrical portion of 'this permit shall not be va1i1 until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFUllY EXM1INED 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 OCCUPAr~CY 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 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. HAI,IE(please PrintlPS, k?,-_;::. I.I\/HI ,AI':::'! SI(':I^TURE~J~_[,(J~ fOR OffICE USE ONLY Units NA. Sq. ftg. Ita;n Occy Load Sq. ftg. Access 17 If! if Occy Group i!J'-:< Sq. ft9. Other Zone R-I"J Fire Zone Flood Plain BUILDHlG PERI'I!T Charges an~ Surcharges PLUI1BING PERMIT Charges and Surcharges ELECTRICAL PERi~lT Charges and Surcharges ItECHANICAL PERMIT Charges and Surcharges Tyoe/Const.. ~N' Bedrooms Stories I ~o __ Plan Ck. Conm/Ind ~. 65%/Blrlo Ppr Fpp -------/~--- Plan Ck. R'es /. 30%/Blda Per fee I Fence Dt:Rlo Sidewalk - -711-- --- --- / I I A/e Paving __~_~S::_~__I Curb Cut ,60 I Floor furnace and vent Recessed wall ~n~rp hp~tpr ~nrl vpnt I I I I I I I I I App 1 i ance vent ~~oaratp I Stationary evap. cooler I Vent fan with sinale duct I'Vent system apart from I heatino or A.C. I Meehan i ca 1 exhaus t hood and du~t I ~.jood stove/heater I I I OATE fI !II /14 n x Value Value Value i,laec. - x x TOT^L VALUATION 12.<.0 SystemsOevelopment Charqe (1.5~l . 60,-- Irota1 Comb, Permit L( 'I. ;:> '< 1<<. "1'<:. I I TOTAL . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description I. examole- Tax Lot 100, Lane County Map Reference 1/ OJ 43 , 2. examole- Lot 1. Block 3, 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical 'ceilinqJor forced air Qas 2. examole. waterheater/electrlcal/or solar Eo Square footage or valuati.on. etc. - I. examole- 1250 sq. foot house, 500 sq. foot garage 2. exarrple- iiri1ew project, check-OOw - if addition, cneck add, etc. F. ' Building permit information: 1. example - construct single family house with an a ttached garage 2. exam~le - 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 TEM1 AND CONTRACTORS To avoid design or construction delays, Building Oivision 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 I. 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 penmit 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. (p ) (p & c( 1-(~73 Ii ,f V. FOR OFFICE USE ONLY Pennit Clerk 0Aft ili JL, PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Infonnation: PLANS REVIEWED BY: . name L~R~ ~ f51'11f' signatur . date "./--e~, .