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Home My WebLink AboutPermit Building 1986-12-10 jif ~~ I IrISPECTIOII L1IIE 726-37<i.9 . I CITY UF SPRIIIGFIELD COIIBIIIATlON APPLICATION/PERMIT e 'If Owner ,J Lm &H.r'?<5 S Y', Address t119 ?(J'l J/,fl Rd. _~J.1t1, " . Construcfion lender Build Single 'I I I~ .~ I~ ~ Job Address .3:?:S M/lJ-;"; ~&J;.r Legal Dmription/7<J~.J.s''3I, 1'Z]fI1Itf> f (~l!F ~ 'If EnERGY SO Heat !'Jater Heater Range Ep;l1'r,~ Valu, of I-Iork: ~ ?f! k :T7, . Ph '1'11 7:'" ..,IlJli1'iino Permit Info: Describe I-Iork( ;..e.. onc/....rih- d /d)lr.lily nesidence Uith ".ttached (laraae) ) /~ lNFORtIATION Lilli:: 726-3753 .\" Sq. Fto. '.Iain ~q. !='tg. Access. Sq. Ftg. Other ~llew_Add-".l ter _reo. Fence Demo Change/Use Other - - r/h!3 tZ"e.tfif.. C&r.1U-bLJ -,. J../0/5iY!Ce.. hu~ Ffh3I2:r:C Address Ut~llifl HAr-, (nameJ Phone (address) (1 ics. no.) (exo; res) ?/-3//n (ohane no.) Primary Bt.I/J7h'E. C;fI,...V/l$ rKiJdlCR (/It:;' TrJ/CtJ1<.. -7/)(, dtBCa&J;- Q'f3 -&q&.f ( Structural Electrical 11echan; ca 1 CONTRACTORS Iname) Gen~ral &!'(u:f?.vC 6:,(.1.If; ~d/J{Lt'S (address) ?/,~k(.5f (1 ;r.s. no.) (pxoirpc;) (nhnnp nn.' ~.3(od{ 31' 3 ~ "/"/1 Plumb;nq Electrical I,lechani ca 1 PLUIIBIrIG ELECTRICAL MECHANICAL rm. Each single fixture FEE CH~ yo '" rlJA&liE. "0. Residence of furnace/burner to SQ. FT. BTlI's I ~~L..c.HAR.G..E.. I Relocated building (new fix. additional) S.F. Residence (I bath) Duplex (1 bath) each Additional bath New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall ~n~iP hp~tpr ~nrl vpnt Storm Sewer Of amps.1 Appliance vent So.i;'oaratP Stationary evao. conler W . Vent fan wi th sinala duct. Vent system apart from I heatina or A.C. Mechanical exhaust hnnd nnd rlUit \"iood stove/haater Sewer Temporary Construction Change in existing rps; dp';nl"P Imultifamily, comm. or Tnrlllc:.t.r;rtl Hatar service COI11.I./IND. FEEDERS I Install/alter/relocate rlic:.trih fppdprc:. 10f amps. I I I I SSUANCE OF PFR'lI T TOTAL CHARGES I-IHERE STATE L1W REQUIRES shall not be vali~ until the I TOTAL CHARGES that the Electrical work be done by an label has been signed by an Electrical TOTAL CHARGES Electrical Contractor. the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFULLY EXArllNEO the completed apfl1ication for permit. and do heraby certify that all information hereon is true and correct. and I further cartify that any and all work cerformed shall ba done in accordance with the. Ordinances of the City of Soringfield and the Laws of the State of Oregon pertaining to tha work described herain. and that IlO DCCUPAllCY will be made of any structure without the permission'of the Building Division. I further cartify that my registration with the Builder's Board ;s in full force and effect as required by ORS 701.055, that if exempt the basis for exemntion is noted hereon. arid that only subcontractors and employees who are in comoliance with OP.S 701.055 will be used on th~S :JPject. . IlAilE(please print) , ~/.o_c:; (J. !H4<<1iU SIr,i1ATUREk f 4A/f4APf.L-DATEJhl- 9- ft, / FOr. OEFICE USE Q;ILYI /I Units Sq. Ftgl.( Hain x Value Occy Load SQ. Fta. Access x Value Occ'y Group Sq. Ftg. Other /t-N/_":;'_~ value~7..... TOTAL VALUATIOtI Zone-.G/ Fire Zone Type/Canst. Bedrooms Stories~ Flood Plain Ox C60<:F"# 8<8 BUILDlIIG PERfllT '71!::? 5'0 Charges and l' - - _;1..0 .~ Surcharges r /, S'7' PLU'1BING PERMIT Charges and Surcharges Plan Ck. 6S%IBldo Plan Ck. 30%/Blda Fence CorrvnlI nd \ Ppr FpF' Res Per Fee '4. r <::'3' Syste~s Development Charoe (1.5~) D~mo ELECTRICft.L PERI~lT Cha rges and Surcharge~ 11ECHANICAL PERMIT Charges and Surcharges Sidewalk TOTAL tft:>. ~ 'I b5:07 .A/C Pavi n9 Total Comb. r~rmit Curb Cut !"9= ~~ ",,' , - I - . - I -'-~.-~ e' ~ COMBINATION APPLICAI~ON/PERMIT (CAP) t. Applicant to furnish A. Job Address B. legal Description I. example- Tax Lot 100, Lane County Map Reference II U'j 43 2. example- Lot I. Block 3, 2nd Addition to Springtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinq/or forced air Qas 2. examole- waterheater/eJectrlcal/or solar E. Square footage or valuation, etc. - L examole- 1250 sq. foot house, 500 sq. foot garage 2. example- if'new project, cneck new - if addition, chee k add, ete. F. Building permit information: 1. examole - construct single family house with an attached garage 2. examole - 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 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 ~ivision 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 ~nd 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'VALIDATION ! (;;ui5dJi /2- {V -! It; to V. FOR OFFICE USE ONLY Permit Clerk . .l i 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 ~~"Y~ ,PL.EZ;"t!!9f' signature 4J2...~~~~- '/ /' . date /2-/~-.&'(f;.