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Home My WebLink AboutPermit Sidewalk 1990-9-23 . j ." 1INSPECTION LIflE 726-3769 -Job Address 4Q")j M.CjhmfIr...,S Legal Description 11{);Z;;l. 5?/JOOO 1.{01J . liMY t; INFDR/IATION LINt 726-3753 Sq, Ftg. f,lain ~q. Ftg. Access, Sq. Ftg. Other~~ Ilew Add Alter Pep. Fence ~_Change/Use LOt her Wno:::; 0<) .J) CITY UF SPRINGFIE~O COMBIIIATION APPLICATION/PERMIT EIIERGY SOURCES: Heat Hater Heater Range Va 1 u, of Hork:. /760. ..,.0 Builtiinq Pernlit Info: Describe Workli.e., Build Single ~()~en?\~~~ate:'0aa\ l ntT - Owner P {')fi1 r/l e.J/I Address 4q 1 I I {1, J)riOl( 1.J1 ~hhQ niL. s rtlLi_ Rff<9. ~ --f. pho~e' Construction Lender Address DESIGN TEAI~ (name} Phone (address1 (1;c5,no.\ (exnires) (ohane no. I Primary Structural Electrical Mechanical CONTRACTORS (namel {address' (1 ir:s. no. \ (exnired (ohane no. \ Genera 1/')11 ) (Lffi' ./ Plumbina Electrical ~'echanical ~ ' I I PLUIIBIJG ELECTRICAL MECHANICAL --1!Q.,.1 Each single fixture FFF CHARGF Nr CFF CH!llG.E. NO. Residence of furnace/burner to SQ, FT. BTU's qF rH~ Re roea ted bu i1 d; og (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence f1 bathl Duplex (1 bath) each Additional bath SERVICES Recessed wall Snace heatpr and vpnt Storm Sewer Of amps. App 1 i ance vent SPDarate Stationary evap. coolH Vent fan wi th sinale duct Vent system apart from hl!:a t i nq or A" C. Mechanical exhaust hood and duct Wood stove/heatl!:r Water service Temporary Construction Change in existing rp<;,; rtepee multifamily. comm. or Tnrlustr;al Sl!:wl!:r CO~1,/IND. FEEDERS Install/alter/relocate rlic;trih, feeders Of amps. TOTAL CHARGES WHERE STATE LAH REQUIRES shall not be valiJ until the TOTAL CHARGES 1 SSUANCE OF PFRlIlT TOTAL CHARGES that tile Electrical work be done by an. Electrical Contractor, the l!:lectrical portion of this permit label has been signed by an Electrical Supervisor and returned to the Building Division I UAVE CAREFULLY EXAMINED the completed application for r>ermit. 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 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 Or,S 701.055, that if exempt the basis for exemption is noted hereon. and that ::I:(::::::t:::::~S and~Of;' Wg~; CiOliance with :~:11::~~:55 WiKL O;? DATE 9~J?-_7? I FOP. OFFICE USE OIIL Y' .-r // Units Sq, Ftg, 'lain#" J'Y Occy Load Sq. Ftg. Access Occy Group Sq, Ftg, Other~~~ zone-J/ r Fire Zone Type/Canst. Bedrooms Stories x Value x Value x/7&:'01l'Value TOTAL VALUATION /7/lbC::>. ."... Flood Plain BUILDING PER~IIT Charges anc Surcharges Plan Ck, Comm/Ind 65%/Blda ~pr Fpp ------------ Plan Ck. Res 30%/Bldo Per Fee Fence Sys terns Development ' Charqe (1.5~) '. -:2~.YC::> PLUI~BING PERMIT Charges and Surcharges ?~ Demo ELECTRICAL PERIHT S1dewalk Charges and ------------ Surcharges A/C Pavil}9 '2~. 5"0 Total Comb. Permit_ -? ,-/, ~O MECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL ~.'7o ~ . r r, \ . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A,. Job Address B. Legal Description 1. exarnple- Tax lot 100, Lane County Map.Reference II 03 43 2, ..'examele- Lot j, Block 3, 2nd Addition to Sprjngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. exam~le- heat/electrical ceilinqlor forced air Qas 2. examole- waterheaterjelectrical/or solar E. Square footage or valuation, etc. - j, ,;example- 1250 sq, foot house. 500 sq, foot garage 2., examyle- if new project. check new - if addition, ..cneclc. add. etc. F. Building permit information: 1. exam~le - construct single family house with an a ttached 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, OESIGN TEM4 ANO CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design infonmation 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 fonm 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 ANO 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 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 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. PERMIT VALIDATION ~ ,gt-qo ~,~ ~~ V ... V, FOR OFFICE USE ONLY Cl"kr:A{m ) Pennit PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Infonnation: . name , . ,. -< J . '''i . , Permit NoBq \ \~{f\ Address: LMI, \' ~C~ Issued by: KLm ) D~: STATEMENT: INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES Note: Oregon Law, ORS 701.055(4), requires residential building permit applicants who are not registered with the Construction Contractors Board to sign the following statement before the building permit can be issued, Licensed Architect and Engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with .the permit. Fill in the applicable blanks, and initial box 1 and either box 2A or. 2B: 1. ~ I own, reside in, or will reside in the' completed structure, 2. A. L-.J My general contractor is Contractor registration number I will instruct my general contractor that all subcontractors who work on the structure must be registered with.the Construction Contractors Board. OR B. ~ I will be my own general contractor. - If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and ao hire a general contractor, I will contract with a contractor who is registered with the Construction Contractors Board and I will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side ~./' jiS fO~j// 1/-/ /)/ 7- L 5.~ Jo . . . Sigriaturg of Elermit Applicant Date / /. CONSTRUCTION CONTRACTORS BOARD .' 0244J 10/24/89 ~py 10 ISSUING AGENCY PERMIT ':LE w~y TO APPLICANT , . Qi),