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Home My WebLink AboutPermit Building 1984-3-20 ~ , . INSPECTION LINE 1,726-3769 Job Address 1..050 \\Nd (')11. ) . l<Ao..r! ~ / c::x::. ~' ~~ ':21Y' ...lV 0' Legal Description 17."~.'Z?-~ - , . CITY Of SPRINGf IELD' INFORlIATlON liNt COMBIIIATlON APPLICATION/PERMIT 726-3753 E!lERGY SOURCES: Sq. Ftg. 1.lain Hea t ~q. Ftg. Access. Water Heater Sq. Ftg. Other Ilew Add A Her Pep. Range -Fence Demo Change/Use ValuE of Work: -Other&f~"'~ ~9.t.t:? t>t:> jf?~' ~ Buih;;na Pennit Info: Describe Work(Le., Build Single 1 Familv nes;dence With Attachpd Garaae) I " . Owner Ih.L 1>ni n *"~ Condi) Address I n<:::(\ -l1rLr Lo II) frj. Phone rJL q,1.\ ~ s.. .n.J...-\ r\. Construction Le~de~ ~ Address __Jl Ut~ I uN TtAl1 ~ Primary cr- Structural ~, Electrical \r) Mechanical '( CONTRACTORS (name) (name) , Genera 1 ~ ~bri ng (\ N. ,,,--t ~ Plumbino . ~~' Electrica,1'-e.-M>r ~tn-{\.L ~1echanical , <:l PLUI1BlflG M NO. HE fHARr.F ~ Each single fixture ~ Relocated building (new fix. additional) S.F. Residence (J bath\ Ouplex (1 bath) each Additional bath I Water serv; ce I Sewer l Storm Sewer I I Zone 2?...." Fire Zone Flood Plain BUILDING PERMIT Charges and Surcharges PLU'1BING PERMIT Charges and Surcharges ELECTRICAL PERlnT Cha rges and Surcha~ges., ~ MECHANICAL PERMIT Cha rges and Surcharges Tyoe/Const. Bedrooms Stories .t:;"-N I Phone (address) (address) '-I :j .t. :> .0 '::i (flY' nx()J{(l~ + n I ~I'l i rj;j'1() ~ \\ ~l-k flics.no,) (ohone no. 'l (exoiresl (lic~. nn.) (pxoirpc;,) (nhnnp I'ln l ~40 '?a o..m1a,.\~ ~~'3\~ q~p>-/t6ZZ ELECTRICAL Nn Residence of SQ. FT. INew circuits alts. I or extensions I SERVICES I MECHANICAL r:f.LI..IJlAB.liE. Nn I..EEL ..IJlAB.liE. furnace/burner to BTU's / /t:2IC Floor furnace and vent Recessed wall ~n~rp hp~nrl vpnt ITemporary Construction IChange in existing l"'P~irtPnrp . Imultifamily, comm, or I nrltlc:.trial Units Occy Load Occy Group M.. / . U", ....Plan Ck. COlll1llInd ____._L~'____ 65%/Bldo Pj"l'" F~~ ., Plan Ck. Res.... ' /.It?t'> 3D%l81do Per Fee -----_:.........:~--- _____t~~_ . it' C> Fence. . ,. I I IOf amps.1 I ICOMfl./IND. FEEDERS I I Install/alter/relocate I r1idrih fppdprl:. 10f amps. I I I I I I I I I I I I ISSUANC, OF pml1lT TOTAL CHARGES TOTAL CHARGES /". -I TOTAL CHARGES WHERE STATE LAII REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this permit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division 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 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 OCCUPAI~CY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builderls 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 ORS 7Ql.055 will be used on this project. lW'lE(please print)~/2L)~ .J,L3AL~/J .SIGIIATURd~~,//r~ FO~ OfFICE USE OilL Y Sq. Ftg. Sq. Ftg. Sq. Ftg. D_ ISide"a 1 k I A/C Pavi ng I-Curb Cut I Appliance vent ~'poar:~t.p Stationary evap. cooler Vent fan with sinole duct Vent system apart from I heatino or A,C, Mechanical exhaust I hnnd and clul"'t Wood stove/heater DATE~ riain Access Other x Value Value Value 69l'J'e>. - ~/,. x x TOTAL V ALUA Tl ON Systems Development Charqe tl.5~) . ~. , ., " , . , , .. .....; ~ ... ~ " ;; ~\~~ I I l~otal,Comb. ~ermit ~ I I I I TOTAL ~7'" 00 . . ~ L '- COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION II!. I. Applicant to furnish A. Job Address B. legal Description I. example- Tax Lot 100. Lane County Map Reference 11 03 43 2. example- Lot I. Block 3. 2nd Addition to sprfngtield Estates C. Name, etc. of owner and construction .lender D. Energy Sources 1. exam~le- heat/electrical ceiling/or forced air qas 2. examole- waterheater/electrlcal/or solar E, Square footage or valuation, etc. ------ I. example- 1250 sq. foot house. 500 sq. foot garage 2. examyle- if new project, check new - if addition, check add, etc. F. Building permit information: 1. example ~ construct single family house'with an attached gar~ge 2. exam~le - 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 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 descri'ption 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. 8UILOING 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. --- 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 .permit 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. ~d&df;J . 3-~,-t~ , -- , J LJ (}P V. FOR OFFICE USE ONLY II d 'D Permit Clerk U~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit appl i cant e,xemPt.from, regi strati on with the Buil der I s Board because": '. Additional Project Information: #.0 ?L.A>-k ~Y/E..-c....> . . ~Le/.N~ I'f'.c c..::s;;p p//7 c=-, 7<<; ~.-9.i'?;"A'-C'n:.-1' ~ aL}.J S~u.-::.7'.r..J~~ V":'-.6n.~F~ R9/)~~ , . ~/~r~c ~'-__/'(;Oye:z::> ~A"-~. Fc~ ~.rE' PLANS REVIEWEO BY: name LoRM:E"~~~ Signature~~ ... date ?...pt7-,&"