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Home My WebLink AboutPermit Building 1981-8-11 Job Address -', 424- ft1"e;/~ Sr, CITV OF SPRINGFIELD COMBINATION APPLICATION/PERMIT - INFORMATION LINE 726-3753 INSPECTION LINE 726-3769 legal Description ENERGY SOURCES: Heat Water Heater RanJ:le Value of Work: Sq. ftg. Main Sq. Ftg. Access. Sq. ftg. Other _New_Add_Alter_Rep. _Fence_Dema_Change/Use _Other ~ ~ ~ I I Own.",E~rArq I-X C, CL;9.;2~ I Add,... 4##- B" Sr Ph.n716 -~i,J., I I I I I I I Building Permit Info: Describe Work (i.e., Build Single Family Re~id~nce With Attached G~e) l)/sco,<//l/c=c,7 ~ ~r /)"eA/',uS Construction lender Address Phone C:Ot<.lTRACTORS (name) (address) (lies. no.) (expires) (phone no.) ~ (ljcs. no.) (expires) (phone na.\ DESIGN TEAM (nome) (address) Primary Structural Electrical Mechanical General / PlumbinA /-I If) / I I I ! I I Electrical Mechanical PLUMBING ELECTRICAL MECHANICAL NO. I FEE I CHARGE NO. I FEE [CHARGE NO. I FEE CHARGE SERVICES furnace/ burner to ~TU's Appliance vent separate Stationary evap. cooler Vent fan with single duct Vent system apart from heating or A.C. Mechanical exhaust hood and duct Residence of Each sin~le fixture Relocated building (new fix. additional) S.f. Residence (1 both) s9. ft. New circuits, alterations or extensions Duplex (1 both) each Temporary Construction Additional bath Amps. Water service Sewer Wood stove/heater Storm Sewer fEEDERS Heat Puma Air handler to 10.000 CFM Air handler over 10.000 CFM Amps. ISSUANCE OF PERMIT TOTAL CHARGES AhkE TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES that th. ElectTical work be done by the Eledrical Contrador, the ehtctrical portion of this permit shall not be yalid until a label has been signed by an Elemical Contractor and attached to the .Iedricol panel. I HA VE CAREfUllY EXAMINED the completed application for permit, and do hereby certify that 011 information hereon is true and correct, and I further certify that any and all work performed sholl be done in accordance with the Ordinances of the City of Springfield and the lows of the State of Oregon pertaining to the work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building .Dlvision. I further certify that my registration with the Builder's Board is in full force and elffect as required by ORS 701.055, that if exempt the basis for exemption is noted heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. Basis for Builder's Board exemption: NAME (pl.... Pdntl.4.e..GH-' E. It) r:- r '1GNAT~RE (.l!t ~.J ~ .AJ .' '~ . ~- FOR OFFICE USE ONLY W DATE %,il? / x Yalue Value Value Zone Type/Canst. Units Sq. Fig. Main Fire Zone Bedrooms n..cy Load Sq. Fig. Access flood Plain ....tori... ('key Group Sq. ftg. Other BUILDING PERMIT Plan Ck. Comm/lnd Charge I and 65%IBldQ Per fee Surcharges Plan Ck. Res 30%IBldq Per Fee PLUMBING PERMIT Charges and fence Surcharges o.m. ELECTRICAL PERMIT Charges and Sidewalk Surcharges AIC PavinQ MECHA.NICAl PERMIT Charges and Curb Cut Surcharges -------- x x TOTAL VALUATION Systems Development Chorae 11.5%' Total Comb. Permit TOTAL -,",' ~ . ..<;",..-....< ,,:,,',\ _ __ ,_...). ...."'\ : ~......r'j~"",,~,-- _~ .' h "$I" . J: '. V I: i COMBINATION APPLlCATlON/"- (C~:) I. Applicant to furnish Job Address Legal Description 1. example-tax lot 100, Lane County Map Reference 17 03 43 2, example-Lot 1. Block 3, 2nd Addition to Springfield Estates Name, etc. of owner and construction lender Energy Sources 1. example-heat/electrical ceiling/or forced air gas" 2. example-water heater/electrical/or solar Squa"re footage or valuation, etc. 1, example-1250 sq. foat house, 500 sq, foat garage 2. example-if new project, check new.if addition, check add, etc, F. Building perm'it information: 1. example-construct single family house with an attached garage 2. example-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 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 abbrevi- ated schedules you should consult the full schedules C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES A, B, , " C, .' D. E, Ii , ,. III. Applicant to sign and date .. Wheneyer possible, the initial appli~ation will be used as a . >- worksheet only, Where possible, Building Division Staff wilL _~ '_i:.-~ . o' _ prepare a typew.riiten.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. " 'ti' ;\. .-"V. FOR .pFFICE USE ONLY ;:r PROJECT CONDITIONS TO BE SATISFIED' BEFORE OCCUPANCY: Additional Project Information: " "'1 '.i; PLANS REVIEWED BY, nom"" e,ignatur,,:, ..l r'...--'...-V"'....,. ' -""".' .r' ('-" ,j~"'"-', '\.. . \PE~MIT VALlDATI~~ /....., .,:---." " , ..... " '''':' , .: ~.. M_'~.--" \ Permit Cler~ ......... :-:..._) .Jate I ' \ - - -.~-:;''; r-~: