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Home My WebLink AboutPermit Building 1986-10-17 ~ Job Address S~ Afa';AI" s/ ~\(f}? C-&.1\1~\~~\\l\ CI~Y Uf SPRINGFIElU " INFORlIATlON liNe COMBINATION APPlICATlON/PERMIT 726-3753 EilERGY SOURCES: Sq. Ftq. 1.lain Heat ~q. Ftg. Access. Ijater Heater Sq. Ftq. Other1 ~ New Add A ter Rep. ~ Ran!le -Fence Demo Change/Use ~E of Hork: rO -Other-- BUi;:i~1:~~nfo: Oeser be Work( Le.. Build Single I Familv rlesidence ~Hth A,ttached (laraoe) ~ Jeen;lOf' Ur<<c<ku-{'" Q(/"... 90# I R,r;sl/;""6, ~d w~ d~ /I" I !;" 1//1-'1/.5 "orod~ ~ /,,6',1- e:."," ~ ~ i<"C..- nics. no.) (axnires) (ahone no.) ~. '- '-' . I ItISPECTIQ;1 UIIE 726-3769 Legal De~cription ~ 'V4,~h~ Address PI" J-{' 'v P /Z4l.. ;; , t//'LL4~ f) or ~;-/1n/,e-L/A/ Phone I::AvL:5 14u-/cJ~",,-//:..-<.. , AftJ.t./t:' Owner Construction lender Address Ul:.~I{j[{ ItAU (name) Phone (address) Primary No~e. Structura 1 Electrical Mechanical CONTRACTORS (name) (address) / &:;,#.eUJ#<,F / nic~. no.) (pxoirp':;) 'ff'W <;' %? (ohnnp M, ) General ~U/'?'/I h /Z~";6 {;,. Z. }".2. ~~7"-7~ Plumbina Electr;cal ~1echan; ca 1 PlUlIBING ElECTRICAl MECHANICAl 110. FEF r.HARr.F Nn~ rrr rH~ NO_ rrr r~ Each Single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (I bath) Duplex (1 bath) each Additional bath ISERVICES I Recessed wall Sn~~p hp~r And vpnt Sewer ITempOrary Construction IChange in existing res i qe,nce Imultifamily, comm. or IndustriAl IOf amps. ICO~1./IND. FEEDERS IInstall/alter/relocate I' dhtrih. fppdprc: IOf amps.1 I I I Appliance vent c:eoa ra tp Stationary evap. cooler Vent fan with sinole duct Vent system apart from heat;na or A.C, Mechanical exhaust hood And durt ~Ja ter servi ce Storm Sewer Hood stove/heater TOTAl CHARGES TOTAl CHARGES WHEnE STATE L\lj REQUIRES that the Electrical work be done by an shall not be valiJ until the label has been signed by an Electrical ISSUANCf nF PFRlfIT TOTAL CHARGES Electrical Contractor. the electrical portion of this pe~it Supervisor and returned to the Building Division I HAVE CAREFUllY EXN1INED the completed aprlication for permit. and do hereby certify that all information hereon is true and correct; and I further certify that any and all work oerformed 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 UO OCCUPAUCY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Goard 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 w~o are in como1iance with ORS 7n1.055 wi~~ US~~his~~t...... tpil~~/? /&~//,v"3> g/F< ..-' ~"7~ ~ 1lA/IE(please print) If/o.e ~ r / ;q~:u;'~' SIGIl^TURE ~y~ :;A,~ om /c;I;?')'pc FO~ OFFICE USE OIIL Y <.J v Sq. Ftg. r1ain Sq. Ftc). Access Sq. Ftg. Other Tyoe/Const. JZ;'-"'Ie.-2.units Bedrooms \. Occy load Stories ~roup ~ 4'\.... '.L ~ x Value Value Value Zone--.Ce..- . Fire Zone Flood Plain x x TOT^l VAlUATlOIl BUIlDIIlG PERf.fIT 3e. e!? . Plan Ck. Conmll nd Charges an.~ 65%/Bldo Pj'r rpl? Surcharges ---7q-u- Plan Ck. Res 30UBldo Per Fee PlU'~BING PERMIT Fence Charges an,d ------------ Surcha rges, DfIlIlO ElECTRICAl PERrm 'Sidewa 1 k Charges an~ ------------ Surcharges: A/C Pavi ng MECHANICAl PERMIT Curb Cut Charges and ------------ Surcharges 'Systems Development I Charo. (1.5~) Total Comb. Permit TOTAl ?~~ . . .. COMBINATION APPLICATION/PERMIT (CAP) t. Applicant to furnish A. Job Address B. legal Description 1. examp.le- Tax Lot 100. Lane County Map Reference 17 OJ 43 2. example- Lot I. Block 3. 2nd Addition to Sprlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example~ heat/electrical ceilinq/or forced air Qas 2. examyle- waterheater/electrical/or solar E. Square footage or valuation, etc. i. exam~le' i250 sq. foot house. 500 sq. foot garage 2. example- if new project. check new - if addition, check add. etc. F. Building pennit information: 1. example - construct single family house with an attached garoge 2. example - 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 3D3 (a) of the Structural Special,y Code H. DESIGN TEAM AND CONTRACTDRS I 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 s~ould 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 wi,ll 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . ,.. PERMIT VALIDATION B{R:2c,c ( (O/'?--O ~\{b Permit Cl~rk~ g Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature " VI ~ date .,~--'. ~ " .