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Home My WebLink AboutPermit Building 1986-6-30 j IIISPECTlON LINE 726-3769 . Job Address (#0 41.1':'" $ r Legal De<criPt;onI7'b-:;'_:;'.~~'l O~~ $~ :. CITY Uf SPRINGFIELO COMBINATION APPLICATION/PERMIT ..- EilERGY SOURCES: Heat . liater Heater Ranqe V~?at7 Phona~/>~ ~ullGinQ Permit Info: ~~~ Familv nesidence Hit ft./.u.f ~ . , _~~BJ I NFORlIA Tl ON l! Nt 726-3753 Sq, Ftq. 1,Ia i n ~q. Ftg. Access. Sq, Ftq. Other New Add Alter ~ep, Fence _DemO_Change/Use _Other i I~ ~ OCS ~/.;AJtJ.T Addr!:. 1b.<:7J (l/1/C.{.. Z >>t~ sf Describe Work(i.e., Build Single Attached Garaae) ~~ Construct;"n lender ~..... 11echanical CONTRACTORS (name) (addr~"s) (1 ics. no. \ (exoires) (nhnnp ~ 4 Vi (1 ice:.. nn. ) (pxnirp(,\ (nhnnp J I Address Ut~ lliN I tN1 {name} Phone (address) Primary Structural Electrical nn_ ) Genera 1 Plumbina Electrical .W.wtlfl-- .~. tL.<::;'!} I/V. / ~, ~~HiF. f,1echani ca 1 , PLUIIBING ELECTRICAL MECHANICAL NO. Each single fixture I FFF CHARr.F Nn~1 I FFF ICHARr.F un Res idence of furnace/burner to SQ, FT. BTU's I ~I='I=' IRelocated building (new fix. additional) I'S.F. Residence (1 bath) IDuPlex (1 bath) each IAdditional bath I ~Jater servi ce I Sewer IStorm Sewer New circuits a1ts. or extensions Floor furnace and vent SERVICES Recessed wall ~n~rA kp~tp~ ~nrl ~pnt ITempOrary Construction I'Change in existing rpc;, i (tp,nre Imultifamily, comm. or Tnrlu<:.trial 10f amps,l I COIf.!. II NO, FEEDERS IInstall/alter/relocate I rlic;,trih fpprlprc;, 10f amp~1 I I I Appliance vent "'-eoaratp Stationary evap. cooler I' V'ent fan wi th sinole duct I' Vent system apart from heatina or A.C. / I Mechanical exhaust hood and rlurt I Hood stove/heater I I I ("5"'--' ISSUANCF nF PFR!IIT TOTAL CHARGES TOTAL CMARGES WHERE STATE L'\\~ REQUIRES that tile Electrical work be done by an shall not be vali1 until the label has been signed by an Electrical TOTAL CHARGES /5.. eY&> Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Division Flood Plain 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 Derformed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of DreC]on pertaining to the work described herein, and that rw OCCUPA'~CY 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 ons 701.055, that if exempt the basis for exemotion is noted hereon, and that only subcontractors and employees who are in compliance with OP.S 701.055 will ~sed on thO oject. ?'. , -.. '" llAI-lE(please print) CA RL G,ATl::.lllVoD SIr.ilATU U. :;./~~ATE-6-~-~ F~P. OFFICE U., . .1.. - ( Sq. Ftg. t1ain x Value Sq. Ftg. Access x Value Sq. Ftg. Othe~_~ ~l!::-Value -;z~.co TOTAL VALUATION , I I Zone CG TYDe/CDnst.~--~ Bedrooms Stories / Units Occy Load Occy Group 11-"2 Fire Zone BUILDING PERNIT Charges an~ Surcharges Plan Ck. Comm/lnd 65%/Blda P~r Fpe ------------ Plan Ck, Res 30%/Bldo Per Fee Fence -g, 7.r Systems Development Charoe (1.5~) I/-d. PLUI~BING PERMIT Charges and Surcharges -------------1 Deo>o I Sidewal k 1 A/C Paving ____/~~__' Curb Cut .~ I Irotal Comb. rermit I.S-: 6D /1. ~S- , ELECTRICAL PERIHT Cha rges and Surcharges MECHANICAL PERMIT Charges and Surcharges I 1 TOTAL - COMBINATION APPLICATION/PERMIT (CAP) I, Applicant to furnish A, Job Address B. Lega) Description 1. ~xample- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot I. Block 3. 2nd Addition to Springfield Estates . C. Name. etc. of owner ana construction lender D. Energy Sources 1. examole- heat/electrical ceilina/or forced air Qas 2. examole- waterheater/electr;calior solar E. Square footage or valuation, etc. - I. example- 1250 sq, foot house. 500 sq, foot garage 2. examDle~ if new project. check new - if addition, cneck add, etc. F. Building permit information: 1. example. construct single family house with an attached garllge 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 303 (aJ of the Structural Specialty Code H. DESIGN TEM1 AND CONTRACTORS To avoid design or construction delays. Building ~ivision 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. --- 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. ,I I I J. V, FOR OFFICE USE ONLY . PERMIT VALIDATION , ,~' s~~~o ,~~ "\g Permit Clerk ~. PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit I appl i cant exempt from regi strati on wi th the Buil der I s' Boa rd because: Additional PrDject InformatiDn: " PLANS ~IEWED BY: /I/?Q># ~\M7 i' name Lt!>7'!~ 7t.. ~~ signatur~ ~ k' ~ _ ..../~"c..a.. -=> ,. date ~-:?c>-B6"