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Home My WebLink AboutPermit Building 1983-9-6 . . INFORlIATION liNt 726-3753 Sq. Ftq. r.lain ~q. F'tg. Access. Sq. Ftg. Other Ilew Add Alter Rep, --Fence Demo Change/Use Other- - r;j) I~ 10 9J if Address Phone V~'IO :,'~s cp BU11ciina Permit Info: Describe Work(i.e.. Build Single Fami1! nesidence With Attached Garaael kt"'".. ('00+ r."'MYY\eJ'"c._" 0.0 ~a '-...) Owner c; . \J. Construction Lender Address Dt>lGN ItAH {name} Phone (address) (lies. no,) (exni res) I no, \ (ohone Primary Structural Electrical Mechanical CONTRACTORS Inamel (address) General ~'I~'CY\ ~ok?~cJI~, Plumbina (1 ice;.. no.) (pxnirp<;.) (ohonp nn_ ) , -:l~\ N.~4~ ~~. \ ry~~ '* Electrical ~'echan; ca 1 PLUIIBI riG ELECTRICAL MECHAN I CAL NO, FEF (:HARGF: Nn ~~~ r~A~r.~ NO I='~~ rl-lA R(.: I=' 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 (1 bath) Ouplex (1 bath) each IAdditional bath jwater service jsewer lstorm Sewer I I I I I I SERVICES Recessed wall ,n~~p hp~tpr ~nrl vpnt Temporary Construction Change in existing rp'i j dyJ'~p Imultifamily, comm. or tnrluo;.tri<ll IOf amps, ICOMM,/IND, FEEDERS I Install/alter/relocate rlio;.trih_ fpprlpro;. IOf amps.1 I App 1 i ance vent ~po"lratp Stationary evap. cooler Vent fan wi th ~inole duct Vent system apart from I heatino or A.C. Mechanical exhaust hnod <lnd dud Wood stove/heater ISSUANCF OF PFRIIIT TOTAL CHARGES TOTAL CHARGES WHERE STATE L\li REQUIRES that the Electrical work be done by an,'Electrlcal shall not be vali1 until ~he label has been signed by an Electrical Supervisor TOTAL CHARGES Contractor. the electrical portion-.of this permit and returned to the Building Division I HAVE CAREFULLY EXAMINED 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 110 OCCUPAllCY 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 exemption is noted hereon, and that only subcontractors and employees who are in comp~e with OPOS 701.055 will be used on this project. IlAlIE(please print) _ ~./ .Ii ~/U'.df' __SIGW\JUR~.r'/ L- ,/) /' ~ QATE 7'-6- oJ FOP. OFFICE USE DilLY Sq, Ftg, Sq. Ftg, Sq, Ftg, Zone Tvpe/Const. Bedrooms Stories Uni ts Occy Load Occy Group f1ain Access Other x Value Value Value Fire Zone x Flood Plain x TOTAL VALUATION BUILOING PER/lIT Charges and Surcharges _____5_~, GO 2..'UI Plan Ck, Comm/Ind 65X/Rlrlo P~r Fpe Plan Ck. Res 30%/BldD Per Fee Fence Systems Development CharDe (J.5~) , PLUt1BING PERMIT Charges and Surcha rges Demo _ ___ __ ___ __-,"Sidewalk I A/C Paving I Curb Cut ------------ I I I I ELECTRICAL PERI~IT Charges and Surcharges jrotal Comb. Permit I I TOTAL 1>58, 2.4 I MECHANICAL PERMIT Charges and Surcharges . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VAll DATION I. Applicant to furnish 1~~4 A, Job Address B, legal Description I. example- Tax lot 100. lane County Map Reference LP 1I uj 43 2, example- Lot I, Block 3. 2nd Addition ,to C: Spr.lnglie1d Estates Name. etc. of owner and construction lender 0, Energy Sources I. examole- heat/electrical CeilinjlOr forced air Qas 2. example- waterheater/electrlcal or solar E. Square footage or valuation, etc. L example- 1250 sq. foot house, 500 sq. foot garage 2, example- if new project. check new - if addition, check add. etc. F. Building permit information: L example - construct single family house with an attached garage ~J- 2, example - remodel existing garage into family room 3. examele - convert single family residence into restaurant (Change of use) G. Value of work as defined in Section 303 (a) of the j · Structural Specialty Code ,.' H, OESIGN TEM1 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. 'I 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 . \. 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, BUILOING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEOULES 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. --- Ill. 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. V, FOR OFFICE USE ONLY Permit Clerk 0A ~di.u PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builderf5 Board because: Additional Project Information: PLANS REVIEWED BY: I j name signature date .