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Home My WebLink AboutPermit Building 1982-2-8 ----- .)-~- INSPECTION LINE 726-3769 . CITY Of SPRINGfiELD COMBINATION'" APPLfCAQONI PERMIT I INfORMATION LINE 726-3753 ( I ENERGY SOURCES: Sq. ftg. Main 6.1. t; Y.lt.LA/_~' _ _ __ { H.at Sq. fig. A".... Water Heater Sq. Ftg. Other ~al Description 17-0...3 -_-3~- ....~.1 JD I Ranqe _New_Add_Alter_Rep. - I Value of Work: _Fence_Domo_Changel Use 1.4 _9g,. tH _Oth., Building Permit (nfo: Describe Work (Le., Build Single Familv Residence With Attached Garaae' /U-- )UH-l;.vN_~/I- ~ 1J.I>>M.f-;;;!I.;;);. . f( 7/) - tV M I Job Address Owner fA", ~~ ~ hht? M~ Phone ~ ~ '0 .... '\:::, ~ Address Construction lender Address Phone General .117E Jrot? ,t::/A/~ /A!..c., (address) (tics. no.) (expires) (phone no.) ~ (address) (lies. no.) (expires) (phone no.' ;ZfSl?7A c..A't?W-#) 1f )'1077 1~I24Pr:z. r;k..4C>:U~ DESIGN TEAM (name) Primary Structural Electrical Mechanical CONTRACTORS (nome) PlumbiM Electrical Mecha,nical PLUMBING ELECTRICAL MECHANICAL 1\10. I FEE I CHARGE NO. FEE ' CHARGE NO. FEE CHARGE Residence of furnace/burner to ~TU's Appliance vent separate Stationary evap. ,cooler Vent fan with sinQle duct Vent system aport from heating or A.C. Mechanical exhaust hood and duct Each sinQle fixture Relocated building (new fix. additional) S.F. Residence (1 bath) sQ. ft. New circuits, alterations or extensions SERVICES Duolex (1 bath) each Temporary Construction Additional bath Amps. Water service Sewer Wood stove/heater Storm Sewer FEEDERS Heat Pumo Air handler to 10.000 CFM Air handler over 10,000 CFM Amps. ISSUANCE Of PERMIT , TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES Ihal the Electrical work be done by the Electrical Contractor, tho electrical portion of this permit shall nol be valid until a label has been signed by an EleclI'jcal Contrador and attached to the electrical panel. 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 hedn, and that NO OCCUPANCY will bo made of any structure without the permission of the Building Division. I further certlfy that my registration with the Builder's Board is in full farce and e'ffect 0 s 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: SIGNATURE~"';~~~ FOR OFFICE ~E ONLY DATE ?/R/IY..:6...- NAME (pl.a.. pdnt) /(tJC J!OOrJ.A/G- /)JC., Zone Type/Canst. Units Sq. Ftg. Main Fire Zone Bedrooms n .cy load Sq. Ftg. Access Flood Plain C;torie- Qccy Group Sq. Ftg. Other BUILDING PERMIT #1:H.1JO Plan Ck. Comm/lnd Charges and 65%/ BldQ Per Fee Surcharges I./L Plan Ck. Res 30%/ Bldg Per Fee PLUMBING PERMIT Charges and Fence Surcharges Demo ELECTRICAL PERMIT Charges and Sidewalk Surcharges AI C Pavina MECHANICAL PERMIT Charges and Curb Cut Surcharges -------- x Value x Value x Value TOTAL VALUATION Systems Development Charae n.5%l Total Comb. Permit TOTAL .h.29, /2.., ... -~I7: 'v APPlICATION/P~. (CAP~ ~- COMBINATION 1]1" I.' Ap'plicont to furnish A. Jab Address .' ,.. B. Legal Descriptian ! \ ,. 1. example-tax lat 100, Lane Caunty Map Reference 17 03 43 2. example-Lot 1. Black 3, 2nd Additian ta Springfield Estates C. Name, etc. of owner and construction lender- D. Energy Sources 1. example-heat/electrical ceilinglor forced air gas 2. example.water heater/electrical/or solar E. Square footage or valuation, etc. . 1. exomple-1250 sq. foot house, 500 sq. foot garage 2. example-if new project, check new.if addition, check add, etc. F. Building permit information: 1. examole-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. Volue of work os 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 & Electricol'Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the opplicant need fill-in only the Na. Baxes adjacent to the appropriate item(s) to be instolled B. Full Plumbing, Mechanical, and Electricol 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 III, Applicant to sign and date Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Division Stoff will prepare a typewritten 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: .:-. '.' ", Additional Project Information: PLANS REVIEWED' BY: nom'" "ignaturo j-: .. '":" ., . --;'{, \' .... ~-~... . ;;R~I; ~ ALlD~;IO~ ;: , \' ,\ '... J J :,'. . ,> .1. " Permit Cler~ , \, '. " "'atf"