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Home My WebLink AboutPermit Building 1982-2-8 (2) INSPECTION LINE 726-3769 . CITY Of SpalNGFlELO COMBINA TlON' APPLlCATlON/PEWMIT I INFORMATION LINE 726-3753 Legal De5triptian I , ~t/1LA,~~~~,4L ENERGY SOURCES: Sq, ftg. Main Sq, Ftg. Accen. Sq. Fig. Other _N.w_Add_Alter_Rep. __fenu_Dema_Change/ Use ti -3 3.fk-,-~ _Oth., (.,fo: Describe Work (i.e., Suild Single ~ ~ I\) ..... ~ ~ Job Add,... {i r; Heo' Water Heoter Range Value of Work: Own., LdA7 fkle-u{,//c- ;~~ , Addren ~~ _C? oM ~ phone Addr.ss Phone Building Permit ".;;~~-"t;;~' j; "7 /J.(1}-f1' . .1'7fJ ~WJ1A . t:~nlt'I!~litln lender DESIGN TEAM (name) (address) (lies. no.) (expires) (phone no.) Electrical ~. Primary Structural Mechanical CONTRACTORS (name) (address) (Iics. nc.) (expires) (Dhone no,) General /l12...E JI./20 P/Yk /k'C, :;2g'07'A- cA'/.)M""~ -t1- )0/07; lo,&)frZ '!?#4e>~('t.... Plumbinc:t Electricol Mechanical PLUMBING ELECTRICAL MECHANICAL NO. FEE CHARGE NO. I FEE . CHARGE NO. FEE I CHARGE Additional both Amps. furnoce/burner to IITU's Appliance vent separate Stationary evap. cooler Vent fan with single duct Vent system aport from h.atinp or A.C. Mechanical exhaust hood and duct / Residence of I I I I Each single fixture Relocated building (n.w fix. additional) S.F. Residence (1 bath) SQ. ft. New circuits, alterations or extensions SERVICES Duplex (t bath) each Temporary Construction Water service S.wer Wood stove/h.oter Storm S.......r FEEDERS Heat PumD Air handler to 10.000 CFM Air handl.r over 10.000 CFM Amps. ISSUANCE' Of PERMIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES that the EI.ctricol work be done by the Eledricol Controdor, the el.dricol portion of this p.rmit sholl not be valid until a 10b.1 has been signed by on ElectriC'OI Contrador and attached to the electrical ponel. I HA VE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that 011 information h.reon is true and correct, and I further certify that any and 011 work performed sholl be don. in accordance with the Ordinances of the City of Springfield and the Lows of the Stat. of Oregon p.rtaining to the work deICribed herin, and that NO OCCUPANCY will be made of any structur. without the permission of the Building ,Division. I further certlfy that my registration with the Suilder's Boord is in full force and eff.ct as required by ORS 701.055, that if exempt the basis for exemption Is noted heron, and tnat only subcontractors and employe.s who ore in compliance with ORS 701.055 will be used on this project. Basis for Suilder's Board exemption: ~~' / ./ SIGNATURE,~~~~fl-<!! FOR OFFICE lifE ONLY DATE .;z,/nlf1-"2 NAME (pl.a.. pdnt) if tJ 13' A'.oO P/ -//G- / A/ C; , x Value Value Value c:."..,rilt~ Unih t"'lccy load Occy Group Sq. Ftg. Main 11;.... Ftg. Acces' Sq. Ftg. Other x x Ion- fire lone flood Plain Type/Canst. Bedrooms TOTAL VALUATION BUILDING PERMIT Charges and Surcharges fJ.2R./J'O /,IZ Plan Ck. Camm/lnd 65%/Slda Per fee Pion Ck. Res 30%/Sldg Per fee Syst.ms Development Chara. n.5%1 PLUMBING PERMIT Charges and Surcharges fence Demo Total Comb. Permit ELECTRICAL PERMIT Chorg.s and Surcharges Sidewalk AIC PavinQ MECHANICAL PERMIT Charg.n and Surcharges TOTAL '#;;"9. / /v Curb Cut COMBINA nON APPlIC~ nON/PERI (CAP) ~n,"~ITY O'~t~~,~NGFIELD Springfield. Oregon Department of Public Works OFFICIAL RECEIPT No..B 57994( r ! ~rt~1 C III. Appliccmt to sign and date ' 1- .,' t, Whenever possible, the initial application will be used as ( ,/ worksheet only. Where possible, Building Division Staff wili" 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 ather fees and chorges are due and payable when the permit is issued. I. Applicant to furnish A. Jab Address B. Legal Description . . I. example-tax lot 100, Lone County Map Referel" 2. example-Lot I. Block 3, 2nd Addition to Springf C. Name, etc. of owner and construction lender D. Energy Sources 1. example-heat/electrical ceilinq/or forced air aa ~. examDle-water heater/electrical/or solar E. Square footage or valuation, etc. 1. example.1250 sq. foot hause, 500 sq. foot garas 2. example-iTriew project, check,new-if addition, cl add, etc. F. Building permit information: 1. example-construct single family house with an oj garage 2. example-remodel existing garage into family roc 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 Divi~ Staff must be able to contact appropriate persons res design information or job site corrections, etc. II. Abbreviated Plumbing, Mechonicol & Electrical Schedule, A. Except where blank spaces occur in the description pc . of the Mechanical and Electrical Schedules, the applic need fill-in only the No. Boxes adjacent to the apprap item(s) to be installed B. Full Plumbing, Mechonical, and Electrical Schedules are available at the Building Division 1. To conserve space on the permit form the schedule~ have been abbreviated 2. If the item(s) to be installed ore not covered on the ated schedules you should consult the full schedule, C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AN CHARGES ON THE SCHEDULES ( (" Address 19'i ~ ~~ /I ill) I 2..f674 ~~- Date :1 -~ Rec'd From R/J J I ,( I \ , ( I I (' ( ,.. ( ( ~ {i< Received For: / Md 3 M.hA'H.Jf:. V 10/" <iJ..2.P .au f. J ,. .(- c , ...n.. \, "". ( CI CI ~ (I n ! .! ( ( Amount Received _"~ .kJv AUTHOlllr:u:o SIONATUIII~ .Hll\.TON.fU"...Ull. ..",NfllJl" llual[Nll. 011.'7.0' if :J...q.J2 ( " " V. FOR OFFICE USE ,ONLY Permit Cler~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional' Project Information: PLANS REVIEWED BY: nome "iignatu'rE" ~at-