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Home My WebLink AboutPermit Building 1984-10-5 I INSPECTION LINE 726-3769 Job Address 7; 7 ::71~.J.sf- Legal Omription \~ ()~ ~~ ~? e CITY Uf SPRINGFIELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat Hater Heater Range . INFORlIATION liNt 726-3753 Sq. Ftg, 1,Iain ~q. na. Access. Sq. Ftg, Other Ilew Add Alter Rep. -Fence Demo Change/Use Other- - o b r-- <:: ~ Od (') ~ '1('Yl Address UtSlGN TEAI~ (name) Phone (address) Va~~ of Work: ~ ~ f1 () , qOf/, BU11o;nQ Permit Info: Describe Work(1.e.. Build Single i~v m;;;dLtta;;=~,ad #1 ~_~~nA/~~z- U rJ ,. ' / (] Owner aJ-+~ IA/It.7 Address .:l::J() G: ~0~ ,b~~ , 97</OX , Construction Lenter ~L\( ..,-l\ \..\ t'\ '"\ TER<, Phone 4' J'S- 51P Jro (lies. no.) (exoires) (ohane ~ r- no,'\ Primary Structural Electrical Meehan i ca 1 CONTRACTORS Iname) ~/b Plumbina r jJ~k~~", ~~~, Q'l.l2.--/:::.' _ / (addrp<;<;. ) flies. no.) (~)(o;rp<;. ) (ohonp no. ) Genera 1 Electrical ~1echan;cal PLUI1B1 NG ELECTRICAL MECHANICAL NO, FE!=' r.HARr,F Nn ~~~ r~QQr.~ Nn ,J:1=1= r~GQr.t:' tS Each single fixture 5:-- 'llj:- Residence of SQ. FT, furnace/burner to BTU's Relocated building (new fix, additional) \ New circuits alts. or extensions -':\\'V'\f'""O~~.F. I SERVICES I \";)-:"' k~~ I I I I I I Floor furnace and vent S.F. Residence 11 bath) Duplex (1 bath) each Recessed wall Sn~~p hp~tpr ~nrl vpnt Sewer !Temporary Construction IChange in existing rps.i dp~nr:p Imultifamily, comm. or TnrllJ<;.tr;al 10f ICOMM./IND, FEEDERS I Install/alter/relocate d;c;tr;h. fppdprc; 10f amps. ~ 'S= TOTAL CHARGES that the Electrical work be done by an. label has bee~'signed bY'an Electrical I I \~.OO I App 1 i ance vent seDaratp I Stationary evap. cooler I Vent fan with sinole duct I Vent system apart heat;no or A.C. I Mechanical exhaust hood ~nd rlll~t I I'lood stove/heater I I I from Additional bath ~Iater servi ce Storm Sewer amps. TOTAL CHARGES WHERE STATE LAW REQUIRES shall not be vali~ until the ISSUANCf OF PFRIIIT TOTAL CHARGES Electrical Contractor. the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFULLY EXMlINED the completed apfllication 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 OrelJon pertaining to the work described herein, and that rw OCCUPAHCY 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 comoliance with ORS 701.055 W~)2()~tz.c?5//?&r' NAllE(please print)-1LR fA '1...1,,. ,I ~/.41TFffc, sIr,rIATVREa'__~.f It)~ DATEc;,>>t ;J3.Slf FOR OFFICE USE"OiiLY / / ~, Type/Const~ l~) Units So, Ftg. liain ~ x Value ' Bedrooms Occy Load Sq. Ftg. Access x Value Stories Occy Group\:?-"? 'Sq, Ftg. Other x Value Zone r r Fire Zone Flood Plain BUILDING PER/lIT Charges ant:: Surcharges -----~,,~- ~,GoB ~~c:c .------3:CO-1 D~mo ______\.'='00 ISidewalk . (J::) I A/C Paving If'\ CO I Curb Cut ------V'46-1 . I ~ Plan Ck. 65%/Bldo Plan Ck, 3D%lBldo Conm/lnd Ppr Fpp Res Per Fee t;J. :Lt--~?~_~~ 169.:!.O ~lJ,1/ I I I I TOTAL VALUATION Systems Development CharDe (1.5~) , l\..\l.~ PLUI~BING PERMIT Charges and Surcha rges Fence ELECTRICAL PERI~IT Charges and Surcharges ITotal Comb. rermit I I TOTAL \ C\Q .~ I \rf5'i ~ ! ' - ~ MECHANICAL PERMIT Charges and Surcharges 5?1../0700 . ~ COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B, Legal Description 1. example- Tax Lot 100, Lane County'MapReference II 03 43 2, example- Lot 1. Block 3, 2nd Addition to Sprlngtield Estates ' C. Name~ etc. of owner and construction~lender D. Energy Sources _ 1. exam~le- heat/electrical ceilinQ!or forced air Qas 2. example- waterheater/electrical/or solar E. Square footage or valuation. etc. - 1. 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: 1," examele - construct single family house with an attached garage 2. exam~le - 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 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, & 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. --- III, 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 signa ture. 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,VALIDATION ~'J I<. rI- ''$'61 Ph,/f)8<1 cw. ' " '. Permit Clerk ~4. . PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: b.l J ~\\.\~\_ '!'\.~~'\~ ,(') ~p,. ~~(",)\\Er'D ~~~ f!\r c.\ ~\. ...c:~'-< Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: , ' .~ .1 . '~ <.- /C.o ~ PLANS REVIEWED BY: .na~l\~R}"'\" date'0-~~'-\ "