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Home My WebLink AboutPermit Building 1986-10-1 Job Address CJc20 mol4rJ ~@ ~ CITY Of SPRINGfiElD COMBIIIATION APPLICATION/PERMIT EIIERr,y SOURCES: Heat I~ater Heater Ranqe fi2- Ai -~1::7-'lO-\~q .' . INfOR/IATION Lltlt .1 726-3753 Sq. ftg. 1.lain ~q. Ftc). Access. Sq. Ftg. Other New Add Alter ~ep. -Fence Demo Change/Use Other - - I IIrISPECTIOII LItlE 1726-3769 Owner ~ If'h-oo.J::;_ Address >? &, 3 m ~ Phone 7Lf 7 ;3371 V~ j?o:O..fiJ vi BuilciinQ Pennit Info: Descr,be \~ork(i'.e," family nesidence With Attached r,ara~e) v1/i (J~ /YL1-red., if Build Single ~ 10 .....::J c:::t -S:) Legal Oescription Construction lender Address UtS I oN I EArl (name) Phone (address) (lies. no.) (exoiresl l' (ohone nO.l Primary Structural Electrical Mechanical CONTRACTORS (name) General Jiarrl Ue ~r PlumbinQ I (addreso;) /<:i-;tf~ 1.f2r.., &, d -..J (lies. no.) (e>tnil"'esl 10 ~;)c( ~f f) (ohonf=l no.) 7cJ.h -sqb '2- Electrical ~1echanica' PlUIIBING ElECTRICAl MECHANICAl rm.' Each single fixture r FEE I CHARGE Nn.-' ~ Hr: t rl-/8.RG..E. ~m_ Residence of furnace/burner to SQ. fT. BTU's 'rrL'..cHARG.E.. Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (] bathl IDuplex (1 bath) each Additional bath SERVICES Recessed wall Sn~~p hp~tpr ~nd vpnt ~!ater service !TempOrary Construction IChange in existing res i d_e.nce Imultifamily. comm. or Industrial IOf amps. ICOMI-I./lND. fEEDERS I Install/alter/relocate di~trib. feeders IOf amps.1 I I I I Appliance vent SPDarate S-tationary evap. cooler Vent fan wi th sinale duct Vent system apart from heatina or A.C. Mechanical exhaust hnnd ~nd dUl't I I'lood stove/heater I I I Sewer Storm Sewer TOTAL CHARGES WHERE STATE l~W REQUIRES shall not be vali~ until the TOTAl CHARGES ISSUANcr Of PfRtHT TOTAl CHARGES that the Electrical work be done by an Electrical Contractor, the electrical portion of this perr.1it label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE yAREFULlY EXN1INED 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 oerformed shall be done in accordance with the Ordinances of the City of Soringfield and the laws of the State of Oregon pertaining to the work described herein. and that UO OCCUPAUCY 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 ORS 701.055. that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project. Zone Fi re Zone Flood Plain Tyoe/Const. Bedrooms Stories Units Occy load Occy Group SIf,IlATURE ~ fOr. OffICE USE OIIL Y Sq. Ftg. r1ain Sq. ft9. Access Sq. ftg. Other u DATE/tJ ,-!-Y6 IlAl.1E(please 'print) &eNe hs/el{' x x Value Value Value x TOTAl VAlUATION BUILDHlG PERmT Charges an'::: Surcharges' .30 c-,O Plan Ck. _______~_!.::?~ ...Q.S!/Blda I 5; 7 Plan Ck. , 't 30%/Blda Fence Co,,"/I nd Ppr J:'pp Res Per Fee Isyste,ms Development Charae (1.S~) I I I I PlUt1BING PERMIT Charges an,d Surcharges, D~mo ElECTRICAl. PERr~IT Charges an~ Surcharges, 11ECHANICAl PERMIT Charges and Surcharges 'Sldewalk A/C Pavin9 Total Comb. rermit I TOTAl L/-o 0 tf Curb Cut . .. COMBINATION APPLICATION/PERMIT (CAP) 1. Applicant to furnish A. Job Address B. Legal Description I. example- Tax Lot 100, Lane County Map Reference 1/ oj 43 2. examEle' Lot 1. Block 3, 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example~ heat/electrical ceilina/or forced air Qas 2. examole- waterheater/electrical/or solar E. Square footage or valuation, etc. - I. examole- 1250 sq. foot house, 500 sq. foot garage 2. examole- if new project. check-new - if addition, check add, etc. F. Building pennit information: 1. example - construct single family house with an atta-ched garage 2. exam~le - remodel existing garage into family room 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 I 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 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. --- III. Applicant to sign and date Wnenever possible, the initial application will be used as a worksheet only. Where possible, Building Division Staff wi,ll 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 fe~s 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: . ~ . PERMIT VALIDATION 8&~(rb 1 0 -I - Yh Permit Clerk ~(' ~ ~ . Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLAN~ REVIEWED BY: name signature date