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Home My WebLink AboutPermit Miscellaneous 1981-7-20 I INSPECTION LINE 726-3769 I I legal Description I .: Job Add,... ~- NA/'-u .::5T. {ZOO 1,6-; 3~S{ 0"",", .z:;;", ~ ;# 7'<::7 Add,....3/12- #A/;"1 $ _ VA/~p.JeL.L:> ,oR / Construction lender Address DESIGN TEAM (name) Primary ,Ilj,tructural Electrical Mechanical rnNTRACTOR5 (name) General Plumbina ~ Electrical Mechanical PLUMBING CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT - 'ENERGY SOURCES, Heat Water Heater Ranj:lo Value of Work: . INFORMATION LINE 726-3753 Sq. Fig. Main Sq. Fig. Access. Sq. Ftg. Other _New_Add_AlteT_Rep. _Fence_Demo_Changel Us. _Other ~ ~ ~ ~ '7* - _~? 7 B 'Id' P " I I D 'b W k (' B 'Id S' I "'7~/-7." '. J VI mg erm. n 0: elen e or I..., VI In9 . Phone/"" /.... "";5~" Familv Residence With Attached Goraae' j)/~AAhUec.r ~,.; 'o..;2.."UAJ Phone (address) (address) ELECTRICAL FEE I CHARGE NO. NO, I Each sinAI. fixture Relocated building (new fix. additional) S.F. Residence (1 bath) Duplex (1 bath) each Additionol bath Water service Sewer Storm Sewer TOTAL CHARGES /1/i9 ke Residence of sq. ft. New circuits, alterations or extensions SERVICES Temporary Construction Amps. FEEDERS Amos. TOTAL CHARGES (lies. no.) (expires) (phone no.) Jt ,. . (lies. no.) (expires) (phone no.' MECHANICAL FEE CHARGE NO. CHARGE lEE furnace/burner to I~TU's Appliance ven.t separate Stationary evap. cooler Vent fan with sinAle duct Vent system apart from heating or A.C. Mechanical exhaust hood and duct Wood stove I heator Hea' Puma Air handler to 10.000 CFM Air handler over 10.000 CFM ISSUANCE OF PERMIT TOTAL CHARGES WHERE STATE lAW REQUIRES that the Electrical work be don. by the Electrical Contractor, the electrical portion of this permit .hall not b. valid un,i1 a lab.1 has bHn signed by an Electrical Contractor and attach.d to the .Iectrical pan.l. I HAVE CAREFULLY EXAMINED the campleted application for permit. and do hereby certify that all information hereon is true and correct, and I further certify thot any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the lows of the State of Oregon pertaining to the work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I further certJfy that my registration with the Builder's Soard is in full force and effect a s required by ORS 701.055, that if exempt the basis for exemption is noted heron, and that only subcontractors and employees who ore in compliance with ORS 701.055 will be used on this project. Basis for Builder's Board exemption" . #' ~ \ () NAME (pl.o.. p'i.'lllA.. /? /J L-.J9 .f1/! ~ f//,~IP,'J,~}/uRE .~4-1f6(?H.c ~~ATE 7-;< d,l' . FOR OFFICE USE ONLY \ . Zon~ Fire Zone Flood Plain Type/Const. Bedrooms Ctorie" BUilDING PERMIT Charges and Surcharges PLUMBING PERMIT Chorges and Surcharges ELECTRICAL PERMIT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges Units n-t;.y Load -occy Group Sq. Ftg. Main Sq. Ftg. Access Sq. Fig. Other Plan Ck. Comm/lnd 65%1 Blda Per Fee Plan CIt. Res 30%/ BldQ Per Fee Fence Demo Sidewalk Alc PaviM Curb Cut x Value Value Value x x TOTAL VALUATION Systems Development Charae n.S%} Total Comb. Permit TOTAL 'r '"I!",:i . .,,;t'v";~~' )~'Y[:".\i\,;.I'Y"~"'J \~-"";-...J''.~4'..;'V '"" , , ~, ' '\) -\, COMBINATlO~, APPLICATION/PERMIT (., I. Applicant to furnish A, Jab Address B, Legal Description 1, example,tax lot 1 DO, Lone County Map Reference 17 03 43 2, example,Lat 1, Black 3, 2nd Addition to Sprin'gfield Estates. C. Name, etc. of owner and construction lender D, Energy Sources 1. example-heat/electrical ceiling/or forced air gas 2. example-water heater/eledrical(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. example-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. Value of work os defined in Section 303 (0) 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. Abbrevioted Plumbing, Mechanical & Electricol'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 ore 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 If I III. Applicont to sign and dole Whenever possible, the initial application will beused.as.a -- --_ _~ worksheet only. Where possible, Building Division Slaff 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 ore due and payable at the time of the application, and no plans will be processed until these fees ore paid, All other fees and charges ore due and payable when the permit is issued. ./ ,:" .,' / ~ " ..' ~:' III ," ',., \ ;-".{' .. '-;..I ~. ~- w'; y"-! \.' ~ pall.VAUDAT.ION ",:' , '.' . .' :1 V. FOR OFFICE USE ONLY Permit CierI- PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: PLANS REVIEWED BY: nam" eignaturo ;1 ;1 '1 , ,j ~ate