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Home My WebLink AboutPermit Building 1984-07-16%ry I IISPECT I ON 726-37 69 CITY OF SPRINGFiELD COMBI iIATI ON APPL I CATION/PERMIT 726-3753 Job Address EIIERGY 5 Hea t l.Jater Ranqe Sq Sq Sq Ftg Ftg Ftg I'lain_ Acces s . _ 0therl-eqal Descript'ion 'U'iillhrr esOwnerlj Addres ttr*\45+Phone lLto-3-L53 Builcii Fami I y nqzPernrit info: Describe Work(' Residence llith Attached Garaoe '€., Build Single \(tN qH11 cons trucii od-|ender/ Address Phone \ name address I exDt res ohone no. Pri Structura I E l ectri ca l Mechanical name addres s lics. no- )pYnt rpq ohone no-'l,r, fl-l I t Pl umbi nq E l ectri caI HechanicaI PLUI{B I NG ELECTRICAL MECHANICAL FFF CHARGE NO FFF CHAAGF N0 FFF CHARGF Each single fixture Residence of sQ FT furnace/burner to BTLI' S Relocated building (new fix. additional) New circuits alts or extensions Floor furnace and vent 5. F. Residence(l bath)SERV i CES Recessed wal l Snacp hpripr and venf Duplex (l bath) each Additional bath Tempora ry Construct j on Apol iance vent seoa rate l^later servi ce Chan rp< i ge in existing d pnrp Stati onar.v evap cool er Sewer multifamily, conrn. or Tndu<trial Vent fan with sinole duct Storm Sewer 0f amps,Vent systern heatinq or A apart from .c. coMr.r./IND. FEEDERS l'lechan ical exhaust hood and duct I nsta I I /a 1 te r/ rel ocate distrih- feeders l'Jood stove/heater 0f ampE ISSUANCF OF PFRIlIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES I^JHERE STATE L,1tl REQUIRES th# the E'lectrical work be done by an Electrfcal Contractor, the electricat portion of tfis permit shalI not be vali'J until the labe'l has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAHINED the completed application for oermit, and do hereb.y 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 0rdinances of the Cityof Springfield and the Laws of the State of 0reoon oertaining to the work described herein, and that N0 0CCUPANCY will be madeof any structure without the permission of the Building Division. I further certify that my reqistration vrith 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 thatonly subcontractors and employees r.rho are in comcliance with OPS 701.055 wi be,used on this nroj ect. llAtlE(please print SIGNA ,, f//,tE : USE 0i{l Zone Tyoe/Const.ts-----Sq. Fto f{ai n x Val Fire Zone Bedrooms Load Sq. Ftg. Access x Value_ Flood Plain S to ri es Group Sq. FtS Va'lue TOTAL VALUATION- .0ther BUILDING PERI.IIT Charges and Su rcha rges -€ts- 4E- Plan Ck. Conrn/lnd 65%/Bldq Per Fee s terirs (t opmen rqe Plan Ck. Res 30%/81dq Per Fee PLUI4BING PERMIT Charges and Surc ha rges Fence Derno ELECTRICAL PERIIIT Charges and Surcha rges Sidewalk A/C Pavi ng Tota'l Comb. Permit I,IECHANICAL PERMIT Charges and Surc ha rges Curb Cut TOTAL I\ .J\--.tr'(l.tQ-- GN I LAI.I ;I (}R5 'N -G-- COI'IBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description l. example- Tax Lot 100, Lane County Map Referencel7 03 432. example- Lot l. Block 3, 2nd Addition to Sffin-g--field EstatesC. Name, etc. of owner and construction lenderD. Energy Sourcesl. 2.E. Squa or forced air gasexampl e- hea t/e_l sglll se_l_ clilj ngl exampl e- waterheater/ei ectri ca I /oiET6-ota9e or valuation, EEil-r sol-a r F l. example- 1250 sq. foot house, 500 sq. foot garage2. exarTrpTe- JT-i-ew project, check-new - it adoition, check add, etc. Building permit information:1. examp l e a ttac hed - construct single family house with an garage II III IV 2, example - remodel existing garage into family room3. example - convert single family residence into Es ti-urant ( change of -use )G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriatepersons regarding design information or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in oniy the No. Boxes adjaientto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedulesare avai lable at the Bui)ding Division1. To conserve space on the perm.it form the schedules have been abbreviated?. If the 'item(s) to be instailed are not covered onthe abbreviated schedules you should consult thefuI I schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be del.ivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is.not authorizedto sign the electrical 'label. Appf icant to sign and date [,Jhenever possible, the.in.i tial application will be, used asa.worksheet only. Hhere possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actuai permit is issued for hissi gnature. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans will be processed until thesefees are paid. AlI other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLYv PERMIT VALIDATION \1r, \S8fr Perm'it Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit applicant exempt from registration with the Builder's Board because: nal Project Information:Add i PLANS REVIEWED BY: name date -EL/natures'l g