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Home My WebLink AboutPermit Building 1983-10-12lt NL ilE m COIIBIiIATION APPL I CATION/PERMIT 726-3753 Job Address 4 EIIERGY SOURCES Hea t l.Jater 1 . Ftg. Sq. Ftg. Access Sq. Ftq. Other l,ler^r Add -Fence c ha nge/U se -0t 0 s $ 0wn Address Bui ldinq Perm'it Info: Describe l,lork( FamiIy Residence l'lith Attached Garage .€., BUild Single -ffi )\ Addre s s Phone DL5TGN ILAI.I name addre s s exDl res ohone no. Primary Structura l E l ectri ca1 Hechan i ca I CONTRACTORS name add res s lics. no-exD ! res l ohone no. Genera I )ql 1c\-.\,,-\l Pl umbi nq El ectrical l,lechani ca I PLUI,IB i NG ELECTRI CAL MECHAN I CAL FEE CHARGE NO FFF cllapcF NO FFF .HARGF Each single fixture Residence of SQ FT furnace/burner to BTU' S Relocated building (new fix. additional) New circuits alts or extensions Floor furnace and vent S. F. Residence ( I bath)SERV I C ES Recessed wal 1 Snarp hpatcr and vpnf Duplex (l bath) each Additiona'l bath Temporary Constructi on Apol iance vent seDa ra te l,later servi ce Change in existing rpq i denre Stationary evap cool er Sewer multifamily, conrn. or lndustrial Vent fan with s inole duct Storm Sewer 0f amps.Vent system apart from heatino or A.C. cor,lr.r. /IND. FEEDERS Mechanical exhaust hood and duct Insta l I /a l ter/rel ocate dist-rib. feeders l'lood stove/heater 0f amps. ISSUANCE OF PFRI{IT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES l.lHERE STATE Lll.l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pernit shall 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 apolication for oermit, and do hereb.y certify that all information hereon is true and correct, and I further certif-v 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 Oregon oertaining to the work described herein, and that N0 0CCUPAI'ICY will be made of any structure without the permission of the Building Division. I further certify that my registration vrith the Builder's Board is in ful'l force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and enrpioyees who are in comcliance with OPS 701.055 wi1l be used on this project. r{AtrE(p'rease pr:^tl ?rvCL il, Prock S I GNATURE o-t2- Zone----Type/ con s t _-ts Sq. Ftg. l'lain -"- x Value_ Fire Zone Bedrooms 0ccy Load Sq. Ftg . Access Val ue Flood Plain Stories 0cc.y Group !q. Ftg. 0ther x Value_ TOTAL VALUATION BUILDING PERNIT Clrarges anC Surcha rges Plan Ck. Corrn/Ind 65%/81do Per Fee Svs tenr Cha rqe s Deve 1. 57(opment Plan Ck. Res 30%/81dq Per Fee PLUI4BING PERMIT Charges and Surcha rge s Fence Dgmo ELECTRICAL PERIlIT Charges and Surcha rges Si dewa I k A/C Paving Total Comb. Permit I,IECHANICAL PERMIT Charges and Surc harge s Curb Cut TOTAL {T),'IZ Legal Oescriotion \-l NV ,$-..fnonu \t) I rf\= COI4BINATION APPLICATION/PERI,IIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Descriptionl. examp'le- Tax Lot 100, Lane County Map Referencel7TfT32. examole- Lot l. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION l. examol e- ^.--------r-a, examD I e-+t. Square foota heat/electrical cei I i r forced air gas ura e ec or sofar ge or valuat on, eIexamp-le- 1250 sq. foot house, 500 sq. foot garageelample- if new project, check-new - if addition, check add, etc. 2. F. Building permit information:1. example - construct single family house with anattached garage ?. examp]e - remodel existing garage .into family room3. g&!ple - convert single family-residence inio _ ;EsTilrant (change of"uie)G. Value of work ai defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construct.ion delays, BuildingDivision Staff must be able to contatt appropriitepersons regarding design information or job s.itecorrections, 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 only the No. Boxes adjaientto the appropriate item(s) to be installedB. Fu'll Plumbing, Mechanical, and Electrical Schedulesare available at the Building Division1. To conserve space on the-permit form the scheduleshave been abbreviated2. If the item(s) to be instaljed are not coyered onthe abbreviated schedules you should consult thefu l I schedu'lesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the iabel must be delivered to theelectrical contractor for signature by his electrica'lsupervisor, The general contractor ii.not authorizedto sign the electrical Iabel.Applicant to sign and date I'lhenever possible, the initial app)ication wilI be used asa.worksheet only. l.lhere possible, Building D.ivision Staffwill prepare a type written copy and returiit to theapplicant at the time the actual permit is issued for his s i gna ture. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans wiil be processed until thesetees are paid. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY II III IV t v Permit Cl PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit app)icant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: name S'I gnatu re date *,rqb, \q/ \D, .