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Home My WebLink AboutPermit Building 1980-12-08L CITY OF SPRINGFIELD COMBI IIATION APPLICATION/PERMIT 726-37 53 Job Address Gar oesc"iption )-)OZ3 b3+ EIlERGY RCES Hea llater Heater Ranqe !q. Ftg. Access._ -l'lewJdd Al1ea,e,. _Fence_Demo Change/Use 0ther 0ther n So. Ftg . Ftg. Val ue of l,lork 0wne Descri Workn e Sing eItnAddr6s s Phone (ll nr{Con s tructi on \ c0q o\ N Addres s Phone I CS. nO.exoi res ohone no.DES i GN TEAII name addre s s Primary Str"uctura I El ectri cal l'lechani ca l addrpss'lics. no-)exDlres )CONTRACTORS name (-\ a'\f\o \-Generai \ PI I I El ectri l'!echa n i EL ECTR I CAL MECHAN ICALPLUTIB I NG FFF .HARGF NO CHAPGFiiO.l FEE CHARGE NO furnacelburner to BTU' s Each single fixture Residence of FTSQ Relocated bui Iding (new fix. additional ) New circuits alts. or extensions Floor furnace and vent S ERV I CES Recessed wal I Snace heatpr and vent S . F. Res i dence('l bath ) Duplex (1 bath) each Temporary Constructi on Apol iance vent seDa rateAdditional bath Stati onar.y evap cool erl,Jater serv ice Change in existing res i dence Vent fan with sinole drrctSewerI ndustri a.l multifamily, comm. or 0f Vent systern apart from heatinq or A.C,Storm Sewer c0r,1r.1. /IND. FEEDERS Mechanicai exhaust hood and duct l'Jood stove/heaterI nstal I /al ter/rel ocatedistrib. feeders 0f -amp s. ISSUANCE OF PFRIIiT TOTAL CHARGES TOTAL CHARGESTOTAL CHARGES I^IHERE STATE LAI'I REQUIRES that the Electrical wo shall not be valiC until the label has been signed rk be done by an Elec by an Electrical Contractor, the electrical portion of this permittricai Supervisor and returned to the Bui)ding Division I HAVE CAREFULLY EXAMINED the completed application 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 NC 0CCUPANCY will be madeof any structure without the permission of the Building Division. I further certify that my reqistration urith 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 ernployees who are in comcliance with 0l?S 701.055 vlill be used on this nroject, tlAl''lE(p1ease print)S IGiIATURE (oFt-.r a C. A+-.x DATE { Ftg Ftg Fts Val ue TOTAL VALUATION--. x x Load luee/Const Group Bed rooms Sto ri esFlood Plain 0the r Fi re Zone Zone Val ue l'la i n Acces s ni ts So Plan Ck. Comm/ind 65%/B1da Per Fee Svstems Develogment charqe (t.sq)'BUILDING PERI.lIT Charges and Surcharges Plan Ck. Res 30%/81dq Per Fee Fen ce ,€oPLUI'4BING PERMIT Charges and Surcha rges Derno SidewalkELECTRICAL PERI|IT Charges and Surc ha rges OC> Total Comb. PermitA/C Pavi ng Curb Cut14ECHANiCAL PERMIT Charges and Surc harges &D I TOTAL .fr- ) \ nhnnp nn L t-oP otFIa COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, Znd Addit.ion toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION i. exampi e-2. eramETe--E. SquaiE-6otag heat/el ectrical ti or forced air gas water r e ec or soTar e or valuation,c ;I 1. exanple- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check-i-ew - .if aodition, check add, etc.F" Bui lding permi t infcrmation:1. llqlnple - construct singie family house with anattached garage?. example - rernodel existing gar.age into family room3. **plE - convert single iailily"residence intorestaurant (change of use)G. Value of work as defined in Section.303 (a) of theStructural Specialty CodeH. DESIGN TEAI4 AND CONTRACTORS To avoid design or construction dela_vs, BuildingDivision Staff must be able to contact appropriatepersons regarding design informat.ion or job site correc Li ons , etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. [xcept vrhere blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjacentt0 the approoriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Building Division1. To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consuit theful I schedulesC. BUILDING DIVISION STAFF l.JiLL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electrjcalsupervisor. The general contractor is not author.izedto sign the electrical label.Applicant to sign and date Whenever possible, the initial application will be used asa worksheet cn1y. Where possible, Build.ing Division Staffwill prepare d type written copy and return it to theapplicant at the time the actual permit is issued for his s i gnature. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no pians will be processed until thesefees are paiC. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY III IV Permi t Cl erk PROJECT CONDITIONS TO BE SATISFiED BEFORE OCCUPAI{CY: Permit applicant exempt from neg'istration with. the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: name s'l gna tu re da te COMBINATION APPLICATiON/PERMIT (CAP ) Appticant to furnish A. Job Address B. Legai Description 1. examole- Tax Lot 100, Lane County Map Referen TTTTI:?. gxamplq: Lot-l. BIock 3, ?nd Addition to Sprrngfield Estates C. Name, etc. of owner and construction 'lender D. Energy Sources heat/el cal cei I i wa or e or valuation, 1. example- 1250 sq. foot house, 500 sq. foot ga ?. example- if new project, check new - if addit - check add, etc. F. Building permit infcrmation: 1. examole - construct single family house with attaclea garage 2. examole - rernodel existing garage into familj 3. .*mn-g - convert singie iamiiy-resiOence in1 restaurant (change of use)G. Value of work as defined in Section 303 (a) of tl Structural Specialty CodeH. DESIGN TEAI.I AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriat persons regarding design information or job site. correct ions , etc. II. Abbreviated Plumbing, ltlechanical, & Electrical SchedrA. lxcept r,rhere b]ank spaces occur in the descriptir portion of the i'lechanical and Electrical Schedulr the applicant need fill-in only the No. Boxes ad. to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedu' are available at the Building Divisionl. To conserve space on the permit form the schr have been abbreviated2. if the item(s) to be installed are not coverr the abbreviated schedules you should consultfull schedules C. BUILDING DIVISION STAFF HILL FILL OUT ALL FEES AI CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered eiectrical contractor for signature by his elect supervr'sor. The generai contractor is not autho to sign the electrical label.III. Appiicant to sign and date Whenever possibie, the initial application will be u .-. a worksheet only. Where possible, Building Division if,will prepare a type written copy and return it to th. appiicani at the time the actuai permit is issued fo}-,,.- s i gnatu re.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. AII other fees and charges are due and payable when the permit is issued. V. FOR OFFICE USE ONLY CITY OF SPRINGFIELD City Holl Springfield, Oregon Deportment of Public Works OFFICIAL RECEIPT No. B 55330 1. examol e-2. Exlrni-l e--E. SquaFE-E6tag ( ( C ( Dote Address l9 r c C ( ( ( ( ( ( ( ( 6) \ n a'q*r\.30- Received OO c \ ( C ( (; Amount Received (-t SIGNATURE SXEL'OR.TUINIULL FRIXTEIS . EUGCNE OF E7'O' 5'!II.! Permi t Cl erk____ \_--l PROJECT CONDITIONS TO BE SATISFiED BEFORE OCCUPAIICY: Permit applicant exempt from registratjon witlr. the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: -date name Si gna tu re (