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Home My WebLink AboutPermit Miscellaneous 1990-2-12 ] INSPECTION LINE 726-3769 . J -. I NFORl1ATlON LI Nl 726-3753 Sq. Ftq. 11ain ~q. Ftg. Access. Sq. Ftg. Other " New Add Alter Rep. -, V ,..:::::a- -Fence Demo Change/Use .S) ValuE ~t)~1)~ Other- - 0 BuildinQ Pe~lit Info: Oescrlbe Work{ i.e. I Build Single I\l J ~~~~;i%:~~~~' ,~ ,\ M.f\ UJ.<\) N\ l\tl\AV \ -\',-\\ (lies. no.) '. eOireS'), (ohoneno.1 U _.J~~. ~ V"~ CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat Nater Heater Range_ Job Address 3584. Marcola RC'l"rJ Legal De<<ript!on ;;"... H 1 ?('I?_ ,('I-()('I Owner Lnt- 1 a':lQ r'A-J::J>j _ r:.J: ~1'.~ld o Address Construction Lender. Address OE~lbN TlAI1 Primary' Structural Electrical Mechanical CONTRACTORS General Pl",Mr.() Plumbina .~:a.MF. 11.c:. aR"Vl:i' ", Phone (namel Phone {address\ .. (name} (address' {lie,,", no.l . " p_n_ R~y 11~~Q. Pnr~l~n~. no 07~" lexoires.' (ohone no. \ ~lechanical Electrical .c:.aMR .a.c:. 1\R('\"~ NO. I Each single fixture PLUI1BING ELECTRICAL MECHANICAL I FEE I CH~RGE Nn. I Residence of FF~'..c.J:iAIW1=" NO. ~~I=" n:ARfiL SQ. FT. furnace/burner to BTU's New circuits alts. or extensions Floor furnace and vent Relocated building, (new fix. 'additional) S.F. Residence (1 bath) Duplex (1 bath) each .t Additional bath " Water serv; ce Sewer Storm Sewer Recessed wall So~rp heatpr ~nd vpnt" SERVICES Temporary Construction Change in existing res i QCJ1Cf> multifamily, camm. or Industrial I Appl iance vent sPD3ratp S-tationary evap. cooler Vent fan wi th sinole duct Vent system apart from heating or A.C. Mechanical exhaust hood i1.nd duct IDf COMM./IND. FEEDERS Install/alter/relocate rlic;.trib_ fppdero;. amps. Wood stove/heater Of amps. I SSUANCF OF PFRIIl T TOTAL CHARGES TOTAL CHARGES , TOTAL CHARGES WHERE STATE l;'l~ REQUIRES that the Electrical work be done by an,:E1ectrical Contractor, the electrical portion of this pemit shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED 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 performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein. and that fW OCCUPAlKY 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 pro' t. HMIE(please print) Zo~e Fire Zone Flood Plain BUILDING PERIIIT Charges an~ Surcharges PLUI1BING PERMIT Charges and Surcha rges ELECTR I CAL PERil! T Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges DATE? JO,Jc;(./ " Value Value Value JIM FLESHMAN LIe. #1480S SIGrlATUR FOr. OfFICE ~OHLY ~ Type/Const. Units Sq. Ftg. 11ain Bedrooms Occy Load Sq. Ftg. Access Stories Occy Group Sq. Ftg. Other x x x e;\\vv~, \f\ . .- () Plan Ck. Comm/Ind rJ \::.:;J"'" . 65'l1l\ldn pl"r Fpp -- - ---- Plan Ck. Res . 30%/Bl dQ Per Fee 1\(') \~ C\ , '.\:- , ) -~ TOTAL VALUATION Systems. Development CharQe (1.5~ . Fence D~RlO' 'S1dewalk AIC Paving Total Comb. Permit Curb Cut c:€r I TOTAL I ~ ,/ .' " . . .' ,.. COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot I. Block 3, 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources . 1. example- heat/electrical ceilinq/or forced air Qas 2. example- waterheater/electr1cal/or ~ 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, c,heck add, etc. F. Building permit information: 1. example - construct single family house with an attached garllge 2. example - 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 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 n~ed 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 SCHEDULES 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. --- Ill. Applicant to sign and date Whenever pOSSible, the initial application will be used as a worksheet only. Where possible, Building Division Staff will 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 fees are paid. All other fees and charges are due and payable when the permit is issued. " " \ >(r VvPO ~ q) ~r \ f}- ,I \ " " ' " ,'. ,,' '. , , V. FOR OFFICE USE ONLY Permit' Clerk Q~ PROJECT CONDITIONS TO BE SATISFIED BEFO.RE OCCUPANCY: .,.'.... ,'; - " , Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date r I Ran!1e J I INSPECTION LINE f726-3769 ,I Job Address OQ '6 ~ (legal Oeser; pt i on ~ \(1 J\C'f)~() ) TY F SPR NG IELO COMBINATION APPLICATION/PERMIT EIIERGY SOURCES, Heat Hater Heater Sq. ~q. C1J ..n - o cp --- Owne~0~1\~ ~ ~'10{'(r\) A~\ ~) . ~ ~T Phone )JM-) ( _ _). qi411 on L der Phone (address \ Address DESIGN TEAI1 (name) Primary Structural Electrical Mechanical CONTRACTORS (name) {address \ Genera 1 PlumbinQ Electrical ~ \ {l . ValuE of H'f\ 1(1) Buildino Permit! info: Describe Work{Le.. Build Single :~~~r~~'~R 6t"' -h000\ \ - ni~s. no. ,D rexnires1 *' " x- IVlO \ f ohoop n('l, I f" (l ics. no.' (pxoires) (ohone no. \ \"'\(")-\1 .,- ~l(\ Ci't\('01 _ \J\ ~\- - ~ ~ ffi, ~ ~ '" ~'~ 1 Qh- "\ ~ - '\ \ - . I ~l \ 3 ~ I) '" ~'echani ca 1 PLUllB I NG NO. FEE CH~RGE NO. Each single fixture Residence of Relocated building (new fix. additional) New circuits alts. or extensions S.F. Residence 11 bath \ Duplex (1 bath) each Additional bath SERVICES ELECTRICAL MECHANICAL FFF ':HARGF tin. FFF r.I~ARGF SQ. FT. furnace/burner to BTlI's Floor furnace and vent Recessed wall Sn~~p hPntpr nnd vpnt Storm Sewer Of amps. Apol;ance vent Sf'oarate Stationary evap. cooler Vent fan with sinale duct Vent system apart from heatinq or A.C. Mechanical exhaust hood and dud ~Ia ter serv; ce Temporary Construction Change in existing res.;denq' multifamily, comm. or Industrial Sewer COM/.I./IND. FEEDERS Install/alter/relocate d;c;.trih. fppdprs Of Wood stove/heater amps. TOTAL CHARGES WHERE STATE LAH REQUIRES shall not be vali1 until the . TOTAL CHARGES that the Electrical work be done by an. "Electrical Contractor. the electrical portion of this pemit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAfHNED the completed apf11ication 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 Springfield and the Laws of the State of Oregon pertaining to the work described herein. and that'rW OCCUPAlKY 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 7(')1.055 l'lill be used on this project. FLr;ltt SIGIIATURE~~ FOP. OrFICE USE OIlI.Y Sq. Ftg. f1ain Sq. Fta. Access Sq. Ftg. Other IWoIE(please printL.J)AV; d Zone Fire Zone Type/Const. Bed rooms Units Flood Plain Stories Occy Load Occy Group BUILDING PERHIT Charges and Surcharges Plan Ck. Comm/Ind ____________~/Rldo Per Fpe Plan Ck. Res 30%lBldo Per Fee Fence O~mo' PLU!1BING PERMIT Charges and Surcha rges ELECTRICAL PERI\IT Charges and Surcharges ---J2 'd / Curb Cut 'Sidewalk AIC Paving MECHANICAL PERMIT Charges and Surcharges ISSUANCF OF PFR!IIT TOTAL CHARGES DATE./.,t/j ~ x Value Value Value x x TOTAL VALUATlOII Systems Development Charqe (1.5~) . Total Comb. rermit TOTAL ~. J . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION J. Applicant to furnish A. Job Address B. legal Description 1. example- Tax Lot 100. Lane County Map Reference 17 03 43 2. example- Lot 1. Block 3. 2nd Addition to Sprlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceiling/or forced air qas 2. example- waterheater/electrical/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 as defined in Section 303 (a) 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. 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 SCHEDULES 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 Whenever possible, the initial application will b~ used as a worksheet only. Where possible. Building Division Staff will 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 fees are paid. All other fees and charges are due and payable when the permit is issued. V. FOR OFFICE USE ONLY ~-CS1 \ I)~ \cs4'60 Permit Clerk ~D~) , J PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date