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Home My WebLink AboutPermit Miscellaneous 1989-10-3 II'ISPECTION LINE . CITY U~ SPRINGFIELD 726-3769 COMBINATION APPLICATION/PERMIT .z, EIIERGY SOURCES: Job Address :::s ~fll:') ~ jI?~CJ1L / J.'Z::> Hea t Legal De5cription Water Heater Range__.=_____. ValuE of Hark: Owner~7'..... ~ ~?/.h"~~~ Address 2~ ;:Y't? S-J?tfZ?~ ~ Phone /'5~l>. """,,"/9- ,. i r Construction lender Address DlSIGN IlAl1 . INFDRlIATlON lINl 726-3753 Sq. Ftg. Hain ~q. Ftg. Access. Sq. Ftg. Other Ilew Add A Her Pep. --Fence Demo Change/Use -Other- -- ~ ~ ...... BuiltiinQ Permit Info: Oeser.be Work(i.e.. Build Single Familv llesidence Hith Attached GaraC1e) 6RAz>/""""= -? fi~ ~ L:; . ~,,-- -,- .. / ,~/~ '/J1I"':7/A'J~~,... lname) Phone (address I fohone no. I Primary Structura 1 Electrical 11echanical CONTRACTORS Iname) Ganera 1 L / 70/' Plumbina F1~rtric;!.l ~'echanical PLUf.lBING NO. FEE CH~ j1n Each single fixture Residence of Relocated building (new fix. additional) flies. no.1 (exoires) {address' (lies. no.' A ,~ ..~ (exDir~) ~ (ohonp no. \ ELECTRICAL MECHANICAL --E.E.L..GliARliE. NO" FFL.c!lABliE. SQ. FT. furnace/burner to BTU's New circuits alts. or extensions Floor furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall So~~P hpatpr and vpnt amps. Appliance vent <;.poaratp Stationary evap. c;onlpr Vent fan with sin91e duct Vent system apart from hp~tinq or A.C. Mechanical exhaust hood and dlJ~t Water service Temporary Construction Change in existing rp<;.jqencp multifamily, comm. or Tndustri~l Sewer Storm Sewer Of CO~1./IND. FEEDERS Install/alter/relocate di<;.trib. fperlPrs Of Wood stove/heater amps. ISSUANCF OF PFR'llT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L"/ REQUIRES that tile Electrical work be done by an,'Electrical Contractor, the electrical portion of this permit shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXM11NEO 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 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 UO OCCUPAUCY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s 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 7nl.055 will be used on this project. IWIE(please print).f?Oj IY7IJIt/..-5 SIGIlATUR~ FOn OFFICE USE 0I1LY Sq. Ftg. IIain Sq, Ftg. Access Sq. Ftg. Other Zone Type/Canst. Bedrooms Units Occy Load Occy GrouD Fire Zone Flood Plain Stories BUILDING PERfIlT Charges and Surcharges Plan Ck. Comm/lnd 65%/Bldo Ppr Fpp Plan Ck. Res 30%/Bldo Per Fee Fence PLUliB ING PERMIT Charges and Surcharges D~mo ______ ___ __J Sidewalk I' AlC Paving ____________, Curb C~t I ELECTRICAL PERIHT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges DATE~...t:/7~: x Value Value Value x x TOTAL VALUATlOtI Systems Development Charoe (1. 5~ R~L. ~G'~~. I I ,I I' I Total Comb. Permit C-"?Y"' AL ~ TOTAL~/r. / r F -== .. . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION 1. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 43 2. exa~le- Lot 1. Bloc~ 3, 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender O. Energy Sources '. 1. examQle- heat/electrical ceiling/or forced air Qas 2. examyle- waterheater/electrlcal/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, check add, etc. F. Building pennit information: 1. exam~le - construct single family house with an attached garage 2. example - remodel existing garage into family room 3. exam~le - convert single family residence into restaurant (change of use) G. Value of wor~ as defined in Section 303 (a) of the Structural Specialty Code H. DESIGN TE~l 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 OIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES o. 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 chec~ 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. #/oO~ [0,3.84 V. FOR OFFICE USE ONLY Pennit Cl erk . PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because:. Additional Project Infonnation: PLANS REVIEWED BY: ,-, .. . ~ name L&?..iII?,gE.~"""""'~5ignature ~~.-. ./ date/L5l~?-8"3. ,- I /~ n u . INFORltATION LlN' 726-3753 Sq. Ftg. Main ~q. Ftg. Access. Sq. Ftg. Other lIew Add Alter pep. -Fence Demo Change/Use Other- - =>\) ~ - ICJ ~ II INSPECTION LINE n 726-376g . Job Address 3fi85fV1avC/JICL Legal Description \'1 ()'A?D()() CITY UF SPRINGFIELD ~ CDMBItIATlDN APPLICATION/PERMlT EIIERGY SOURCES: Heat I~ater Heater Range /2dJ Owner & -Iv, iJ t-'::yA-d~ Address d-d- '':) . 5ff{ ~ f- .')~ Constr;;-cUion lender Phone V~';)f\ 1'/Ot[D,cO BuilciinQ ~ennit Info.: .Descr,be Work.(i..e., Build Single ~a ilv Residence With Attached Ga~a~e~_ ~ . .2Q~f\f): ~~ ~ .... ~~/...~~.....- F~&c..~~<" .r , - - t!5ri:::..~~.;:y~ ~J.7../ 2'~ (lies. no.) (exoires) (ohane nO.l - Address DESIGN TEAr1 (name} Phone (addressl Primary Electrical "* Structural Mechanical CONTRACTORS (name) Genera 1 (') .f.r -1 ocr ~ Plumhina (address 1 (1ic~_ no.) (exoires) (ohane no.) Electrical ~'echanical . PLUlIBING ELECTRICAL I FF L J:HARG.E. NO, MECHANICAL --.lli1. FFF r.IIARGF NO FFF r.1IARli[ SQ. FT. furnace/burner to BTU's Each single fixture Residence of Relocated building (new fix. additional) S.F. Residence (J bath) Duplex (1 bath) each IAdditional bath I ~Ia ter servi ce ] Sewer "'77'2l ~torm Sewer New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall SD~C~ h~~tpr ~nd vpnt II/IJ. ,.. Of amps, Appliance vent s.~Darat~ Stationary evap, cooler Vent fan with s.inole duct Vent system apart from heatina or A.C. Mechanical exhaust hood ~nd duct Wood stove/heater Temporary Construction Change in existing res.J de.ncp multifamily, comm. or Industrial COMfI./IND. FEEDERS Installlalterlrelocate d;~trih_ fppdpr~ ~. ' Of amps. e;. '=-'-' ~>/,.-__('" ~~......, ~ ~ ;4,ce. ~A/A/ -S ~A'7<__ /.,.-< --=y. ISSUANCF OF PFRllIT /-:;: :"'7/=/7"". TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L'W REQUIRES that tile Electrical work be done by an. Electrical Contractor, the electrical portion of this permit shall not be valid 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 oerformed shall be done in accordance with the Ordinances of the City of Spri ngfi e 1 d and the Laws of the Sta te of Oregon pertai n i ng to the work descri bed herei n. and tha t IlO OCCUPAIKY wi 11 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 project. .$.A"";.-V~ SIGIlATU~~~_ .-/ DATE/~~' FOr. OFF I CE USE OIIL Y Sq. Ftg. Sq. Ftg. Sq. Ftg. IWIE(please print) Po,," / Zone .1.1 / Type/Canst. Bedrooms Stories Units t1ain x Value Access x Va 1 ue Otherhw-.. f~~'!!Ta1ue TOTAL VALUATION Fire Zone Occy Load Occy Group Flood Plain BUILDING PERfllT Charges and Surcharges Plan Ck. Comm/lnd ____________.....2.2l/Rlrlo Ppr J:'P~ Plan Ck. Res 3D%/Bldo Per Fee _~_~~~~__ Fence DfIR10 Systems Development Charqe (I.5~) PLU!~BING PERMIT Charges and Surcharges ELECTRICAL PERliIT Cha rges and Surcharges /IECHANICAL PERMIT Charges and Surcharges 'Sldewalk AIC Paving " - A/c> rel!!F . Total Comb. Permit Curb Cut TOTAL~~. #'~ ., . . COMBINATION APPLICATIONIPERMIT (CAP) PERMIT VALIDATION 1. Appl icant to furnish A. Job Address B. Legal Description I. ~xample- Tax Lot 10D. Lane County Map "Reference 11 03 43 2. example- Lot 1. Block 3, 2nd Addition to' Springtield Estates C. Name. etc. of owner and construction lender O. Energy Sources .. 1. example- heat/electrical ceilinq/or'forced air OdS 2. example- waterheater/electrlcal/or ~ E. Square footage or valuation. etc. , I. example- ]250 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. examFle - remodel existing garage into family room 3. exam~le - 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 I. 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 OIVISION 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. \ O.Jf}-g<1 ,~I~ ~" " V. FOR OFFICE USE ONLY Pennit Clerk MlO~ / - . PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Pennit applicant exempt from registra~ion with the Bui~der's Board because; Additi ona 1 Project Infonnatton: "., . . ~ " l name ki~j~F h~~ '.'-. signature ~__~.::.~.? -/; ,- . PLANS REVIEWED BY: date /~"'7t7 ~ ~