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Home My WebLink AboutPermit Sewer Connection Record 1981-7-17 , I INSPECTION LINE 726-3769 I f \ ,\ ) > CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT I-'?~/ / . ":2 fJ Building Permit Info: tescribe Work {I.e., Build Single Phone/<4' (0 - J()~JJ Family Residence With Attached Garo!:lo) ~E,(?A/',eS k .~.tUe.a 447cB"qL /'1P/AJ6 l)/~ t:/,P ~,e~PA//) tJ.LeAN-"d7 Au/) &?AI/~ ex-~.scD , Job Add,... 6..:'2R,,-') - /'1A)# S- l.gol D."dp'lon 5Lf 00 - 11 () 2- 34 L/ () I Own., ,L, /lEAV/L/A/ I Add,... 0sJ'5 - ~/A; 5T I .5PR./~/F/eL D C)R. 97<177 I Construction lender I Address I DESIGN TEAM I Primary I Structural I Electrical I Mechanical Phone (oddren) (nome) CONTRACTORS (name) (oddren) General J Plumbln. ,# Ie? Electrical Mechanical PLUMBING NO. I FEE \ CHARGE NO. 1 Residence of . INFORMATION LINE 726-3753 ENERGY SOURCES: Heat Water Heater Range I Value of Work: Sq. Ftg. Main Sq. Ftg. Access. Sq. Ftg. Other _New~Add_Alter_Rep. _Fence_Demo_Change/ Use _Other (Iic5. no.) (phone no.) (expire5) (Iin. no.) (expires) (phone noJ '.\\ ~-o. !.~~_J <~( I ;/--~ 1 // ~._\ ElECTRICAL MECHANICAL FEE ~ CHARGE NO. I Each sin~le fixture Relocated building (new fix. additional) S.F. Residence (1 bath) "".ft. New circuits, alteration5 or extensions , . furnace/burner to . lTU's Appliance vent separate Stationary evap. cooler Vent fan with single duct Vent system apart from heating or A.C. Mechanical exhaust hood and duct SERVICES Temporary Construction Duplex (1 bath) each Additional bath Amps. Water service Sewer Storm Sewer FEEDERS Amps. TOTAlCHARGES#d hE TOTAL CHARGES Wood stove/heoter Heat Pump Air handler 10 10.000 CFM Air handler over 10,000 CFM ISSUANCE OF PERMIT TOTAL CHARGES M f\.. ~ ~ ~ FEE I CHARGE WHERE STATE LAW REQUIRES that th. Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall not b. valid until a label has bHn signed by an Electrical Contractor and attached to the electrical panel. 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 Stole of Oregon pertaining to the work described herin, and that NO OCCUPANCY 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 os required by ORS 701.055, that if exempt the basis for exemption is noted heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. N::f~~I.BOU.~d::::,=: :.m~;o~ \ y,-I~SIGNATUR4,vj ~L./IAw j!i~J~J DATE :~ /'7/~' FOR OFFICE USE1S'NLY Zone Type/ Comt. Units Fire Zone Bedroom- t"\ccy load Flood Plain Ctori"~ .....ccy Group BUilDING PERMIT Plan Ck. Comm/lnd Charges and 65%/ BldCl Per Fee Surcharges Plan Ck. Res 30%/ BldQ Per fee PLUMBING PERMIT Charges and fence Surcharges Demo elECTRICAL PERMIT Charges and Sidewalk Surcharges AIC Pavin" MECHANICAL PERMIT Charges and Curb Cut Surcharges -------- Sq. Ftg. Main c:."". Ftg. Access Sq. Ftg. Other x Value Value Value x TOTAL VALUATION Systems Development ChorQe (I .5%1 Total Comb. Permit TOTAL ;,.-.",=, ~ \ (.) COMBINATION APPLlCA liON/PERMIT I. Applicant to furnish A. Job Address B. Legal Description 1. example-tax lot 100, Lone County Map Reference 17 03 43 2. example.Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example-heat/electrical ceiling/or forced air gas 2. example-wat"er heater/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. examole.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 Speciolty Code H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building ~ivision Staff must be able to contact appropriate persons regarding design information or job site corrections, etc. II. Abbreviated Plumbing, Mechonical & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechonical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjocent to the appropriate item(s) to be instolled B. Full Plumbing, Me<:honical, and Electrical Schedules are available at the Building ~ivision 1. To conserve space on the permit form the schedules have been abbreviated 2. If the item(s) to be instolled are not covered on the abbrevi. ated schedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES 111. 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 typewritten 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 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: PLANS REVIEWED BY: name eignatur: \ ptMIT V AL;O;TION .-/ Permit Cler;, ~ate ~