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Home My WebLink AboutPermit Sewer Connection Record 1981-7-27 INSPECTION LINE 72W769 4t CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT . INFORMATION LINE 726-3753 Job Address 6A3/) - Nh'/N' .S'r ENERGY SOURCES: Sq. Ftg. Moin Sq. Ftg. Access. Sq. Ftg. Other _New_Add_Alter_Rep. _Fence_Demo_Change/ Use _Oth"" ~ ~ IcS ~"I D'd~~L\L\O Own" /if, C, /.::1/ A::::.K ~ fr7 /? ~,/ 1// - /? r:7~ 21 0 F :iuilding Permit Info: Describe Work (Le., Build Single Address7...~..J.:'~o .-/~/A.e~LA ~hon&;l'.:J3- 0..,.::). )amilv Residence With Attached Garage) ~Pr'../:l..i./9 SgkN:FJ6 ~Te:F'/.?AL .to/-J//u& CJ~ Heat Water Heater RanRe Value of Work: Legal Description Construction lender Address DESIGN TEAM Phone (nome) (address) (lies. no.) (expires) (phone no.) Primary Structural Elftdrical Mechanical rnNTRACTORS (name) (address) (ljcs. no.) (expires) (phone no.) Gftnftral Plumbing }fIn / Eledrical Mechanical PLUMBING ELECTRICAL MECHANICAL NO. I FEE I CHARGE NO. I FEE I CHARGE NO. FEE I CHARGE Relidence of 'furnace/burner to I:!.TU's Appliance vent separate Stationary evop. caoler Vent fan with single duct Vent system apart from heatinR or A.C. Mechanical exhaust hood and duct Each sinQle fixture Relocated building (new fix. additional) S.F. Residence (1 both) ,q. ft. New circuits, alterations or extensions SERVICES Duplex (1 both) each Temporary Construction Additional bath Amps. Water service Sewer Wood stove/heater Storm Sewer FEEDERS Heat Pump Air handler to 10.000 CFM Amos. Air handler over 10,000 CFM ISSUANCE OF PERMIT TOTAL CHARGES,,(), /0-E" TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall not b. valid until a label has been signed by an Electrical Contractor and attached to the electrical panel. NAME (ple..e pdnt) ,/Jj 1/? V / 1.1/ . I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true and correct, and I further f;ertify that any and all work performed shall be done in accordance with the Ordinanc:es of the City of Springfield and the Laws of the State of Oregan 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 c:ertlfy that my registration witt. the Builder's Soard is in full force and effect a s 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. 4q.;/f~' c,LA"~E..7~f/ G I Balis for Builder's Soard exemption: (: /3 u c /( t-1,:~ATURE FOR OFFICE USE ONLY Zone Type/Const. Units Fire Zone Bedrooms nccy Load Flood Plain 'l:.tori'" t')ccy Group BUILDING PERMIT Plan Ck. Comm/lnd Charges and 65%/ BldQ Per fee Surcharges Plan Ck. Res 30%/ BldR Per fee PLUMBING PERMIT Charges and Fenc:e Surcharges Demo ELECTRICAL PERMIT Charges and Sidewolk Surcharges AI C Pavina MECHANICAL PERMIT Charges and Curb Cut Surcharges -------- '1:.""" ftg. Main Sq. Ftg. Access Sq. Ftg. Other Value Value Value TOTAL VALUATION x Systems Development Chare.e (1.5%) Total Comb. Permit TOTAL COMBINATION APPLICATION/PER. (C~P) I. Applicant to furnish A. Jab Address B. Legal Description 1. example-tax lot 100, Lane County Map Reference 17 03 43 2. example-Lot 1. Black 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-water heater/electrical/or solar E. Square footage or valuation, etc. 1. exomple.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 af 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 abbrevi- ated schedules you should consult the full schedules C. BUILDING DIVISION STAff WILL fiLL OUT ALL fEES AND CHARGES ON THE SCHEDULES III. 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 c;ignatur'" .PERMIT VALIDATION Permit Clerk '~ato ~