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Home My WebLink AboutPermit Signage 1989-5-8 ~lll1~l'lCTIOII lHll 726-3769 Job Address ,-~~q ~ \\\t\ ~ 'f\ ,-Ii\~ 00 l.eo.1 Oe<<ription \ f) U'd'.:')43a m~11 LIlY uf SI'RIIMlllU CDl1BIIIATlON APPliCATION/PERMIT EIIERGY SOURCES: Heat Hater Ileater I I I I I ~71o-lomQ . ItlfORlIAT: ..'1 L:.,,- 726-3753 So. ftq. '.lain ~q. ftl). Access. So. Ftq. Other flew Add P.l ter :!eo. --Fence Demo Change/Use Other -- -- )) .::0 ~ Descrlbe Work(l.e.t Build Sin91e I[ '\ ~ttached r.araae) ~ I ~j>> (1j.id) It - j Ranl1e_ Valuf of Hark: owner(\~t\ ~ t ~r\~(.to ( ,\'Jdrcss-h~Q \"N\ ~ (\ co~~~ AeJ QW1f\ ,\Jdress Ut~llirj Il/\rl \nallleJ Primary Structural Electrical !lechanical COIITRACTORS (name) Genera 1 lluilt1ina r rnllt Info: filr.lilv ne.sldence \lith \ 1)}ffifYi)) an J Phone Phone (address) (address \ Plurnbino Electric.1 _\\\?_, \ 0 00 ~CJ....N\ \\\ l f\ (\ IIp.c:h~n iCi\ 1 PlUIIRllIG j;U.1 -----IE.ch sinole fixture IRelocated building (new fix. additional) I' S. F. r.es ideoce _(I hathl Duplex (1 b.th) e.ch Additional bath ~!a ter serv i ce Sewer ISlorm -, I I I I I SeHer FF F I rHARr.F I I I I I I I I I uli I I I I II I I I I (1 ics. no.) (eXl'llres) (Dhone no. J ~ ~ ! I I I I I (I ic", no. l (pxnirps\ (ohoop nn I o28Q \'\'{\ \ (\ C\s\QJLL ~ r\ . ~e Uni ts .Oeey load Occ.v Group ElECTRICAl MECHANICAl Plan Ck. Comm/lnd 65!/Bldn Ppr Fee Plan Ck. riee;, 30%/Blda Per Fep Fence Demo ClECTRICl.L rERI~IT Chc1 rges clod SurCharges _J~S?2__~1 Sidewalk ~ 'l.~ I Ale Pavin9 I Curb c.ut jJO_'_ I Residence of SQ. FT. \ /New circuits alts. or extens;o~s \ (I " ,,,-J<l...'"'l'\Y. tA ISERVICES -I ITemporary Construction IChanqe in existing rp$ i dp'nr~ Imultifamily, camm. or fnc1uc;,trial 10f I COI" I. II NO. FEEDERS Ilnstall/alter/relocate dic;,trih fppdprc;, I Of .mp~1 amps.1 IIL LllARGE IJIJ tEH I I v_+: I I I I I I I I I I rllllRGl - furnace/burner to BW's 1\~cC' I I I I I I I I Apol iance vent <';(>I)artltp I Stat ionarvv evap. cooler I Vent fan with ..innle rluct I Vent systeM apart from I heatinq or A.C I i'1echanica I exhaust hnnrt and rll1rt Wood stove/heater ISSUANCF OF PFR!11T I IIAVE CM1ErULLY EXNlIrl[1) t~le completed aprlication for rJcrmit. and do hereby certify that all information hereon is true and correct. and I further certify that any and all ""ark oerformed shall be done in accordance with the Ordinances of the City of Soringfield and the laws of the State of Orenon oertainin9 to the work described herein, and that UC OCCLJPAUCY \.,,11 be made of any structure without the permission of the Ouildin!} Division. I further certify that my re!1istration "lith the Bu1lder's Board is in full force and effect as required by Or.:S 701.055. that if exempt the basis for exemntion is noted hereon. and that ,::,~, ::::'::::::' ';: ,.~': :":: '" '; ::: :" :::,,:::.:':~;~ ::~,r,:' , s.' f, Yi FO~ orF I EE lISE DilLY Zone Fire Zone flood Plain Tyoe/Cons t. Bedrooms Stories BUILDltlG PERr.11T Char~es an~ Surcharges Sn. Fto. rlain SQ. Ftl]. Access So. Ftg. Other x , Value Value Value , ------------ TOTAl VALUATION PlU'10ItlG PERMIT C~i1rges and SurCharges "ECIIMIICAl PERMIT Charges and Surcharf'jes Syster.lS Development I CharQe (1.5') I I I I I Tota 1 (omb. Permi t I dJ \CCJ?\~ ,I ~'o\L~ .:/ r I ,:)( ) I I TOTAL . . COMBINATION APPLICATION/PERMIT (CAP) .f. Applicant to furnish ~ A. Job Address . B. legal Description I. example- Tax lot 100. lane County Map Reference II oj q3 2. example- lot J. BJock 3, 2nd Addition to Springfield (stales C. Name. etc. of owner and construction lender : O. Energy Sources I. example. heat/electrical ceilinq{or forced air Qas Z. examole- water"healer/electrlcal/or solar E. Square roolage or valudtion. etc. -- - I. examole- 1250 sQ. foot house. 500 sq. foot garage Z. example. if new project. check-new _ if addition, Check. add, etc. F. Building permit iufonnalion: 1. example - construct sill!Jle family house with an at lached gar"ye 2. examoJe - remodel existing garage into famlly room J. examDle - couvert Single family residence into restaurant (change of use) G. Value of work as defined in Section 303 fa) of the Structural Specialty Code H. OESIGN TEAI-1 ANO COIITRACTORS To avoid design or constl'uclion delays. BUilding Division Staff must be able to contact appropridte 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 iternfs} to be instal led 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 itemfs) to be installed are not covered on the abbreviated schedules you should consult the full schedules C. BUILDING OIVISION STAFF WILL FILL OOT ALL FEfS AI/D CHARGES 01/ 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 s1gn and date Whenever possible, the initial application will be used as a worksheet only. Where Possible. Buildlng 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 \.lill be processed until these fees are paid. All other fees and charges are due and payable when the permit is issued, . J PERMIT VALIDATION \~~1S fJS ,61 I V. FOROFFICEUSEOUlY Permit'Clerk ~ ~ PROJECT CONDITIONS TO BE SAT/SF/EO BEFORE OCCUPArlCY: I ~ . Permit applicant exempt from registration with the Builder's Board because: Additional Project Infonnation: PLANS REVIEWED BY: name signa ture ~ da te ,1