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Home My WebLink AboutPermit Miscellaneous 1981-7-21 INSPECTION LINE 726-3769 t, CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT Job Address ~j6'/-' /'frflii;' :5-, Legol Description Owner \ I n rd, '64 30 02>l1(Y) ~'..:';' /Y7 e. Ill(.' A A/I.. ',,<? ~~J/n/::~- Address Phone Construction Lender Address Phone DESIGN TEAM (address) (name) Primarv Structural Electrical Mechanical CONTRACTORS (name1 (address) General , '.' J/'t, l-"*' " ...~ 4" ...,0.., ... rJ,1O ,. ..',...' /' /~. ~.,...,.-: ,"S-,f)-'.J.!:~'/I.t[ ,:,/ - C::.p c-: i,'-c! l:'CCi1. '.c::': - '7.' ':/I;;'~~;" / i'~, ?","""". ',"; .~ J'. ".;....... __, ~~~ __J, I f ""\ - iF __. 747-')..[01 Plumbina L' , -..dk'}NN,~> Electrical Mechanical PLUMBING NO.1 fEE I CHA.RGE NO.! Residence af Each sinRle fixture Relocated building (new fix. additional) S.F. Residence (I bath) ~ 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. I_Fence_Dema_Change/use _Other Building Permit Info: Describe Work (i.e., Build Single Famil'i. Residence With Attached Garaae) ,.(:6 j:)/.J /12<: L,e:)7/'::'"/d,rill /'~ ';;C:/L' c",:.", 7'l///A. ,~ (lics. no.) (expires) (phone no.) /' /1 '-" ~-~./ I 71'\:'" I;;"'/', \\ ;/ l (Iics. no.) {exaires} (ahaM na.\ ElECTRICAL MECHANICAL FEE I CHARGE NO. I furnace/burner to ~TU's Appliance vent separate Stationary evap. cooler Vent fan with single duct Vent system aport from heatinj:l or A.C. Mechanical exhaust hood and duct ..,.ft. New circuits, alterations or ex'-nsions SERVICES Temporary Construction Dualex (T bath) each Additionol bath Amps. Woter service Sewer Storm Sewer fEEDERS Amos. /,./~ r" ~" ,- -. TOTALCHARGES/)c.:.,." r'~-'''c' TOTAL CHARGES Wood stove/heater Heat Puma Air handler to 10,000 CFM Air handler over 10,000 CFM ISSUANCE OF PERMIT TOTAL CHARGES \) \) V) ~ ~ FEE I CHARGE WHERE STATE lAW REQUIRES that the Electrical work be done by the Electrical Contrador. the electrical portion of this permit sholl not be valid until a label ,has boen 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 sholl be done in accordance with the Ordinances 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 mod. of any structure without the permission of the Building Division. I further certify that my registration with tho Builder's Board is in full forco 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 b. used on this project. Rods for Builder's Boord exemption: C:::. \ ' NAME (pleaso print) ....1'V\ S G;.Y"\ : L ... ~,,\\o-_"\ . '''' .l. r ,'-'I- r c)\ ...._ :'" \~'''_ H ',. CIGNATURc ". ,ltt'~ ~~ ~$l,.'V. Iu..il ",' ---I. 2.'1 " I DATE" (' l.. ,f J FOR OFFICE USE ONLY Zone Type/Const lnits fire Zone 'l.,drooms .....ccy Lood Flood Plain C,torit'- <"'lccy Group BUILDING PERMIT Pion n. Comm/lnd Charges and 65%/ B/do Per Fee Surcharge, Plan Ck. Res 30%/ Bldg Per Fee PLUMBING PERMIT Charges and Fence Surcharges Demo ELECTRICAL PERMIT Charges and Sidewalk Surcharges Alc Povino MECHANICAL PERMIT Charges and Curb Cut Surcharges --------- c:.... Ftg. Main Sq. Ftg. Access Sq. ftg. Other x Value Value Value x x TOTAL VALUATION Systems Development ChorDa n.S%) Total Comb. Permit TOTAL COMBINATION APPl1CATION/PER~CAP) 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. example-1250 sq. foot hause, 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 ,per'sons 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: naml'" o:..ignaturo '-ERMIT VALIDATION Permit Cler~ ~at~