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Home My WebLink AboutPermit Building 1983-9-6 I . I IliSPECTIOtI LIUE 726-3769 Job Address (p. ? (" I.f N /J I N I.egal Description /7 -.t):< .:I'-/-i31 CiTY OF SPRI;IGFIElD COMBItlATION APPLICATION/PERMiT ElIERGY SOURCES: Heat [-later Heater 4:> -:;'c:>o ~ Ranqe ValuE: of Work: ." //5/)0 - Ph _.Huilriina Permit Info: Describe Work(i.e.. one 71/, .,CS: ~..cr.1ilv l1esidence I~ith JI..ttached Garaael ItJ i s::1/l1 >'" w,q V " -r. L t:' +.1- b),D V t- INFORlIATIDN UNE ' 7?6-]753 Sq. Ftg. t,'ain . ~q. Ftg. Access. Sq. Ftg. Other tlew Add A lter ~ep. --Fence Demo Change/Use Other - - Build Single ~ ~ ~ Owner 6h /l YI /)/ p.10 ), ('j. Address f.'":lt.l/ /liniN (I, </r"~/' IIV .EN/-" )" IJrc/l- r ohone no .Il Construction lender /'/",1/;- ,\ddress Ul:.)lljfl Il:.Ar1 (name) Phone (address) nics. no.) {exoires} 11\ ~ " Primary Structura 1 Electrical Mechanical CONTRACTORS Genera 1 loame) f)wNey- (address) (lir:<:;_ no. l (pxnirec:) (ohonp nn~ \ Plumbino Electrical r.lechanical PlUllBlIiG ELECTRICAL MECHANICAL 110. ' Each single fixture FEE 'rIlMr,F ~n rrL..cJi.!I&liE. NO. Res i dence of furnace/burner to SQ. FT. BTU's 1=1=1= r'1ARG.E.. /. Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent IS.F. Residence 11 bathl IDuPlex (I bath) each IAdditional bath I ~Iater. service I Sewer I Storm Sewer I SERVICES I Recessed wall ~n~~p hp~tpr ~nrl vpnt TOTAL CHARGES WHERE STATE l'H REQUIRES shall not be valiJ until the jremporary Construction IChange in existing rpc;. i de.n('p Imultifamily, coom. or tnduc;.trirll iOf ICO~1./IND. FEEDERS IInstall/alter/relocate I' nic;.tr;h fpprlprc. 10f amp~1 I I I I I TOTAL CHARGES TOTAL CHARGES that the Electrical work be done by an "Electrical Contractor, the electrical portion of this pemit label has been signed by an Electrical Supervisor and returned to the Building Division amps.1 I App 1 i ance vent 5eoar<ttp I Stationary evap. cooler I V'ent fan with 5inole duct I Vent system apart from I heatinCl or A.C. I Mechanical exhaust hood and duc:t I Wood stove/heater I I I ISSUANCE OF PFRrm 1 HAVE CAREFUllY EX~~INED 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 rw OCCUPAIKY 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 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. SIf.IIATURE-W 4f~..,w)~.h..)Jv mn OFF I CE USE om.. Y Sq. Ft9. Sq. Ft9. Sq. Ftg. OATE ?.;.~ -\("..3 IIAlIE(please print) )/Ai./I'/' JiI WAIu..I) Zone K-(' ,.cb? . Fire Zone Flood Plain Tyoe/Const. 6" oW Bedrooms Stories Units Occy load Occy Group riain x yalue Access x Value Other~~~ Value TOTAL V AlUA TI ON /~18O BUIlOltlG PERt-IJT Charges an~ Surcharges ~ _ Plan Ck. ___J~_~_____ 65%/Bldo LJ" Plan Ck. . l' .~%/BldQ ConmlI nd Ppr Fpp R.es Per Fee 6. S'e> Systems Development Charqe (1.5%) , NA. PlU11BING PERMIT Charges and Surcharges Fence I ELECTRICAL PERI~IT Cha rges and Surcha rges I Demo I Sidewalk I AIC Paving Curb Cut jrotal Comb. Permit 10. 'to /6.'0 11ECHANICAL PERMIT Charges and Surcharges 1- j'OTAl - . I . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION G/VJSt/ I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax Lot 100. Lane County Map Reference II OJ 43 2. example- lot 1. Block 3, 2nd Addition to springtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinq/or forced air Qas 2. example- waterheater/electrlcal/or solar E. Square footage or valuation, etc. ------ 1. example- 12S0 sq. foot house, SOO sq. foot garage 2. example- if new project. check new - if addition, check add, etc. F. Building pennit information: 1. example - construct single family house with an a ttached garage Z. 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 TEA/4 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 penmit 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. BUIlOING DIVISION 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 be 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 penmit 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 penmit is issued. '- .' . V. FOR OFFICE USE ONLY Permit Clerk (10 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ,iI Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: nameLc;:IR~ jZl~~ Signatur~ -~~ , date '9~t::-~3 r