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Home My WebLink AboutPermit Sewer Connection Record 1981-9-22 INSPECTION LINE 726-3769 -. CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT . INFORMATION LINE 726-3753 Legal Description \.:577~ - MAJAI sr, \I("')~ ~':cl ~ ~ . '-' ~...) J ~ (f9klrl J. ..5rg/A//J?/'/)Lr-":P - - -- /? L7 J/ Building Permit Info; Describe Work (i.e., Build Single y, t:J /Jt:JX ,.:252'2-- Pho..,6?",-2:1Of' Fomll. Re,lden,e With Atto,hed Go,ooe) /S!L6.6A/E' t?740)-- Sewe-,€. .p/~/Ai~ (AJok.6) ENERGY SOURCES: Sq. Ftg. Main Sq. Ftg. Access. Sq. ftg. Other _New_Add_Alter_Rep. _Fence_Demo_Changel Use _Other ~'<) ~ I~ 1~ Job Address Heat Water Heater Ran_ge Value of Work: Owner Address Construtfion lender Address Phone DESIGN TEAM (nome) (address) (lies. no.) (expires) (phone no.) Primary -~ :1"1 Structural Eletfrical M...hnn;cal CONTRACTORS (nome) (address) (lies. no.) (expires) (phone no.) General Plumbina /I/o ,. Electrical Mechanical PLUMBIHG ELECTRICAL MECHAHICAL NO. I FEE I CHARGE NO. I FEE I CHARGE NO. I FEE I. CHARGE Each sinRle fixture Relocated building (new fix. additional) S.F. Residence (I bath} ~.... ft. furnace/burner to I\TU's Appliance vent separate Stationary evap. cooler Vent fan with single duct Vent system aport from heating or A.C. Mechanical exhaust hood and dutf Residence of New circuits, alterations or extensions SERVICES Duplex (1 bath) each Temporary Condrutfion . Additional both Amps. Water service Sewer Wood dQve1h.""'r .i><'>.... / Storm Sewer FEEDERS Heat Pump Air handler to 10.000 CFM Air handler over 10.000 CFM Amps. I I - I I I I TOTAL CHARGES A J~ I ISSUAHCE OF PERMIT /P~ TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be done by the Eledrical Contractor, the electrical portion of this' permit sholl not be valid until a label has been signed by an Electrical Contrador and attached to the eledrical panel. I HA VE CAREFULLY EXAMINED the completed application For permit, and do hereby certiFy that all inFormation hereon is true and correct, ond I further certiFy that any and all work perFormed sholl be done in accordonce with the Ordinances of the City of Springfield ond the Laws of the State of Oregon pertaining to the work described herin, and that NO OCCUPANCY will he made of ony structure without the permission of the Building ,Division. I Further cernfy 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 heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. Units occy Load nccy Group SIGHATURE~1cA~1 FOR OFFICE USE o~i.y - I'" ) 'I ~ .....,.ttg. Main x Sq. Fig. Access x Sq. Ftg. Other DATE t7- ~ 2tf'L / . Rasis For Builder's Board exemption: HAME (pleo.. P';!:ll-::::::Tl.~~-_~....1..ui... Zon~' fire Zone Flood Plain. Type/Canst. Bedrooms (:torie- Value ."'alue Value TOTAL VALUATION BUILDING PERMIT Charges and Surcharges Plan Ck. Comm/lnd 65%1 Blda Per Fee Plan Ck. Res 30%1 Blda Per Fee Systems Development Charoe n.5%\ PLUMBING PERMIT Charges and Surcharges Fence Demo Total Comb. Permit ELECTRICAL PERMIT Charges and Surcharges Sidewalk AI C Pavin(:l MECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL ,.- -, ....,..,.-"'... .,.,'-'- ~v., ""';.~ ,'.~r . y COMBINATION APPLICATION/PEa {CAP} I. Applicant ta furnish A. Jab Address B. Legal Description 1. example-tax lot 100, Lane County Map Reference 17 03 43 2. example-Lot 1. Block 3, 2nd Additian to Springfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example.heat/electricol ceiling/or forced air gas 2. example-water 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 Sectian 303 {a} of the Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction delays, Building Division Stoff must be able to contact appropriate persons regarding . design information or job site correctionsl 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 possiblel 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 na 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: namp "ignaturp 'I --0.' . -.' w'~ ,. ;..~"'-l. ~.. · PERMIT V ALIDA TIO~ .l.:.. .~. ./ Permit Clerk ~at"