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Home My WebLink AboutPermit Miscellaneous 1986-9-12 Job Address ;::; 12D f'7l~ . CITY U~ SPRINGfiELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat Hater Heater Range ValuE of Hork: ~~~~ INFOR/1ATlON LINt 726-3753 Sq. Ftg. 1.la i n ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. -Fence Demo Change/Use , Dther- - 0Q ~ \) ~ I--{::::; I..r::, JINSPECTION LINE 726-3769 Legal Description ownerJ/J11/){lhl jJ/iA ~Jzth1fl/ ~/ AddressfJ ~ fJJo/ ///S/)I) FA/ (/A1 0_ C~nstruction Len~ Phone f/ %1- 6?53 '7 BuilriinQ Permit Info: Describe Work(i.e., Build Single Family Residence With Attached GaraQe) ~/{ r /~)/;tf/'zL .M6:th " Address Ul:.~ HiN TEAf1 lnameJ Phone (addressl {lies. no.' rexoires\ fohane no.1 Primary ~~ ~. --vii' r Structura 1 Electrical Mechanical CONTRACTORS (name) (address) flies. no.' (pxnirp<d (nhnnp nn. \ Genera 1 Plumbino Electrical ~.PAr f-f/ftJJ~/~ 135 - 70:t '" ~1echanical PLUlIB I NG ELECTRICAL MECHANICAL -1i!h1 Each single fixture I FFF I rHARr.F "n "0> rHIlJllll:. Nn I="~~ I CHARGE SQ. FT. furnace/burner to sru. s Residence of Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (] bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall Sn~rp hp~tpr ~nrl vpnt Storm Sewer Of COMH./IND. FEEDERS Install/alter/relocate dic;trih. fppders amps. Appliance vent seoaratp Stationary evap. cooler Vent fan with sinole duct Vent system apart from heatina or A.C. Mechanical exhaust hood and duct Wood stove/heater ~Jater service Temporary Construction Change in existing rec; j q~"ce multifamily, conm. or Indu<;,trial Sewer ~ ~ ~r;;;MJ amp~ (' ..I~-".LJ~ LI'1" 1600 /pO /5, 6 CJ ISSUANC, nF PFR!llT TDTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L"~ REQUIRES that the Electrical work be done by an, shall not be vali1 until the label has been signed by an Electrical Electrical Contractor. the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFULLY EXAt1INED the completed apf'Jlication for permit, and do hereby certify that all information hereon is true and correct, and I further certify that any and all work Derformed 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 rm OCCUPAr~CY 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 ons 701.055, that if exempt the is for exemption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 701.055 will bud on this project. IW.IE(please print~>",u,vIS H/J/Je~L SIGIJATURE,. / a/A /~ tI~ FOr. OFFICE USE OIHtl Sq. Ftg. riain Sq. Ft9. Access Sq. Ftg. Other DATE 9"/~-8D' Zone Fi re Zone Flood Plain Tvpe/Const. Bedrooms Units Dccy Load Occy Group x Value Value Value x Stories x TOTAL V ALUA TI Ot! BUILDING PERmT Charges and Surcharges Plan Ck. Corom/lnd 65%/Rldo PPr ~pp ------------ Plan Ck. Res 30%lBl do Per Fee Fence Systems Development Charoe (1. 5%) , PLUt~BING PERMIT Charges and Surcharges Demo ELECTRICAL PER!HT Charges and Surcha rges MECHANICAL PERMIT Charges and Surcharges (5.00 ISidewalk --------.-&0-1 A/C Paving I Curb Cut I~_LW Total Comb. Permit .':1000 ~ 20 I TOTAL /5, {jO . . . - COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATIDN 1. Applicant to furnish A. Job Address B. legal Description 1. example- Tax Lot 100. Lane County Map Reference II oj q3 2. exam~le- Lot 1. Block 3, 2nd Addition to sprlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. exam~le- heat/electrical ceilinq/or forced air qas 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - I. 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. example - construct single family house with an attached garl!ge 2. example - remodel existing garage into family room 3. exam~le - 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 persons regarding design information or jab 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. BUILDING DIVISION STAFF WILL FILL DUT 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 b~ 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 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. b ~'/iJ0!J q _ 1,&-7J& V. FOR OFFICE USE ONLY Permi t' Cl erk Cc-- . PROJECT CONDITIONS TD BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: " name signature date