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Home My WebLink AboutPermit Sidewalk 1984-8-8 " 'I INSPECTION LIIIE 726-3769 Job Address 41o~ \'i\r\if\ ~. Legal Description \"\()'} ,?l)~?-O\~ . . '+n\~ Electrical Mechanical CONTRACTO~. Lnamel~ . _ General\ ~~ ' -\1li.."\f\O> Plumbina \'- \.\ 0 NO, Each single fixture Relocated building (new fix, additional) $.F. Residence (1 bath) Duplex (1 bath) each Additional bath ~Iater service Sewer ,( Storm Sewer FFF r.HARr,F Nn l v"ii'f .}~y.!l~:~~ q'";~II,,~3?:. t\. MECHANICAL .~ 1iE'L 1DJARliE. ELECTRI CAL Electrical ~1echan;cal PLUlIBI NG ITL J:HARliE. tin I furnace/burner to BTU's Residence of SQ. FT. New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall I ~n~r~ hp~tpr ~nrl vpnt 1/}oO ITempOrary Construction IChange in existing res j qp,.nr.p ImUltifamilY, corrm. or lnnllc:trirll 10f amps,1 ICDMM./IND, FEEDERS IInstall/alter/relocate 1 ni"trih, fpprier" Of amps. I I 1 1 I 1 App 1; ance vent seOaritte I Stationary evap. cooler 1 Vent fan with sinnle duct 1 Vent system apart from I hea t i nq (lr A. C. 1 Mechanical exhaust hnnrl "lnd dud Wood stove/heater , 1 1 TOTAL CHARGES II).CD TOTAL CHARGES WHERE STATE L,'W REQUIRES that the Electrical work be done by an, shall not be valiJ until the label has been signed by an Electrical ISSUANC, OF PFR!1lT I TOTAL CHARGES Electrical Contractor. the electrical portion of this pe~it Supervisor and returned to the Building Division IlAHE(please print) /f?<:; ,~)/ ///(1 wl50'n 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 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 OCCUPAHCY 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 basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. SIG!IATURE ,~;;) {/L,~M4 FOr. OFFICE USE O!ILY Sn. Ftg. I1~V.l\\DU1=X Value~-,~ .- Sq. Ft!J. Access x Value - ..... Sq. Ftg. Other x Value 4 --"""! TOTAL VALUATION _n:::\~ . OATER-.f-;jP.If Zone l!,~' Tyee/Const. Fi re Zone \) Bedrooms Flood Plain Stories ...... Units Occy Load Occy Group - - - BUILDING PERNIT Plan Ck. Comm/Ind IVJ)_~ Charges and ------------ 65%/Bld~ ppr fpp Surcharges Plan Ck, Res T 30%/Blda Per Fee , PLU'~BING PERMIT .JO.CD Fence I Charges and Surcharges .'\1) OeAlO I ~.OO ELECTRICAL PER!~IT I 'Sldewa lt Cha rges and ------------ I A/C Paving \. "l .. p:J Surcharges I1ECHANICAL PERMIT I Curb Cut Charges and ------------ Surcharges I Systems Development Charae (1.5~) . ITotal Comb. Permit I. u ,OTAL I 12. .w .. . . ,~ .... COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION 1. Applicant to furnish A. Job Address B. Legal Oescription 1. example- Tax Lot 100, Lane County Map Reference II OJ 43 2. example- Lot 1. Block 3, 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceiling/or forced air Gas 2. example- waterheater/electrical/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house, 500 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 attached garage 2. examEle - 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 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 permit 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 OOT ALL FEES AND CHARGES ON THE SCHEDOLES 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 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. /G -#. bS~Y7 P- !'Jij~~1 V, FOR OFFICE USE ONLY Penni t Cl erk {} ~A1A--. . 1 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Pennit applicant exempt from registration with the Builder's Board because: Additional Project Infonnation: PLANS REVIEWED BY: na:xh()P ~~ s;gnatur~ IOAt-/ da~eB-PrQ 1 '/8\ ~1 .1