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Home My WebLink AboutPermit Backflow Test 1987-10-14 .... I INSPECTION LINE 726-3769 . CITY Uf SPRINGfIELD COMBIIIATION APPLICATION/PERMIT EilERGY SOURCES: Heat I~ater Heater Range ValuE of Work: t INfORl1ATION LJNt I 726-3753 Sq. Ftg. '.Iain ~q. Ftg. Access. Sq. ftg. Other Ilew Add Alter Rep. -Fence Demo Change/Use Other - - 00 o C) ~ -J 1(,0 ,/e, 2</ legal Description $cu:J Job Address Owner ;ZOO ;j;;i,. L~d;;A L/6J?L/ r 41kJ?v Phone 1Zh 5'?RCJ Address UtS II,;N WIll In_l Phone (address) BuiloinQ Permit Info: Describe Work(i.e., Build Single Familv nesidence With Attached Garaoel ~u;rd/~'. ?: . . /~d/f/~nvt} /;;?L3~~ (exo; res) flies.no.1 no. , Address Construction lender Structural 0l~0 I (put'? Primary Electrical Mechanical CONTRACTORS t......l (address) f1 its. nn.) (pxoirp",) (ohone nn.) Plumbino .Ii' {j~ Genera 1 v ( \U\ jL( Electrical "lechani ca 1 I'UIlIlllG ELECTRICAL MECHANICAL NO. I ~ ftF l otARGE NO , FFF I r~ NO. , "L' JJiARlil: Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated bu;ld;ng (new fix_ add;t;onol) S.F. J!eo.;icleRce (1 batlll Duplex (J bat:h) each Additi.....l bath New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall Sn~~p hp~tp~ ~nrl vpnt Storm Sewe.,.. Of amps.1 App 1 i ance vent o:;,~oarilt~ Stationary evap. cooler Vent fan with sinale duct Vent system apart from I heatino or A.C. I'MeChanical exhaust hnod and duct I ~jood stove/heater I I 1 Sewer Temporary Construction Change in existing rpc; i dJ'nrp multifamily, camm. or Industrial ~later servke ~ COMfI./IND. FEEDERS I Install/alter/relocate dic:trih. fpprlprc;. IOf amps.1 I I I ISSUANCf OF PFRlllT TOTAL CHAREfS WHERE STAlE t,lW REQUIRES shall not be vali1 until the TOTAL CHARGES TOTAL CHARGES that tile Electrical work be done by an.'Electrical Contractor, the electrical portion of this pernit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFUllr ~'lNED 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 tbe Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAIlCY will be made of any structure ~thout 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 ORS 701.055 will be used on this project. ,p j, It tlA .B /fl/q SIGNATURE (2, A.om/A iZ.oAd- I i'OfOfF I CE USE DIlL Y 7~-' I Units Sq. Ftg. Hain x Occy load Sq. Ftg. Access x Occy Group Sq. Ftg. Other x A V(P-6 DATE / t?':"Ir/~ r? -I NAME(please pr;nt) Zone Fi re Zone Tvne/Const. Bedrooms ValuE:' Value Value Flood Plain Stories TOTAL VALUATION BUILDING PERMIT Charges and Surcharges Plan Ck. Comm/Ind ____________ 65%/Bldo Ppr Fpe Plan Ck. Res 30%/BldQ Per Fee LS.~ I Fence _uu_ -~'7:S1 D~mo I Sidewalk ------------ lAIC Pavi ng Curb Cut Systems Development CharQe (1.5%) PLUMBING PERMIT5- Charges and Surcharges ELECTRICAL PERI~lT Charges and Surcharges I ITotal Comb. rermit j r1ECHANICAL PERMIT Charges and Surcharges I I TOTAL /S.75 - . COMBINATION APPLICATION/PERMIT (CAP) I. Appl icant to furnish A. Job Address B. legal Oescription 1. example- Tax Lot 100. Lane County Map Reference 17 03 43 2. example- lot I. Block 3, 2nd Addition to >pr,ngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinQ/or forced air Qas 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. ----- I. exam~le- 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. exam~le - construct single family house with an attached garage 2. example. remodel existing garage into family room 3. exa~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. OESIGN TEAM AND CONTRACTDRS 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 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 fu 11 schedu 1 es C. BUILDING DIVISION STAFF WIll FIll DUT All FEES ANO CHARGES ON THE SCHEDULES O. 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 permit is issued. V: FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . PERMIT VALIDATION /0317 1{)'-lcf~r1 II I ,. , Permit Cl erk C4---' . I Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date .