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Home My WebLink AboutPermit Building 1983-8-11 Ranne ValuE of Hark: It>~. -0 Builriina Penmit Info: Descr,be Work{i.e.~ Build Single Familv nesidence I~ith Attached Gara~) h/~~'<, ~"'''''D 1~.6~.I"'........,.c.-. lUAU. <. /Iv/' C~,b~ ~N"".s.N. rl '1 JrISPECTlOII LINE 726-3769 . CITY OF SPRINGFIElD COMBHIATlON APPUCATION/PERMIT EilERGY SOURCES: Heat Hater Heater , Job Address ~/ Vd /l1~ f"/ ~. . I' A;2.W' - iFl'J1Dl legal De,cri pt i on ":;;'" J L T/,'}, ~ \~ I D :=r?') ~ r-t--, C(:c.;../ SA"o,J- Owner Address,;z J' J J uJ,-j / A _e./I'<, fr- Phone.:l'Y3'?JI: : Construction Lender /t/ p"'/ ~ , Address DESIGN IEAI1 (name) Primary Cec. ,'/ Structural Electrical Mechanical CONTRACTORS (namel General CPt:::" I Phone (address) flies. no.) S"..cKo..,l .;L,r J? ..v'. ~...eQ'e IE"", "'"",<! , INFOR/1ATION lIN' " 726-3753 ;q. ~tq. IA1ain ~, -q. . tg. ccess. W Sq. Ftg. Other ,".r New Add Alter ~ep. \IV -Fence Demo Change/Use I....... Other - - , '\Q ~ (exnires) ~ --" y (ohone no. J 3V,J-Th".' C::::--'" lev""" (address\ (lire;. no.) (pxnirpc;) (ohnnp nn.' I -2-<:Y] 7 tI-V.i/"_ .e-#... .)7' E.....'J'~--<t:- O~ ~9-. '?Y./ f.?/.... l I I I I I TOTAl CHARGES TOTAl CHARGES I TOTAL CHARGES WHERE STATE L\H REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical portion of this permit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division I Plumbino Electrical I I fIN 1J L- ~1echanical PlUllBlIIG ElECTRICAl NO. FFF fHARGE HO ~~~ r~ARr,~ NO. Each single fixture Residence of SQ. FT. Relocated building (new fix. additional) INew circu~ts alts. or extenslOns I SERVICES S.F. Residence (1 bath) louPlex (1 bath) IAdditional bath I ~Iater service Sewer each Temporary Construction IChange in existing rps i d~n('p . Imultifamily, COI1111. or InrllJc;trial IOf ICO~1./IND. FEEDERS l'Install/alter/relocate I ni~trih fpprlpr~ jOf amps. I I Storm Sewer amps.l MECHANICAL furnace/burner to BTU's H~ njAI?.f::~ 1/ Floor furnace and vent I Recessed wall ~na~p hpatpr ann vpnt Appliance vent seoaratp Stationary evap. cooler Vent fan with c;.innle duct Vent system apart from I heatino or A.C. I Mechanical exhaust hnorl and dur:t I \1ood stove/heater I I I I I I I I I I ISSUANCE OF PFRrlIT I HAVE CAREFULLY EXM1ItlED the completed apfllication for permit, and do hereby certify that all infonmation 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 NO 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 ORS 701.055, that if exempt the basis for xemption is noted hereon, and that only subcontractors and employees who are in compliance with OP.S 701.055 will e used on t is project. UAI,IE(please print) C l?c..: ( s..".'><o..... DATE f-I/-.r .3 riain x Value Access )( Value OtheV#57'llc. Co. ~,.:. Value I~_ CI&:l TOTAL VAlUATION Zone Fire Zone Flood Plain Units Occy load Occy Group S IGIIATURE FOr. OFFICE USE mil Y Sn. Ftg. Sq. Ftg. Sq. Ftg. Tyoe/Const. Bedrooms Stories BUILOHlG PERNIT Charges an~ Surcharges --__t~'-~__ ~;~~B~~~ L/" Plan Ck. . 7 30%/Bldo Conm/lnd Pf'r Fpp Res Per Fee PLUl1BING PERMIT Charges and Surcharges Fence ------------1 Demo I 'Sidewalk I AIC Paving I Curb Cut ---- ----- ---I, ELECTRICAL PERr:IT Charges and Surcharges /lECHANICAl PERMIT Charges and Surcharges t syste.~s Development Charoe tl.5~) , I I Irota, Comb. rermit 1- l'OTAl 10,0/0 . ~ COMBINATION APPLICATION/PERMIT (CAP) 1. Applicant to furnish A. Job Address B. Legal Oescription 1. examole- Tax lot 100. Lane County Map Reference II 03 43 2. example- Lot I. Block J. 2nd Addition to ~prln9tield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. example- heat/electrical ceilinqlor forced air Qas 2. examole- waterheater/electrical/or solar E. Square footage or valuation. etc. - I. examole- 1250 sq.' foot house. 500 sq. foot garage 2. example- if new project. check new - if addition, check add. ete. F. Building pemit information: 1. example - construct single family house with an attached garage 2. examele - remodel existing garage into family room 3. examole - convert single family residence into restaurant (change of use) G. Value of work as defined in Section 303 (aj of the Structural Specialty Code H. OESIGN TEAI'I ANO CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate . persons regarding design infonnation 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 pennit fonm 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. BUILOING OIVISION STAFF WILL FILL OUT 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 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 pennit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . .. . PERMIT VALIDATION (p 1'5 3d--' g/ I ~ S 3 , ~ ~ l '- Permit Clerk ~1 ) Permit appl icant exempt from registration with the Builder's Board because: Additional Project Information: I PLANS REVIEWED BY: ~R#E ;;q~~ignature"'<I~/~_ date~-//-B'3' name .