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Home My WebLink AboutPermit Sewer Connection Record 1981-7-15 I INSPECTION LINE 726-3769 I Job Add,... $(!)(?)7 - I legal Description L) ~. I " I Ow,o' C.,q J/Z. q.- K. L/91?? J?, I I 0_/ S " Le. L:} ..<: "'3 ; 1/ Building Permit Info: Describe Work (i.e., Build Single AddresS-:>O 6fJ'- ~ tJ /C. LJ phoneCGJ(T -7b), 3 Fanlily Residence With Attached GarOQe) I Bt.JGeIl/6 9'7;.,La6" l!ePAI'.&S 7'h ..:5&-a/.ffP~ I Co",,",Ho' l.,do> ~ re"AP ,q/_ .;t:j;o/;;.;~ I Addren Phone I I OESIGN TEAM I Primary . CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT . INFORMATION LINE 726-3753 ft1A/~J S7: n023~32- I ENERGY SOURCES: Heat Water Heater Range I Value of Work: Sq. Fig. Main Sq. FIg. Access. Sq. Hg. Olhe" _New_Add_Alter_Rep. _Fence_Demo_Chonge/Us8 _Other '- t'- "* ~ ~ (nome) (address) (lies. no.) (expires) (phone no.) Structural ~ Electrical Mechanical CONTRACTORS (nome) (address) (lies. no.l (expires) (ahone no.) General Plumbino /1/6 / Electrical Mechanical PLUMBING ElECrRICAl MECHANICAL FEE CHARGE NO. FEE . CHARGE furnace/burner to I\TU's Appliance vent separate Stationary evap. cooler Vent fan with single duct Vent system apart from heoting or A.C. Mechanical exhaust hood and duct Wood stovelheater Heat Pumo Air handler to 10.000 CFM Air handler over 10,000 CFM ,. " , NO. FEE CHARGE NO. Residence of Each sinQle fixture Relocated building (new fix. additional) S.F. Residence (1 both) ~.... ft. New circuits, alterations or extensions SERVICES Duplex (I bath) each Temporary Construction Additional bath Amps. Water service Sewer Storm Sewer FEEDERS Amps. ISSUANCE OF PERMIT TOTAL CHARGES /fA1 hf=E TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES that the Eledrical work be done by the Electrical Contrador, the electrical portion of this permit shall 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 inf~f\'O~c.gn is true and correct, and I further certify that any and all work performed shall be done in occordance with the Ordinances of the City of Springfield a~nd the laws of the State of Oregon pertaining to the work described herin, and that NO OCCUPANCY 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 ond 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. Ba.;. fo' Builde,', Boa,d ex:mp,;o,. ~~ I (K) L4f- NAME (plea.e p';",) ('I. ~.h."v-d ? Lc..lAAl,...\r SIGNATURE ~(Ar DATE7jitS/~1 FOR OFFICE USE ONLY ~ ., J . Zone Type/ Canst. Units C;:". Ftg. Main Fire Zone Bedroom- nccy load Sq. Ftg. Access Flood Plain ",torie~ Occy Group Sq. Fig. Other BUILDING PERMIT Plan Ck. Comm/lnd Chorges and 65%/BldR Per Fee Surcharges Plan Ck. Res 30%/ BldR Per Fee PLUMBING PERMIT Charges and Fence Surcharges Demo ELECTRICAL PERMIT Charges and Sidewalk Surcharges Alc Povinn MECHANICAL PERMIT Chargos and Curb Cut Surchorges -------- x Value x Value x Value TOTAL VALUATIOI"' Systems Development Charae CT.5%l Total Comb. Permit TOTAL -i::." '. A C. COMBINATION . APPLICATION/PERMIT ,(CAP) I. Applicant to furnish A. Jab Address B. Legal Description 1.. example,tax lot 100, Lane County Map Reference 17 03 43 2. example-Lot 1. Black 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D, Energy Sources 1. example-heat/electrical ceiling/or forced air gas, 2. example-wa.ter;'heater/e1ectrica1!or solar E. Square footage or v.aluation, etc. 1. example,1250 sq. faat hause, 500 sq. faat 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 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 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 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 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 possible, 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 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: Additional Project Information: PLAN5 REVIEWED BY, nom'"' ..ignatur'"' . PERMIT VALIDATION . ~ .. ., . . Permit Clerl~ '. '""ate