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Home My WebLink AboutPermit Demolition 1985-5-20 . I INSPECTION LINE CITY UF SPRINGFIELD 726-3769 COMBINATION APPLICATION/PERMIT Job Address . .I) () 7/ miUA-v ~~;~GY ~ Le9al Description \fjo..a.~ ~:)~ ()J3..8.() I !/a~. Heater - ~qe_ LIJAbt1/U ALilZf. JC/~/ ValuE of H"K) II\. Address Pho'rie tf ~~~H~n~e~t~~~Inf~~ 12/0 -96~ \ .c1..uitb li.l:ffif\., Owner Construction Lender Address UL, I GN TEAf~ Primary Structura 1 Electrical Mechanical CONTRACTORS Inamel (<J Wu-, tJ Genera 1 Plumbina Electrical ~lech~n;c~' NO. . " INFORlIATIDN UNL 726-3753 Sq. Ftg. Nain " ~q. ftg. Access I' Sq. Ftg. Ot New Ad Alter Rep. Fene _Demo_Change/Use o er (name) Phone (address) ~ I '1, ~~l, {ahOM no. \ Describe Work(i.e., Build Single ,o.ttached Garaae 1 (lies. no.l (exn;re~ ~ 1( ~Jd~-rT (address) 1'7 uJ fj, (nhnnp nn ) nies.no.1 SUi/A. r.J,l1i-Pd I I' (pxo;rpc::.) PLUfTBI NG rHARliJ NO I ~~I=' I rl-l ELECTRICAL MECHANICAL FFF r.HARr,F NO "'" Residence of furnace/burner to BTU' 5 Each single fixture SQ. FT. Relocated building (new fix. additional) S.F. Residence (J bath) Ouplex (1 bath) each Additional bath ~Ia ter servi ce Sewer Storm Sewer New circuits alts. or extensions Floor fu rnace and vent SERVICES Recessed wall Sn~rp hp~tpr ~nrl vpnt ITemporary Construction IChange in existing rp<;. i rlJ'~n('p Imultifamily, COrTI!!. or Inrluc;trial IOf ICOMM./IND. FEEDERS I Install/alter/relocate rlic;trih fpprlprc; IOf amps.1 I I I Appliance vent seoartl.tp Stationary evap. cooler Vent fan wi th sinale duct Vent system apart heatino or A.C. Mechanical exhaust hood <lnd durt from amps, Wood stove/heater TOTAL CHARGES WHERE STATE L~H REQUIRES shall not be valiJ until the TOTAL CHARGES that the Electrical work be done by an. label has been signed by an Electrical I SSUANCE OF PFRIIIT .1 TOTAL CHARGES Electrical Contractor, the electrical portion of this pe~it Supervisor and returned to the Building Division I HAVE CAREFULLY EXM11NED 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 tJO OCCUPAIKY 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 exemption is noted hereon, and that only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project. NN~E(please print) Zone Fire Zone Flood Plain BUILDING PER~IIT Charges and Surcharges PLur~B ING PERMIT Charges and Surcha rges ELECTRIC?L PERfm Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges Ste 1/(' R.,} '" SIGIIATURE ~,4! FOP. OFFICE USE 0;11 Y Sq. Ftg. ITain Sq. Ft9. Access Sq. Ftg. Other x ~'1L DATE .~.2(J -8"< Tvpe/Canst. Bedrooms Stories Units Occy Load Occy Group x Value Value Value x TOTAL VALUATION Plan Ck. Comm/Ind ___________._~/Rldo Ppr Fpp Plan Ck. R-es 30%/Bl do Per Fee Fence Isyste.ms Development Charoe O.5~) OCtmo ___________-' Sidewalk I A/C Paving ____________, Curb Cut I lb.OO Total Comb. rermit I I TOTAL I B-,Oc) . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION 1. Applicant to furnish A. Job Address B. legal Description 1. example- Tax Lot 100. Lane County Map Reference 17 oj 43 2. examEle- Lot I. Block 3, 2nd Addition to sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinq/or forced air Q3S 2. examole- waterheater/electrical/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. examele - construct single family house with an attached garage . 2. examole - 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 (a) of the Structural Specialty Code H. DESIGN TEN1 ANO 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 ~ivision 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 OUT 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 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 signa ture. 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. ~ O,,~5 C)/Y V. FOR OFFICE USE ONLY Permi t Cl erk &~ tI 1 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date