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Home My WebLink AboutPermit Building 1981-5-21 .; ~',.' ",t:'--"'''- f' 'f '. r ", r".' ~'~ I INSPECTION LINE 726-3769 .' ~, CITY/.OF SPRINGfiElD COMBINATION APPLlCATION/pERMIT .. INFORMATION LINE 726-37S3 . 00 /;::-o<-~ . ~ 6\ I Job Add".. -1-:/6'7 - 114 /:U sf I L~of~,~t.on M('OUilJ7 -JII,IH/?if/t. f;;. 75;;'0 lJ.. O':l.-,~"1 -.."1 J. -td;l'(J(). /16 'Y.. L/..rJlI;Fd . awn..c;;j.cf PAm X E 12 At?; e/'/A . 'JIi'}ur-r ~-<<. I Add,... 9t/o -56 . 'I :zJ,o Phon,v/.-32'30 I I ConHruclion lender '-A /Y'J L V d I Address ' - I OESIGN TEAM I Primary I Structural I Electrical I Mechanical CONTRACTORS I O....."rol I Plumbinct I EI~ctricol I Ml.'!chonical ENERGY SOURCES: Heat t'l''15.. Water Heater IE" L ~ d ,4/'- Range _ Value of Work: Sq. Ftg. Main ~'" I Sq. Ftg. Access. ---12.....;L I Sq. Fig. Other _New _Add _Alter _Rep. ___Fence_Dema_Changel Us. _Other Building Permit Info:' Describe Work (i.e., Build Single Famil... Residenr:1! With Attochl!rl Garaoe' -ri "/7tC ~ -rJ Ve.,/uol!f1<; BA p",l - <. ?' o./.Z 1:-- ,/ rl .ve. aJ-J I to /;,; () Phone (name; (address) (lies. no.) . (expires) (phone no.) .::?'/".. /:?:; '2..1 7S1C-<'<, $"6 I #/'::-7/1./_ t?LA 0 r,e:- JJdrr~ II /)It'' '-#.I i.I/.:~r Oi!'P?;b-tJ ":J!.11 f3t2I,p-~Li V t: iu II//V 1"""" __-' l"~l (nome) ;)/)5f) I;.), f1rMrlWOj (address) Pb,&'m.).S ::J()- q to (p- 3D-8:l. 6/13-/'/ /Y -rvUl/U_ ~M<; flies. no.l (expires) (ohone no.) , , H tE r.I.VL f',l.A 17 ....,..-u..'uv !?tV rd..>: - ^'l"I"Q-'-i.I.~u k'lIyl-ll',r-eJE" PE"v/ZY-._!:;-/V<;eJ. //v .-(.~,.../ r;Pt:=...'A.I.,....f)...L.~.PA~'P. / . '2a.!lic t,e3 - /(,f / ',/ 'Mn'lQ/-1J.8;t. . , I PLUMBINC -," HECiRICAl ..10.1 FEE I 1 CHARGE-rNO. j I I I o J MECHANICAL FEE I CHARGE I NO. FEE I CHARGE-l I I I ~'I E~~ ~n~e5fj~lur~ I q Ir.'elo'o,.dbuildin,;\~t()ci~ ~ {new tUl. aoa.tlonarf .,,- [ I () I S.F. ..,iden,. II . (1 bath) I Bl Quolu (1 bath) each I I 01 Additional both I I ! I W!.f.~'~i{. // ",,'';;.1 / I f.!;:~nAJlt I .., I p""r.5f/IV"'- I ol Stor.m Se......r ( I I I Residence of furnace/burner to IHU's Ap~liance vent separate Stationary evap. cooler Vent fan with single duct Vent system apart from heotinq or A.C. Mechanical .",hausl hood and d~ct ./ I Sq: ft. New circuits. alterations or extensions f)tf)"Jf~t./ ~/I : SERVICES too~.l" t.t. "'-2&:r 11~~ .v Temporary Construction Amps. 3 PI///. ~i'fX/S~/1/t.; Wood stavel heater FEEDERS Heat PumD Air hondler to 10.000 CFM Air handler a".' 10.000 CFM Amps. -I '1 : iK ,t~v' ""'(J~ 3 I./iw ~(,. }/(II fbf)~ r. . TOTAL CHARGES TOTAL CHARGES ISSUANCE OF.,PE'RMIT I TOTAL CHARGES II I WHERE STATE LAW REQUIRES that the Eledricol work be done by the Elertrical Contraclor, tho eledrical portiorl of this permit sholl not be valid until Q label has been ,igned by on Electrical Contrador and attached to the eledricaJ panel. I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that 011 information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and th.e laws of the State of Oregon pertaining to the work described herin, and that NO OCCUPANCY will b. mode of any structure without the perminion of the Building Di...ision. I further certify that my registration with the Builder's Board is in full force and effect os required by ORS 701.055, that if exempt the basis for exemption is noted heron, and that only subcontractors and employees who are in c:ompl;ance with aRS 701.055 will be used an fhis profect. \ Basis for Builder's Boord eumption: #. =II/a d:LL SIGNATL+~ 777 FOR OFFICE USE ONLY"" ., , I Stl/,., t' ./.a.-~ OATE T / , , NAME (please print) Ifll:fAL C LA/'.) ~n. /],J--;? 4;. ~ Zone Fire Zone Flood Plain Typel Canst. Bedroom s (.tori.' Units n -cy load Ocey Group Sq. Ftg, Main Sq. Ftg. Access Sq. Ftg. Olher x x Value Value _._Value . TOTAL V ALUA TION PLUMBING PERMIT Charges and Surcharges Fence I Systems DI!",elopment Charae 1t.5~ft\ I I BUILDING PERMIT Charges and Surcharges Pion CIt. Comm/lnd 65%/Blda Per Fee Plan CIt. Res JO%/BldC' Per Fe. Demo Total Comb. Permit elECTRICAL PERMIT Chorges and Surcharges Sidewalk A/c Pavina MECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL COMBINATION APPLICATION/PER. (CAP) . I. Applica~ to furnish A. Job Address B. legal Description 1. examale.tax lot 100, lane County Map Reference.17 03 43 2. example-Lot 1. Block 3, 2nd Addition to Springfield Estates C. Nome, etc. of owner and construction lender D.. Energy Sources 1. exomole-heot/electricolceiling/or forced air gas 2. exomole.woter heater; electrical/or solar E. Square footage or valuation, etc. 1. examole-1250 sq. foot house, 500 sq. foot garage 2. exam pie-if new project, check -;;e;,-if addition, check add. etc. F. Building permit information: 1. exomole-construct single family house with an attached garage 2. exomple.remodel existing gor09& 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 Structu,al Specialty Code H. DESIGN TEAM AND CONTRACTORS . To avoid design or construction delays, Building Division ~ t, Staff must be able to contact appropriate persons regarding .. l \ .. .. design 'informotion~or job site corrections, etc. . II. Abbreviated Plumbing. Mechanical & Electrical Sched~les 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 sched'ules have been abbreviated 2. If the item(s} to be installed are not covered on the abbrevi~ aled schedules you should consult the full schedules C. BUILDING DIVISION STAFF WilL Fll.L 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 signaturt.. IV. Fees and Charges Pion check fees ore 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: ~ . Additionol Project Information: PLANS REVIEWED BY: namf" ~i9notur"" . PERMIT '{ALIDA TION , -.' ;" ., Permit Cler~ r -.1.. ~ate . ...., ---'- .....J.- "