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Home My WebLink AboutPermit Building 1984-12-21 INFORI1ATION liNt 726-3753 Sq. Ftg, I,lain ~q. Ftg. Access. Sq, F!'ll OJh r --1~ewj(Add 1ter__Rep. Fence De Change/Use Valu' of f'4 fft) Other-- BU11Gina Permitrlnfo: Describe Work(i.e., Build Single Familv nesidence With Attached Garaoel ~ c\Ttl"".9-\~ & - ,.~ I'\Q...O\.0 . . I HiSPECTIOII LItlE 726-3769 Job Address 4\ Q CO ~o..: I\. '&... Legal Description /7.();!.'j,.?'2. t:J/S'CI , CITY OF SPRINGFIELD CD/IBIIIATION APPllCATION/PERMlT 1 E!IERGY SOURCES: Heat r Hater Heater I Ranqe Owner \~n Address~\U'O " I . Address Phone Uc)ltiN ItAN (name) (address) Primary ~~rLu.rl~ \ S'ernl'f\ c:\h ~~ Structural (lies. no.) Electrical Mechanical CONTRACTORS rme I, General i\oc t ~ - (addrpss 1 p~ .l13m (\~~rp;1 wi":np Plumbinq Electrical ~lechanical PLUltBIrIG ELECTRICAL NO,' Each single fixture tJt (axoires) (ohone no.'l l ~ ~' ,~ r 001 MECHANICAL , FEF 'CHARGF Nn, , FFF 'rHl\RliE-1lll.....' Residence of furnace/burner to SQ, FT. BTU's I n'i= Ir':iARG..E.. ./. ITempOrary Construction IChange in existing , fPo;J 4~nr:p . I Sewer Imultifamily, conm. or T nduo;. tri ~ 1 lstorm Sewer IOf amps.l I I ICOI'ifl./IND. FEEDERS I 1 Install/alter/relocate I I di~trih_ fppdpr~ I Of amps.1 I I I I I I I I I I I ISSUANCE OF PFR/IIT TOTAL CHARGES TOTAL CHARGES Ii: -I TOTAL CHARGES WHERE STATE LW REQUIRES that the Electrical work be done by an.'Electrical Contractor. the electrical portion of this permit shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division Relocated building (new fix. additional) IS.F. Residence (1 bath) I Duplex (1 bath) Additional bath each ----I New circu!ts alts. or extenslons , '2.~R~ I SERVICES I IS:" ~later service Floor furnace and vent Recessed wa 11 ~o~re-hp~tpr ~nrl~ I I I I Appliance vent 5.eoaratE' Stationary evap.. coolE'r I'Vent fan with sinole duct I Vent system apart from I heatina or A.C. I Mechanical exhaust hood ~nd dud. I \iood stove/heater I I I I HAVE CAREFULLY EXAMINED tbe 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 performed 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 flO OCCUPAflCY 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. <l 'S, ~~"'1/~ 11~7 rlAl-tE(p1ease print) 'f-.... [). ,% '-"",/1 ~~ SIGrlATURE FOr. OFFICE USE Orll Y / (I Sq, Ftg, liain ""~D~ rYd> ,,",,' Sq. Ftg. Access x ,<'\ Sq, Ftg. Ot r /1 IJ, ~'~ Systems Development L.n Charqe (1.5~) " I )YA '/'r-_ <1 r-- 1......~Jn - .. I I I I Zone t!: ~ Fire Zone Flood Plai" I .or - /\/ Units Occy Load Occy Group~-2 Type/Canst. Bedrooms Stories BUILDING PERI,IIT Charges anc Surcharges LJ LJ De> Plan Ck, Conmllnd '7' 7' 65%/Rldo PPr fpp ------------ Plan Ck, Res i. 7C:; 30%/Bl do Per Fee PLU'~BING PERMIT Charges and Surcha rges Feflce I Demo I Sidewalk A/C Paving I I i J ELECTRICP,L PERr~IT Charges and Surcharges 11ECHAlUCAL PERMIT Charges and Surcharges ___-.is-: - . ~() Curb Cut ----------~ OATE/v-v--t~' . Value Value Value 7,<"(!:lO. -- TOTAL VALUATION /1<. $'0 ITotal Comb, rermit I I TOTAL , ~/.3~ 17-S.B~ j I ~ . . COMBINATION APPLICATION/PERMIT (CAP) . I. Applicant to furnish A. Job Address B, legal Description I, example- Tax lot 100, lane County Map Reference 17 03 43 2. exam~le- lot I. Block 3. 2nd Addition to ~prlngfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. examele- heat/electrical ceilinqlor forced air Qas 2. examole- waterheater/electrlcal/or solar Eo Square footage or valuation, etc. - I, exam~le- 1250 sq. foot house, 500 sq, foot garage 2. examole- 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. 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, DESIGN TE~1 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 Pl~mbing, 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 OUT All FEES AND CHARGES ON THE SCHEDULES 0, 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 permit is issued. . ' '. PERMIT VALIDATION . . , , {3C,103! J ~'~ ,iV' ?~t ,,' J 1'0/ V. FOR OFFICE USE ONLY Permi t Clerk~ Ii , 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-'-~;?fttE! ~~~Signature~~,; -_ , r --p .~ ,. " i '. date I~-'Z I'.~