The URL can be used to link to this page

Home My WebLink AboutPermit Building 1984-12-21 (2) . . I HlSPECTlO1I LlIIE 726-3769 Job Address L\ ~ .: {\ ~ . Legal Dmription 1'.()z.~,,?'2. t!;/5'''' , , CITY OF SPRINGFIELD C01mIrIATlDN APPLICATION/PERMIT E!IERGY SOURCES: Heat Hater Heater ~\- Phone IHFORliATlON Li~E 726-3753 Sq. Ftg. 1,Iain ~Q. Ftg. Access. Sq. F~'ll DJh r -1lew)(Add lter _Pep. , Fence De Change/Use ValuE of f~ rtf1:), Other- - BUilGino permlt&InfO: Describe Work(i.e.. Build Single Famil.... Residence IH th A.ttached Garaae) l ~ (\Ttl'"I.p-,~ t\:) ~ nv:> Ranoe ~ .c:. o ~ ~ Address Ut.~ il.:iN I l:.N1 Phone (name) (address) J:'Q."0 ~~\ S\unt1\ c\'-'.J&~_ (lfes. no.) (exnires) A '~ Cohone no.\ Primary Structural Electrical Mechanical CONTRACTD~S name(, ", General ; Plumbina (address) {l~ 1}&r> . - (\~~r.;' Eo Inh:np nn ," - ~ 1- E1 ectri ca 1 ~techanical PLUItBIrIG ELECTRICAL MECHANICAL .Jill." I Each single fixture I FEE" 1 rHI\Rr.f ....lIP I I j:'j:'j:' I fl:!ARG..E.. ~m. I Residence of furnace/burner to SQ, FT. BTU's l 1='1='1=' I rl-4l1B.G.E... :': Relocated building (new fix. additional) " .,.,.. New circu~ts alts. or extensl0ns , ~~R~ SERVICES IS:- Floor furnace and vent S.F. Residence (] bath 1 Duplex (1 bath) each Additional bath Recessed wa 11 ~n~rp hp~t~r ~nrl ~~nt IWater service I Sewer IStorm Sewer ITempOrary Construction IChange in existing rpS; dflnr.p , Imultifamily, comm. or Tnrluc;.trial IOf amps. Appliance vent c;.poaratp Stationaryevap.. cooler Vent fan with sinole duct Vent system apart from I heatina or A.C. I'MeChanical exhaust " hood and dud I Wood stove/heater I I I I I I I I I I IOf amp..1 I I I I I I I I I I ISSUANCE OF PFRr1lT TOTAL CHARGES TOTAL, CHARGES I~ -I TOTAL CHARGES WHERE STATE L'W REQUIRES that the Electrical work be done by an 'Electrical Contractor, the electrical portion of this permit shall not be valid until the label has been signed by an Electrical Supervisor and returned to the BUilding Division CO~~,/IND, FEEDERS Install/alter/relocate d;~trih. fppdpr~ I HAVE CAREFULLY EXAMINED 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 performed shall be done in accordance with the Ordinances of the'Cit~ of Springfield and the laws of the State of Ore~on pertaining to the work described herein, and that NO OCCUPAUCY will be made of any structure without the permission of the Building Division. I further certify that ~ 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 7Q1.055 will be used on this project. <l :r, ~ ~u..;l "''l-, 1117 llAI-IE(p!ease print) ~ lJ. r ' ;v-/i "'i-N , SIr,rlATURE~ 4N FO~ OFFICE USE DIlLY ( Sq. Ftg. f1ain~.#_.rwr.. i;kx Sq.,Ftg. Access x Sq. Ftg. Other x nATF / ').r1"I.-J ~' I Zone~ Fire Zone Flood Plain TYDe/Const, Bedrooms Stories Units Occy Load Occy Group~-2 Value Value Value 7-~~ .- BUILDING PERI,l!T Charges an~ Surcharges LJ'I CO Plan Ck, ___2__:.____ 65%1Bldo Plan Ck, 30%lB!do I Fence ------------ I Demo ___-.is - I Sidewalk . ~() I A/C Paving I Curb Cut I /.7~ COll1l1/1nd PPI'" Fpp Res Per Fee TOTAL VALUATION 2. ~ syste, ms Development Charoe (l,5~) " I 11'.1' - Gf -r-' 1~~I;/1 I' -. . I , I I II hotal Comb, Permit I /1<. $''' PLU'lBING PERMIT Charges and Surcharges ELECTRICAL PERI~IT Charges and Surcharges IIECHANICAL PERMIT Charges and Surcharges I I TOTAL ~/. 36 j / 7"3'.8~ . COMBINATION APPLICATION/PE~~IT (CAP) I. Applicant to furnish A. Job Address B. Legal Oescription I. example- Tax Lot 100. Lane County Map Reference -II oj 43 2. examole- Lot I. Block 3, 2nd Addition to ~prlngtield Estates ' C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilin~/or forced air Qas 2. examDle~ waterheater/electrical/or solar Eo Square footage or valuation, etc. - I. examole- 1250 sq. foot house. 500 sq, foot garage 2. example- if new project. check-new - if addition, cneck add, etc. F. Building permit information: 1. example - construct single family house with an attached garage 2. examole - remodel existing garage into family room 3. examOle - convert single family residence into restaurant (chang~ of use) G. Value of work as defined in Section 303 (a) of the Structural Specialty Code H. OESIGN TE~' 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 abbreviated schedules you should consult the full schedules 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 signature. IV. Fees and Charges Plan check fees are due and payable at the time of the app 1 i ca t ion, and no plans wi 11 be processed unfi 1 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: . PERMIT VALIDATION f3 (.,103( Vi Q)-t~ , ~ 1'(( Permit Clerk ,Jh /) , Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: .. I PLANS REVIEWED BY: name_Loh;?/'V~ ~&:""&iPSignature~'-j.~- '. date /~-'2,.ti~ ~...--~