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Home My WebLink AboutPermit Backflow Test 1988-3-1 ". .~ -'~" Job Address . t/U'D ht~ , CITY Uf SPRINGfiE~D COMBHIATION APPLICATION/PERMIT EIIERGY SOURCES: Heat Hater Heater Range ValuE of Work: ~ INFOR/1ATION LINt 726-3753 Sq. Ftq. 1.laio ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. -Feoce Demo Chaoge/Use -Other- - I~ 10 I INSPECTION LINE 726-3769 legal Description Owner. /&;;AIP~-v.J IJlw'ccr i(zto fh~ Address Phone BuilGinQ Permit Info: Describe WOrk(i~e~. But d Single Familv nesidence With Attached GaraQe) -\ f'JAJL ~-l-'A --- Address Ut.::illiN TI::.Af1 (name! Phone (address 1 flies. no.) (exoires) -..:.J -...:J I I (ohone no. \ Construction Lender Primary , "" Structura 1 ~ .~ V t;'"\"""l, Qnd Electrical Mechanical CONTRACTORS (name) (address) (l ice;.. no. (exoirp<;.) (ohonp no. ) Genera 1 Plumbino c/fV!"M (}i~b4 -"'-- 1.rl, ) I I Electrical ~lechanical PLUllB I NG ELECTRICAL MECHANICAL NO. FFF rHAPr.F N~ ~J:'~ rl.l~ NO ~~~ r~ Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence 11 bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall Sn~rp hp~tp~ ~nrl vpnt fiY Temporary Construction Change in existing res i d_e.nce Imultifamily, COI111l. or Inrlustrial 10f amps. ICO~1./iND. FEEDERS I install/alter/relocate rlic:.t~;h fpprlp~c:. 10f amp~ I I I Appliance vent <;.eoarate Stationary evap. cooler Vent fan wi th sinele duct 1 Vent sys tern apa rt from heatine or A.C. I'Mechanical exhaust hood and durt I Wood stove/heater I I I Water service Sewer Storm Sewer ISSUANCE OF PFRI1IT TOTAL CHARGES WHERE STATE L~H REQUIRES shall not be valid until the TOTAL CHARGES TOTAL CHARGES that the Electrical work be done by an. Electrical Contractor, the electrical portion of this permit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXMIINED 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 City of Springfield and the laws of the State of Oregon pertaining to the work described herein, and that UO OCCUPA[~CY 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. IWIE(please print) fJ1.( Itt. C/!!J!i1 B.E/e::; SIGrlATURF.~~~ OATd-l~~ FO~ OFFICE USE DrlL Y Zone Fi re Zone Flood Plain Tvpe/Const. Bedrooms Stories Uni ts Occy Load Occy Group Sq. Ftg. r1ain Sq. Ft!J. Access Sq. Ftg. Other x Value x Va 1 ue x Value TOTAL VALUATION BUILDING PERfllT Charges ane: Surcharges Plan Ck. Comm/lnd 65%/Rlde Ppr Fpp ------------ Plan Ck. R'es 30%/Blda Per Fee Systems Development Charqe tl.5~) '. PLUI~BING PERMIT I/C"" cO ~~~~~:~g:~d (' - - ulL' -.:-1 S-- ELECTRICAL PERIHI Charges and ------------ Surcharges MECHANICAL PERMIT Charges and Surcharges Fence DfIRlo 'S1dewa1k A/C Paving Curb Cut /rota' Comb. I I TOTAL Permit /0.7s . ,_~~ ,.f" - . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax lot 100, lane County Map Reference '17 oj 43 2. examE1e- Lot I. Block 3, 2nd Addition to ~pr'ngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinq/or forced air qas 2. exa~le- waterheater/electrical/or solar E. Square footage or valuation, etc. I. examDle- 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. exam~le - 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. OESIGN TEM1 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 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. /1040 '3 -- i - r~ V. FOR OFFICE USE ONLY Permit Clerk Cc- 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