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Home My WebLink AboutPermit Building 1990-11-14 "1 I INSPECTION LINE 726-3769 Job Address L\-~ \ 1\ . \~ trr:: . ~ t: Legal Description ~f)~~m r)\qCj) . CITY UF SPRINGFIELD COMBINATION APPLICATION/PERMIT E!IERGY SOURCES: Heat \~a ter Hea ter Range - INFORlIATION LINt n~-37S1 Sq. Ftg. i4ain-c, ~q. Ftg. Access. Sq. Ftg. Other Ilew Add A Her Pep. -Fence Demo Change/Use Other- - g - C)J --.) ,)(( Owner\i\~rO~""7-10 \~)9n:~ L \D ValuE DPIScO Address ~~ L1Qfp\... D~,J'(7r1\ BU'lo,no P~rmit Info: Descr,be WDrk(l.e.. Build Single '- ~ ~'~~~j1o~tm DV-lU \~~~r~~t:chQdifV~l ~t~J Construction Lender 1- (\ crGd-5 \ttm1)\{~1~'QX0 - ~~~~~~sTEAM Inamel PhOr:ddreSS) \ \{ ') ,,~}s_ nD~~exoire~1 -- - (ohona no.) Primary b~ ,...,.."Lt:;T l~ Structura 1 Electrical Mechanical CONTRACTORS Inamel . :~:::::o ~\~ \~N\hn('};-\\'()\ {Sn~'{ \Z\~Wt O~\,~1~5~1 Electrical ~'echanical PLUI.IBI NG ELECTRICAL MECHANICAL NO. Each single fixture FEE rHARr.F Nn~ HF rlfARliE. Nn Residence of furnace/burner to SQ. FT. BTU's '...E.E.L J:Ji8BliE. Relocated building (new fix. additional) INew circuits alts. or extensions ISERVICES I ITempOrary Construction IChange in existing rp'} j dJ'nrp Imultifamily. comm. or IndlJ~trial 10f amps.1 ICDffi~_/INO. FEEDERS I IInstall/alter/relocate I d;<:.tr;h. fpprlpr<:. 10f amps.1 I I I Floor furnace and vent S.F. Residence () bath) Ouplex (1 bath) each AdditiDoal bath Recessed wall ~n~~p hp~tp~ ~"rl vpnt Sewer Appliance vent c;.poaratp Stationary evap. cooler Vent fan wi th s;nole duct I'Vent system apart from heatino or A.C. IMechanical exhaust hnnrl ;,nd rlll~t I H~~d stove/heater I I I Water servi ce Storm Sewer TOTAL CHARGES TOTAL CHARGES WHERE STATE L\H REQUIRES that the Electrical work be done by an shall not be vali~ until the label has been signed by an Electrical ISSUANCF nF PFRIIIT TOTAL CHARGES 'Electrical Contractor. the electrical rortion of this permit Surervisor and returned to the Building Division 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 oerformed shall be done in accordance with the Ordinances of the City of Spri ng fi e ld and the laws of the Sta te of Oregon perta i ni ng to the work descri bed herei n, and that flO .QCCUPAIKY wi 11 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 ORS 701.055 will be used on this project. N~priot) ~}\JIHIJ>JY L. 6E'fl..ll'1 SI"II^TURE~ ~ ~DP.TE..1.l..::J tJ-<J?") 'lC . FO~ OFF I CE USE O1lL Y I I Zone ("V Type/Canst. Units Sq. Ftg. fiai" Fire Zone Bedrooms Occy load Sq. Ftg. Access Flood Plain Stories Occy Group Sq. Ftg. Other x Value Value Value x x TOTAL V ALUA TI Ot! BUILDING PERflIT Charges and Surcharges I c:. CD Plao Ck. \.) . 65%/R1~o ----~-(r~--- ~~~~B~~~ Fence CDnm/l nd Ppr f"P/>l Res Per Fee Systems Development Charqe (1.5~) PLUt1BING PERMIT Charges and Surcharges D~mD "Sidewalk A/C Paving Total Comb. Permit ELECTRICAL PERlm Cha rges and Surcharges 11ECHANICAL PERMIT Charges and Surcharges TOTAL I~. r;:s Curb Cut .. r t COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100. Lane County Map Reference II oj 43 2. example- Lot I. Block 3. 2nd Addition to ~prln9tield Estates C. Name, etc. of 'owner and construction lender O. Energy Sources 'I. examele-'heatlelectrical ceilinqJor forced air Qas 2. example- waterneaterjelectrlC3r!or solar E. Square ,footage or valuation. etc. 1. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check new - if addition, check add. etc. F. Building pennit 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 TEAM 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 fu 11 schedu 1 es C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEOULES O. 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . . .' PERMIT VALIDATION \ ~ , 1~ 'f---f10 ~ \ 8lB2( P,rnit Cleek MiiiJ Permit appl icant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature I date