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Home My WebLink AboutPermit Building 1986-9-24 CITY Uf SPRINGfIELD COMBINATION APPLICATION/PERMIT ENERGY SOURCES: Heat I~ater Heater ,Hrr>- 0';-4.( '. t ...., ~~ I INSPECTION LINE 726-3769 'f'.:< j/ MAIN S'r, Legal Description /7-02. '1'2-~Z PA-Rr~ C? /9<JO Job Address Owner './V'-'#;'7V2'/!i" Msr ~~"'PPI/Y,,;' AddressN/9r/4N'1'IL. /'ipso - )..,!;:SS/3c ~('f- rI TNS/V f-~.V' /flhJd"'T. c'!..:; ,-=-<' Phone '7i'tr--3 3~.3 Cons truct; on lender . S ~F Address DESIGN TEAI1 Phone (address ) (name) .-/ .J.c::LF /Y //1 J.I//J ,{j / It (namel, /AI<' (IONS,': er- 1./ //J IV III /VIA (address) Primary Structural Electrical Mechanical CONTRACTORS Genera 1 Plumbina Electrical ~1echani ca 1 PLUIIBI NG NO, ~FF rHAIUiF NO Each single fixture Residence of Relocated building (new fix, additional) t\ e -' ~1-11 5300 .- INFORltATION liNt 726-3753 Sq, Ftg, 1'1ain ~q, Ftg, Access, Sq, Ftg, Other Hew Add Alter Pep, -Fence Demo Change/Use , Other- - ~ ~ I\l Range Va~E of Work: 0" .G?aoo'- Bu116ina Permit Info: Oeser be Workli.e., Build Single Familv nesidence With Attached Garaae\ ,;P~7'7'/~~ ,/N~./.<::::>./9 a>P I ~~#5'~ 5p#~ ~ .~T/~ I//pc=-c::::> /?n::>/f'c. flies. no.) (exl1;res) '" j~ ~ .."... ~~ LV ~ " (ohane no. I f1ic~.no.) (exoiresl (ohone no.) ELECTRICAL MECHANICAL ~~~ r~ NO ~~~ r~;RGf ~ SQ, FT. furnace/burner to BTU's New circuits alts. ~ or extensions '7 e>'R h7~G SERVICES -;z;;?..S? Floor furnace and vent S.F. Residence (J bath) Oup1ex (1 bath) each Additional bath Recessed wall Snace hpater and vpnt amps. Appliance vent seoarate Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from heatina or A.C. Mechanical exhaust hood and duct Wood stove/heater ~Iater servi ce Temporary Construction Change in existing res i 4f!J1ce. multifamily, COIl1Tl. or Industrial Sewer Storm Sewer Of , COMH,/IND, FEEDERS Install/alter/relocate di~trib. feeders Of amps. I SSUANCf OF PFRIIlT TOTAL CHARGES TOTAL CHARGES ::<2-5?> TOTAL CHARGES WHERE STATE L,\l~ REQUIRES that the Electrical work be done by an,'Electrica1 Contractor, the electrical portion of this pert:lit shall not be vali~ until the label has been signed by an Electrical Supervisor 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 performed shall be done in accordance with the Ordinances of the City of Spri ngfi e 1 d and the laws of the Sta te of Oregon perta i ni ng to the work descri bed herei n, and that UO OCCUPAllCY 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 ORS 701~5 Wi~ b~.d on this project, IW1E(p1ease print) ~C:;;VE;S: ~ SIGrlATU O'UOJ'P /I!, nL DATE f'h~ FOP. OFFICE USE 'Q;IL Y {/" Sq. Ftg. riain x Value Sq, Ft9, Access x Value ;7.?-2 Sq, Ftg, Dther.h'r/>>~ Value ?aa?, .,..4> TOTAL VALUATlOII Zone c:::: L. -S-~A/ Units Occy Load Dec.y Group Tvpe/Const. Bedrooms Stories Fi re Zone Flood Plain BUILDING PERfIlT Charges and Surcharges , -2"7 c::-= ' Plan Ck, ConmlInd __~_~__.:?-____ .....2..5l/BJdo Ppr Fpp I "3 Plan Ck, Res '. C> 30%/B1 do Per Fee Fence PLUr~BING PERMIT Charges and Surcha rges Domo _ ___ Z.:?;f~__Sldewa1k . 90 AIC 'paving ELECTRICAL PERIHT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges Curb Cut 2/./-=3 'Systems Development Charae (l,5~) , .{/..(1 . Total Comb. Pe~mit -5"720 TOTAL 78.33 . 1"-' I '. , / . " ) " I' " 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 II oj 43 2, example- lot 1, Block 3, 2nd Addition to Spn ngti e)~ Es ta tes C. Name, etc. of owner and construction lender D. Energy Sou~ces 1. example- heat/electrical ceiling/or forced air qas 2. examole- waterheaterjelectrical/or sotar- 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. examEle. remodel existing garage into family room 3. exam~le - 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, OESIGN TEAM 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 I'of the Mechanical and Electrical Schedules, the appl,iicant need fill-in only the No, Boxes adjacent to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedules are avai,lable 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 I schedul es C, BUIlOING, OIVISION STAFF WIll FIll OUT All FEES ANO CHARGES ON THE SCHEOUlES D. As noted on the CAP.. the label must be delivered to the electrical contractor for Signature by his electrical supervis'or. The general contractor is .not authorized to sign ;the electrical label. - III. Applicant tal sign and date Whenever pos'sible, the initial application will. be used as a worksheet only. Where possible, Building Division Staff wi 11 prepare: a type written copy and return it to the applicant at!1 the time the actual permit .is issued for his signature. I 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. II V, FOR OFFICE USE ONLY II ~ ~ SI..R )\,\p ~. V\ 1-\0 Permit Clerk 0/ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: II Permit applicant exempt from registration with the Builder's Board because: Additional II II ~roject Information: PLANS REVIEWED BY: II, name' L V'7?nb /Lre:;E?3' I signature ~~ ,,, ~ - y r date "7~2t::-g,,::;