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Home My WebLink AboutPermit Building 1983-1-1 I H1SPECTlON LINE 726-376g . . 8%lJ:Jp Job Address 47.. 5Z.~ M Il.. \ N '>\ leg.l Description\'\ ell') ~? ""\? CITY Uf SPRINGFIELD COMBINATION APPlICATION/PERMIT ElIERGY SOURCES-i- He.t GO\.t:.C, \'I.ter He.terB. t=l" I D\~\ Owner. e. OC.Lc..-:.::>"It.. Po 100><:. \~7& rc:.1Jc.1t"'~ DIlt'( Cj. 744D Phone INFDRlIATlDN LINt 726-3753 Sq. Ftg. 1.I.in ~q. Ftg. Access. Sq. Ftg. Other -11ew_Add..d>I ter ~ep. Fence Demo Change/Use V~E of Work: 00 Other-- BUilGi~; ~e~;o: Describe Work(i.e., Build Single F.milv nesidence With Att.ched G.r.ce) FAG!c"4~r ~c~~~ ~ . R~ /_'r1.-../,~~~....".r- Range E le.c::r 0\) .~ Address Construction Lender Address Dt, I uN T EAr-! {name) Phone (address) (lies. no.) (exnires) (ohane no.'\ Primary ";:.TIJ /:; 17..1 '-YDbD ?6...A~ , \ PD.~X 577 Coo,,> ~101Z/f 974Z(;:> 'Z.,,~"" ~ If.- ~ ~, Structura 1 Electric.l Mechanical CONTRACTORS I name> faddrec;s) (1 ire::. flO.) (pxn;rpc::) "'I (nhnnp nn ) Gener.l .t-ll\ S, It. tt~ ?O~K 5."'C>~ TE..Ut;/1,"'MST4-o~-. 1630 eI'!./1 A4- (;~1 ~S" Plumbina ....... , Electrical ~lechanical PlUllBING ELECTRICAL MECHANICAL NO. FFF rJ1AR(;F Nn ~FF r~~ NO SQ. FT. furnace/burner to BTU's H~ rullR.G..E. ./ Each single fixture Residence of Relocated building (new fix. .ddition.l) ~ New circuits alts. or extensions ~- Floor furnace and vent S.F. Residence (1 b.th) Duplex (1 b.th) e.ch Addition.l b.th ISERVICES I Recessed wall ~n~r~ hp~tpr ~nrl vpnt Hater service ITempOrary Construction IChange in existing rp'i j d_P.rH~P Imultifamily, COnrTl. or Inrlustrial Appliance vent ~~Da r~ tp Stationary evap. cooler Vent fan wi th sinole duct Vent system apart heatino or A.C. Mechanical exhaust hnnrl ~nd rlu~t from Sewer 10f .mps.1 ...... lAwN .s~A'''Mr'''~f' S)lJ~ I COMJ.I.II ND. FEEDERS I ~ I r- I Install/alter/relocate I n"eYlS/c>,S .;). rlic;.trih_ fpprlprc;. I IOf .mp~1 I I I I I I I I I TOTAL CHARGES MIl>(. /6. ~ TOTAL CHARGES I~ - TOTAL CHARGES WHEnE STATE l,\11 REQUIRES th.t the Electric.l work be done by .n,'Electric.l Contr.ctor, the electrical portion of this permit shall not be va1i1 until the label has been signed by an Electrical Supervisor and returned to the Building Division Storm Sewer Wood stove/heater I SSUANCF OF PFRI1lT I HAVE CAREFULLY EXM1INED 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 1 d and the laws of the S ta te of Oregon perta i n i n9 to the work descri bed herei n. and tha t UO OCCUPAr~CY wi 11 be made of any structure without the permission of the nuilding 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. IlAl-1E(ple.se print)_/ .c~ l;"~r;-rr Zone~ Fi re Zone Flood PI.in Tyoe/Cons t. ~ \ \ Bedrooms Units Occy lo.d Occy Group~~. SIGIIATURE FOr. OFFICE USE OfllY Sq. Ftg. 11.in ?a.. ~ '(:) ~ Sq. Ft9. Access Sq. Ftg. Other OATE Stories \ 8''''7: V.lue .#A.~_- x Value x Value BUILDING PERf.IIT Charges an~ Surcharges ~ CPO Pl.n Ck. conmll.nd ~~ 65t/81dn Ppr ~pe ---- --=;,-.;u- PI.n Ck. Res ",..." 30%/Bldc Per Fee It!>. - -------~c;6- Demo _ ___ !!2:....~__S1dew.lk , 'fa .J!: 0 ( TOTAL VAlUATIDr' f~. c Inll()(, 3',' A ,-, ~^ r_,< syste. ms Development "I" co....O ,..,..."" Ch.rce (J.5~) /Y~. I PlU'~BING PERMIT Charges and Surcha rges Fence ELECTRICAL PERf:IT Cha rges and Surcha rges AIC P.ving I Curb Cut I Total Comb. Permit MECHANICAL PERMIT Charges and Surcharges TOTAL # ?~~Y' J . COMBINATION APPLICATION/PERMIT (CAP) \, I. Applicant to furnish A. Job Address B. Legal Description I. example- Tax Lot 100, Lane County Map Reference 17 U3 43 2, example- Lot I. Block 3, 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender 0, Energy Sources . 1. example- heat/electrical ceilinqlor forced air Qas 2. example- waterheater/electrlcal/or ~ E. Square footage or valuation, etc. I. example- 1250 sq. foot house, 500 sq. foot garage 2. examp.le- if new proj~ct. check-nfw - 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. 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. DESIGN TEM4 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 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 SAT.ISFIED BEFORE OCCUPANCY: . ~ERMI~ VALIDAJION ,. ' Permit Clerk {p IgCo () , Lf0 . '. ... . ~~L ,...; , Permit appl icant exempt from registration with the Builaer's Board because: Additional Project Information: PLANS REVIEWED BY: name signature '.' 'I date