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Home My WebLink AboutPermit Building 1984-9-14 -. . 'J .'IIISf'~ErION LINE i 726-3769 Job Address 330S MA-/Io.J Legal De<cription /7 0 ~ s I Address us C/.O /11/ G;c.;t..EfNIf! /VA CITY OF SPRINGFIELD COMB IllATION APPLlCATION/PERMIT EilERGY SOURCES: Heat A / / /0"/'0 l~ater Heater u --, I<" C.. Range ValuE of Hark: /Z-.fTo-O- C' qo~ Builc;~Info: ~ \~ork(Le.. i)r-" Phone ~~.. ~ l'1.esidencelITth /l.ttached{laraoel g-z.f2, / U- /UJor ) \. ------- ~r '2.,/ INFORlIATION LINe . 726-3753 Sq. Ftq. Hain ~q. Ftg. Access. Sq. Ftq. Other Uew Add Alter Rep. -Fence Demo Change/Use -Other - - Owner' C lie1:>1 1"" Co R..p PE-mz." ""/1'+0 I Construction lender Address DeSIGN TeAr1 ,= Phone (addrE"';'c;. ) (name) . (li'"-5. no.) (pxnires) ~ if Primary Structural Electrical Meehan; ca 1 CONTRACTORS (name I (<lrlrlress) flies. no.) p(,;1o,fZ.I.. 22..'10b (pynires) s:-/ ~ ~ I Genera 1 / NCOfk.E. ?/Zo P m:rz., I 1111 In"'M/oJT Plumbino Electrical ~1echan;cal PLUf.lBING \::)~ FEE cHARGE ~~ \:;CC fin I furnace/burner to BTU's ELECTRICAL MECHANICAL NO.' lEaCh single fixture IRelocated building (new fix. additional) I'S.F. Residence (1 bath) IDuplex (I bath) each IAdditional bath I ~later service Nn ~ Residence of SQ. FT. New circuits alts. or extensions Floor furnace and vent Build Single ~ 0J -.3 <::> l:;r ~ (ohone no.~) (ohnne no,) '/6S"-~2S Z- \)~ H~ I r~AR~~ SERVICES Recessed wall ~l);H'P tlP;:ltp.- ~nrl I/pnt Appliance vent seoarate Stationary evap. cooler Vent fan with sin(11~ duct Vent system apart from heatinq or A r Mechanical exhaust hood and durt ITempOrary Construction IChange in existing rps j dJ'Jl('~ Imultifamily, comm. or Tnduc:.t.rial 10f amps.1 I COMI-I.IINO. FEEDERS I IInstall/alter/relocate I r1ic;trih_ fpprlprc:. IOf amps. I I I Wood stove/heater Sewer Storm Sewer TOTAL CHARGES TOTAL CHARGES WHERE STATE L_"~ REQUIRES that the Electrical work be done by an shall not be vali~ until the label has been signed by an Electrical I SSUANCE OF PFRIH T TOTAL CHARGES Electrical Contractor. the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFULLY EXMlINED the completed aprlication 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 He OCCUPAIlCY 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 SUbcontractor.s and employees who are in compliance with OP.S 70l.0~ W.iillll b bee u u:seedd 0 o~n i~_ project. IWIE(please print)~ MMq1f SCk7eIL- SIGIIATURE ~ '-"--- DATE'7 !f!Jl 1- FOR OFF I CE USE DIlL Y II So. Ftg. liain Sq. Ftg. Access Sq. Ftg. Other Zone Fi re Zone Tvpe/Const. Units Occy Load Occy Group x Bed rooms Stories x Flood Plain x TOTAL V ALUA TI ON BUILDING PERfIIT ____CO~.L~ Plan Ck. Comm/Ind IShstems Development Charges and 65%/Bld(1 Per ~PP C aroe (1. 5~) . Surcharges '2.,~ Plan Ck. Res I 30%!Bldo Per Fee PLUt~BING PERMIT Fence I Charges and ------------ Surcha rges DfIRlo I ELECTRICAL PERmT I Sidewa I k I Charges and ------------ SU.rcharges lAIC Pavi"9 ITotal Comb. rermit IIECHANICAL PERMIT I Curb Cut I TOTAL Charges and ------------ Surcharges I Value Value Value ~).~ CoG, .<""b f I . . '---. ??4 () Io~-y COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION Ii #- 0 '3 .sir; / ~J 9 /;'-I/!<( ,Qd' I. Applicant to furnish A. Job Address B. legal Description 1. examp.le- Tax Lot 100. Lane County Map Reference Ii 03 43 2. ~xamp]e- Lot 1. Block 3. 2nd Addition to Sprlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. exam~le- heat/electrical ceilinq/or forced air Qas 2. examyle- waterheater/electrlcal/or solar E. Square footage or valuation, etc. ----- 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. examole- if new project. check-new - if addition, cneck. add. etc. F. Building pennit information: 1. exam~le - construct single family house with an attached garage 2. examele - 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 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 full schedules C. BOILDING 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. V. FOR OFFICE USE ONLY Permit Clerk if) ~ j , PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: -, -,. '. 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