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Home My WebLink AboutPermit Signage 1983-12-6 I INSPECTION LINE 726-3769 . CITY UF SPRINGFIELD COMBIIIATION APPLICATION/PERMIT EIIERGY SOURCES: Heat \~ater Heater Range Valu, of Hork: . INFOR/lATION LINt II 726-3753 Sq. Ftg. Haln ~q. Ftg. Access. Sq. Ftg. Other flew Add Alter Pep. --Fence Demo Change/Use Other- - "...q, W Job Address ~t\ II \'\\fi 'If\ ~,. ., Legal De5cription _. Owner'~ .,r... ~ ~l\'1'1 (11 ITf'o"\I\ ~u-t... ~ l:f\ 8 " Phone (lies. no.) (exoiresl 6' ~ LN- , no. \ Address DtSIGN TEAI1 (name) Phone (address) BuildinQ Permit Info: Describe Work(i.e., Build Single Familv Residence With Attachpd Garaae) ~ \()rtl\\'{'n.~) ~~ i:-~ & ru' - 4- \ :. r"o'^ t:, Address ~Ur\. construction~~~}J' (ohnnp Primary Wl. ~. Structural Electrical Mechanical CONTRACTORS (name) (address) flics. no.) (pxoires) (ahoM no ) General Plumbino Electrical ~I'\T\O.A) ~1echanical PLUI1B I NG ELECTRICAL MECHANICAL ..J!!h Each single fixture FEE r:HARr.F Nn I='I='~ rlffi.RG.E. NO Residence of furnace/burner to SQ. FT. BTU's !:'!:'~..cJ:iAR.G.E., / Relocated building (new fix. additional) l's.F. Residence (] bath) IDuplex (1 bath) each IAdditiooal bath I ~Iater service I Sewer Istorm Sewer I I I I I I INew circuits alts. or extensions ISERVICES I Floor furnace and vent Recessed wall ~nn~P hPntpr ~nrl vpnt ITemporary Construction IChange in existing rp~ j dJ'JH~p . Imultifamily, comm. or Tnrllld.r;;:jl 10f amps.1 ICOMH./IND. FEEOERS I Install/alter/relocate I r!i c:t.rHL fpprlprc: Appliance vent s~oaratp Stationary evap. cool~r Vent fan with s;nole duct Vent system apart from I heatino or A.C. Mechanical exhaust hood and du('t Wood stove/heater Of amps.l TOTAL CHARGES . WHERE STATE L\IJ REQUIRES shall not be valiJ until the TOTAL CHARGES I SSUANCE OF PFR!JIT TOTAL CHARGES that the Electrical work be done by an-:Electrical Contractor, the electrical portion .of this pemit 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 Springfield and the Laws of the State of Oregoo pertainiog to the work described herein, aod that 110 OCCUPAIICY 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 701.055 will be used on this project. / I IIAf.JE(please printlf - ~ SIGIIATUR$. .,..,.~ .. FOr. OFFICE USE OIIL Y Zone Tvpe/Const. Units Sq. Ftg. f1ain Fi re ZonE' Bedrooms Occy Load Sq. Ftg. Access Flood Plain Stories Occy Group Sq. Ftg. Other OATEl\! x x Value Value Value x TOTAL V ALUA Tl ON BUILOING PERMIT Charges and Surcharges Plan Ck. Comm/Iod ____________ 65%/Bldo Ps>r Fpp Plan Ck. Res 30%/Bldo Per Fee Fence Systems Development Charoe (I.5~) '. PLU'1BING PERMIT Charges and Surcharges I Demo \O.C6 I Sidewalk ------~ L,fr\-I A/C Paving i Curb Cut ------------ I C;\n~.! i~~ ~lo\\~' 6 ,ill ELECTRICAL PERmT Cha rges and Surcharges MECHANICAL PERMIT Cha rges and Surcharges Total Comb. Permit TOTAL ~ \D.LoD 0:=-- . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. exampJe- Tax Lot 100. lane County Map Reference 17 03 43 2. exanyle- Lot 1. Block 3, 2nd Addition to. sprlngtield Estates C. Name. etc. of owner and construction lender O. Energy Sources . 1. examole- heat/el1ectrical ceilinQ/or forced air Qas 2. example- waterheater/electrical/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 permit information: 1. example - construct single family house with an attached garlJge 2. examole - 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 (a) of the Structural Specialty Code H. DESIGN TEM1 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 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. --- 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 signa ture. 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. , I I J. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . PERMIT VALIDATION (02-01'+' j2.:-1o-~5 Permit Clerk " " .' ~dLL . Permit appl icant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature ,; :.!. !\ date I