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Home My WebLink AboutPermit Building 1986-11-5 l IrISPECT IOfl LINE 726-3769 . ~\>~ ~(i)( t\ ,.,IIS) . }.rvuv.rJ Itl,~ Job Address 3C?~ 7 Legal Deseription/70.z. 3/ 42. Mr41A.J 5r: tPh8/6r.A-C. CITY Uf SPRIrlGflELD COMBIIIATION APPLlCATION/PERMlT EilERGY SOURCES: Heat l~ater Heater Ran~e .....-- . /' , INfOR/1ATION UNe 726-3753 Sq. Ftq. '.Iain ~q. Ftg. Access. ~ Sq. Ftg. Other / New Add Alter Pep. -Fence Demo Change/Use I Other- - (Address '1' , II _ <)J4 L- "eM Owner .J ErOVF-Ft:'L JlA//!.€ F'roNf s,. Dr Phone Valus,Pf \:/ork: - '...... ItS /2.t7r? ert) / 'Builcii'no Permit Info: Describe I~ork{;-.e.. Familvl1esidence I-lith ,l\.ttached Garaael Build Single -'''dJ E\ C5 ....::> .JJ -+- ;f~~ ~ J.l1P..-r (" ,! S~.e..r _ Construction Lender Address DI:~lliN TEAll (name) Phone (i'l.ddre~s) D. '7'='L ~ r'\ nics. no.l (exoiresl (ohane no.l Primary Structural Electrical Mechanical CONTRACTORS (name) (addres~) (l ics. no.' (pxoirpc:.) fohnl"lp fln , General t?WU-$7 Plumbino Electrical C. m~ l' \ -(,r'<, \~ ~1echanical PLUIIBltlG .ELECTRICAL MECHANICAL NO. ~ FEF CHAR(;F NO ~~~ r~ARr.~ NO ~~~ r~ARr.~ Each single fixture Residence of SQ. fT. furnace/burner to BTUI s Relocated building (new fix. additional) New circuits a1ts. or extensions Floor furnace and vent S.F. Residence (1 bath] Duplex (1 bath) Additional bath I ~later servi ce I Sewer I Storm ~ewer SERVICES Recessed wall ~~~rp hp~tp~ ~nrl vpnt each l I I I I - I I I Temporary Construction Change in existing rpc:. i dPrJrp !mult.{{amilY. cOnYn. or IndlJo:;trirll 10f amps.! ! COM/.1. /IND. fEEDERS I IInstall/alter/re1ocate I dic:.trih fpprlp.~c:. IOf amps.1 I I I Appliance vent c:.poaratp Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from I heatina or A.C. Mechanical exhaust hnnrl and durt. Wood stove/heater TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be va1i1 until the TOTAL CHARGES that the Electrical work be done by an label has been signed by an Electrical ISSUANCf OF PfRtllT TOTAL CHARGES Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFULLY EXAt1INED 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 fie 1 d and the laws of the Sta te of Orel)on oerta; ni n9 to" the work descri bed herei n. and that rw OCCUPAllCY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builderls Board is in full force and effect as required by Or.S 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in com~liance with OP.S 701.055 will be used on this project. )< :'I~AI'IE (p 1 ease print) Kotl Moc;es SIr.IIATUREW ~ FOP. OffiCE USE mIL Y , Zone Tvoe/Const. Units Sq. Ftg. riain Fire Zone Bedrooms Oeey Load Sq. Ft!J. Access Flood Plain Stories Occy Group Sq. ftg. Other ,~ DATE If- 5'"'- tJ1, x x x Value Val ue Value y BUILDING PERHlT . cJ.() ~() Plan Ck. Coom/l nd Charges and .5 65%/Bldo Ppr Fpp ------------ Surcharges! 8~ Plan Ck. R"es 30%/Bldo Per Fee PLur~BING PERMIT Fence Charges anp ------------ Surcharges~ DfjmO ELECTRICAL, PERInI .Sidewalk Charges an<l ------------ Surcharges I AIC Paving MECHANICALiPERMIT I Curb Cut Charges an~ ------------ Surcharges '. I TOTAL V ALUA TI Ot! Systems Development Cha roe (1. 5~) Total Comb. Permit TOTAL JI/.3J . . .. COMBINATION APPLICATION/PERMIT (CAP) PERMIT.VALIDATION I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax Lot laD,. lane County Map Reference 17 03 43 2. examele- lot 1. Block 3, 2nd Addition to ''\. '. Spnngtield. Es~a,~~es \. \ ;' t 'C: 'Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceili~Q/or forced air Qas 2. examole- waterheatertelectrical/or solar E. Square footage or valuation, etc. ----- I. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project. check new - if addition, chee k add. ete. F. Building permit information: 1. examDle - construct single family house with an attached garllge 2. exam~le. 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 Special~y Code H. OESIGN TEM~ 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 ANO 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 w;:l1 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. g~r;350 Il-(Pr-gb V. FOR OFFICE USE ONLY Permi t Cl erk (2c PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVI EWED BY: name signature #//;//NI- date /1-5j~~