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Home My WebLink AboutPermit Building 1988-12-8 f '.., _ "_" 'I INSPtCTION LINE ,726-3769 __--- , Job Address _;;;1 14'A?/u ,~7. I.egal De,cription /7-t!)~-7;./-",/-c>:a>~ INFDRlIATIDN lINl 726-3753 Sq. Ftq, 1.lain ~q. Ftg. Access. Sq. Ftq, Other lIew Add Alter Rep. Ranfle . -Fence Demo Change/Use r. v {' /./ ValuE of Hork: G> I Other- - Owner fr/)(J, r />> Fe (' 1\ /l5?J,O , \::J Address, ;>,/_. .~._,1\ a. :,..._ rA ^ ,/ /lohou.e Buil"ino'Pen1li1 Info: Describe Hork(,)'.e., Build Single ~ ,1/" ..,;t).L' / '--.raJ..." - ,/Y,l/' ?f'{3'~i'FamilY nesidence I~ilh Mtached Garane , 9J ~/i/</ P?"7- ~ ;// / h $ f'.::z.,1I /.-'h,;,J~/,.; I h !?~d Co'li'"struction lender ~, !:. ,~// _ Address Phone I DESIGN TEAM (name) {address' .1IIIt CITY UF SPRINGFIEI.O COMBIIIATION APPLICATION/PERMIT EilERGY SOURCES: Heat l~ater Heater 6- / ~' :>Q - (l ic:~. nn.) (exnirf'Cj) ~Jllrc- ~ ~\ (l'lhnnp no. J Primary Structural Electrical l1echanical CONTRACTORS (name) ) f)///I /Yl () ~ (address) (lics. no.' (exoires) (ohone no.) Genera 1 Plumbino Electrical ~lechiln;ca' PI.UI,IBING EI.ECTRICAI. MECHANICAl. NO. FEE CHARGE..l'n ""--..cJJARG..E. tin Hr n~JlRG[ sq. FT. furnace/burner to BTlI's Each single fixture Residence of Relocated building (new fix, additional) !New circuits alts. or extensions I SERV ICES i ITemporary Construction [Change in existing rf>~irlp':nl"r [mUltifamilY, corm!. or Inrlus.trial IOf amps.1 I COMI,!. II NO, FEEDERS I [Install/alter/relocate I r1i~trih. fpprlpr~ IOf amp,-I I [ I Floor furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each Add it i ana 1 ba th Recessed wall ~o~rf> ~p~tpr ~nrl vpnt Sewer Appliance vent s.eo.a ra te Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from I heatino or A.C. Mechanical exhaust hood and dUI"t. ~Iater service Storm Sewer Wood stove/heater ISSIIANCF OF PFR'1IT TOTAL CHARGES TOTAL CHARGES Wl1mE STATE L\H REQUIRES that the Electrical work be done by an shall not be valiJ until the label has been signed by an Electrical TOTAL CHARGES Electrical Contractor. the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFUllY EXA~1INED 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 Oregon pertaining to the work described herein, and that rw OCCUPAHCY 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 ons 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with OP.S 701.055 will be use! O~~iS pro~~ ~ IWIE(please print) ~CLl> \ 1=-~lA.ocK::. SIGiIATURFMz:: 1!1#~OATE II-N-tY v FO~ OFFICE USI1"OIIL Y ~,. Units S"!. Ftg. f1ain h Value Occy load Sq. FtfJ. Access / x Value Occy Group LY'- "2.. Sq. Ftg. Other~ Value -::zsz:::>. ~ TOTAL VALUATION ,c:,,/ Type/Const, Bedrooms Stories ~~N Zone Fi re Zone Flood Plain BUILDING PER~1lT Cha rges an~ Surcharges ~/~. PLII'1BING PERMIT Charges and Surcharges E ~ ~-....... Plan Ck. --t.....L.=.----- ~5%1BldO c-- Ian Ck. .7"/ ,30%lBldo ~ Fence Conm/! nd Per Fee Res Per Fee II-ILi-h--"l (0 ,~O 1;)7(,.,1) syste, r.1S Development I Charoe (1.5%) p...,.~ j'?EwdowRe ~C:l?~b- 3'.:-~-~ 9.75" 4C~/2'ff/'~~ e.r I (~7S:) - D~mo ELECTRICAL PERIHT Charges and . Surcharges Sidewalk A/C Paving [ I' I " .-- Total Comb. rermit MECHANICAl. PERMIT Charges and Surcharges Curb Cut I TOTAL '/~.= . . ~ .!! , , .. COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION '. I. Appl icant to furnish A. Job Address B. legal Description 1. example- Tax Lot 100. Lane County Map Reference 17 03 43 2. exam~le- Lot I, Block 3, 2nd Addition to Springt;eld Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examele- heat/electrical ceiling/or forced air qas 2. examyle- waterheater/electrical/or solar E. Square footage or valuation, etc. - I. examole- 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 garage 2. exa~le - 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. DES I GN TEAr.1 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 DUT ALL FEE5 AND CHARGES ON THE 5CHEDULES 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. 111. 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. (?-rlfo I 'd -y /fb V, FOR OFFICE USE ONLY Permit Clerk ~ . PROJECT CONDITIONS TO 8E SATISFIED 8EFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED 8Y: name ~#~ /-2~~ignature ~.?k--7 date //-.<r 6:& " /'