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Home My WebLink AboutPermit Building 1990-1-31 t, i'l. I' ~ INSPECTION LINE 726-3769 . CITY UF SPRINGFIELD CO/mIllATlON APPLlCATlON,PERMIT EIIERGY SOURCES: Heat I~a ter Ilea tcr . INFORltATlON LINE 726-3753 Sq. Ftg. '.'ain :q. Ftn. Access. Sq. Ftg. Other New Add Alter Pep. --Fence Demo Change/Use Other- - -C\ ,8 ~ p Job Address /f?~tJ )1/1/;; sf. Legal Description J1/ o3~/G/;J 3 ' 5.::;J1. . "n../ IODocf Ranfle Owner f~u I X,'", rI f" / / Address Skn>'J- /-10/ jrt,J'kt'!.f sf, :~/,j , Construction lender Phone Va~ of Hork: 00 .,If' 35'00 - BUll<iino Pennlt Info: Describe Work(Le., Build Single Familv ~esidence With Attached GaraQe~ ~''{) / JI/ ", I ' 11/1 . , "{/ IN' X 7 () ,., K ,5' /.I r,'oi~(O tCJ.J'I v IJ(et-f .fr'iltH.~/ /h'url "'",vered -'A/L)I1;1(f 72(,-M:'/ ~ Address UESI GN llAH {namel Phone (address 1 !lies.no.\ (exnires) (ohone no. I Primary Structural &er~;;j A-"li!I'"d t/ 1:175 JJ. G"'Avp" E"'I' ." 'Eupt"- .::::;:' 'f ,"",(1Ie'S ; t, '87-0 t/35 Electrical Hechanical CDNIRACTORS lnamel General EUfera IJ. A'.IJ/'I/~ (address) ,')A A (1 ics. no.' LQ,QC\D ') , (pxnJrps1lr I Jphone nt'.) \ O-I-1JDf-Qn * Plumbino Electrical ~lechanical PLUlm ING ELECTRICAL MECHANICAL Each single fixture FEE CllARGE NO _ 1 en:' rHAJH;~ NO. Res idence of furnace/burner to SQ. FT. BTlI's rFF CHARGE.. NO. Relocated building (new fix. additional) New circuits alts. or extcns ions Floor furnace and vent S.F. Residence 11 bath! Duplex (1 bath) each Additional bath SERVICES Recessed willl Sn~~p hp~tpr ~nrl vprt Storm Sewer Of COM/.I.IIND. FEEDERS Install/alter/relocate flistrib. fppders amps, Appliance vent sel)a ra te Stationary evap. cooler I Vent fan wi th sinale duct Vent system apart from heatino or A.C. Mechanical exhaust hood and duct Wood stove/heater Sewer Temporary Construction Change in existing res j deJ'lce mUltifamily. COITlT1. or Industrial ~Iater service Of amps. I SSIJANCF OF PFRPIIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WIlERE STATE L'H REQUIRES that the Electrical work be done by an Electric.1l Contractor. the electrical portion of this permit shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division I IIAVE CAREFUllY EXArllNED the completed application for flermit. and do herehy certify that all information hereon is true and correct. and I further certify that any and all work nerformed 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 Orel]on perta i n i ng to the work descri bed here; n. and tha t 1m OCCUPAUCY wi 11 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 re~uired by ons 701.055. that if exempt the basis for exemption is noted hereon. and that on ly subcontractors and employees who are in comp 1 i ance wi th ons 7()1. 055 \'Ii 11 be used on th i s projec t. IlAI-1E(please print)~'wt. ru", r'1If1( SIr.il^TURE_k~4 4dt1'~V!- V FO~ OrFICE USE oln)!' 17 ~ Type/Cons~/~ Units S~. Ftg. Bedrooms Occy load Sq. Ft~. Stories / Occ,V Group ~-2. Sq. Ftg. Dm/- 3/-$_ Zone CG Fire Zone Flood Plain f1ain x Access x Other ;-41A'/V/~~X TOTAL Value Value Val ue -:?,5' ~ eo-c V^LUATION BUILDING PER/lIT Charges an~ Surcharges LI Plan Ck. ___~1..-:.f2~__ ~'Blde Plan Ck. 7_'2.. 3 30%/BldQ Conmll nd Ppr Fpp Res Per Fee 'J.r. q:? Systems Development Charoe (1.5~) PLUIIBING PERMIT Charges and Surcha rges Fence ELECTRICAL PERI\IT Charges and Surcharges Dlll110 _ ___ _ _ ___ __ J 'Sidewal k I.A/C Paving _ _ _ _ _ _ _ _ _ _ _ _I Curb Cut I Total Comb. Permit tf6. 73 liECHAN I CAL PERMIT Charges and Surchar!Jes TOTAL I , 7?: bb I . COMBINAIION APPLICATIONIPERMIT (CAP) .- I. Applicant to furnish A. Job Add ress B. legal Description 1. example~ Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot I. Block 3, 2nd Addition to springtield 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/electrical/or solar E. Square footage or valuation, etc. I. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check~ew - if addition, check add. etc. F. Building pennit information: 1. exam~le - construct single family house with an attached garage 2. examDle'- remodel existing garage into family room 3. examyle - 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 TEN1 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. --- III. Applicant to sign and date Whenever possible, the initial application will be used as a work~heet 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 penmit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: I. ' . , " PERMIT VALIDATION o 1l3<1 \ [t, 0- \~,fJ v Penni t Cl erk ) - t \\ fl\--; . .. Permit applicant exempt from registration with the Builder's Board because: Addit.i ona 1 Project Information: PLANS REVIEWED BY: name. / ..6>29,N'...r ?~~ Signature~~ date ?~<9--"9i::> - / ."