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Home My WebLink AboutPermit Building 1982-4-24 'I INSPECTION LINE 726-3769 , CITY UF SPRINGFIELD CDrIBIIIATI ON APPLI CATION/PERMIT E!/ERGY SOURCES: Heat TCLX .'[0 f xOO Hater Heater ~ Job Address I~)O MAli.) ST. Legal omriPtma'i?_1?3 - ~c, - 4..;::; INFORlIATION L1N. I 726-3753 Sq. Ftg. l'lain ~q. ~tg. Access. Sq. Ftg. Other ~iew_Add){AlterHep. Fence Demo Change/Use Other- - ~ \) 1* ~' Owner YJ.l /<.1 1"... B. F6-.z / R I Address ~j;. 't") q~::-",.. 1J.l1UE... $,PFLC. OR Ranqe_._~_ ValuE of Hork: 3I!)d). M BU11riinQ Permit Info: Oescribe Work{i~e.. Build Single Familv nes;dence With Attach~d G~raa~\ ('~O"'MEE~ C 1':/ I A/ 1/f'JR.4 r/"JJ 74/0<1<1< Phone Construction lender ---Phone (address) !lies. no.) Address Ut~lu~ ItM1 (name) Primary k!MJA t.f'l_tJ. Pfu9..P. I i Structural , Electrical , II I" C -"'~RI)I l;?R . Mechanical CONTRACTORS (namel 'General RalVhL;-' uJ. {~j{?>'2- (address) ,/ (lies. no. I~ 2/-:'- Plurnbina Electrical \=>.u.._r,e.e:.~ED EL"-"-TRIC- ~'echani ca 1 PLUllBlIiG ELECTRICAL NO. I FEE I CHARhF Nn I ~I='LI...c.HAB.G.E. NO, I Each single fixture Residence of SQ. FT. I'Relocated building (ne~ fix. additional) Is.F. Residence II bath 1 10uplex (1 bath) each Additional bath /fNew circu~ts alts. or extenslons Z aR M~.s. ISERVICES [ ;s:- !TempOrary Construction [Change in existing r~~ j 1e!H'P . [multifamily, comm. or Industriill I [Of I&:? amps.1 [CO~1./INO. FEEDERS I Install/alter/relocate rli~trih_ fpprlpr~ Of amps.l I [ [ ks:",... I I ~Ia ter servi ce Sewer Storm Sewer I I 30..... {axoiras} J (ohona no.) IJ. 7~C Sf?;:' l ~ (E'xoirpst '12-111"' ('ohanE' no _ ) " I MECHANICAL : .-.--~~.. I r~ABiif~ furnace/burner to BTU's / Floor furnace and vent Recessed wall ~nilrp hpiltpr ilnrl vpnt Appliance vent <;.enaratp Stationary evap, caolE'r Vent fan wi th sinole duct Vent system apart from hpiltino or A. r. Mechanical exhaust hood and duct Wood stove/heater .' ISSUANCE OF p~RmT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L~W REQUIRES that the Electrical work be done by an Electrical 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 Buil~ing Division I HAVE CARE~ULLY EXA/l1NEO 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 Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that liD 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 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 used on this project. IIA1.IE(please printl\c:'.kJb.LO W .~Il. ~ SIr.tIATUR~ '\ ~~r ~ OAT~i(h 1- ' 1 "'3'. c:;l:::l::::l. C>C ~O~ Or~ICE USE DilLY Zone c.. - 'f Type/Const. -SZ:,A/ Units Sq. Ftg. f1ain x Fire Zone_ IJ.A . Bedrooms Occy Load Sq. Ftg. Access x Flood Plain Nt::? Stories I Occy Group #-'1 Sq. Ftg. Other x 1'fJ.;).(j CQ<i:.~ Systems Development +2".82- *t:;'h4S"J Charqe (1.5~l . BUILDING PERf1lT Charges and Surcharges _n_n?Y:.~~_ ."6 Plan Ck. Comm/Ind 65%/Bldo P~r F~~ Plan Ck. Res 30%/Bldq Per Fee Fence PLU'1BING PERMIT Charges and Surcharges Demo ELECTRICAL PERtH! Cha rges and Surcharges IIECHANICAL PERMIT Charges and Surcharges ___n_~"-~:_ /.20 .Sidewalk AlC Paving I Curb Cut I Value Value Value TOTAL VALUATIDrI ~~,..... ~ I ITotal I I TOTAL Comb. Permit 5"6.1~ L .56.16\ .. . I. Applicant to furnish A. Job Address B. Legal Description 1. examole- Tax Lot 100, Lane County Map Refer, ( II oj 43 2. examp'le- Lot I. Block 3, 2nd Addition to springtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinq/or forced a 2. examyle- waterheater/electrlcal/or solar E. Square footage or valuation. etc. - I. example- 1250 sq. foot house, 500 sq. foot c 2. example- if new project. check-new - if add1 .chec K add, etc. F. Building pennit information: . ( 1. example - construct single family house witt attached garage . 2. . examele - remodel existing garage into famil 3. examJ'le - convert single family residence. ir ( restaurant (change of use) .G: Value of work as defined in Section 303 (a) of t Structural Specialty Code .H. DESIGN TEAM AND CONrRACTORS ( .To avoid design or construction delays. Building :. Division Staff must be able to contact appropria persons regarding design information or jOb site corrections, etc. ( II. Abbreviated Plumbing, Mechanical, & Electrical Sched . A. Except where blank spaces occur"in the descripti portion of the Mechanical and Electrical Schedul the appli.cant need fill-in only the No. Boxes. ad "'." to the appropriate item(s) to be installed. \, B. Full Plumbing, Mechanical; and Electrical Schedu are available at the Building Division 1. To conserve space on the permit form the sch ~t have been abbreviated ~ 2. If the item(s) to be installed are not cove, the abbreviated schedules you should consult fu 11 schedu 1 es C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES A CHARGES ON lHE SCHEDULES D. As noted on the CAP, the label must be delivered electrical contractor for signature by his elect ~, supervisor. The general contractor is ,not autho ~cl:- to sign the electrical label. '- Applicant to sign and date Whenever pOSSible. the initial application will be u a worksheet only. Where possible, Building Division will prepare a type written copy and return it to th applicant at the time the actual penmit is issued fo signa ture. IV. Fees and Charges Plan check fees are due and payable at the time of t 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. ~ COMBINATION APPLICATION/PERMIT (CAP) ""- ~ III. V. FOR OFFICE USE ONLY , ~ PERMIT VALIDATION . CITY OF SPRINGFIELD ( ( City Hall Springfield, Oregon Department 01 Public Works ( OFFICIAL RECEIPT - No. B 59015( D~\O 19 X'~ '-- Rec'd Fron\ x:<. (~ Q (l 1\..5'\ ( Address A. 4\ S . CXn 5\0 (J, D\- ,. c Received For. 9\QO~qS 4 , . lha1.i)> 0JLA .00 no L\;C)o ,Lf6 ( .~ ~90 L1.,DJo 1.m V ' . ( ( ,. ( 4 << Amount Received oLQ .I tp K~[)r>- -AUTHORIZED SIGNATURE r' \... ( 0fL~ 'f \l ( 4 BRIGGS ~AINT~RS/LITHOGRAPHERS.ItUG~NIE, OR~OON 'Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . . ~ Permit applicant exempt from registration with the Builder's Board because: . Additional Project Information: PLANS REVIEWED BY: . name 1_t:>7?#E ~~";='R Signature~.-Ya........., ., , da te 5"7"- ::;'~