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Home My WebLink AboutPermit Building 1985-10-21 (2) / . IlllsPtCTIOII LlIIE 726-3769 Job Address I ell)i 114.,,,) Sl'" legal Description I7~03-:<.I" - J,!) - '1/')O -- .~~ CITY UF SPRIIIGFIELD COMBIIIATION APPLlCATION/PERI1lT ElIERGY SOURCES: Heat l~ater Heater Ranqe INFOR/lATION LINt 726-3753 5q. Ftg. 1.lain :5200;-1;7- ~q. F'tg. Access. Sq. Ftg. Other -,lew_AddXAI ter _Pep. Fence ~ ChangelUse Other- - ~ - I~ W Owner f',,,u.vc. l:.v't$'1l2.. PRI ~e=...5' Address'ltW '5. HA...1 ~T Phone Y~E..." /'J,UF"- '1(,0'7 '1/.-"6'12-''11''7 Mechanical CONTRACTORS (name) (address) (lir:e;, no.' General PAR. Po. ('AAJ~rRrx. rllUV PI) R..14 77"~ J::.x,l'vl! M('1../"'- Plumbina n...... LFA/'.... R..U_IJ;/~6- Electrical r ..... <l, EL.E" rAI(.__ Construction lender Address Ul:.~ Hir~ lI:N1 Primary Structural Electrical ~'echanfcal IlO. 1 Each single fixture Inamel Phone (addressl PLUllB IfIG FEF rHII.Rr.F Nn Relocated building (new fix. additional) s:cso Residence of S.F. Residence (] bathl Duplex (1 bath) IAdditional bath l\olater service I Sewer Istorm Sewer I I I I each I New circuits aits. 2-.- or exte~sions . I SERVICES I ValUE of/jiork: JI'15')O(). " Builciina Pennit Info: Describe Work(Le., Familv ~esidence With Attached Garaae) Build Single AL"iE1l. ~ " I~'" I^,~ no It t') 14A'_ (lies. no.l (exnires\ (OhOM no.'l ~ ~r- 'f ?;~P" (ohn"p 1'11"1 1 ., '!..!..iL t:; )0 ')' ELECTRICAL ""L~I furna;e/burner to I In /kW BTU's .. / Floor furnace and vent G, att:. MECHANICAL """ lrl-l~ SQ. FT. I$:- Recessed wall ~n~rp hp~tpr ~nrl vpnt I Appl iance vent s~oaril:t.p I Stationary evap. cooler I Vent fan with sinole duct. I Vent system apart from I hea t i nq or A _ C. I Mechanical exhaust hnnd and durt. I Uood stove/heater I HAVE CAREFUllY EXM11NED 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 rw OCCUPAUCY will be made of any structure without the permission of the Building Oivision. I further certify that my registration with the Builder's Goard 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 comoliance with ORS 7Ql.055 will be used on this project. IIAIIE(please print) "'''''1101.0 ~. ~lt.p.... SI"GIIATURt-5J ~ _ OATEJ'Y~://ir" 20ne ('JI Fire Zone Flood Plain BUILDING PERI.IIT Charges and Surcharges PLUI1BING PERMIT Charges and Surcharges ELECTRICAL PERI~IT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges FOr. orFICE USE DilLY Sq. Ftg. t1ain .'It Value Sq. Ftg. Access x Value Sq" Ftg. Other.;a>,c-~ Value~c:::::2:'. c:>re D (p55f) 'I TOTAL VALUATION ~\J .~ ?Po\\) 31.2..0 Type/Const. Bedrooms Stories ~IY Units Occy Load Occy Group yz ;B-2 I Plan Ck. Comm/lnd 65%/Bldo ~pr Fpp Plan Ck. Res 30%/Bldo Per Fee _____y.e~~_ 1.1'< /~ e>p Fence ----~~-~---- . l/(> Demo ____~_~_' Sidewalk .6(> I AlC Paving __':_/~~~~_II Curb Cut .0/" Systems Development Charoe tl.5~) . &/1 I /~. I- I I I I _0. I I ITotal Comb. Permit I I TOTAL, /tP ~ 3':2 100/. ~Z .-...;..,-- ., .4'"'-'. .. '" .,'--' {' \ , -' COMBINATION APPLICATION/PERMIT (CAP) 'PERMIT VALIDATION I. Applicant to furnish A. Job Address B. legal Description 1. example. Tax Lot 100. lane County Map Reference 1/ 03 43 2. examole- Lot I. Block 3, 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources . 1. examole. heat/electrical ceilinq/or forced air Qas 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation. etc, - 1. examole. 1250 sq. foot house. 500 sq. foot garage 2. examp.le- if new project. check-new _ if addition, cneck add. etc. f. .Building pennit information: 1. examole - construct single family house with an attached garoge 2. exam~le - remodel existing garage into family room 3. exam~le - 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 TEAM 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 Pl~mbing. 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 pennit 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 .0. 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 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. . s ~ (~~~ j W \'}. . \\" ~ \1'\D V. FOR OFFICE USE ONLY Cl erk CflJ Permi t PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . Permit appl icant exempt from registration with the Builder's Board because: Additlonal Project Infonnation: ~€' ~.c-cGr~~~ k-....-..='-7......~__ (~~!.~ ~-=-~ /~-2~-r PLANS REVIEWED BY: .. "0. . ~~~ -:-7~- , date //-~~ name....L-CJl5'Rt!!;" ~~signature - . .