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Home My WebLink AboutPermit Backflow Test 1988-3-29 , .. " I INSPECTION LINE 726-3769 . CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat Hater Heater Range ValuE of Work: ~ INFORJIATION LIN, 726-3753 Sq. Ftq. I"aln ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Pep. --Fence Demo Change/Use -Other- - ::21 3'0 '-1n~ legal Description 1'70 \ ~ t-, L/;x 0 d. 7W , /1 I ;, /, -r I Owner (?AA :+ .-r /).11>~ Address //fV. AMldl1m. I~Y-:- If Phone'Y'9f 1/ f'. / V 3.;( O,;).. Construction Lender ~ / d'ol ...."..,/'1 -f-., ~~~-'''' rrltlA zt Job Address (name) Phone (address) OJ B BUllrlinQ Permit Info: Describe Work(i.e., Build Single ,~\ Familv Residence With Attached Garaqel 1--) ~ ~qL~ =::: /::;f~ I "',' ""~~':;;~oo :~ -"1 r '1 " Address DESIGN TEAI~ Primary Structura 1 Electrical Meehan; ca 1 CONTRACTORS (name) (addres.s) (1 ;('0;.. no.) (exoireo;.) (ohonp nn, \ Plumbina VYff4b ~ko/ General Electrical ~1echanical PlUI1BING ELECTRICAL MECHANICAL -1!Q..,,1 Each single fixture FFF rHARr,f Nn """ C"ARliE. ~I Residence of furnace/burner to SQ. FT. BTU's t't't' I.-CliARG..EJ Relocated building (new fix. additional) New circuits alts. or extensions Floor.,furnace and vent S.F. Residence () bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall Sn~~p np~tpr ~nrl vpnt Storm Sewer Of amps. Appliance vent SPI)~r;ltp Stationary evap. i.oolpr Vent - fan wi th ~inole duct Vent system apart from heatino or A.c.. Mechanical exhaust hnnrl ~nrl rll~rt ~Ia tel'" servi ce Temporary Construction Change in existing rps- j 1e."rp multifamily, comm. or IndlJ!;,tri~l Sewer COMM./IND. FEEDERS Install/alter/relocate rlic;trih_ fpprlprc: Wood stove/heater Of amps.! 'd?\ ISSUANCf OF PFR!1IT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L.'I~ REQUIRES that the Electrical work be done by an'Electrical Contractor, the electrical portion of this permit shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXM1INED 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 OCCUPAUCY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s Board 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 compliance with ORS 701.055 will be used on this project. IWIE(please print) f1/C.If/l.CL L.(;;H/iMlJe~ SIGIlATUREhJ I~ DATE J-;.!I-rr Zone Fi re Zone Flood Plain Tvpe/Const. Bedrooms Stories Units Dccy load Occy Group FO~ OFFICE USE DIllY Sq. Ftg. 11ain Sq. Ft!J. Access Sq. Ftg. Other L x Value Value Value x x TOTAL VAlUATlOIl BUILDING PERmT Charges and Surcharges Plan Ck. Comm/Ind 65%/Bldo PPl'" Fpe ------------ Plan Ck. R'es 30%/Bldo Per Fee (~. 01' Fence ------------ . 7'5: D~mo Systems Development Charqe (1.5~ ' ELECTRICAL PERlm Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges 'Sidewalk A/C Paving I I I jTotal Comb. Permit PLUMBING PERMIT .;' Charges and ') Surcha rges Curb Cut I I TOTAL.. /575 '.... .. .. COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish, A. Job Address B. Legal Description I, example- Tax Lot 100, Lane County Map Reference II 03 43 2, example- Lot I. Block 3, 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinQ/or forced air Qas 2. exa~le- waterheater/electrical/or ~ 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. examele - construct single family house with an attached garage ' 2. example - remodel existing garage into family room 3. examp'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 CDNTRACTORS 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 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. i I \ ( ?-\ !t>/g~ /' -/1 o V. FOR OFFICE USE ONLY Permit Clerk c~ . 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 signature date ,