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Home My WebLink AboutPermit Backflow Test 1987-3-18 I IrISPECTION LINE 726-3769 . . CITY UF SPRINGFIELD COMBIIIATION APPLICATION/PERMIT E!IERGY SOURCES; Heat \~a ter Hea ter Range ValuE of I-/ark: t INFORlIATION liNt 726-3753 Sq. Ftg. '.Iain ~q. Ftg. Access. Sq. Ftg, Other Ilew Add Alter Rep. --Fence Oemo Change/Use Other - - I ~ .;:J. .0 1- CP I- I Job Address d \ 41 Main S-\- . Legal Description n - t\~ -- -;'1,.. .4;2 -- ()?Afil" Owner \SrrJvto.,.m()~ Jl~1\.1 Address ~\~~ IV~~i~~rl construction0ender I Phon;;7~ ?,{~ BuilainQ Permit Info: Describe Work(l~e.. Build Single Familv nesidence With Attached Garaael Address Ut~lliN H.Ar-' InameJ Phone (address) ~(WL )iflln) rlo,n{'~ \ (l fcs. no.) {exoiresl (ahone no. Primary ~ {;!,"'V';:" ( \ 0,;-1,(;;,0'1 "} ~ ~ Structural El ectri ca 1 l1echanical CONTRACTORS Genera 1 (name) flU Hl2}V (address) (lics.. nn.) (pxoirpc:;) (nhnnp nn Plumbina Electrical ~lechan; ca 1 PLUIIBIrIG ELECTRICAL MECHANICAL NO.1 -----lEach single fixture IRelocated building (new fix. additional) IS.F. Residence (1 bath I IDuplex (1 bath) each IAdditional b~th I ~Jater servi ce I Sewer I Storm Sewer hll(\ t.~1\1I1 _____ ~rol )?1A\ttM I I I I FFF f.HARr.F Nn ~~L....cHARG..E. NO t ~~~ r u !J!UE. Residence of SQ. FT. furnace/burner to BTlI's New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall Snn~P hp~tp~ ~nrl ~pnt Of amps. Appliance vent (,poaratp Stationary evap. cooler I Vent fan with sinole duct I Vent system apart heatina or A.C. I ~lechanical exhaust hood iind du~t II'Jood stove/heater from Temporary Construction Change in existing ~PS.j,",PJll"p' multifamily, comm. or Tnduo;,trinl C0I11.I./IND. FEEDERS \ t:, (S( IInstall/alter/relocate rlio;,trih. fppdpro;, 10f . I I I amps. -j\ TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be valij until the ~ 60 TOTAL CHARGES h< ttia t tile E1 ectri ca 1 work be done by an label has been signed by an Electrical ISSUANCF OF PFRIIIT TOTAL CHARGES Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFUllY EXA/'UNED 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 UO OCCUPAr~CY 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 ORS 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 p. t. Zone Fi re Zone Flood Plain ~ IWIE(please print)6J3'leI1DA- ~__ SIr,II^TU~;.''';'~QA , Far. OFF I CE USE OIIL Y Tvpe/Canst. Units Sq. Ftg. fia;n Bedrooms Occy Load Sq. Ft9. Access Stories Occy Group Sq. Ftg. Other OAT< ::f -,-I ~ -c:j..,: , x Value x Value x Value TOTAL VALUATION \ BUILDING PERflIT Charges an~ Surcharges Plan Ck. Comm/Ind 65%/Bldo Ppr Fpp Plan Ck. lies 30~/Bldn Per Fp.e Fence Systems Dev~lopment Cha rQe (1. 5l11) PLUt1BING PERMIT rV; DU Charges and "....- ----Cl.-:r--~-- Surcharges ""':) /(07) ELECTRICAL PERI:IT Charges and Surcharges D~mo I I I Sidewalk 11ECHANICAL PERMIT Charges and Surcharges A/C Pavi ng I Curb Cut ____________1 Irotal Comb. Permit I I TOTAL .' 1~,bO . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100. Lane County Map Reference 1I oj 43 2. example- Lot 1. Block 3, 2nd Addition to sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources . 1. example- heat/electrical ceiling/or forced air Qas 2. examole- waterheater/electr;caJ/or solar E. Square footage or valuation, etc. - 1. 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 gar~ge 2. examole - 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 TEM1 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 fu 11 schedu 1 es 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. V. FOR OFFICE USE ONLY ~,\ PROJECT CONOITIONS TO BE SATISFIEO BEFORE OCCUPANCY: . ,?) Permi t C1 erk PERMIT VALIDATION ,.J' .. r/fii 8 \g,(/ ~/ 'l ~/ -- \. i Permit app1 icant exempt from -registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature I date _ SENDER: Complete items 1,2, 3and4. ut your address in the "RETU AN TO" space on the. averse side. Failure to do this will prevent this card f ~. being returned to you. The retUrn rec:eipt t89 will.erovld8 .... 'lou the name of the person detivered to and the date of :'" d8liv!'!Y. For additional fees the fOllowing services ere ~ available. Consult postmester for fees and check bOx(8I) -< tor servicels) requested. i 1. )(ShOW to whom, dat88nd address of delivery. ~ 2. 0 Restricted Deliverv_ /; 3 n ~ Article Addressed to: ~C>-~~ O1l Lj '1 lYlo...L..v ~J OR. "fll.{77 o l~ ...s ~ 1 4. Type of Service: o Registered 0 Insured .lB'Certified 0 COD o Express Mail Article Number f>475 '711a Zh'l Always obtain signature of addressee .Q!.agent and OATE DELIVERED. i! !!l n 21 m -I != Z 21 III m :;; -II ~ S;gnatU~.. 6. Signatul-~ ~ X / 7. D7~7f-7 /fl. 8. Add_'~ Address (01qJ Ifrequar<<l tI1IfJ ~,.., ? (<(7 '-;1;>1 t1--.- 5'ffLf. 0 IC 97'(7,7 UNITED ".'IoU POSTAL SERVICE OFRCIAL~,~ SENDER INSTRUCTIONS PrInt YllUrname.--. end Z1PCocIe In the 8P8!;8 below. . . Com"""" Items 1. 2. 3. end 4 on the.......... . AtlllCh to front of artlclalf_ parmlta, .,. ""afRxto_of_ · ::r-~ artIcIe"ll8lum IlaoaIpt III '" to number. ~RN. . II II . ~~~. ... u.&MAIL .. , PENAL TV FOR PRIVATE USE. S300 rlTV ("\t:" SPQI",Jf::s:'IELD (Name of SenderJ_ DEPARTMENT OF PUBLIC WORKS (No. and _:M>t.l_J PJO.:Blil< drIPLD;lIIo;) C;PP'.NGFlfID OREGON 97477 (City. State. and ZIP COdo) .