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Home My WebLink AboutPermit Building 1986-9-12 ~ CITY UF SPRINGFIELD COMBINATION APPLICATION/PERMIT ENERGY SOURCES: Heat Hater Heater Range ValuE of Work:~~ . n~ INFORltATION LINt 726-3753 Sq, Ftg, 1.lain ~q, Ftg. Access. Sq, Ftg, Other New Add Alter Rep, -Fence Demo Change/Use Other- - ~ I~ \1'\ ~ I I INSPECTION LINE 726-3769 Job Address W~'1 ~htIt.J ~r.. Legal Description Owner.011LL .1J..)AuS71l/~ Address Phone BuildinQ Permit Info: Oeser.be Workli.e.. Build Single Familv Residence With Attached Garaae\ Construction lender ~~~~ A7~:A~~ _ I ~HI Address Phone DESIGN IEAr1 lname) .- (address) (lies. no.1 (exn;res) Primary /<:)1-1 ~(~ .~ ~ Structural Electrical Mechanical if CONTRACTORS lname) (address) (1 i~s. no.) (~)(nirpc;.\ {ohone no. I (ohone no. l Genera 1 /<? te?A~_ Plumbina Electrical ~'echanical PLUIIB I NG .....llih FEE CHARr,E Nn Each single fixture ELECTRICAL MECHANICAL 'OE.L.cHAllG.E. NO. FFF rlJABJiE. SQ. FT. furnace/burner to BTU's Residence of Relocated buildin9 (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence 11 bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall Sn~c~ h~~tpr ~nd vpnt Storm Sewer Of COMI.1. /IND. FEEOERS Install/alter/relocate rli~trin_ fppdpr~ amps, Appliance vent c;.p.n~ ra t~ S'tati'onary evap. cooler V-ent fan with sin91e duct Vent system apart from heating or A.C. Mechanical exhaust hood and duct Wood stove/heater Sewer Temporary Construction Change in existing rplI j Ql;'.nce multifamily, comm. or Induc;trial ~Iater service Of amps. ISSUANCf OF PFRr1lT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L\I/ REQUIRES that the Electrical work be done by an,'Electrical Contractor, the electrical rortion of this permit shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed aprlication 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 ue OCCUPArKY 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 ORS 7QI.055 will be used on this project. 1/AI.1E(please print)Y3(/..le.1\! bA -r-111 /nYI ()'S1h'\ SIGNA;U~(Q;;,~c<- FO~ OFFICE USE crlLY . Sq. Ftg. rlain Sq. FtD. Access Sq. Ftg. Other Zone Fire Zone Flood Plain Type/Const. Bedrooms Units Occy Load Occy Group x Value Value Value x Stories x TOTAL VALUATION BUILDING PERf1lT Charges and Surcharges / !S 6-t) ------------ .G.tJ Plan Ck. Comm/lnd 65%/Bldo Por Fo. Plan Ck. Res 30%/BldQ Per Fee Fence 5"!!E- D_ Sidewalk A/C, Paving syste.ms Development CharQe (1. 5~ . PLU11BING PERMIT Charges and Surcha rges Curb Cut I .l I I I. Irotal Comb. rermit ELECTRICAL PERriIT Cha rges and Surcharges MECHANICAL PERMIT Charges and Surcharges I I TOTAL ;zc:; ~ . r , . . , - . , COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION 1. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100. Lane County Map Reference 17 03 43 2. example- Lot I. Block 3, 2nd Addition to Springfield Estates C. Name. etc. of owner and' construction lender D. Energy Sources 'I. examole- heat/electrical ceilinq/or forced air Qas 2. examole- waterheaterjelectrical/or solar E. Square rootage or valuation, etc. - I. examole- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check-new - if addition, cneck. add, etc. F. Building pennit information: 1. examole - construct single family house with an attached garage 2. example - remodel existing garage into family room 3. example - convert single family residence into restaurant (change of use) G. Value of work as defined in Section 303 (aJ of the Structural Specialty Code H. DESIGN TEAM ANa 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 OIVISION 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 b~ 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. ( ~1~1-:\ .) /fl?' C/ (~ V. FOR OFFICE USE ONLY Cu 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 7),L. 1t/~ signature #~ ~dVU- " ~2-f~ date