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Home My WebLink AboutPermit Miscellaneous 1986-7-17 JIISPECTlON LINE ,726-3169 . Job Address ;)'1 L/ 7 v'V'V\', ," Legal Description 1'7t:J~ )(_ - ..~~~~ 6 "-2- CITY OF SPRINGfIELD COMBIIIATlON APPLICATION/PERMIT EilERGY SOURCES: Heat . liater Heater Ranqe INFORlIATION LINt 726-3753 Sq. Ftq, 1.lain ~q, Ftg. Access, Sq, Ftg. Other New Add Alter ~ep. Fence _Oemo _Change/ Use _Other 1 ~ ()\ C} .k. ......t) (j) t:' .1.S"d-O Phone Va~( of Work: ____ If;", 1) "f'/b. BuilrifnQ Permit Info: Describe Work(i.e., Build Single Familv Residence Hith .A.ttached Garaael Q,lr\ ,l._~ ~.A.O n.t: nh" \+ =, Owner c;. c"... \ \ Address Se.r,)~!l' e. c;.~I()I\.'s. Constructinn lender Address UESIliN TEArl l name I Phone faddress} (l ;cs. no.) (exniresl (ohane no.~} Primary i\\_ .~.:v;rl -1~ Structural Electrical Hechanical CONTRACTORS (name). General P~rbl ;JuV"\. (address) ~~fIMP,^+ . '^^ (\\'1\:+.. .p.II.€.t> (1i(':c;,~ no.) (p'lCq,i.rp",' rl)~nnr nn ) ~ ~^.A.-J f',,~r ~r-~r~Df.L_~; . I (j ;28~'15;: Plumbino Electrical ~'echanical PLUllB I NG ELECTRICAL MECHANICAL NO. FtF rHARhF Nn~ Each single fixture Residence of <<LJ:.liAIlliE ..1lO......i I j:'~l= I ru SQ. FT. furnace/burner. to BTUts Relocated building (new fix, additional) INew circuits alts. or extensions I SERVICES Floor furnace and vent S.F. Residence fl bath\ Duplex (1 bath) each Additional bath Recessed wall ~n~~p np~tp~ ~n~ vpnt ~Ia ter servi ce !TempOrary Construction IChange in existing rp~ j qP.f1t'P Imultifamily, camm. or Induc:trial Storm Sewer 10f amps, Appl hnce vent ~.poa l"'rt t.P I Stationary evap. r:nnler I Vent fan with sinole d\lr:t I Vent system apart from I heatino or A.C. . I Meehan i ca 1 exhaus t I hood and rlurt Il'100d stove/heater I II I I I I Sewer COI~'./IND. FEEDERS Install/alter/relocate rli~trih fpprlprc; 10f amps.1 ISSUANCf OF PFRIHT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical ~ortion of this penmit shall not be valij until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXMIINED 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 OCCUPAHCY 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 comoliance with OP.S 701.055 will be used on this project. 1lM-IE(please printLR ArVb~ f\ttB 1<..11 f0 SIGrlATURE_~ d Jf7Il~ FO~ OFFICE USE DriLY Sq. Ftg. Ilain Sq. Ftg. Access Sq. Ftg. Other Tvpe/Const. Bedrooms Stories Units Occy Load Occy Group l/ DATE7-/7-']b I, Zone Fire Zone Flood Plain < Value Value Value < < " TOTAL V ALUA TI at! .. - BUILDING PERfllT Charges an~ Surcharges Plan Ck. Comm/lnd 65S/Bldo P~r Fpp Plan Ck. Res 30%/Bldo Per Fee I Fence 10_ I Sidewalk I A/C Paving I Curb Cut I Systems Development Charoe (1.5~) PLmlBING PERMIT Cha rges and Surcharges ELECTRICAL PERI~lT Charges and Surcharges 44 .ffE- ITotal Comb. Permit I I TOTAL , I i I I MECHANICAL PERMIT Charges and Surcharges 41 ~O - I . . 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 II oj .3 2. examele- Lot 1. Block 3, 2nd Addition to Spnngtield Estates . C. Name, etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinQ/or forced air Qas 2. examyle- waterheater/electricalior ~ 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. example - construct single family house with an attached garage . 2. example - remodel existing garage into family room 3. examole - 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 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 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. --- Ill. 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 fJ/ oJ-- J ~~ 15J 1/r1/~0 V. FOR OFFICE-USE ONLY Permit Clerk~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit appl icant exempt from registration with the' Builder"s Board because: Additional Project Information: " PLANS REVIEWED BY: J../e.'p~ name~~ hJ/fV'I-L signature 7J~ / ,./J1dJM..C date ~/l7~'G