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Home My WebLink AboutPermit Building 1983-6-20 t, ,\ . CITY Uf SPRINGFIElD COMBIIIATlON APPlICATION/PERMIT EIIERGY SOURCES: Heat Hater Heater -: iT;';' ~rl. I n- \ f'\ -)('3. I INSPECTION 1IIIE 726- 37 69 Job Address 3tIY:J fYlo....t.n ~+->' legal Oe'cription/7."....."3/_0~ CJt:>?CI Range INFDRllATlON liNt 726-3753 Sq, Ftg, 1,Iain ~q. Ftg. Access. =r~O Sq, Ftg, Other ~lew_Add_Alter -Y-ep, Fence Oemo Change/Use -Other- - 00 ~ - --\ o ~ ~cr' r-,rLr ~ Du..-b-rrL>j' Address6&v...... 8..D'" ~p 7_____ J\A~ ~?' Construction Lender ' valYs<;m. m Builrilna"Permit Info: Describe Work(i.e., Build Single Familv ~esidence With Attached G~ra~~) ~ r L ~cl.o.. - ~ I)~ ". . D(j 10 Phone ?~""':=>'3S 4 Address Dt~IGN Itl\l1 Phone (address J (lies. no.l (name) Primary Structura 1 E1 ectri ca 1 Mechanical CONTRACTDRS (namel lJ(iJf1..f);/' - ~~\"'~,1 (address) f.!.f'1Al ~ (I uUUnAJ) (1 ies-. no.) Plumbina Electrical VER/K'" ~lechanical PLUIIBIIIG ELECTRICAl ND,I FEF r.HARhF Nn ~~~ r~AR~~ NO, Each Single fixture Residence of SQ, FT, Relocated building (new fix, additional) New circuits alts. or extensions S.F. Residence 11 il'a th 1 Oup\ex (1 bath) each SERVICES Additional bath lremporary Construction IChange in existing , rps i dJ'nr:p Imultifamily, comm. or tnrltJc;.trial 10f amps,l ICOMM,/IND, FEEDERS I Install/alter/relocate rl;~tr;h_ fferlpr~ ,Iof ~O amps.1 I I I I I I I/~- I I I ~!ater service Sewer Storm Sewer {exoiresl {ohone no.\ A ~ AT "l (pxnirpc;.) lohnnp nn_ MECHANICAl furnace/burner to BTU's n'~ nIAR(.':-~ ~ I , Floor furnace and vent Recessed wall ~narp hp~tpr ~nrl vpnt Appliance vent c;.eoaratp Stationary evap. cooler Vent fan with sinole duct Vent system apart from I heatinq or A.C. Mechanical exhaust hood and duct. Wood stove/heater I I I ISSUANCf OF PFRrHT TOTAL CMARGES WHERE STATE l~W REQUIRES shall not be vali1 until the TOTAl CHARGES that the Electrical work be done by a.n' label has been signed by an Electrical /". - TOTAL CHARGES Electrical Contractor, the electrical portion of this pe~it Supervisor and returned to the Building Division I HAVE CAREFUllY EXAMINED the completed aprlication for permit, and do hereby certify that all information hereon ;s 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 tlO OCCUPAIKY 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 OP.S 7Dl.055 will be used on this project. HAI,IE(please print)~..., i)u l]..~ SI"IIAT~, Q __ G FD~ OFFICE USE DIllY 7-T - J Tyoe/Const. (""W Units IY.~. Sq, Ftg, 'lain Bedrooms--..~.L _ Occy Load Sq, Ftg, Access ."'r'::?t!' Stories / Occy Group ZJ- ~ Sq, Ftg, Other ZoneMooN Fire Zone ~.~ . Flood Plain)\l~ DATEG/POhc;- x Value Value Value .~~ ... x x BUILDING PERI,IIT Charges anc rl;;:}.~r:J:s ~ PLUt1BING PERMIT Charges and Surcha rges Plan Ck, Comm/lnd 65%/Bld~ Ppr ~pe Plan Ck, Ifes 30%/Rl do Per ~~e Fence TOTAL VALUATION J= v-n.. \I 5~16~ste. J:1S Development 'JJ~'l~ ?:3.inarQe tI,5~) , 7~ crco. ITotal Comb. Permit I I TOTAL & U oeo ------~~---- <.S6 Demo ElECTRICAL PERI:IT Cha rges and Surcharges /0..".0 I-Sidewalk -------~-ye;-I A/C Paving I Curb Cut I I 11ECHANICAL PERMIT Charges and Surcharges 76'.96 /5/.96 . . ...., . :... . I ,- CDMBINATION APPLICATION/PERMIT (CAP) PERMIT VAlID~TION I. Applicant to furnish A. Job Address B, Legal Oescription I, example- Tax Lot 100. Lane County Map Reference II 03 43 2, exam~le- Lot I, Block 3, 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinQ/or forced air oas 2. example- waterheater/electrical/or solar E. Square footage or valuation, etc. I. examole- 12SD sq, foot house, SOD sq, foot garage 2. example- if new project. check-new - if addition, ctlecK add. etc. F. Building permit information: 1. examole - construct single family house with an attaChed garage 2. exam~le - 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 (a) of the Structural SpeCialty Code H, DESIGN TEAl,! AIIO 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. --- 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. ~c2\ \qg3 U . ;# ,(01 /~& V, FOR OFFICE USE DNLY Permit Clerk H\~ . PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: .1 Permit applicant exempt from registration with the Builder's Board because: . -. Additional Project Information: "fJU~LE)'-NG... ?€~l':n,-r r~ ~,..C; z:,~~<~ (~N7:>~ ~Y/'5/'-^,S C>~ 'Ss.e:::. S"....~ SOo/('q).. 'l?r.u'-"'A(~. /~ ,4.t...i"JEIf'Z,y F.l?/1~ttFP PLANS REVIEWED BY: . 'name ~~ ~cSZ:;;~ Signatur~_ -- ~ .:. ~d~~e ~-/:>~e:iT . / I J