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Home My WebLink AboutPermit Building 1983-4-25 . . , J IrISPECTlOII L1r:E. 726-3769 Job Address 1(:0/ f1'JQln ~-f__ Legal Dmription \ rt (\~ ~ c:;41 .... CITY Of SPRIIIGfIELD COIIBI ;IATI 011 APPL1 CAT 10111 PERMIT E!IERr,y SOURCES: Heat ('""'52J)C Hater Heater Ranqe i\yalUE of Hork: ~" .. J:::.f p c.', tfu..:r b 00::; Builc;;nQ Permit Info: Oescribe Work(Le.. Build Single Familv ~es;dence With Attached Garaoe) rl.. ...,./" I) ~ d. M1V" c$ V'e O/<1tl < , 1 ncQI,/f)..... lIIfORllATlON UNE 726-3753 Sq. Ftg. 1.lain ~q. Ftg. Access. Sq. Ftg. Other lIew Add Alter Rep. Fence_Demo _Change/Use _Other ~ -- ~ Owner 8 Or,'ry h'e U. tit,' I,'ry Address If? 1'\ I 'Y'Y1 c. ;~ Sf ' t,'< /.1- r5('O .".J Phone - ~{)V':"""'C. Construction l'ender J / , "" ....4h..'" Address Ul:.~ll.iN HN1 (name) Phone (address) flies. no.) (exoiresl (ohone no. f1echanical CONTRACTORS f~~m~) General IJp )/).< Plumhino (aclrlr~~'i) 7lc..~() ?1" (lies.. no.) .4f Primary Structural Electrical (pll'o;rpc;,) (ohonp nn..) 'YJ1 CI Ii, ".,.., ~l '1.xrt ") ~('I. ~,.__, p,1 tJ~j 'iL;?, '13S-7~-<. Electrical ~1echanical PLUIIBI NG ELECTRICAL MECHANICAL NO. fff ~HARr,F ~n "li...... JJIARG.E. NO SQ. FT. furnace/burner to BTU's H'r: r':J.ARG..E.. ,/ Each Single fixture Residence of Relocated building (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 ~o~~p hp~tpr ~nrl vpnt Sewer !Temporary Construction /Change in existing rp~ i rlJ'_nrp ImultifamilY, camm. or lndll"trial I Of amps.1 rCOMH./lNO. FEEDERS IInstall/alter/relocate I rli~trih fpprlpr~ 10f amp~1 I I I I App 1 i ance vent seoaratp I Stationary evap. cooler I Vent fan with sinale duct I Vent system apart from I heatino or A.C. , I Mechanical exhaust hoorl and dur:t I Hood stove/heater I I I Water serv; ce Storm Sewer ISSUANCE OF PfR1llT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATEl:\l~ REQUIRES that the Electrical work be done by an 'Electrical Contractor, the electrical portion 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 EXNtINED 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 Derformed shall be done in accordance with the Ordinances of the City of Spri ngfi e 1 d and the laws of the Sta te of Oregon pertai ni n9 to the work descri bed herei n 1 and tha t UO OCCUPAHCY 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 701.055 will be used on this project. IIAHE(please print) Hq ""~ . Zone Fi re Zone Flood Plai" Tyoe/Const. Bedrooms Stories Units Occy Load Occy Group .J /1('., SIGNATURE----21,....._tL~J1J1~. fOr. OffICE USE arK Y J So. Ftg. 11ain x Sq. FtO. Access x Sq. Ftg. Other x DATE li-2.I,'~'ir<. I11QC; 0 YJ 9' Value Value Value TOTAL VALUATION BUILDING PERI.1lT Charges an~ Surcharges _~._C}~____ ~~~~B~~~ ,,/" ) Plan Ck. . ~ 30%/Blda [ Fence ------------1 Demo I Sidewalk I AlC Paving I Curb Cut ------------ I CorrrnlInd Ppr Fp@ Res Per Fee Systems Development Charqe (1. 5~) PLU'~BING PERMIT Charges and Surcharges ELECTRICAL PERI:IT Cha rges and Surcharges " ~. ITotal " Comb. rermit I 0. tl() , I TOTAL MECHANICAL PERMIT Charges and Surcharges ~ . COMBINATION APPLICATIDNIPERMIT (CAP) l. Applicant to furnish A. Job Add ress B. Legal Description 1. example. Tax lot 100. lane County Map Reference II oj 43 2. example- Lot 1. Block 3. 2nd Addition to 5prlngtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. example. heat/electrical ceilinqlor forced air oas 2. example- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - 1. example- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project. check new - if addition, check. add. ete. . 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 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 8. 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. BUILOING 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 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 signa ture. 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 CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: _.~~~ . PERMIT VALIDATION '" I' , /> . ~ ., -, ( Permi t clerdwoJ J . - ! . Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: ~ REVIEWED BY: ~II ( namep!eo[)Q~ ~Signatu \~-- ~ 4a;-s'>., /