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Home My WebLink AboutPermit Building 1990-1-22 Legal / fJ I (J mIL j () J hr e.eJ.--- Description I/~ D3' 36 - J..I J 1L. 051-oD 1IIIt CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat I~ater Heater Address ~db fud'A.i--- 1JA1;6Yl / D/D ~ J1-r.aJ.- Phone INFDRl1ATlON LINt 726-3753 Sq. Ftg. "lain ~q. Ftg. Access. ~ Sq. ftg. Other New \ Add Alter Pep, Range -Fence Demo Change/Use valu~roD ,W Other-- BUilriinoiPermit Info: Describe Work{i.e., Build Single Familv nesidence With Attached Garace) Wif/O-V~U- /I X I DD~ ., jlNSPECTION LINE 726-3769 Job Address Owner' Construction Lender' Address DESIGN lEN~ (name) Phone (address 1 (lies. no.l (exn; res) (ohane no. I ~ Primary Structural Electrical Mechanical CONTRACTORS Inamel General /'J'JttL/.-; VIlLlA/VYl "'" T/l~. 2/ ,q JCI i) (chone no. l f)ZjLj- jaW 3 (address) (1 ic~. no. \ 1-17 2,r:;Cj (exn; rp~;.) Plumbina Electrical ~'echanical PLUl1B 1 NG ELECTRICAL MECHANICAL NO, FEE CHARGE NO c~~ r~ARUt NO. :EL .!:JJARG.l sq, FT. furnace/burner to BTU's Each single. fixture Residence of Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (l bath) Duplex (1 bath) each SERVICES Recessed wall SDace heatpr anrl vpnt Storm Sewer amps. Appliance vent seOil ra tp Stationary evap. t:nolp.r Vent fan with sinole duct Vent system apart from I heating or A.C. Mechanical exhaust hnnrl nod dur:t Temporary Construction Change in existing reo:; i c!..f'JH~P Imultifamily, comm. or Inrludrial IOf ICO~1./IND. FEEDERS l'Install/alter/relocate rli ...tri I'L fpprlpr... I Of amp~ h2EC r. OpT/'? 9c;T ~ ~L O~/~;'.,..' k , ~~rc= )%~/7: TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE lA\~ REQUIRES that tile Electrical work be done by an.'Electrical Contractor, the electrical portion of this pemit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division Additional bath ~Iater service Sewer Wood stove/heater ISSUANCf OF PFR!IIT I HAVE CAREFUllY EXAMINED 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 performed 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 rw 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 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 7~1.055 will be e on this project. IWIE(please prin~~-.... SIGII TURE , , FOr. OFFICE DATE~ Zone~/ Type/Const., <"""'YV Units Fi re Zone Bed rooms Occy Load Flood Plain Stories / Occy Group 73-2. UL BUILDING PERflIT __.ka~~ Plan Ck. Corrm/lnd Charges and 65t/R1do P.er Fee Surcharges 1'- '1'3 Plan Ck. Res 30t/B1do Per Fee PLUI~BING PERMIT Fence Charges and ------------ Surcha rges D~o ELECTRICAL PERI\lT 'Sidewalk Cha rges and ------------ Surcharges AIC Paving 11ECHANICAL PERMIT ___./5_~__ Curb Cut Charges and Surcharges "c:?Z) USE'oj)IILY J ,// Sq. F~n x Value Sq. Ftg. Access x Value Sq. Ftg. OtheVP7." ~;..~ Value~. ~ 15U-~ PrJ.:I~l_Cj()TOTAL VALUATION ' ('-1 ~ : s;J ~h;;~~s (~~5~lop~ent AI'~. ---- ITotal Comb. Permit I I TOTAL /BZbB .,.... ., .... ~ . . COMBINATION APPLICATION/PERMIT (CAP) ""') 1. Applicant to furnish A. Job Address B. Legal Description 1. examole- Tax Lot 100, Lane County Map Reference II oj 43 2. example- Lot I. Block 3, 2nd Addition to >prlngtield Estates C. Name, etc. of owner and construction lender o. Energy Sources 1. example- heat/electrical ceilin~/or forced air qas 2. examele- waterheater/electrlcal/or solar E. Square footage or valuation, etc. ----- I. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check new - if addition, check add. etc. F. Building permit infonnation: 1. examp)e - construct single family house with an attached garage 2. examele - remodel existing garage into family room 3. examJle - convert single family residence into restaurant (change of use) G. Value of work as defined'in Section 303 (al 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 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: " v Permit . J PERMIT VALIDATION !-tlJ-q() is g3 ( \ Clerk65~ " \'p'e\-mit appl i cant :exemPt fr6in/regi str'ati on with the"Bu~) d,~r' ~"~qard}b~c~u~e:: " , Additional Project'Information: .> " PLANS REVIEWED BY: name signature " I , .... . I, ,i", , 'I.J .:':. , '.,,' date ...:t;.t