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Home My WebLink AboutPermit Miscellaneous 1985-5-17 I IrISPECTION LIIIE 726-3769 Job Address /0 /0 lIIa;-</ 6/ legal Description . Address <SUb Po (60)( ZOO Owner Construction Lender Address Ul:.SHiN IEAH (name) Primary Structura 1 Electrical Mechanical COIITRACTORS I name I General Plumbino 8(1) 0 Electrical ~'echan;cal PLUllB I NG NO. 1 Each single fixture Relocated building (new fix. additional) S.F. Residence 11 bath 1 Ouplex (1 bath) each I I I I I -+ I~FIt)l.lltEV'tt=1 I I-/'!;., I I I I I I I I I I QO.~O Additional bath ~Iater servi ce Sewer Storm Sewer CITY OC SPRIIIGFIELD COMBIlIATlON APPLlCATlON/PERMIT EilERGY SOURCES: Heat ~~ater Heater I Ranqe - ... . IHFORllATlOH L1l1t 726-3753 Sq. Ftg. 1.loin ~q. !='tg. Access. Sq, Ftg. Other Ilew Add A lter ~ep. --Fence Demo Change/Use Other- - ~ * o 4" ValuE of Hork: ~ ~~ ~uilGino Permit Info: Oeser be Work(i.e.. Build Single Phone F I~)t /Familv ~esidence With Attached Garaoe) Tt<S1aW 3 111)(3 ~ '+ I ";DeLl;tJ Phone (address) I l (ohane no. I flies. no.) (exni res) + (address) (lies. no.) (pxnirps) (ohonp no.) P e.("&IX ef2P FFF rHAR(;F Nn I I I~,tm I ,~o I I I ELECTRICAL I cE..L.IJ:HARG.E:Lm '(ELI~ MECHAIIICAL Residence of furnace/burner to BTU's SQ. FT. New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wa 11 SOrtrp hp~tpr ~"rl ~p"t ITemporary Construction IChange in existing rpo;; r1J'nrp Imultifamily, COI1lll. or Indll<;.tri~l Appliance vent seoarate Stationary evap. cooler Vent fan with sinole duct Vent system apart heatinq or A.C. Mechanical exhaust hood and durt from 10f ICOMM./INO. FEEDERS I Install/alter/relocate r1i<;.trih. fpprlpr<;. Of amps.1 amps. Wood stove/heater ISSUANCE OF PFRI1IT I TOTAL CHARGES Electrical Contractor. the electrical portion of this pe~it Supervisor and returned to the Building Division I HAVE CAREFULLY EXM1INED 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 NO OCCUPAUCY will be made of any structure without the permission of the Building Division. -I ftll"tAcr-esrtHy that mv reaistrrttinn_w-i-t-h ..;,.;; a.:.;; ;;:;;;;; ~ . Boar:Li.s_in-fu.l~~Ge-and-e,UeGt-as_tequ.ir-e.d-.b.Y-DR5-7nl n~c.. ""at if exempt-the "'v~i 5 -for-exempttorri~-nuted-hereon,-arnLthi!.t ::,::(:~::::t::~::~S an em~r~~ lo~~e with :~:'1::~~:55 w~ ;;~h/L DATE ~-;; 7/Fs ~ . ..-FolfOYFICE USE OHLY / Zone Type/Canst. Units Sq. Ftg. t1ain Fire Zone Bedrooms Occy Load Sg, Ftg. Access Flood Plain Stories Dcc.v Group Sq. Ftg. Other BUILDING PERfllT I Plan Ck. Conm/lnd Charges and ----------- 65%/Bldo P~r Fpp Surcharges ' Plan Ck, Res 30%lBldo Per Fee PLU'~BING PERMIT 02.0. 0(:) Fence Charges and ----n~g;-O-- Surcharges Demo ELECTRICAL PERIHT I Stdewo 1 k Charges and ------------ I AIC Paving Surcharges /1ECMAHICAL PERMIT I Curb Cut Charges and ------------ Surcharges I ~ x Value Value Value x x TOT^L VALUATION Systems Development Charoe tJ.5~) ITotal Comb. Permit : TOTAL I CllJ;f{) . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Appl icant to furnish A. Job Address B. Legal Description 1. example- Tax lot 100. Lane County Map Reference II 03 4J 2. examEle- Lot I. Block 3, 2nd Addition to sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examele- heat/electrical ceilinq/or forced air Qas 2. example- waterheaterjelectrlcal/or ~ E. Square footage or valuation, etc. I. example- 1250 sq. foot house. 500 sq. foot garage 2. examp.le- if new project. check new - if addition, check add. etc. F. Building permit information: 1. example - construct single family house with an attached garllge 2. example ~ remodel existing garage into family room 3. exam2le - 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. OESIGN TEM1 AND 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. --- 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 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. -{ ~y ~ ,,} ffJ -6<1676 V. FOR OFFICE OSE ONLY Permit Cl erk r,[i -1 k- ( PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY; Permit applicant exempt from registration with the Builder's Board because: OU-J fi..pfL-- C3 Iff~J...f' r( e.- II q- J~!/ L/ ~fi!:tJ .#edeah/..f ( :Z;aa'~ c.4~//46y Additional Project Information: PLANS REVIEWED BY: name signature date ,