The URL can be used to link to this page

Home My WebLink AboutPermit Building 1982-12-29 tIrISPECTlON LINE. 726-3769 Job Address . tit CITY OF SPRINGFIELD INFORlIATlON UNt COMBlilATlON APPLICATION/PERMIT 726-3753 ErlERGY SOURCES: Sq. Ftq. 1.lain Heat ~q. Ftg. Access. Water Heater Sq. Ft9. Other New Add Alter Pep. Range --Fence Demo Change/Use ~ V1l1u€ of flork: Other- - Owner~r//."~u{g~~~ ,U4/qD~ Address ,. Bu,{oina Pernllt Info: Oescribe Hork,(i.e.. Build Single /072. /11 K.A'~ ~'Y'~A-flq6 Familv Residence With Attached Garaoel /D71 !U~' Legal Oe'cription \' If)'??,">:> ~ I ()Ll CrrO Construction lender Address OES I GN TEArl (name) Primary Structura 1 Electrical Mechanical CONTRACTORS (namel );()ft: ~~/)AA/'{: /,00, Genera 1 Plumbina Electrical ~lechan;cal PLUllBI NG NO.1 lEaCh single fixture I Relocated building (new fix. additional) IS.F. Residence (l bathl IDuPlex (1 bath) each IAdditional bath I ~Iater service I Sewer I Storm Sewer I I I I I I :x: ~ )J ...... 0 ) ::> " ) "", t -- I Phone (address) -r~~-iJ;'~~ /-?i2~ - ..- ~~/&~ b. .;'}-/;. C>VMI'c"i-'''__';'' 4::ZO w"tr c/~i:- /I, ~ I (lies. no.) (exnires) (ohane no. ~ (",rlrlress) (lire:. no.) (f>xoirp~) /~!l'3 (ohonp nn.) 2,51074 C-f;>;i//)fJL. b~' /9'03' ~4:tU..t '7 ELECTRICAL rHAor.J NO rI-lAt?r.~ MECHANICAL FEE rHARr.F NO >>> >>> Residence of furnace/burner to STU's SQ. FT. New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall ~o~c.P hp~tpr ~nrl vpnt ITempOrary Construction I'Change in existing rp<; j drJ'lr:~ Imultifamily, comm. or Tnrlll"t.ri~l IOf ICOMM./IND. FEEDERS I Install/alter/relocate r1iddh fpprlpr" IDf I amps. Appliance vent ~f!l)a ra tp Stationary evap. coolf!r Vent fan with sinole r1urt. Vent system apart from I heating or A.C. Mechanical exhaust hood and durt Wood stove/heater amps. I I I ISSUANCE OF PFRIIlT I TOTAL CHARGES Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Division TOTAL CHARGES TOTAL CHARGES WHERE STATE L,'ll REQUIRES that the Electrical work be done by an shall not be vali3 until the label has been signed by an Electrical I HAVE CAREFULLY EXN1INED 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 NO OCCUPAIKY 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 ORS 701.055 will be used on this project. IlAI,IE(please print)~ /('II/f1::1. "vOY /It)F SIr.IIATU~-r."~/ ~, DATE /.2/?'Y /;;-2 FOr. OFFICE ilSE OIIL Y j Zone Tyoe/Canst. Units Sq. Ftg, t1ain x Value Fire Zone Bedrooms Occy Load Sq. Ft9. Access x Value Flood Plain Stories Occy Group Sq. Ft9, Other x Value BUILDING PERmT _3.Q,J~9_____ Plan Ck. Conm/l nd Charges and 65%/BldQ Per ~op, Surcharges \ I ~1S Plan Ck, Res -- 3D%lBl do Per Fee PLUl1BING PERMIT Fence Charges and ------------ Surcha rges Demo ELECTRICAL PERI~IT I Sidewalk Charges and ------------ I AIC Paving Surcharges tiECHAN I CAL PERMIT Curb Cut Cha rges and ------------ Surcharges TOTAL VALUATlOtl Isystems Development Charqe (1.5~) I --I Total Comb. rermit -- TOTAL r ' )~3,~~ . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description I, example- Tax Lot 100, Lane County Map Reference II 03 43 2. example- Lot I, Block 3, 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilin~/or forced air Qas 2. example- waterheater/electr;cal/or solar E. Square footage or valuation, etc. - I. example- 1250 sq. foot house, 500 sq. foot garage 2. examyle- if new project. check-new - if addition, check add, etc. F. Building pennit information: 1. example - construct single family house with an attached garage 2. example - 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 TEAf! 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 DN 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . PERMIT VALIDATION ~ ~ J5Q~ rtu, Jjo/D ---- --:-.. cj 33/~ cIudL 3(, () () J/~ Permit Clerk .~~ Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature ... .. _.. ..-.-...>..-......-......._..-~-~ ...... _.~..-._,- ....~"._....~~.._- .....-.........".. date _........'........._4....~..........,............,...-...:.-......- ,....;..;,......;............""""""~~ .