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Home My WebLink AboutPermit Building 1989-8-1 ,. llNSPE~T10N LrNE 726-3/69 Job Address /Dtjl../, legal Description . /YI 0 jfr,') +-, CITY Uf SPKINGflELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat Hater Heater Range ValuE of HorK: /5~-~ "'7J_~'2J - Bufl<iinQ Pennit Info: Oeser be WorK{i-.e.. Phone/~Ql ~ Familv Residence With Attached Gara~e\ WMrDDYVl -. I NFORHATlON lINE 726-3753 Sq. Ftg. I.lain ~q. ~ Ftg. Access. Sq. Ftg. Other New Add Alter Rep. -Fence Oemo Change/Use Other- - Owner f:}Vf }/JrUl -f1cru9I1~ Address /D'J& rn~ 5:'t: Build Single vo ~ C> -h. C> \J\ 4/:-'2-- :[(1 ft\IJli &L Construction lender Address DESIGN HAr~ (name) Phone (address\ flies. no.) Cexoiresl A * ~ (ohone no A Primary Structura 1 Electrical Mechanical CONTRACTORS (namel General /?/'--..t"""/~ (address\ (1 ics. no.l (exoires) (nhone no. \ Plumb;na Electrical ~lechanical PLurm ItlG ELECTRICAL MECHANICAL NO. ~ Each single fixture Relocated building (new fix. additional) FEE CHARGE 'l(l F F "- J:IlARli[ Nn FFF CH'IIlliE. Residence of furnace/burner to BTU's 7.$ ~ SQ. FT. S,F. Residence (1 bath! Duplex (1 bath) each /' 'New ci rcuits alts. or extensions ...- ..:z e>l"I fi'} &>7? = SERVICES ::?2~ Floor furnace and vent Recessed wa 11 Snac~ h~~tpr'and vent Sewer Temporary Construction Change in existing res} ~~.nce. multifamily, camm, or ~nrlllstriill I Appliance vent c.eoarate Stationary evap. cooler Vent fan with sinole duct Vent system apart from heatina or A.C-. Mechanical exhaust hnnd ilnd duct Wood stove/heater ;7.0C- Additional bath Water service Storm Sewer Of CO~~./IND. FEEDERS Install/alter/relocate distrib. feeders amps, Of amps. TOTAL CHARGES WHERE STATE LAH REQUIRES shall not be vali~ until the '7'2~~. TOTAL CHARGES that the Electrical work be done by an. label has been signed by an Electrical ISSUANCF nF PFRIHT ;:<'Z ~ :5'2::'. TOTAL CHARGES M //1 . /.";,-:. """" Electrical Contractor, the electrical rortion of this permit Supervisor and returned to the BUilding Division 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 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 ons 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 71")1.055 will be used on 'this project. NAHE(please print) . ~,f/4/ /Y. ~~fi""#~IGrIATUR<.4 ~~~'/;Q//f~/ OATEy-~/~g:7 ------- ~ -.- . -. FOr. OFFICEAlSE ONLY / Sq. Ftg. riain Sq. Ftg. Access Sq. Ftg, Other /' Stories Units Occy Load Occy Group x Value Value Zone Fire Zone Flood Plain Type/Const. Bedrooms x x Value TOTAL VALUATION BUILDING PERHIT Charges ant: Surcharges , ~ . Plan Ck. CQrrmlInd ___AA:..____ ..Q.2!/Bldo P.l'r Fpp c- Plan Ck. Res I . '7 ~ 30%lBl dQ Per Fee /b. '25" 'syste,ms Development ' 11~ ~ Charqe tl.5~) . t~ .r~ PLUI~BING PERMIT Cha rges and Surcha rges _ __ '3.?.:., ~=- 1./"3' ___3-?~.2~_ /-/3 /$:. ..= ___-L_______ -;?S Fence ELECTRICAL PERrm ' Charges and Surcharges D~mo 'Sldewa I K AIC Paving Tota' Comb, Permit TOTAL &"7;"2(; -- / tfJ5~i- i 1 MECHANICAL PERMIT Charges and Surcharges Curb Cut " . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description 1. example~ Tax Lot 100. l~ne County Map Refere~ce 11 OJ 43 2. examele- Lot I. Block 3, 2nd Addition to ~prlngtield Estates . C. Name. etc. of owner and construction lender O. Energy Sources 1. example- heat/electrical ceilinqlor forced air Qas 2, example- waterheater/electrlcalJor ~ 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, cned:. add 1 etc. F. Building permit information: 1. exam~le - construct single family house with an attached garage 2. examele - remodel exis~in9 garage into family room 3. exa~le - 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 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 itern(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 ANO CHARGES ON THE SCHEOULES 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 Pennit Clerk l PROJECT CONOITIONS TO BE SATISFIEO BEFORE OCCUPANCY: Pennit applicant exempt from registration with the Builder's Board because: Additional Project Infonnation: PLANS REVIEWEO BY: name ~R/~'fiL~."::;""'Signature~~_--"> date ~',,->- ~ L C---. . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax lot 100, lane County Map Reference JI UJ 43 2. examDle- lot 1. BloCK 3, 2nd Addition to sprlngfield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. example- heat/electrical ceilinq/or forced air q 2. examole- waterheater/electrlcal/or SOlar E. Square footage or valuation, etc. ------ 1. example- 1250 sq. foot house, 500 sq. foot garag 2. example- if new project, check new - if addition check add, etc. F. Building permit information: 1. example - construct single family house with an attached gar~ge 2. example - remodel existing garage into family roc 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 TEAM AND CONTRACTORS To avoid design or construction delays, Building Oivision 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 Oivision 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 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: . CITY OF SPRINGFIELD City Hall Sprlngfteld, Oregon OOlee 01 Community and Economic Development OFFICIAL RECEIPT 14537 (/ - I 19 ~y Da1e 1) Rec'd From i7r.ek'h (..{;VI HOI1.~(jt, J Address Received For<#- ~ t10lj OGr-D] I. 2.--0 fJf 1,0' () 0 ~', I) ff 1Lb GO r:;5lo J-,..J ~ ~p 7j",1(;D C;OZD I .I~ m piC::;. 00 r:;157 T) .1"'J f . z,6' . ~ · Amount Received 1f IjJh I 6/ --- . m.~THO~~ I - ~ I Frantler BUSINESS FO~MS. INC. l$OJI342,ll.' Permit Clerk Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name i..bR/~' ~':"i~;'~Signature~~~~~..-"> /L // ~;, date P"> '_=-= /C:=>~; c...:> c.