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Home My WebLink AboutPermit Miscellaneous 1981-7-20 ,..,. I INSPECTION LINE 726-3769 I Job Address Itegal Description I II lOw,., ;:{ K,.e y L Add..../R5 - C.RR.$'r 7Jk'.. 8).4~. /,/',,0. t (1f.Y OF SPRINGFIELD COMBINATION APPLICATION/PERMIT . INFORMATION LINE 726-3753 //:24-- .MA/~.l ,-\-~C(J .sr. Sq. Fig. Main Sq. Fig. Access. Sq. Fig. Other _New_Add_Alter_Rep. I_FenCe_DemO_ChangefUs. _Other ./ 0/ ,...,/ / / ..Building Permit Info: Describe Work (i.e., Build Single Pho~ (() -t:7\t)~ Familv Residence With Attached Garo~el __, _ l()hc."A)AJ~l:: r h /Jp J)RA;I\ 7 I ENERGY SOURCES: ~ ~ ~ ~ Heat Water Heoter 033'541 Ran~e Value of Work: Construction Lender Address Phone DESIGN TEAM (name) (address) (lies. no.) (expires) (phone no.:' Primary Structural Electrical Mechanical CONTRACTORS (name) (address) (IiCl. no.) (expires) (phone no,) Gen..rnl PlumbinA #/0 / PLUMBING ELECTRICAL ~ MECHANICAL Electrical Mechanical NO. ' FEE I CHARGE NO. I FEE I CHARGE NO. I FEE I CHARGE I I I I ,- I I I SERVICES furnace/burner to ~TU's Appliance vent separate Stationary evap. cooter Vent fcm with sinRle duct Vent system apart from heating or A.C. Mechanical exhaust hood and duct Residence of Each sinAle fixture Relocated building (new fix. additional) S.F. Residence (t both) s~. ft. New circuits, alterations or extensions Dualex (l bath) each Temporary Construction Additional bath Amps. Water service Sewer Wood stove/heater Storm Sewer FEEDERS Heat Pump Air handler ta 10,000 CFM Air handler aver 10,000 CFM Amps. ISSUANCE OF PERMIT TOTAL CHARGES 1f,0 /i~ TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contrador, the elechiCClI portion of this permit shall not be valid until a label has b..n signed by an Electrical Contractor and attached to the electrical panel. I HA VE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that 011 information hereon is true and correct, and I further certify that any and all work performed sholl be done in accordance with the Ordinances of the City of Springfield and the Lows of the State of Oregon pertaining to the work described herin, and that NO OCCUPAN.CY will be made of any structure without the permission of the Building Division. I further certify that my registration witt. the Builder's Board is in full force and effect a s required by ORS 701.055, that if exempt the basis for exemption is noted heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. Basis for Builder's Boord exemption: NAME (please print) ~,..kr k e.. ""L- . I "GNATU" ~k ~ 11~ FOR OFFICE USE ONLY r / DATE .2/.2v/f1 , , Zone Type/ Canst. Units Sq. Fig. Main Fire Zone Bedroom' Occy Load Sq. Ftg. Acce!' Flood Plain Ctarier Ocey Group Sq. Fig. Other BUILDING PERMIT Plan Ck. Comm/lnd Charges and 65%/ Blda Per Fee Surcharges Plan Ck. Res 30%/ BldR Per Fee PLUMBING PERMIT Charges and Fftnce Surcharges o.mo ELECTRICAL PERMIT Charges and Sidewalk Surcharge. Alc Pavina MECHANICAL PERMIT Charges and Curb Cut Surcharge. -------- x Value Value Value TOTAL VALUATION x Systems Development Charaft n.5%1 Total Comb. Permit TOTAL 1" --- ~ ~;~----.....-~ '_ ,.".... ~ '.,;,_~ ",'" ," 't~ .." .' - 0' ", COMBINATION APPLlCA T1~N!PER~r~AP; ... ~. .....J .., I. Applicant to furnish ,. , A. Job Address B. Legal Description 1. example-tax lot 100, Lane County Map Reference 17 03 43 2, examole-Lat 1, Black 3, 2nd Addition to Springfield Estates c. Name, etc. of owner and construction lender D. Energy Sources . ~ ( 1. example-heat/electrical ceiling/or forced air 90s .: -f." '" ,2. example-wat~r heater/electrical/o,r'solor ).: 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, etc. F. Building permit 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 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 abbrevi- ated schedules you should consult the full schedules C, BUILDING DIVISION STAFF WILL Fill OUT ALL FEES AND CHARGES ON THE SCHEDULES 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 typewritten 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: Additional Project Information: PLANS REVIEWED BY: name ",ignatur.... ,-.' Permit CierI.- " "l.. tRMIT VALIDATION " '. . I ~at"" 'c .,. -TI"-1if"'l