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Home My WebLink AboutPermit Miscellaneous 1988-12-15 Job Address 1:20 3 . f1I1.. ~ CITY Uf SPRINGfiELD CDHBlIIATlON APPLlCATlON/PERMIT EHERGY SOURCES: Heat l~a ter Hea ter Range ValuE of \-lark: ~ INfURl1ATlON UNl 726-3753 Sq. Ftg. 1.la;n ~q. Ftg. Access. Sq. Ftg. Other IJew Add A Her Rep. -Fence Demo ChangelUse Other- - ()() ~ J INSPECTION L1I1E 726-3769 Legal Oe~cription () I , II l Owner Yj1~ht4-L I~ Address Phone ~ - Buil{;;na Pennit Info: Describe \~ork(Le.. Build Single Familv Residence With Attached Garaae) "1-'1 Lt..u f/Vl/ 7; A../ C) lJ-\ I Construction lender Address DESIGN TEAl1 (name) Phone (addressl (1 ics. no.) (exo; res) (ohane no. Pr; ma ry Structural Electrical V]\.{~ 1, Mechanical CONTRACTORS Plumbinn /JI/ flilAUvl'-eJ I2u~A d 6!td/~ < (lir:s.. no.' (exnires) '1 )\11 rV '"') (nhone no.) (name) (address) Genera 1 PLUIIBIrlG ELECTRICAL MECHANICAL ~ ~ ". "" I Electrical ~techan;cal NO FEE CHARr.F NO FFF r~ARhF NO. FFF rHARr.F sq. FT. furnace/burner to BTlI's Each single fixture Residence of Relocated building (new fix. additional) New circuits alts. or extensions Floor fu rnace and vent S.F. Residence (I bath) Duplex (1 bath) each SERVICES Recessed wall Sn~rp hp~tpr ~nrl vpnt Storm Sewer Df amps. Appliance vent s~oarat~ Stationary evap. cooler Vent fan with sinole duct Vent system apart from heating or A.C. Mechanical exhaust hnnd ~nd duct Sewer Temporary Construction Change in existing res.i dence. multifamily, conrn. or Tndu<;trii'll Additional bath ~Iater service CO~1./IND. FEEDERS Install/alter/relocate distrib. feerlers Wood stove/heater Df amps. \_~~ ISSUANCF OF PFRtHT TOTAL CHARGES . TOTAL CHARGES I TOTAL CHARGES Wm:n.E STATE L.'t~ REQUIRES that tile Electricill work be done by an Electrical Contractor, the electrical portion of this perr.1it shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXArllNED t~e comr>leted apr1ication for Dcrmit, and do hereby certify that all information hereon is true and correct, and I further certify that any and all work ncrformed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of OreC]on pertaining to the work described herein, and that 1m OCCUPAliCY will be made of any structure without the permission of the Buildin9 Division. I further certify that my registration with the Builder's Board ;s in full force and effect as required by ORS 701.055, that if exempt the basis for exemr>tion is noted hereon, and that only subcontractors and employees who are in compliance with OP.$ 701.055 will be used on this project. IlAI-lE(please print) R __I 1J0~(f)J> d ~., ,', l SIGIIATURE ;:J ~ m... (7 ~ 'l1":"':"""~ DATE 17.;/i.d ~f{ Zone Fire Zone Flood Plain FO~ OFFICE USE DilLY Type/Cons t. Units Sq. Ftg. f1ain Bedrooms Occy Load Sq. Ft~. Access Stories Occy Group Sq. Ftg. Other ," x x Value Value Value x TOTAL VALUATlDN BUILDING PERI'1lT Charges an': Surcharges , Plan Ck. COIl1l1/lnd ____________ 65%/Blda P.er Fee Plan Ck. Res 30%/Blda Per Fee I Fence I Demo _n__L$'.'.~_J Sidewalk ,? 5 I AIC Paving ____ ________1 Curb Cut I 'Systems Development Charce (1.5~) PLUI1BING PERMIT Charges and Surcharges I I ELECTRICAL PERI~IT Cha rges and , \ Surcharges "'\ Tota 1 Comb. Permi t ' MECHANICAL PERMIT Charges and Surcharges TOTAL /5-75 J - ~ COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax Lot 100, lane County Map Reference 1/ oj 43 2. example- Lot 1. Block 3. 2nd Addition to springtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. exam~le- heat/electrical ceilinqfor forced air Qas 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - I. example- 1250 sq. foot house. 500 sq. foot garage 2. exa~le. if new project. check-new - if addition, checl< add, etc, F. Building permit information: 1. example - construct single family house with an attached gartlge 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 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 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. il J-qO? (5'-- rt (2/ V. FOR OFFICE USE ONLY Permit Clerk tL PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board .because: Additional Project Information: PLANS REVIEWED BY: name signature date