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Home My WebLink AboutPermit Building 1987-7-27 '1 ;.- ii~-' ( - q-8. fJ 'J . ~, IIIISPECTION LINE 726-3769. ' CITY Of SPRINGfiELD COMBINATION APPLICATION/PERMIT MA-I,{/ (cvl? rtlI(A/I.D~~) I ~~;~GY SOURCES: I.. Hater Heater I RanQe Job Address 140 >r legal Description INFORlIATlON UNe 726-3753 Sq. Ftq. r'lain ~Q. Ftg. Access. Sq. Ftq. Other ~lew_Add_Alter ---,~ep. __Fence__Demo__Change/Use _Other I' \X:\ ~ ~ I~ I~ I Owner lJJ?,' JlJItL)fu//A/ Address 1 (');;?{') A/, I.A.Z' j1J.I17L 7)1/A/~neM 0/7477 ValuB of Work: ~ .P /0 .5 bb - Bul'Gina Pe~lt Info: Describe Work(i.e.. Far.lilv tlesidence l~ith J'l.ttached Garaae\ 7'b?,.f t?rr /fA/1/ )1!3A'/)Or tVI TIf \1 1(. ~Cl/fiJ';-CMIW-W? &1-1r. r:"t,A<;G A I ~()()r .3Y.5fPM Phone . 717?./1/ Constructinn Lender Address Ut~J(jU TEAr1 Phone (address) (name) nics. no.) . Primary Structural Electrical Hechanical CONTRACTORS I namel (address) nics. no.) General ME NO/'').pIALt?- /A/C Build Single (exniresl (ohone no. t.:2dll <)"3 DO~'b.. ~ ') /:,~ ' }!Ji{ (pxnirp,:;) (ohonp nn ) Plumbina .:2~07A- r/fl:JlJ/ ){U ,it/9'O'77 ~!f/,97 E//{;.:I3,1./,c: , 0..4 . cy 740:?- I HAVE CAREFULLY EXArfINED 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 UO OCClJPArKY will be made of any structure without the permission of the Building Division. I further certify that my registration with ~he Builder1s Board is in full force and effect as required by ons 701.055, that if exempt the basis for exemotion is noted hereon, and that only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project. AO E- SIGrMTURE~~ ~ ~.<lm '7h.7/g-r , FO~ OFF I CE IIst'OiiL Y- ,I Units Sq. Ftg. Hain )t Value Occy Load Sq. Ftg. Access ,'It Value Occy Group Sq. Ftg. Other x Value Electrical ~1echanical PlUllB IrlG ELECTRICAL 110. FFF I CHARGF Each single fixture NL' , I Residence of SQ. FT. /NewcirCU!ts alts. or extenSlons ISERVICES I I r:E,LIJ:IJARliE. IIn Is.F. Residence (J bath 1 I Duplex (1 bath) IAdditional bath 1~later service I Sewer I Storm Sewer ITemporary Construction IChange in existing rp~ j q~rp Imultifamily, corrrn. or TnrlIJc:t.r;tll 10f ICm~,t./lNO. FEEDERS IInstal1/alter/relocate I r1ic:trih. fpprlprc: 10f amp..1 \ IWIE(please printLL!::f I C-Ir/!&-J Zone Fire Zone Flood Plain Tvpe/Cons t. Bedrooms Stories " BUILDING PERHIT Charges anC: ~ Surcharges 0- vi <"" Plan Ck. COIl1l1/lnd ,___L)_f(Z:..,2'Q.__ 65%/Blda PJ'r F.. I/. ""..., Plan Ck. Res T_ ~~ - 3D%/Blda Per Fee Fence PLUflBING PERMIT Charges and Surcha rges Demo ______ ___ __J Sidewalk I A/C Paving ____________1 Curb Cut I ELECTRICAL PERI~lT Charges and SurCharges MECHANICAL PERMIT Charges and Surcharges \ 77 440;z 6!1. ~ MECHANICAL '"1 , J:~I= furnace/burner to BTU's Floor furnace and vent . I I I, I I I I I l I , I Recessed wall I ~n~rp nptltpr ~nrl vpnt I I I App 1 i ance vent 5eDarate I Stationary evap. cooler I Vent fan wi th sinale duct. I Vent system apart from I heatino or ll. C. . I Mechanical e'xhaust I hnnrl tlnd durt I Wood stove/heater TOTAL VALUATION Isyste.ms Development CharQe (1.5~) ITotal Comb. rermit I I I I I 9tJ~p ~ I I TOTAL - COMBINATION APPlICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax lot 100. Lane County Map Reference 17 03 43 2. examole- lot I. Block 3. 2nd Addition to Sprlngtield Estates C. Name,-etc,-of~owner and construction lender C. Energy Sources " , , 1. examole-' heat/electrical ceilinq/or forced air Qas 2. examole- waterheater/electrical/or solar E. Square footage or valuation, etc. - I. examole- 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. examole - construct single family house with an attached garage 2. examole - remodel existing garage into family room 3. examole - convert single famlly residence into restaurant (change of use) G. Value of work as defined in Section 303 (a) of the Structural Specialty Code ' H. DESIGN TEM1 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 Z. 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . III PERMIT VALIDATIDN }l:-13~ a?cJ/ , Permit Cl erk .. Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date " : 1 -'\.. 'v i - I I i l