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Home My WebLink AboutPermit Building 1983-1-10 . . I IrISPECTIOII L1I1E. 726-3769 Job Address /f199 (WUnll2i(' )0ct1ee_i--.. Legal Oe5Cription 1'1-"3. ;Z~~3/.' ""~~ CITY UF SPRI1IGFIELO COtIBI1IATION APPlICATION1PERMIT EnERGY SOURCES: Heat !-Iater Heater Ranqe INFORlIATION LHk 726-3753 Sq. Ftq. 1.lain ~q. Ftg. Access. Sq. Ftq. Other lIew Add A Her Rep. --Fence Oemo ChangelUse Other -- - ~ N \;J () Owner (l1J./! /17/) <lva.! ..s , . _ (Valu€ of Ho.rk: ",0 J!.I'l1{'J7fJa.17('!!')r{1) /}' h. (){>{; Builciina Permit Info: Describe l~orkli..e.. Build Single Familv nesidence With Attached Garace) ,ljcmnd /,,, COlnmr:lf'/aO /:&,JtOj 1 1.11/2 t- Phone VI N Address Construction Lender .) " -/-c,i'-f(O nd - D.//'-L(v l)ll Address Phone Ut~ ll,jr~ H.Ar.' (name) I address 1 Primary lmar! /.nnn I anduofnJo/J/h/~A Structural nics. no.l (exl1ires) , {ohane no. I -:ZS~-3D8'3 Electrical Mechanical CONTRACTORS lnamel General ~ onc00o M.. r f~"si Plumbino (address) (lir:c:. no.) (exoirec;,) /308:'S- Sl.tJ. L[\LL'L ( 11:-:5'fIiIJ +?t'YI..' t:J. () (ohnnp nn.1 /.-2C-799{" E1 ectri ca 1 "1echanical PLUI1B IIIG ELECTRICAL MECHANICAL '. SQ. FT. furnace/burner to BTU's /!:r:c'..cHARG.E.. / NO. . , FEE 'CH~..JJn . H'~ , rHM.IiE _'10 y Each single fixture :>-~ Residence of Relocated building (new fix. additional) ,/ New circuits alts. or extensions ::l caR _aRE SERVICES IS:- Floor furnace and vent S.F. Residence (I bathl Ouplex (1 bath) each Recessed wall Sn~rp hp~tpr ~nrl vpnt , ~P,j:'.,. kr,JI. Appliance vent ~eDil ril. tp Stationary evap. cooler Vent fan with sinole duct I I' Vent sys tern apa rt from I I/'- heatino or A.C. ~. ? I'Mechanical exhaust 1(1.5'10_ .... hond and durf "- IInstall/alter/relocate I Hood stove/heater " I r1ic:trit'L fpprfpr<:. IOf amp<-I 1S"16A..' ~P/~ 1..1b!.<.9 I I I I I I I I I I 1 I I SSUANCE OF PFlum /c:::>. c.e. -:;'0, ","0 TOTAL CHARGES /,'J.- I TOTAL CHARGES ~~. s-o that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit label has been signed by an Electrical Supervisor and returned to the Building Division ~,- Additional bath 1~later service Sewer T~porary Construction Change in existing rP'Sj~~nr.p multifamily, comm. or Tndu"trii'l.l Storm Sewer Of amps. CONN.1IND. FEEOERS TOTAL CHARGES WHERE STATE L'W REQUIRES shall not be vali) until the I HAVE CAREFULLY EXNIINEO 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 Oreaon pertaining to the work described herein, and that 110 OCCUPAHCY 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 7nl.055 will be used on this project. 1IN-IE(please print)_i?:,. /., r, vrj L~" (." ~/) SIGilATURE (),---~jl,.i.,./ .:/3~...r'J:jj OATE 1;1../:/.3/ g 2.. Zone .:::; c:. Fi re Zone Flood Plain TypelConst. ~_~ Bedrooms Stories 1 Uni ts Occy Load Occy Group FOR OFFICE USE OIJL y S~. Ftg. Sq. Ftg. 2'- < Sq. Ftg. ;/V riain x Value Access x Value Other .KlI9o.r<>~ Value /-f-'........... co- TOTAL VALUATlOtl /,~- - -,/0.80 p-7 I-=<~~ Systems Development '"" _...,!--/ Charqe (1.5%) '..........r I _-. ..... - BUILOING PERNIT Charges an~ Surcharges 7<>. ..... Plan Ck. Comm/lnd 65t/Rldo Ppr Fpp Plan Ck. lies 30:/Bldq Per Fee Fence PLur1BING PERMIT Charges and Surcharges ~.~8 ";?t:::l.- ------------ .Ii'-=- Oemo ELECTRICAL PERI~IT Cha rges and Surcharges I1ECHAtlICAL PERMIT Charges and Surcharges ______~~_ Sidewalk . 60 A/C Pavi ng ~:.. ~ I Curb Cut __u___I. "$1{ I I I I Total Comb. Permit TOTAL /'f~.I< ---~ I'I~./~ i i . COMBINATION APPLICATION/PERMIT (CAP) I, Applicant to furnish A. Job Address B. Legal Oescription 1. examole- Tax Lot 100. Lane County Map Reference II 03 43 2. examele- Lot I. Block 3, 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. examole- heat/electrical ceilinq/or forced air Qas 2. examole- waterheater/electricaltor solar E. Square rootage or valuation, etc. ----- I. examole- 1250 sq. foot house, 500 sq. foot garage 2. examole- 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 room 3. exam~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. 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. - 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: t PERMIT VALIDATION ~v liD~ O~CCJ \W ,\U) / . : Permi t Clerkdv ~ . . -, / - , Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: J , J ~ name sign ure .... :..-.... "--. -..=---... -...... ..,~".,~:,.::.=-::,=-''''".':;-'.7-75. ';'~::r-;;'" " f "