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Home My WebLink AboutPermit Building 1979-12-6 CITY Of SPRINGFIE,D INFOffilATION lINt COMBIilATION APPUCATION/PERMIT 726-3753 EIIERGY SOURCES: Sq. Ftg. Hain 3-1<4._ Heat ~b, l?~ ~q. Ftg. Access. I'later Heater f::.IJ'JU. Sq. Ftg. Other . r r... }Jlew_Add_A1ter-,~ep. RaQqe~~____ Fence Demo Change/Use /7-03-':U:;-'I-/ ValuE of Hork: Other- - ~::::ss 0~~ 0~~~-r~Jc-'? Phone741f1b1.~~~~~~i~;~Inf~~ A~~~~h~~eG~~~~~l,e.. Build Single ~w:'j''-'''- of"fta:.. e>rQ;'. r<.1~ E:;il-5TI~ Construction ,ender MT oSth:.. a,W" 'I-loMf'h {A/y,' <<;1l\.11~ Address Z16?J f1?,bj1Ztf- fZO-j ~~~ Phonefp9>lp 13 ?51j- - DESIGN TEAf.' (name) {address} " (lies. no.) (exoir~s) jlNSPECTION UIIE 726-3769 Job Address . . ~ 1.3.10 oL,VMPI0 ""'T ~ -- -- Legal Description T.4t.lor //1')/ M,P.SOt. Primary "^'T -sH b('K,vJ \..1.?~ Structural ,/ Electrical ,/ l1echani ca 1 V CONTRACTORS (name) Genera 1 IV\,T ..;,i-fPOt'.V i..lo M'U7 PlumbinQ / ~ bI'2.-" Ie, PL'1 } Mt:?LI.x... Electrical fIAT ~~:w rlootvW-cC_ ~lechanical ~\A PWIIBIIIG NO.1 ~IEach single fixture I Relocated building (new fix. additional) Is.F. Residence (] bath] I Duplex (1 bath) each IAdditional bath ITempOrary Construction [Water service IChange in existing res,i d_e.nce [Sewer [multifamily, conrn. or Indue:;trial Istorm Sewer I 10f--'J{1J [ ICOMI'I./IND. FEEDERS I I Install/alter/relocate ni~trih fppdpr~ I <Of amps.1 I [ [ I [ [ I I [ I SSUANCf OF PFR!11T 3".s> TOTAL CHARGES '1 f!9 TOTAL CHARGES dSOO I TOTA, CHARGES S C!:$J WHERE STATE L.\l~ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division (ohone no.' I (address) fl ice:;. no.) (ohane no.) (exDi res) I f/[)/.. ;;:;/17-.. r.,ECTRICA, MECHANICAL FEE (H~Jill.....1 I Residence of Cj€.!' SQ. FT. New circuits alts. or extensions Floor furnace and vent rHARliE. ..llil.....1 1..Ef.L .cJlARG.E. <FF 300 furnace/burner ta BTU's SERVICES [Recessed wall I Snac:p hpatpr and vpnt [ I [ [ V~nt fan with Iz.oc slnole duct I Vent system apart from I heatina or A.C. I Mechanical exhaust hnnrl and rluct I \'/ood stove/heater [ ;l~ amps. [ [ 1/ 1.J.s<P1 I I I Appl iance vent "p.piJratp. [Stationary evap. cooler I HAVE CAREFULLY EXN1INED 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 \'lork oerfonned shall be done in accordance with the Ordinances of the City of Spr; ngfi e 1 d and the laws of the Sta te of Ore~lOn perta i ni ng to the work descri bed here; n, and tha t rw OCCUPAr~CY wi 11 be made of any structure without the permission of the Building Division. I further certify that my registration with the B~ilder's. Board is in full force and effect as required by O~S 701.055, that if exempt .the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. IlAHE(please print) ZonejoJ. -2. Fi re Zone--1J Flood Plain NfJ BUI,DIIlG PERIIIT Charges an':: Surcharges PWI~BING PERMIT Charges and Surcha rges I I ~\ E,ECTRICAL PERI:IT Cha rges and Surcharges 11ECHANICA, PERMIT Charges and Surcharges Q Iek:-VAN Ob~VO(tT ~u. t/atw.,;,J DATE IZ,-w.. 71 S IGIIATURE FO~ OFFICE USE DilLY I Sn. Ftg. Sq. Ftg. B-L Sq, Ftg. Type/Const. V- / HR'.- Bedrooms Stories riain :w4 x Value ~StJlJ 99 Access x Value Other x Value TOTA, VA,UATION ';(500_"0 S~stems Development J:l '1. so C arqe (1.5~) Units Occy ,oad Occy Group Plan Ck. Comm/lnd 65~/Rldo Ppr Fpp Plan Ck. ROes 3D%/Bldq Per Fee '31. 40 ____n_if..~.:99_ /.qa '1.00 Fence ------------ , ?><.. ~S,OO [Sidewalk _nnn ~,~~-I A/C Paving .s: 00 I Curb Cut _n_n_ .~_I Demo [Total Comb. rermit [ I TOTA, I QOJ{8 <# J.17.98 ~ . 10 COMBINATION APPLICATION/PERMIT (CAP) l. Applicant to furnish A. Job Address 8. legal Description 1. example- Tax Lot 100. Lane County Map Reference II 03 43 2. exa~le- Lot 1. Block 3, 2nd Addition to SprIngfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. exam~le- heat/electrical ceilinq/or forced air oas 2. exa~le- waterheater/electrical/or solar E. Square footage or valuation, etc. 1. examole- 12S0 sq, foot house, 500 sq, foot garage 2. example- if new project, check-new - if addition. check add, etc. F. Building pennit information: 1. example - construct single family house with an a ttached garage 2. example - remodel existing 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. DES I GN TEAI'I AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or jab 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: . ~ PERMIT VALIDATION I2t, G -:f:t 5'2.., 3CS b 6P 4/~)6 pp 4..8 J D ~p 14CJS/z ~D ~p _50G 19~ Permi t Cl erk Lf'/D / ~? ?o Cp 42,c)O I, q'Z- q,O() 3~ 25/)() ).00 5.00 20 /1-1,60 'Lli-C,S Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature AI1._~:.,~ -;, . date /.J~/?-7'J .