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Home My WebLink AboutPermit Building 1988-10-21 Owner .() PC; Address [ 0 ./" /'"' ytv'fv Construction lender Phone INFOR/lATION liNe 726-375J Sq. Ftg. '.Iai,; .. ~q. Ftg. Access. ,/ Sq. Ftg. Other New Add Alter Rep. Fence_Demo _Change/Use . r _Other Buil<iinQ Permit Info:,_Oescrine-Wcfrkl~BuUd Single Familv nesidence With'A~t~~h~d G~r~a~) ~ .' I INSPECTION LINE 726-3769 Job Address "35.;2 0 . CITY Uf SPRINGfIELD COMBINATION APPLICATION/PERMIT EIlERGY SOURCES: Heat Hater Heater Range ValuE of Work: ---- legal Description O(~~ (J I ~ ~ ~ ~ Address Ut~ lliN T t:.Ar~ (name I /'-'?AfL-~ ) Phonl / Primary C' (lies. no.) (exoires) fotione no. I Electrical ----- (~~ Structural Mechanical CONTRACTORS (name) (address) (lies. no.l (exnir~~) (nhnnp nn.) Plumbino /I /1 / fm/YJ 9/J.- PLUf.lBING (/7 // ( I]/U/~ ./ I Vi-V" General Electrical Hechanical ELECTRICAL MECHANICAL Nn. Each single fixture FEF rHARr.F ." I FFF rHAB.liE NO Residence of furnace/burner to SQ. FT. BTU's FFF IJ:HARG.E Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (l bath 1 Duplex (1 bath) each Additional bath SERVICES Recessed wall ~o~rp hp~tpr Anrl vpnt I I 'Cl ....., Q" '-t~ Temporary Construction Change in existing rec;. i d..e.ncp Imultifamily, comm. or Tnrltlc:tr;rtl 10f amps. ICOMfl./IND. FEEDERS I Install/alter/relocate rl;c:tr;h. fppdpl"'C: I Of amps. I I I Appliance vent <;'~Daratp Stationary evap. cooler Vent fan wi th s.in9le d\lct Vent system apart from heatina or A.C. Mechanical exhaust hnnd and durt Water service Sewer Storm Sewer Wood stove/heater TOTAL CHARGES WHERE STATE LAW REQUIRES shall not be valid until the TOTAL CHARGES ISSUANCE OF PFRIIlT TOTAL CHARGES that the Electrical work be done by an 'Electrical Contractor, the electrical portion of this pemit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED 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 Oregon pertaining to the work described herein, and that rID OCCUPAI~CY 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 ORS 701.055. that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 7Ql.055 will be used on this project. 1lAJ.IE(please print) 0A-/IJ ET 3'0 ij f\!JstStJ SIGNATURF./J(J,M1:;t FOP. OFFICE US~ Sq. Ftg. Sq. Ftg. Sq. Ft9. TEJ/) 'l/-gE ( Zone> Fi re Zone Flood Plain Tvpe/Const. Bedrooms Stories Units Occy Load Occy Group Hain Access Other x x Value Value Value , TOTAL VALUATION BUILDING PERIIIT Charges and Surcharges Plan Ck. Comm/lnd 65%/Bldo P~r Fpp Plan Ck. Res 30%lBldo Per Fee Fence I ~, 0 Systems Development Charoe (1.5% . / PLUI~BING PERMIT Charges and_.-~- Surcha rges DBmo 4A ,'J.N' _ ____j:S:..~__~.! '/7~ AIC Paving I ------------7~~d /SfLI , . , Tota' Comb. Permit ELECTRICAL PERrm Cha rges and I '\ Surcharges V MECHANICAL PERMIT Charges and Surcharges ).,'-'1 .'Z-O TOTAL (5. ~-- . . . - COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description 1. examole- Tax Lot 100. lane County Map Reference 1/ OJ 43 2. exa~le- Lot I. Block 3, 2nd Addition to Spr,ngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinq!or forced air oas 2. examjile- waterheater/electrica(/or ~ E. Square footage or valuation, etc. I. examole- 1250 sq. foot house, SOD sq. foot garage 2. example- if new project. check new - if addition, check add, etc. F. Building pennit information: 1. exam~le - construct single family house with an attached garage 2. examele - 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. --- 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. (rz-~ cfL( t 0----21 -fY V. FOR OFFICE USE ONLY Permit Clerk cL--- I. 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'