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Home My WebLink AboutPermit Building 1986-9-22 (2) Job Address "'~l__ legal Description -f/'!'/~ CITY Uf SPRINGFIElD COMBINATION APPlICATION/PERMIT EIIERGY SOURCES, Heat l~ater Heater Range '-----6 el)-A~' oa\ 'IN~~N UNt 726-3753 Sq. Ftg. I.'ain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. --Fence Demo Change/Use -Other -- -- If I 0 ~, 6'1> . JA~ (/Jj) jlNSPECTION liNE 726-3769 ()~ E.. 0/ 7:<Df5 ~E,{c:o~ ~:l() U/M Jt/I TH ()L//cA/9--CC/f)/fA/c (',t,A-<;<; A-- AJI)Or I no.) (exDires) (ohone no.\ ~ ~ o ...::] --- \5\ OwnerDlt?&r'/AI gAAlk-- Address I?b, h ~D66 ~A-...v)j Phone 79/%.2-'1 vall of Work: /3.. {?73 ~ Builtiinq Permit Info: Describe Work(i~e.. Build Single Family nesidence With Attached Garaael Construction lender Address Ut~ HlN TEAH (namel Phone (address) (lies. Primary Structural Electrical Mechanical CONTRACTORS (name) (addr~ss ) ilics. no.) (pxniresl (nhonp nn l Plumbina ~g074 cJlt'tI./ Jtl/ Ei/p}FA/,c:: 1M, Cf/4'f)7- 1'10 '7 1~4/rJ7 '5 -1-_4-t);<,&'Cf General AOE JlCOPlA/6'- li/c., Electrical ~1echanical PlUl1BING ElECTRICAl MECHANICAl ....llih FFF f:HARGE NO ~~~ r~ Nn ~~L..cl:lARG.E. Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) S.F. Residence 11 bath) Duplex (1 bath) each Additional bath New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall Srp,('p h.,.;ot.,... ;onri "I'lnt Storm Sewer Of amps. Appliance vent ~.,.n"'r...tp Station'ary evap. cnoler Vent fan with sinole duct Vent system apart from heatinq or A.C. Mechanical exhaust hood and durt -< ~Ia ter servi ce Temporary Construction Change in existing rpS.i qp';n('p multifamily, COITIn. or Inrl""trial Sewer COMM./IND. FEEDERS Install/alter/relocate di"trih fpprlpr~ Wood stove/heater Of amps. ISSUANCE OF PFRrlIT TOTAl CHARGES TOTAl CHARGES TOTAl CHARGES WHERE STATE L\H REQUIRES that the Electrical work be done by an,'Electrical Contractor. the electrical portion of this permit shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division IlAME(please print) '\ :zone Fi re Zone 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 performed 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 NO OCCUPAIKY 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 701.055 will be used on this project. /t-llclr-1-eL //, Jf.~~ ::~IlA~/(,. /&-e FO~ IH r !l..~.)E Oi~l Y Sq. Ftg. riain Sq. Ftg. Access Sq. Ftg. Other DATE <;r~~k Flood Plain Type/Const. Bed rooms Stories Units Occy load Occy Group x Value Value Value x x TOTAl VAlUATION BUIlDING PERfllT Charges and Surcharges rOLf '5D Plan Ck. ConmlInd ________..:.___ 65%/Bldo PJ'r Fpp d (d Plan Ck. Res .." .." 30%/BI dp Per Fee Isyste.ms Development Charpe (1.5~) , PlU11BING PERMIT Fence Charges and ------------ Surcharges D.eRlO ElECTRICAl PERIHT 'Sidewalk Charges and ------------ Surcharges A/C Pavi ng I I !Total Comb. Permit MECHANICAl PERMIT Charges and Surcharges Curb Cut I I TOTAl /t%. 0 ~ . f'- , I . . COMBINATION APPLICATION/PERMIT (CAP) , ' . . PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description I. example- Tax Lot tOO, Lane County Map Reference II U3 43 2. example- Lot t. Block 3, 2nd Addition to Springfield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- 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. example - construct single family house with an attached gara.ge 2. examEle - remodel existing garage into family room 3. examOle - 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 b~ 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. Gra If( q? 'J -jfJ to~o'- V. FOR OFFICE USE ONLY Permit Clerk Ct- 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 , , .