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Home My WebLink AboutPermit Building 1980-9-15 I INSPECTION L1I1E 726-3769 Job Address 2-1~ '191 Legal Description ~ CITY UF SPRINGFIElD CariB! riA T! ON APPLI CAT! ON/PERMIT "k'Cl tl)~ S()L1 ~~~~GYr)W)RI~ .,. , ('later Heat'fr Range . INFORIIAT!ON LINt 726-3753 Sq. Ftg. 1.lo;n ~q. Ftg. Access. Sq. Ftg. Other flew Add Alter Pep. -Fence Demo Change/Use -Other- - 0(\ 8 VO IU~ I Address ,<C.., ~ 1) Phone VOldJ90k.:C)o Builo;nQ Permit Info: Describe Work{i~e.. Build Single Family nesidence With Attached Garaqe) 1)11 o ()f7t.V\ 11 )mO~J2 I (' ,~f) dt -==<;~ ) I Owner LoIS Bre.n t- ,tlfr)- 143-:<., Construction lender Address DeSIGN TEAll (name 1 Phone (address) nics. no.) (expires) (ohane no.') Primary Structural Electrical 11echan; ca 1 CONTRACTORS Inamel Genera 1 f"\ I .l YY1 QY<:' (address i SntLO~ (l ice;. no.) (pl(l);rec;) (ohnnp no. , Plumb;nq Electrical ~fechan; ca 1 PlUllBlIlG ElECTRICAl MECHAN I CAl NO. Each single fixture FEE r.HARr;F Nn I=~~ rf.jARr,~ NO Residence of furnace/burner to SQ. FT. BTU's ~~~ I nh\Or.~ I Relocated building (new fix. additional) INew circu!ts a.lts. or extenslons.. _ . I SERVICES I Floor furnace and vent S.F. Residence (l bath) Duplex (1 bath) each Recessed wall SDa~e heatpr and vpnt Additional bath I ~Ja ter servi ce I Sewer IStorm Sewer ITempOrary Construction Change in existing rpc;.,i d.p"nr:e multifamily, Camm. or lndus.trial r Of amps. I C0I11'1. /I NO. FEEDERS I Install/alter/relocate dic:.trih. fppdprc:. I Of amp~l Appliance vent seoaratp Stationary evap. cooler Vent fan wi th sinale duct I Vent system apart from I' heatina or A.C. I Mechanical exhaust hood and dud. I \'lood stove/heater I I I ISSUANCF OF PFR'HT TOTAl CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L'I~ REQUIRES that tile 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 I HAVE CAREFUllY EXN1INED 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 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 ORS 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. IWIE(please print) ~,A);,<c::.. K('~",+ SIGIIATURE r:I~ ,- FO~ OFFICE USE OIIL Y Zone Type/Canst. Units Sq. Ftg. Hain Fire Zone Bedrooms Occy load Sq. Ft9. Access Flood Pla"in Stari es Occy Group Sq. Ftg. Other G~ 0_.-1 DATE 9-i.5"- go x x Value Value Value x TOTAl VALUATION BUILDING PERflIT Charges and Surcharges . Plan Ck. Co"",/lnd ____________ 65%/Bldo Ppr I=pe Plan Ck. Res 30%/Bldo Per Fee Fence Systems Development CharQe (1. 5%) PlUt1BING PERMIT Charges and Surcharges Demo ElECTRICAl PERI~IT Cha rges and SurCharges I Sidewalk I AIC Paving n IB~~g___1 Curb Cut Total Comb. Permit I TOTAl @.0C?... rlECHANICAl PERMIT Charges and Surcharges . ~~~ . -. COMBINATION APPLICATION/PERMIT (CAP) "'- , PERMIT VALIDATION II. I. Applicant to furnish A. Job Address B. Legal Description A 1. example- Tax Lot 100, lane County Map Reference '17 03 43 2. examole- Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and.construction lender D. Energy Sources 1. examole- heat/electrical ceilinqlor forced air Qas 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project. check-new - if addition, cheel add, ete. F. Building permit information: 1. example - construct single family house with an attached garage 2. examole - 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 TEAN AlID 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. 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 electrical contractor for signature supervisor. The general contractor to sign the electrical label. 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. 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. be delivered to the by his electrical is not authorized I I I. IV. V. FOR OFFICE USE ON,Y Permit Clerk .. PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: 1 ~ Additional Project Information: . PLANS REVIEWED BY: name signature date \.