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Home My WebLink AboutPermit Building 1990-8-21 , ... --- I INSPECTION LINE , 726-3769 Job Address 7D4 ASF>f.N S-PRIN6~~L....'b Q7'177 Legal Description NAifV/T'I O~ TttEMO~d={bt. tJ. K:J:y:jU";/ ANC!.ATHo LIC Ct+l.,.{1(ct+ SAML CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT ENERGY SOURCES: Heat ('later Heater Range \~ -''-~ I - I \\). ~ ~ 0) . INFORllATION. UN!: . 726-3753 Sq. Ftg. '.la i n ~q. !"tg. Access. Sq. Ftg. Other New Add Alter Rep. --Fence Demo Change/Use --Other -- -- . Owner' (?~t:)3" 3~~ 2"';;J e?1? '7 e:>-e:> '" Phone 7")'.7.)1j ValuE of l'lork: '" ~ Y,515. (Ju , Buildina Permit Info: Describe Work(i_e., Family Residence With Attached Garaael Build Single Address ~~/'f D f(~A/~/C:Z Construction Lender f\DbrTfoN 0/= /-5 PARK/AJ6 SPAGE.S TO A~Jf\t..:r fWRKING L-t5T I Address Phone DESIGN TEAr~ (name) (addressl 'primary W.e4~U;~-~# ~~) . Structura 1 l1ics.nQ)' Electrical Mechanical CONTRACTORS (namel (address) (1 i cs. no.) General MGRS~ BRO~ Plumbina Electrical ~lechani ca 1 PLUr1BING ELECTRICAL NO. I , FEE I CHARGE NO. FFF rHARr,F NO. Each single .fixture Residence of SQ. FT. Relocated building (new fix. additional) New circuits alts. or extensions S.F. Residence (1 bath I I Duplex (1 bath) IAd~itional bath IHat~r service I Sewer IStorm Sewer I I I I I I SERVICES (r,xoires) (ohone.no. I (exoi rp.s) (Qhone no. I MECHANICAL furnace/burner to BTlI's FFF rHAPr,F I Floor furnace and vent Recessed wall Snace heater and vpnt each ITempOrary Construction IChange in existing residence Imultifamily, comm. or Industrial 10f amps~ ICOMM./IND. FEEDERS I IInstall/alter/relocate I distrib. feeders 10f amp~1 I I I I I I I TOTAL CHARGES I TOTAL CHARGES . WHERE STATE L'\W REQUIRES that the Electrical work be done by an shall not be valid until the label has been signed by an Electrical I I I I I I I I I I I SSUANCf OF PF.Rr1I T I TOTAL CHARGES Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Division I. App 1 i ance vent seoarate I Stationary evap. cooler I Vent fan wi th sinale duct I Vent system apart from I heating or A.C. I Mechan i ca 1 exhaust hood and duct I ~Iood stove/heater I I I / ..r I HAVE CAREFULLY EXA~IINED 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 oertaining to the work described herein, and that NO OCCUPANCY 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 comoliance with ORS 701.055 will be used on this project. .4~~ 1/ ~ c:. DATE8/.:J.(/~l?5 rW.1E(please pri~ ""R/Gl-tAR'D' . J4.NOIAJ(c:z:.-. SIGNATURE ~ zon~~-1/Cu.;z:. TYOe/Const~V/~nits Fire Zone Bedrooms Occy Load Flood Plain' Stories Occy Group FOR OFFICE USE ONLY So. Ftg. 11ain Sq. FtlJ. Access Sq. Ftg. Other_~V/~ Value Value Value StS-75: TOTAL VALUATION x x ~ x BUILDING PER~1IT Plan Ck. Comm/lnd 32 . $"3 IShstems Development 618.63 Charges anc ------------ 65%/Blda Per Fee C arqe (1.5%) Surcharges Plan Ck. Res I 30X/Bldq Per Fee PLU/~BING PERMIT I Fence I Cha rges and ------------ Surcharges I D6R1O' I ELECTRICJl,L PERrm I S i dewa 1 k I Charges and ------------ IA/C Pavi ng', . I Total Surchi! rg'es' 5~. 5'"0 Comb. Permit ' 5"t'. ~a 11ECHANICAL PERMIT I Curb Cut Charges and ------------ I 5/. 96 Surcharges I TOTAL ".-.- .~. .. .,...... COMBINATION APPLICATION/PERMIT (CAP) , \ PERMIT VAL! D~TION' . ~ III. I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane Cou~ty Map Reference e 17 03 43 2. example- Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name, etc., of owner and construction lender ., D. ' Energy Sources" I \. , '1. example- heat/electrical ceilingjo~. forced air qas 2. example- waterheater/electrical/or solar E. Square footage or valuation, etc. 1. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, checknew - if addi,tion, check add, etc. F. Building permit information: 1. example - construct single family house with an attached garage 2. example - 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. - 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. . \ .' ~ \ . 8\ \C\L{O 0\O~ \ }~ gcf1l IV. V. FOR OFFICE USE ONLY Permit Clerk d{[)~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from'reg'i~tration with the Builder's B'oard because: .... .'0 ... :~. . .. \. . ~'t \. ". '." . ~ : ~ ~ J. . Additional Project Information: .- -:. PLANS REVIEWED BY: . .,~ name L...e>.R/YE ;zt~G?f' :s!.gn~ture ~~date 7-1'- 9,0.