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Home My WebLink AboutPermit Building 1982-2-10 , Job Addr.u '/()~Lf . Pt1-ddL $~ ;<ITY .Of.~PRINGFIELD COMBINATION APPLICATION/PERMIT . INFORMATION LINE 7260.3753 INSPECTION LINE 726-3769 Legal Description ENERGY SOURCES, Ho"" Water Hoater Ran!:!e Value of Work: Sq. Ftg. Main Sq. Fig. Acceu. Sq. Ftg. Other _New_ _Add_Alter_Rep. _ _Fence_Demo_Change/Uill _Other Owo., El/; j<-~~. Add,... ' F1U,.IM.- (J ),'.1 J. . -~-Jv. Cnn'trudion Lender ( '.AI Phone Building Permit Info: Describe Work (i.e., B\Jild Single Family Residence With Attached Goro~ol ..-V~_.2; .~~:k.1/..w.... fJP1~.JJ_ -()---- "'<::\ --- ~ ~ Address Phone DESIGN TEAM (name) (address) (lics. no.) (expires) (phone no.) Primary ~tructural Electrical Mechanical General CONTRACTORS JL/3 (nome) (addren) (lies. no.) (I)yo,{ A1J;md;ti~ /k _ ~ f/.K (I J iLw..J>&1- /5r (expires) (phone no.l ~,n 4~'l7t/~ PlumbinA Electrical Mechanical PLUMBING ELECTRICAL MECHANICAL NO_ I FEE CHARGE NO. FEE CHARGE NO. FEE CHARGE Additional bath Amps. furnace/burner to ~TU's Appliance vent separate Stationary evap. caoler Vent fan with sinAle duct Vent system apart from heatin~ or A.C. Mechanical exhaust hood and duct Residence of Each sinale fixture Relocated building (new fix. additional) S.F. Residence 11 bath} Sq. ft. New circuits, alterations or extensions SERVICES Dualex (J bath) each Temporary Construction Water service Sewer Wood stove/heoter Storm Sewer FEEDERS Heat Pum., Air hondler to _ ..!.Q.OOO CFM Air handler over 10,000 CFM L /lJa.cJ i"~w' ~L- ? SO Amos. ISSUANCE OF PERMIT TOT AL CHARGES 1. S7J TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES that tho Elomical work be dOM by the Electrical Contrador, the oloctrical portion of this permit shall not bo valid until a label has been signed by an Electrical Contractor and attachod to tho olectrical panol. I HAVE CAREFUllY EXAMINED tho 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 tho Stat. of Or.gon pertaining to tho work described herin, and that NO OCCUPANCY will b. made of any structure without the permission of the Building Division. 1 further c:ertlfy thot my registration with the Builder's Boord is in full force and effect as required by OKS 701.055, that if exempt the basis for exemption is noted heron, and that only subcontractors and employees who ore in compliance with ORS 701.055 will be used on this project. Ba.;. fa' Bu;ld.,', ~;am ~J~ ... NAME (please print) ..I\, SIGNATURE --=r:.~ l\ ._&.^ L ~I\.""" DATE~ -ID.;r~. - , ( / FOR OFFICE USE ONLY ~ Ian" Type/Const. Units Sq. Ftg. Main . "olue Fire lone :!.odrooms r'tccy Load Sq. Fig. Access . Value Flood Plain ttori~. ::>ccy Group Sq. Ftg. Other , Value TOTAL VALUATION BUILDING PERMIT Charges and Surcharges plan Ck. Comm/lnd 65%1 Bldq Per Fee Pion Ck. Res 30%1 Bldp Per Fee Systems Development Char"o 11.5%1 PLUMBING PERMIT Charges and Surcharges 7..!>'V .AD Fonce Demo Total Comb. Permit ELECTRICAL PERMIT Charges and Surcharges Sidewalk AIC Povina MECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL .h 7 fo COMBINATION; APPLICATION/PER. (CAP) I. Applicant to furnish A. Job Address B. legal Description 1. example-tax lot 100, lane County Map Reference 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 1. example-heat/electrical ceiling/or forced air gas 2. example-water heater/electrical/or solar E. Square footage or valuation, etc. 1. example-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 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. AbbreviatedPlumbing, 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 abbrevi- ated schedules you should consult the full schedules C. BUILDING DIVISION STAFF Will Fill OUT All FEES AND CHARGES ON THE SCHEDULES I 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 typewritten 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 I'ROJECT CONDITIONS TO BE SATISFIED BEfORE OCCUI'ANCY: Additional Project Information: PLANS REVIEWED BY, nami"" eignatur.... 1 "'. . PERMIT VALIDATION Permit Cler~ ""at'"