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Home My WebLink AboutPermit Building 1984-3-16 II HISPECTIOtl LItlE '1726- 37 69 . . <...., ,-' Job Address I~" (\ ~ .A fLU .,(\.~;<.r-:: Legal Description I J- 0 3 _ 3 p - Y CITY Uf SPRINGFIELD COMBINATION APPLICATION/PERMIT ErlERGY SOURCES: / Heat. . i'later Heater ^! A_- Ranqe INFORI1ATION UNt 726-3753 Sq. Ftq. I.lain ~q. Ftg. Acces.s. Sq, Ftg. Other Ilew Add Alter Rep. --Fence Demo Change/Use Other- - 00 ~ IV 18 ()(o ~ 00 Construction lender , ValUE of Hark; rd'1 t;,<D(Q, Phone72b"J76 ~ ~~~~1~n~e~1~~~eIQfth A~~:~h~~eG~~~~~l.e., Build Single [SU/<-"'. A L"t-FnA"r-/ "AI .-/.PD J;v.-.n .z;q_~2:> &C-/A Owner \lAl-1'" lQ;=?:-"'/I?; Address_\:t~ MA /JJ Sr. ;;p~ ,.J6r:-t';LI? IJI! Address Ut::dliN TEAr., Primary (namel ~""LC Phone (addres~ ) flies. no.) (exo;res) {ahone no.'} Structura 1 'Y / / Electrical Mechanical CONTRACTORS (namel General \ ~ ,''" J h I ....., IN. (address) PA rN~ ?-I./ /<:; C,RIQAI Do (1ic~. no.) (pxo;rp<;) /<;(2'''- 0'7/;.;'-I (ohnnp nn_) .., l/ {,-Y 9 ') j- , Plumbino Electrical ~'echanical PLUI1BIrlG ELECTRICAL MECHANICAL Nn. FEE r:HARr.F NO ~~~ rHARr.~ NO. ~H. rI-lARr.~ Each single fixture. Residence of SQ, FT. furnace/burner to STUts Relocated building (new fix. additional) S.F. Residence (1 bath) Duplex (1 bath) each Additional bath \ ,~\ ~\) t New circuits alts. or extensions I SERVICES ,I J,. 'IV/ . . Temporary construction Change in exis ing r...~.;d€'nr_r: . multifamily, corran. or Induc;tr;ill Of amps. ICO~1./IND. FEEDERS IInstall/alter/relocate rli~tr;h. fppd...r~ IOf amp~1 Floor furnace and vent Storm Sewer Recessed wall ~nilCP heiltpr il~rl v...~~ Y/.l I Appl iance vent - ~eDa ril tp I Stationary evc1'p. I cooler I Vent fan with I sinale duct Vent system apart from I hea t i no or A. C. Mechanical exhaust hood and dud. I ~Jood stove/heater I ~Iater service Sewer ISSUANC, OF PFRIIlT TOTAL CHARGES TOTAL CMARGES WHERE STATE LW REQUIRES that the Electrical work be done by an Electrical shall not be valii until the label has been signed by an Electrical Supervisor I TOTAL CHARGES Contractor, the electrical portion of this perQit and returned to the Building Division I HAVE CAREFUllY EXN1HlEO the completed app 1 i cati on for permit. and do hereby certify tha tall i nforma t i on 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 fW OCCUPAf{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 exem t the basis for exemption is noted hereon. and that only subcontractors and employees who are in compliance with OP.S 7nl.05 will used on thi oJec. Zone Fi re Zone Flood Plain Type/Const. Bedrooms Stories Units Occy load Occy Group SIGIIATUR. FOr. OFFICE USE Oill Y Sq. Ftg. riain Sq. Fta. Access Sq. Ftg. Other DATE '3/;~ I , (JA).IE(please print~OrJA \..'f) W, PA R IL x Value Value Va I ue 1!!it::J(;>. TOT^L VALUATION 6C1 x x BUILDING PERMIT Charges and Surcharges , IA'> GO . Plan Ck. Corrrn/lnd ___J~J_____ 65%/Bldo PH Fpp Plan Ck. Res 30%/Bldq Per Fee I Fence Demo Afo F~. 'Systems Development Cha roe (I. 5~) . #.4 . '7~ PLU!1BING PERMIT Charges and Surchargi;!S ELECTRICP.L PERI~IT Charges and Surcharges .Sidewalk ------------ I A/C,Paving ____________1 Curb Cut I Total Comb. 'Permit 11ECHANICAL PERMIT Charges and Surcharges I I TDTAL ~a~' I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax lot 100. lane County Map Reference J/ oj 43 2. example- lot 1. Block 3. 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources . . 1. examele- hea"t/electrical ceil inqfor forced air a 2. example-" waterheater/electrlcal/or solar E. Square footage or valuation. etc. - ( 1, example- 1250 sq, foot house, 500 sq, foot garag 2. examyle- if new project. check new - if addition check add. etc. F. Building pennit information: 1. example - construct single family house with an attached garage 2. examyle - remodel existing garage into family rOI 3. examyle - 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. OESIGN TEM1 ANO CONTRACTORS To avoid design or construction delays. Building Division Staff must be ab1e 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 adjacen ( to the appropriate item(s) to be installed ;6'''-'' /'/0 B. Full Plumbing. Mechanical, and Electrical Schedules Amount Received __ _ _~, L_-____-_-___--_ are available at the Building Division --~~- 1. To conserve space on the permit form the schedule ( -~ - 4~' /--..,~ have been abbreviated ~ ~_ ~ 2. If the item(s) to be installed are not covered an ~. _ ~ ~~. the abbreviated schedules you should consult the r AUTHORIZEOSIGNATURE ~ t. full schedules r C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND I ~ iUUOOS..RII'tTUSILITHOORA..HI:RS.I:UOI:NI:.OlllI:OCN 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. . COMBINATION APPLICATION/PERMIT (CAP) II. 111. IV. V, FOR OFFICE USE ONLY ( ...gTY OF SPRINGFIELD_. . City Hall Springfield, Oregon Department of Public Worka OFFICIAL RECEIPT No. B 62608 ( - ( Dale M~. _/~. ,g ~ <I Rec'd From jZ?DN ?A?'f~ Address =;>~/~C~;~,-t?:P. - .,-~. ~ - ( ( Received For: ~,..-:;;!?_ ~ C/HC. 75.::;.;. -::>D ~<.. . )~ ~;;t::. x: C/-67CY" ( -a.P. r4~. /r'Sr f - 1t!).C>~ _ $"0 /C::::::> q 6 - ( ( ~. r Permit Clerk 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 LO;:"i'//d!FR~~ignature ,6~~-_~ _date r- .. ,.- ~ ~ -......_-=~ ~ /C- c:::. / . ~ DATE RECIEVEO 3-/~- 8~ JOB No. $7'C.<<>C. ZONE OCCUPANCY GROUP "'9-:<. UNITS OCCUPANCY LOAD STORIES TYPE CONST. ~N. LEGAL DESCR'PTION / ?-C>~-36'3" - 06 '<00 _AoORESS /7Z0 Ssa A: $7-h.=-<:-..... _'?\','NE~~<!3' z:.~~C~L_ THE CONTENTS H~RE OF HJ\V=: B~EN R::VtEWED. WITH ALT~RAT:CNS rNDICAT~D ItJ C:OLOR'::D PENCIL. CH^N'3ES OR ALTERATIONS MJ\D::: AFT-.:r~ DATO': BELew SHALL BE APPROVED BY THE GUILDl:>.!':; OFFICIJlo.L. CITY OF SPRiNGFiELD. OREGON ApPRovm GY~ ~;:~. 'lmJ-&:A--/ ~ '" ~ <- :\4 '1- '-.t.. W 4:: :t /'~- lL. Q III '" o . - .~ 0.. . 0 ~ c.... A.'V(,.\.E ~lil1>,L.e.. .c'.2.~ r..,' C."'I...r\it~~. . i~ ~~~~ , ~ ., H~ ~i\lD. ...... ... 3ro. P~"I, ~L~U,"O.c.""~..I._~_.' .~ ""1 ,.., d.... Mili; c.. c:. ~ . .~., _____:...... ......-:.. . '. -.-'. \;;,;,... .~......_-.-..~_: -.-..-:.:.-:.-.... , --~:~~::~~_:-:~: '.. ~~:-J;~~J&.:...~----- _d_ -- E..}~T\.oJc;.;:-:;. :- ,+::J !..n~_: -.. r-..-- "f" \<;A>.JT'" --.- f ' ~'\'" M?_P =_. _ i __ :a __ ::____ .. '^W d.- ---~ '__ I i .......f=+cL -~.. ~l.. ~.L-:-.. .!..; ~~'.-:j . ... ~.~ ;,.... -- In _. :- f'\:: I,. cQ ::_... ,:::_::::_:-'. ~ J-i- _ _..., 'u. , ---r'" ." _" ~ , - . -~", - - /' .1 ..~ . -- -', -./\ <( j..: r../) , Z,S' , .., , I , 4: o c4 r- -:r I- :> o v1. ......- i\ I -:% o "^ \ :J. S; r( ll;Lm__ I. - :- L__' 'Q . ~ ,~ -:Jr .-, ~_.. 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