HomeMy WebLinkAboutPermit Building 1980-2-11
NOT/FIEf'
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
I ENERGY, SOURCES:
Heat~S~
(-later Heater,~&.
'-1 INSPECTION LINE
, 726-3769
, Job Addr:e5s laJS' v.I., e.EAI1'~NNIH'-.
Legal Description
~1.. '!.1/U.& III (J~r/!N~JAL t!G..N7'PP
Owner 11/1-111' I3Ro~ t"',I!)A,/!;.T.
Address ~t:,3 ' 1M; ti.~rEHNL1J.L. 81..11P~
(!,,6NrcA/AI/nL C!ENrEe
Range
ValUE of Hork:
P'Ar.3 I 'ati
.~...::l
INFORr1ATION llNt
726-3753
Sq. Ftg. '.1a i n 2t.....a.-"
:q. Ftg, Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
--Other -- --
'cP
~
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T.V.
Buildinq Permit Info: Descrlbe Work(i.e" Build Single
Family Residence With Attached Garaqe)
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I ISSUANCE OF PFR~1IT
~4'J1 TOTAL CHARGES'
Electrical Contractor, the electrical portion of
Supervisor and returned to the Bu{lding Division
I HAVE CAREFULLY EXA~1INED 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 OCCUPAr~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 exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
rW.1E(please print) l)E)//vi S a- 1.-.0 t/j;;----K SIGiU\TUR~~ ~
FOR OFFICE USE Oi~n
I So. Ftg. r1ain ~OOO
/,& Sq. Ftg, Access
8-2. Sq. Ftg. Other
Phone7.v/_J~
Construction Lender
Address
DES I GN TEAr-1
(name)
Phone
(address)
Primary
, Structura 1
; Electrical
: r~echanical
; CONTRACTORS
(name)
(address)
General
: Pl umbi nq
: Electrical
:, ~1echani ca 1
PLurm I NG
ELECTRICAL
NO.1
, FEE 'CHARGE NO
~
Each single fixture
Residence of
SQ1 , O. OO~
SQ. FT.
Relocated building
(new fix, additional)
New circuits alts.
or extensions
IS.F. Residence
(1 bath)
IDuPlex (1 bath)
jAdditional bath
I ~Ja ter serv i ce
Sewer
each
ISERVICES
I
ITempOrary Construction
IChange in existing
residence
Imultifamily, comm. or
Industrial
/ 10f ~O
ICOMM,/IND: FEEDERS I
IInstall/alter/relocate I
distrib. feeders
10f amp~1
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TOTAL CHARGES /f).(}() I TOTAL CHARGES
, WHERE STATE L!\\~ REQUIRES that the Electrical \~ork be done by an,
shall not be valiJ until the label has been signed by an Electrical
Storm Sewer
amps.1
Zone C .. ~
Fi re Zone JIl
Flood Plain~.
Type/Const. 'Sl-J/
Bedrooms
Units
Occy Load
Occy Group
Stori es
I
BUILDING PERf-lIT
Charges and
Surcharges
Plan Ck. Comm/Ind
_______~_,,!..q;J_ 65%/Blda Ppr Fee
Plan Ck, Res
3,~" 30%/Bldq Per Fee
_ _ _ _ _ _ _/.I2.t:,:O I Fence
,q'O I D@mo
___----dS.()O /Sidewalk
I.po IA/C Paving
10,50 1 Curb Cut
- - - - - - - ~ 8'a -I
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PLur1BING PERMIT.
Cha rges and
Surcharges
ELECTRICJl,L PERrHT
Cha rges and
Surcharges
MECHANICAL PERMIT
Cha rges and
Surcharges
'5HlJP
(1 ics. no.)
(1 i cs. no,)
, FFF 'rHARGF] NO. I
(exoires)
(Dhone no,)
(exoires)
! ohane no, )
MECHANICAL
'I
/
1 FFF - r,HARhF
furnace/burner to
BTU's
Floor furnace
and vent
I Recessed wall
Soace heatpr and
I
vpnf
I App 1 i ance vent
seoa ra te
I' Stationary evap,
cooler
I. Vent fan with
sinale duct
I Vent system apa rt from I
heating or A.C.
I Mechanical exhaust
hood and duct
I t,jood stove/heater
I IlIel1T POMP
J I flu? #AAlbU2.
11"0, ID,et/%) C.FAA.
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t,.cr; ,
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~O ,.5'0 '
thi s permit
DA.;Et-II-~
x Tf. ("3
Val ue-'-Z..1fiO.OO
Value
x
x
Value
TOTAL VALUATION~ ;"6""().fX)
Systems Development
Charqe (1.5~) ,
';J.S'S.15
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sf' 'I~3, t3
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ITotal Comb, rermit
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COMBINATION APPLICATION/PERMIT (CAP)
I.
PERMIT VALIDATION
II.
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 qas
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc,
I., 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
Structura 1 Spec i a lty 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.
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. Box~s adjacent
to the appropriateitem(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 schedul es
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 ONLY
Permit Cl erk
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-'J~ ~
c .
da te k2 9.. t"n
.1.;
. NOTIFIE,'
fiAI\3 r 'sa
1 INSPECTION LINE
, 726-3769
'~L "::,UU-~ HI alidrt=-..~#J,QL C'.t-~N](::P
Owner IIJ/1Tr f2:.R(}c.....' ('!:.:J~1!:!:.T
Address 0103 V'l t2E...vrE.VA/I,;.J.I.', 81th). Phone7-W_/~/.i
(!,6/f/r EAlA///:7!. C!.EAirc.e
Construction Lender'
Range
ValuE of \'/ork:
INFORrlATIONllNt ,
726-3753
Sq. FtC). r,1ain ~
:q. ~tg. 'Access.
Sq. Ftg. Other
New Add Alter Rep.
:-Fence "Demo Change/Use
-Other - -
cf
~
'6
, \
~
, r"-
~
Job Address
'nl~ vJ:
(I ENr;:!I..'/Ij3!.C'.~
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ErlERGY SOURCES:
He a t l:!!:/.;;; *'-
Hater H~her e1.E..'" .
. .~. ~ -
legal Description
Buildinq Permit Info: Describe Work(i,e., Build Single
Family nesidence With Attached Garaqe)
T,V, '?:,4DP
Address
, DES I GN TEN1
(name)
Phone
(address)
(lies. no.)
(exnires)
(Dhone no,)
Pri ma ry
Structural
, Electrical
t1echani ca J
. CONTRACTORS
(name)
(address)
(lies. no,)
(exDires)
lohone nn )
Genera 1
: Plumbinq,
Electrical
. '
"~1echani ca 1
PLUfm I NG
ELECTRICAL
MECHANICAL
NO.
FEE I CHARG~ NO
Ff'T. rHARr:;1" Nfl
H'F rHARr:;F'
S.CIJ I D. 0Ci
SQ. FT.
furnace/burner to
BTlI's
~
Each single fixture
Residence of
Relocated building
(new fix. additional)
New circui.ts alts.; '.':,~
or extensions
Floor fu rnace
and vent
IS. F. Res i'dence
(1 bath) ,
Duplex (1 bath) each
/SERVICES
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..
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TOTAL CHARGES 19. CO J TOTAL CHARGES
, WHERE STATE L'l.\1 REQUIRES that tile Electrical \'iork be done by an
shall not be valiJ until the label has been signed by an Electrical
COMM./IND. FEEDERS
amps.1
,
I
I
I
I
I I
I ,
I "'~a
A.AoA
,
I
I Reces sed wa 11
SDace heater and vent
I
I Appl iance vent
seDarate
I Stationary evap.
cooler,
I Vent 'fan with
sinole duct '
Vent system apart from
heatinq or A,C.
Mechanical exhaust
hood and duct
I t'/ood stove/heater
! I HE/7i PU,IAP
J I f1.n? ~h,Vlj/.~r;:p.
11"0. to/aco CFtlll.
I SSUANCF OF PFR~1IT
I
I t.,.CO: '
I L(,S-o
I
Storm Sewer
/TempOrary Construction
IChange in existing
residence
!multifamily, comm. or
Industrial
Of -AL)O
Additional bath
I Hater servi ce
Sewer
I
)
I Install/alter/relocate
distrib, feeders
10f amps./
I I
II
I
IO,ot:)
Electrical
Supe rvi sor
:lS.m c TOTAL CHARGES'
Contractor, the electrical portion of
and returned to the Building Division
f'"'IO,.SO"
thi s permit
I HAVE CAREFULLY EXAr1lNED the completed application for permit, and do here~v certify that all information hereon is true
and correct, and I further certify that any and all work Derformed 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 OCCUPAr~CY will be made
of any structure without the permission of the' Building Division. I further certify that my registration ~/ith 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 comDliance with ORS 701,055 will be used on this project.
NAr-1E(please print) /JEJ/ii/t S
a.- t.-() i/ b7C
~~ ,J;d~/
DA;Ej. -- II -~
USE
Zone (!~:.J.. Tyoe/Cons t. '17 - // Units So, Ftg, /1ai n 2.0<"0 x f{. (,,3 Value I 7.:J...,')(), 00
Fire Zone III Bedrooms Occy Load Sq, FtC]. Access x Value
Flood Plainl/.1. Stori es ! Occy Group L...t-~;J.. Sq. Ftg. Other x Value
TOTAL VALUATION ! 7. ;;. !:'-O, OD
.:15"&.15
I
I
BUILDING PERt'lIT
Charges anG
Surcharges
Plan Ck. Comm/Ind
_______~_~~_ 65%/Bldo Per Fee
Plan Ck, Res
3, ~!-o 30%/Bl do Per Fee
~^ ' . 10, 1':./"1 I Fenc~-
-------~~.~~-I D@m;-
---- ,,'..' , '.. ,.., -~- 'r
__-,_ _ _ 4S.pP-j Sidewalk
'/.tJO A/CPaving
_ ~ _ _ _ _.-R t2'~!L Curb Cut
J~;{ ,
Systems Development I
Charqe (1.5%)
PLU~1BING PERMIT
Charges and
SurCharges
r' ....---
ELECTRICAL PERMIT
Cha rges arid
Surcharges
t1ECHM(I CAL PERMIT
Charges and
Sure ha rges
ITO," 1 Comb. r"mit
,_~TOTAL " '
J tf.5':LJg/
</ '11)3, <J:3
'11.._.....__.
'0, I '. .. ,~
_...~":.-';w.'I;,....':7".....,..........
I I I.
~
_:;. " J.-;
I;:
COMBINATION APPLICATION/PERMIT (CAP)
'1.
. . .. . .
s pj~ IN G ~i~ E to
CI ry
OF
C'
II.
, Applicant to furnish
A. Job Address
B. Legal Description
1. examp 1 e:' Tax Lot 100, Lane County Map R' ',(' ",',
17 03 43
2. example- Lot 1. Block 3, 2nd Additiont
Springfield Estates
,C, Name, etc. of owner and construction lender -
D. Energy Sources ' (
1. example- heat/electric~l ceilinq/or fon
2. example- waterheater/electrical/or sOTai
E. Square footage or valuation, etc.
1. example. 1250 sq. foot house, 500 sq. fc (ga
2. example- if new project, check-new - if
check add, etc~
F., B'uilding permit information:
1. example - construct single family house
attached garage
2. examole - remodel existing garage into f
3. exampl~ - convert single family residenc
res taurant (change of use) , (
G. Value of work as defined in Section 303 (a) -
Structural Specialty Code
+H.DESIGN TEAr,! AND CONTRACTORS, y)
To avoid design or construction delays, Bun. if" 0 \~
Division Staff must be able to contact apprOI '1:, ,"', '\:
persons regarding design information or job ~
corrections, etc.
Abbrev;ated Plumbing, r1echanical, & Electrical Sc ~l
A. Except where blank spaces occur in the descri
portion of the Mechanical and Electrical SchE
the applicant need fill-in only the'No. Boxes
to the appropriate item(s) to be insta~led (
B. Full Plumbing, Mechanical, and Electrical Sch -
are available at the Building Division
1. To conserve space on the ~ermitform the
have been abbreviated C ~vr-\ ~
2. If the item(s) to be installed are not co e-Jt-/ ~
the abbreviated schedules'you should conSi
full schedul es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FW e
CHARGES ON THE SCHEDULES Amount
D. As noted on the CAP, the 1 abe Y;mus t
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
a worksheet only. Wher,e possible, Building DiViS,i ('L
will prepare a type written copy and return it to L
applicant at the time the actual permit is ,iss~ed +- '- _ _
signature. -
Fees and Cha rges
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 ~ue and,
payable when the permit is issued.'
!
, City Hall " '
Sp"ri.ngfield, ~regon 'f',
,Department of, :Public Works.
OFFICIAL RECEIPJ
No. 8 52737 ('
Dote7, -II 19<60 '
Rec'd FromHl'S.tt Cbn5+ . ,
Address~Jo3w. CXkfl+enDJH( 1-
-(
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€
Received For:
nP
4-01
' D
Q4-,OQ
3,3<0
ID.ob
,,4()
'~G_DD
~.Ob
1-0.J:8{)
_ '-61:.-
1-SQ.16
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\ ~lr.)G In,
4C>]D
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Received40:3 : '6 3 C f:-,
( t
be delivel
by his eii
is not aut
i'<'..
(lo ' ,,' .'
- 4-"- AUTHORIZED' SIGNATURE
SHELTON-TURNBUL.L PRINTERS' EUGENE. OR 9:7410\
(.
(L , BY
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58511-8
~i;~-;;~. _
IV.
.
~ .
V. FOR OFFICE USE 9NLY
:
~.
Permit Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Bciilder's Board because:
Additional Project Information:
.pLANS REVIEWED BY:
name
signature
:() -/if'. ""
Ai/.c~_ ,u/~,~.....
da te ' / - ,.?, 9- y(/")
~oIIi.!S'..Jt \ ". _I"'~,-=-:.l:'::':.i. .... ......_ ...._~. "'-~ - _'.............M"..
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