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Home My WebLink AboutPermit Building 1980-6-26 Range ValuE. of I-Jork: 12OC).~ Owne~ ~ \\\:0 f'U\iQ C\ . ~l\,(,,(\ () T \\\-Cl\?~ ~ n(,\\\)('rl. iJ ~l e~ , Address lo' ,0 '\\ \ ~r ;-f\~~_~ -,-^O .. Phone?' BUi!'t,:,inq P~rmit Info: Describe Hork(i'.e., , -\ LAl. or\U.JLlll)llAU.. Famlly f(esldence \vlth Attached Garaqe) , b ~ ri 1 Y\(\.t, ~ ~ .d.o__ " \\) ~ ~ N) f) ! Constructi on Lender ~ \) l, IllsPEcTIml LINE l726-3769 'c'rTY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT ENERGY SOURCES: Heat \'Ja ter Hea ter ; Job Address \.. O~ LU . ('(H"\tO f\ f\\aO -' , Legal Description 'INFORf1ATrON L i NI: 726-3753 Sq. Ftg. r.1a i n ~q. F'tg. Access. Sq. Ftg. Other New Add Alter Rep. --Fence Demo Change/Use --Other -- -- ~~ ~~8 ," t :.J ,.......~' ~ Build Single i D Dl 0 n-t; * L1< I, S1 ~nqf t 11)CLOO .. ^~~ I ITempOrary Construction I [Change in existing I residence I mult ifamil y, comm. or I Industrial / Of amps,/ , I cor~r'1. / I ND. FEEDERS I I IInstall/alter/relocate I I distrib. feeders 10f amps.1 I I I, I I I I I I I I 'I ISSUANCE OF PFRnIT , TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES \4HERE STATE L'\v REQUIRES that tile Electrical work be done by an Electrical Contractor, the electrical rortionof this permit shall not be valiJ until the label has been signed by an Electrical Surervisor and returned to the Building Division Address : DES I GN TI:At'1 Phone (address) (name) (l i cs, no,) . Primary Structural : Electrical , r~echani ca 1, ; CONTRACTORS (name) 1\\("'I\l:lX, ~510S. ~l~ (address) G?O. ~~ NC1oC) (lies. no.) fQ 11 Cbo . Genera 1 : Plumbinq i Electrical : ~1echani ca 1 PLUf1BING ELECTRICAL NO, NO. I Residence of I FFF FEE CHARGE rHAR(;F NO. Each single fixture SQ. FT. Relocated building (new fix. additional) New circuits'alts. or extensions S.F. Residence (l bath) Duplex (1 bath) each I I I I I ISERVICES I Additional bath IHater I Sewer servi ce Storm Sewer .teL() 0 , (expires) (phone no,) I ..,,' -f l I 1 i 1 ~ J (exoires) Johone no, ) 342-, ~ I (llo~ l I MECHANICAL I FFF , I rfjAR(;~ f . I I J ~ l , furnace/burner to BTU's Floor furnace and vent I Recessed wall SDace heater and vent Apoliance vent seoarate Stationary evap, cooler I Vent fan wi th sinale duct /vent system apart from I heatinq or A,C. I Mechanical .exhaust hood and duct I \'Jood stove/heater I I HAVE CAREFULLY EXNlINED the completed aprl ication 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 basis for exemption is noted hereon, and that ooly 'ob,oot",to,' '"d~'mrlOY"'WhO ""0 ,om,li,o" with ors 701.055 wi b, ""d '" thi',:~t. . "AME(pl"" Pclot);(: t:...h 4..40,'> ,~ / / SICIl""RE, ' /' %/l/I(,kLl!!pD>TE lo.f:I(o-/(l FO~ OFFICE USE o~L i... ............ ' t Zone Fire Zone Flood Plain TYDe/Const. Bedrooms Stories Units Occy Load Occy Group So, Ftg. /1ai n Sq. Ftg. Access Sq. Ftg. Other BUILDING PER~1IT Charges and Su rcha rges Plan Ck. 65%/Blda Plan Ck. 30%/Bldq ____________, Fence I Demo ISidewal k I A/C Paving I Curb Cut ---,--------,---1 I , , I I' ~~~-~.6 c 1&00 Comm!Ind Per Fee Res Per Fee PLU~~BING PERMIT Cha rges and SurCharges ELECTR I C,ll,L PERt~IT Cha rges and Surcharges MECHANICAL PERMIT Cha rges and Surcharges x Value Value Value x x TOTAL VALUATION Systems Development Charqe (1.57,) , Total Comb, rermit 1-0 .' II TAL 'L1 CO IG/- ~ t';1 "~_I,':L...,I~...., II~ . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Descrip,tion 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 ceilinq/or forced air qas 2. example- waterheater/electricalior 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. Abbreviated Plumbing, Mechanical, & Electrical Schedules A. Except where blank spaces occur in the desc\iption portion of the Mechanical and Electrical Schedules, the a~plicant need fill-in only the No. Box~s adjacent to the appropriate item(s) to be installed ' B. Full Plumbing, Mechanicalj 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 ~overed 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 note,d 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. 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 type written 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. ~ ~ , ~:.: ~:. ~~: F. J .; ~ II ~ ;j ! ." J ~ i .~ . ~ ~ ~ ~ ~ 'J j .. ~ ~ i ~. - " - V. FOR OFFICE USE ONLY Permit Cl erk PROJECT CO~DITIONS TO BE SATISFIED BEFORE OCCUPANCY: j j 1 ~ ~ Permit applicant exempt from registration witA the Builder's Board because: i ~ ~ ~ 1 ~ ~ ~ j a . ~ Additional Project Information: ) ~ .' PLANS REVIEWED BY: name signature date CITY OF SPRINGFIELD INFORr1ATION UN!:. I, , Cm1BHIATION AP~~),CATION/PERMI1 726-3753 ErJERGY SOURCES: Sq. Ftg. t'!a i n Heat :q. Ftg. Access. \'Ja ter Hea ter Sq. Ftg. Other , .'I:,fY'V Ne\~ Add Al ter Rep. e><l Ran~e 0 - " Fence~Demo~Change/Use \, ' , , ValuE of !'/ork:{2.CQ,C6 Other ' '1,--..., OYJlie~ ~y\\\t. \\ \\\(1(\ ,K~-\",'\ (i r= \\\::'\11( ~ ~ n ('\\9i f: ,~~,J.,::::'~ l"~ . - m Address to \ q -l ~\-.-Co n~D:.~5~-1.i(l () Phon~? ' ~~~ii:~n~e~{d~~~e IQf~h A~i~~h~~e G~~~~~ i.e., Bui 1 d Si ngle I:J :~" ~pn\X\(,~~ ~ rt.; I (\)\\ iJ1~dJ Onl OJI -h *''(1 i. 'SJ'n~' -Duro, r' ,', " Constructlon Lender , , ' l t iCLO 0 ^ \OCU- Address Phone DESIGN TEAM (name) (address) IrISPEcTION LINE 726~3769 C'c. \'\\0 f\ n \GG L0 ,Legal Descriptipn " ,-y;..~ Primary, S true tura 1 Electrical 't1echani cal. CONTRACTORS (name) , General, -'lY\(\,.\L:n ~ ilOS.;::\i41)) U ' , Plumbina (addres s ) Qo~~X. aC(DQ Electrical : ~iechanical PLUf1B I NG ELEGTRICAL NO. I FEE I CHARGE Each single fixture Relocated building (new fix. additional) IS,F, Residence (1 bath) I Duplex (1 bath) each IAdditional bath I I~!ater service I I Sewer I /Storm Sewer I I I I I I I I I I I I I I I 1 I I NO '''~ (1 ics. no,) (exnires) (Dhone no, ) (1 ics, no,) f(jil(~. , () .!:~.~; I I I I I I I I I' I I I .1 TOTAL (exoi.res) (OhC]ne no ) ,342,~ I fltp1 I I I MECHANICAL FFF nIARGF~ SQ. FT, FFF rHARG~ NO. furnace/burner to BTU's Floor furnace and vent I Reces sed wa 11 Soace heat.er and I I Apol iance vent seoarate Stationary evap, cooler Vent fan with sinale duct I Vent system apart from I heating or A.C. I MeChanical exhaust hood and duct . I Hood, stove/heater I I I vent. I I I I I 'I I I I 1 I I I TOTAL CHARGES TOTAL CHARGES I TOTAL CHA~GES WHERE STATE L'~~ REQUIRES that the Electrical work "be done by an Electrical Contractor, the electrica-' portion "of this permit f' shall not be valiJuntil the label has been signed by an Electrical Supervisor and returned to the Building Division ,R~s'i dence of New circuits alts. or ex,iens i'dris';'" ;;"~.,,~;,i,} ISERVICES I ITemporar.y Construction IChange in existing residence Imultifamily,'comm, or Industrial 10f ICOMM./IND. FEEDERS IIn~tall/alter/rel~cate distrib. feeders 10f amp's.1 I amps, I SSUANCE OF PFRnIT I HAVE CAREFULLY EXNlINED the completed aprl ication for permit, and do hereby certify that all information hereon is true' :and correct, and I further certify that any and all work oerformedshall be done in accordance ylith the Ordinances of the City of Soringfield 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 ylith the Builder's Board is in full force and effect as ,required by ORS 701.055, that if exempt basis for exemotion is noted hereon, and that only subcontractors and emfJ10,Y'" who '" io como"oo" with OR5 '701.055 wi b'"':f 00 thi~//1,O,. ct.,' , rW1f(plm, P'iot)~A" .0?,I1 510IlAT"", , ~:li#OATE(O'Aln-!tl - . - FOr OFFICE ~ Zone Fire Zone Flood Plain Ty[)e/Const. Bedrooms, Stories Units Occy Load Occy Group Sri, Ftg. ~1a in, Sq. Ftg. Access Sq, Ftg, Other. ~ ..\-.~.." ,BUILDING PER~1IT Cha rges and Surcharges ~~ IPlanCk, ~-{,~'" ,65%!Blda - ~- - ~{fPd- ~I ;6~~B~~~ ____________1 Fence , Dt;lmo S i dewa 1 k ' Comm/Ind Per Fee ,Res Per Fee I I I I I I I PLUr1BING PERr~IT Charges and Surcharges ELECTRICAL PERr~IT , Cha rges and Surcharges A/C Paving I Curb Cut ---,- -- -7' - -,---/ MECHANICAL PERMIT Charges and Sure ha rges x x Value' Value Value x TOTAL VALUATIml ISystems Development Cha rqe (1. 5%) Total Comb, rermit '[, 00 / U/- ~ .; i' l' ' :r I III. '.::- 'Cor~BINATION APPLICATioN/PER~1IT (CAP) II. Applicant to fu~riish A. Job Address B"legal Description L.:. 'examp 1 e'-,',Tiix' Lot 100, Lane ,County Map Refer' -1703 43 ' 2. examole- LotI. Block 3, 2nd Addition to Springfietd Estates C. Name, etc.' of owner and construction lender D. Energy'Sources ' 1. " example- heat/electrical cei 1 inq/or forced 2. example- waterheater/electricalJor solar 'E, Square footage or valuation, etc, 1. examole- 1250 sq. foot house, 500 sq. foot, f'J, n" 2. example- if newproj'ect, check-new - if add' ~n check add, ',etc. F. Building permit information: 1. example,- coristructsingle family house witl ,(" attache~.g~rage , . 2. example - remodel existing garage'lnto fami' 3.' example ~ convert single family residencei, restaurant (change of use) , G. Valu'e of work as defined in Section 303 (a) of 1 (, Structural, Specialty Code H. DES I GN TENl AND CONTRACTORS To avoid design or construction delays, Buildin~ Div,ision Staff must be able to'contact appropri, ( persons regarding design information~r job site corrections, etc. Abbreviated Plumbing, Mechanical, & Electrical Schec A. Except \'Ihere blank spaces occur in the descripti' ( portion of the Mechanical ~nd Electrical, Schedul the applicant need fill-in only the No. Boxes ac to the appropriate item(s) to be installed / 'B. Full Pl~mbing, Mechanical. and Electrical SchedL ( are available at the Building Divisiori 1. To conserve space on the permit form the set; have been, abbreviated ' 2. If the item(s) to be installed are not cover 0n the abbreviated schedules you should consult full schedules , C. BUI(DING 01VISION STAFF WILL FILL OUT ALL FEES A 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 u a worksheet only. Where possible, Building Division will prepare a type written copy and return it to th ( applicant at the time the actual permit is issued fo, signature. Fees and Charges Plancheck fees are due and payable at the time of tl C application,and no plans \~ill be processed until thl ' fees are paid. ' All other fees and charges are due al~ payable \'Ihen the permiti si ssued. ( l PERMIT VALIDATION J I -I i .... be delivered by his elect is not autho IV. V. FOR OFFICE USE ONLY ~CITY'Of SPRINGfiELD '.. City Hcill Springfield, Oregon Department of Public Works OFFICIAL RECEIPT (" Date Address, Received For: ( f B"r""l/"'lf'\6' .., ..... ~.~ ,.,hJ 1.J ~) f .- .. ( .- J\'\('.~\ /'C\ L_hv! \ \ P .OC) ( t 'No. '\ - \ 19?[) \"'/\1"\1. '. ~\\ ~ D--s\ \C""\C' Rec'd From ~ \ \\\ ;\:.\ \ \ ,,) \,-.:) \....\.. ; _,') V ('). ~~ '2/~~~ \.J:._l,lL\: . .0 ( ( leV. () (j dLm ) 0'L- ( Amount Received BY (I PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAN~Y: ( AUTHORIZED SIGNATURE !58Sll-6 ( \ SHELTON-TURNBULl.. PRINTERS - EUGENE. OR 97401 ( l Permit Clerk Permit applicant exemp't from registration with the Builder1s Board because: I Additional Project Information: PLANS REVI,EWED BY: name signature ..111 ,.J ...1,..............11 -,~ ~ ..~..,.l ,11Il.li" .~ILIII.!I".....11I1 oiil.li"iI. ..0ll..ll~1, , ~ ' date I. ...111.11...1iI1t........t. li...:I.....I. 111..1. ..,loJ ,Ilio... ".IOIIIEI. .111 11.1.01 II .. . ... II iillllllllll...JI