HomeMy WebLinkAboutPermit Building 1980-3-20
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';t INSPECTION LINE
, 726- 37 69
Job Address & i 7 w E~ r
legal Description
~e ~ ~~Hl) /'VtI9-rT/ C/)
Owner ~'aY~ T~W/NG, .
Addressp~ 7fbJ/ 1039"2-
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
, EflERGY SOURCES:
~5;J IIf:}FJJI11/r.,..... Heat t!EL~Cr:
\1ater Heater
Range
Va 1 UE. of I'Jork:
W~?
INFORf1ATION UN!: a
726-3753
Sq. Ftg. r.la in
~q. Ftg. Access.
Sq. Ftg. Other /~
Ne\~ Add Alter Rep.
--Fence Demo Change/Use
~Other -- --
7Cf/-/'f<O
.~P'6n!! ~E~~
1!04~7Y ' s" CC::=Oh .
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Phone
Buildinq Permit Info: Descrjbe Work(i,e., Build Single
Familynesidence With Attached Garaqe)
Construction Lender
Address
DES I GN TEAf.1
(name)
Phone
(address)
(lies. no,)
(exoires)
(ohone no.)
Primary
Structural
- Electrical
I
; 11echani ca 1
CONTRACTORS
(name)
(address)
(lies, no,)
(exoires)
(Dhone no. )
General 1+ f A- r ~ e.o--b/ ~ r/t....- <!!,r-c--"../
,: Plumbi<~q-~ TU/ 11../ /1t;/ 4rJ2. ~
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: Electrical FJ.;'"jvt;J..=Lt /v'
" , ~1echani ca 1 An'r ,(., t.,,->r- >:- e-;r- -
PLU11BI NG
ELECTRICAL
MECHANICAL
I
FFF rHARGF t
" cao
NO. '
I FEE 'CHARGE NO,
I FFF rHARGF NO,
9:
Each single fixture
s~ 'f~
Residence of
SQ. FT.
I
furnace/burner to
< 1diC?...... BTlI' s
Relocated building
(new fix, additional)
New circuits alts.
or extensions
Floor furnace
and vent
S,F. Residence
(l bath)
Duplex (1 bath) each
IAdditional bath
Hater service
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I I I Recessed wall I
So~ce hpritpr rinrl vpnt
I I I - I
ITempOrary Construction I I I Appliance vent I
seoarate
IChange in existing I I I Stationary evap. I I
residence cooler
I multifamily, comm. or I I z. I Vent fan with 17_..../ /.oC
Industrial sinole duct ~_ t).
Of I I I Vent system apart from I I
amps, heating or A,C.
CDr1r'1.IIND. FEEDERS I I I Mechanical eXh, aust I
hood and duct
I IInstall/alter/relo,cate I I I I \'Jood stove/heater I
distrib. fpeders
HOf 15&> 'm"! ilS-l r :
I I I I I I I
I I I I I I ISSUANCE OF PFRrm /a ClrGo
r~.c J TOTAL CHARGES I J. . . I TOTAL CHARGES ~~. cJlC:D 3
that the Electrical work be done by an, Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
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ISERVICES
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Sewer
Storm Sewer
TOTAL CHARGES
, WHERE STATE L~W REQUIRES
shall not be valid until the
I HAVE CAREFULLY EXA11INED 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 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 with the Builder's
Board is in full force and effect as required by ORS 701.055, that i,f exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project,
SIGrJATun(1l~~~~ '
FOR OFFICE US~ '
DATE3 -2.0 -)'2='
NAr-lE(please print) peYjVt5 c;.. LP v ~/l
Zone ~-'2.. Tyoe/ConstJZr),V ~~ .Un its Sq. Ftc]. r1a in x Value
Fire Zone ..or Bedrooms O.ccy Load Sq, Ftc]. Access x Value
Flood Plain Stories / Occy Group ~-~ Sq, Ftg. Other /~ x9.~ Value 1"; .::t::::l. ...
TOTAL VALUATION
BUILDING PER~1IT .r~. -=> I Plan Ck. CommlInd I S~.~ Shstems Development I
Charges and 65%/Bldq Per Fee C arqe (1.5%) "
------------ Plan Ck, Res I
Surcharges <. ~ , 30%/Bl dq Per Fee I
PLU11BING PERMIT I ____!IS. -D I Fence I I I
Charges and
Surcharges /. 1tc. I D@mo I I ,
ELECTRICAL PERrHT ____-.Is. e-c I-Sidewal k I I I
Cha rges and
Surcharges ~~t::> I A/C Paving , I Tota.l 'Comb, Permit I /7'3. /6
MECHANICAL PERMIT :Z~ . c::s-o I Curb Cut I I TOTAL j '73./~ J
Charges and ------------ I
Surcharges .&8 I
L ..
.........
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examp 1 e- 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 n~w project, check-new - if addition,
check add, etc.
F. Building permit information:
1., example - construct single family house with an
attached garage '
2~ examDle '- remodel existing garage into f,amily room
3.examDle'- convert si,ngle family residence into
restaurant (change of use) ,
G. ~alu~ of work as defined in Sectiun 303 (a) bf the
Structura 1 Spec ia lty Code -i
~.~. DES I GN TEAr'l AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to ~ontact appr6priate
persons reqarding 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 Sch'edules,
the applicant need fill-in only the No. Box~s adjacent
to the appropriate item(s) to be installed ,
,B. Full Plumbing, Mechanical, and Electrical Schedules
are avai lable, at, the Bui lding 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 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 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.
V. FOR OFFICE USE ONLY
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Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
"
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Permit applicant exempt .from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name l..t::>ie,Nt!!!f ~~
co--
Signature~~~ date ?-;;a.:l-~
r'NFORllATION U NE '1
726-3753 '
Sq . F t g. r'la i n
~q. Ftg. Access.
Sq. Ftg. Other /~
New Add Alter Rep.
--Fence Demo Change/Use
--Other -- --
~.
roe /;/ Tlor p ;v I .4- L
';1- INSPECTION LINE
, 726-3769
Job Address tJ f ?
-:;AQr'~, ~ A.... ' (!! 1..:?/'J;-z;-71....
---- " CITY OF SPRINGFIELD .
C0/1BIilATION APPLICJl.l)ON/PERMIT
EtlERGY SOURCES:
Hea t c. Le L7"":
\'Iater Heater
IN l:::S r
('JEj-JiC';-'IJ,11- "--
Legal Description
Gy,-e ~ dCK~4R [) r-/~TT7 6tJ
Owner "'lyY~ /7;lw//Y 4,
AJJressp~ f.?b)l /0392-
G"-'G?C:I'.7G
Ran'le
ValUE: of Hork:
JV~P '1
Phone
Buildina Permlt Info: Descr~be Hork(i,e., Build Single
Family Residence With Attached Garaqe)
7!f/-/ V-:<O
Construction Lender
c:~""p t, is ~ " c4';S ~
I 13'.5-fu/-<y> Sf <''':>h
I
.:'SPA:. <C. ~r:- ~~
Address
DESIGr~ TEM!
Phone
(address)
(name)
(I i cs. no.)
(exnires)
Primary
Structural
Electrical
11echani ca 1
, CONTRACTORS
(name)
(address)
(1 i cs. no,)
lexoires)
, Genera 1
/-i- I N r r-- {:! (J-V/ C; I/{-- '" r(!l .;'J
T lA./ i /....) "'J. t ,/ t:..~2. ~
F,L"-jvC;j,-=-LII./
.( 1.77-
Plumbina
Electrical
~1echanical Nor
).: ~r -
(X)
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lohone no,)
lohone no. )
PLUI1BING ELECTR I CAL MECHANICAL
N(', I I FEE CHARGE NO_ FFE rHARGF ~IO . I FFF I rHARGF ~
Each single fixture ,..~ is-V: Residence of furnace/burner to / Q<i2>
<t;r~.., SQ. FT, , < /CO;,~ BTlI's
:;- ; 1;::-.
I ,
Relocated building New circuits alts. ), Floor furnace
(new fix. add it i ona I ) or extensions and vent
I I I
I I I
I I I Temporary Construction I
I I ,I Change in existing I
' residence '
I I Imultifalilily, comm. or I
Industrial
I I 10f amps, I
I I cor.1j'!./I ND. FEEDERS I
II ~~~;~~~:a~~:~~~~locate , I
I L;"/'" 1/,,-). ""01
I~~F-Iv~ 'm" ('- I
'I I II
I I I I I
TOTAL CHJl,RGES ~.s: 410 J TOTAL CHf,RGES I s:~, TOTAL CHARGES
WHERE STATE Ul1 REQUIRES that the Electrical vlork be done by an Electrical Contractor, the electrical rortion of
shall not be valij until the label has been signed by an Electrical Supervisor and returned to the Building Division
S.F. Residence
(I bath)
Duplex (1 bath)
IAdditional bath
each
ISERVICES
I
Recessed wall
SDace heatpr and vent
I
I
Iz.
I ApD 1 i ance vent
seoa ra te
I Stationary evap,
cooler
I Vent fan wi th
sinole duct
I Vent system apart from,
heatino or A.C.
I r1echan i eel I exhaus t
hood and duct
I ~'Jood s tove/hea ter
,
,
I
v!a ter serv ice
Sewer
IStorm Sewer
ISSUANCE' OF PFRtiIT
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this permit
I HAVE CAREFULLY EXA~1INED the completed aprlication 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 8uilding Division. I further certify that my registration ~lith the Builder's ,
80ard 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 \vho are in comoliance with ORS 701.055 will be used on this project.
NAr-1E(please print) /)E/'/,</I5 C- ~ v t.:5/t.
J--- ///
' SIGjj^TU4./l~/]a~&~
For OFFICE USE 0HfY
DATE 3 -20, -~
Zone r-<. Tyoe/Const~1V ~~~ .Uni ts So. Ftg, t1ain x Value
Fire Zone .zzr Bedrooms Occy Load Sq. Ft(J. Access x Value
IFlood Plain Stori es I Occy Group 25?-~ Other:- /C};>~ x9.P Value ,,-;'7 ~ .,.0.
Sq. Ftg. , .
TOTAL VALUATIml
BUILDING PERt'lIT
Charges and
Surcharges
PLU/1B ING PERMIT
Cha rges and
Surcha rges
\? ~ Plan Ck. Comm!Ind
_ _ _ -='_ _~ =- _ _ _ _ 65%/Bl do Per Fee
~,~ Plan Ck. Res
:<. ,.,..= ,30%/Bldo Per Fee
, !is.... 0 'Fence
- - - - -/ ~S-...;: -I D~mo
'-- -~r--.:>;;;- I"'~'~dew~;k
____.J.J_'-____
~ '0 A/C Paving
_____~~.::..~_~:_ Curb Cut --'l
.&'8 I
h_',,';::" ,'~:'::~~,~.,- . " - '~-,~
S '3. '!S"c:=>
ISystems Development
Charpe (1.5%) ,
I
ELECTRICt,L PERr~IT
Charges and
Surcharges
I,
ITotal
hTAL
Comb, Permit
/ 73: /6
MECHANICAL PERMIT
Charges and
Surcharges
, 7 '3Jb
, :1
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COMBINATION APPLICATION/PERMIT (CAP)
I.
II.
Applicant to furnisn
A. Job Address .
B. Legal Description
1. example- Tax Lot 100, Lane County Map Referen
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. examole" heat/electrical ceilinq/or forced a' r
2. examole- w~terheater/electrical/or solar
E. Square footage or valuation, etc,
1. examD 1 e- 1250 sq. foot house, 500 sq. foot g; 17,
2. example- if n~w project, check-new - if addi \
check add, etc.
F. Building permit information:
1. example - construct single family house with ('
attached garage
2~ examole - remodel existing garage into famil
3. examole - convert single family residence ir
restaurant (change of use) ,(
G, Value of work as defined in Section 303 (a) of j
Structural Specialty Code
"H. DESIGN TEN! AND CONTRACTORS
To avoid design or construction delays, Buildin, (
Division Staff must be able to contact appropri
persons regarding design information or job sit
corrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical Sche
A. Except where blank spaces occur in the descript
portion of the Mechanical and Electrical SchedL
the applicant need fill-in only the No. Boxes c
to the appropriate item(s) to be installed (
B. Full Plumbing, Mechanical, and Electrical Sche( \S
are available at the Building Division '
1. To conserve space on the permit form the Sl
have been abbreviated
2. If the item(s) to be installed are not cov
the abbreviated schedules you should consu
fu 11 schedu 1 es
C. BUILDIriG DIVISION STAFF WILL FILL OUT ALL FEES
CHARGES ON THE SCHEDULES (,
D. As noted on the CAP, the label must
electrical contractor for signature
suoervisor. The general contractor
to sign the electrical label.
Applicant to sign and date
Whenever possible, the initial application will bE
a I'lOrksheet only. Where possible, Building DiVis' C>i.
will prepare a type written copy and return it to
applicant at the time the actual permit is issued
signature.
Fees and Cha rges (
Plan check fees are due,and payable at the time 0
application, and no plans will be processed until
fees are paid. All other fees and charges are du
payable when the permit is issued.
be deliver
by his elE
is not au1
I I I.
IV.
V.
FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFO
Permit applicant exempt from registrat
Additional Project Information:
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Department of Public Works
OFFICIAL RECEIPT
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No. B 5 3 0 8 8
Date '3- L\ 19)<n (,
Rec'd From t11f\tt) (nn~v,
Address -P D ~ t () r3C; <:~
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Received For:
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Amount Received
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PLANS REVIEWED BY:
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SHELTON.TURNBULL PRINTERS - EUGENE. OR 97401
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