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Home My WebLink AboutPermit Plumbing 1981-6-23 INSPECTION LINE 726-3769 CITY OF SPRINGFIELD COMBINATION APPLICATION I PERMIT INFORMATION LINE 726-3753 Job Addrm '. I 3Lo l{} ( IQfl 1 fJ n n l()j' ~~SOURCES: ,/ ~:: :::: ::~nn. Legal Description / f) () ~~ c:s '6 ~ n /) ~~I ~::: He~ ~ /' ~~t:~ Oth:~d_Alter _Rep, V lue of Work ~ ___Fence_Dema_Change/ Use 0_.1:::i1l 1) n At- N{')iJ 1;/\) . / ~ "'" (_0".7) I Ql ( f\ fin n..L. () J/l 71 Building Permit Info: Describe W~I.-.(j,e., Build Single Addren ~) 0 () \J !,.J!. A 7J n . f .( V Phone Fomilv Residenr.. With Att<'lched Garaae) I ~Osltd, ,-J!}J_O . - - -.- 1)4(!) 1YJ/~ 'Jo~a fA} Construction! l)nder - (tiJD1CK ,C!Lt) / I l(lics. no.) ~ .c -. C\q l 1 'f> ^ ( ~JJ1v I)) Addren Phone DESIGN TEAM (namei . (addren) (expires) (phone no.) Primary Structural Electrical Mechcnical CONTRACTORS (nome) (address) (lies. no.) (expires) (phone no,) General Plumbinq ~ O~ j..(~U fY\.hlJI(} Electrical (] cU~)IJ1n&JJI(JLI11.J tR0U12 ./ 0' qx:') -Cl)~L '.'1. =-:" Mechanical PLUMBING ELECTRICAL MECHANICAL FEE jCHARGE NO. FEE 'CHARGE i I furnace/burner to ;\TU's 1 I Appliance vent I separate I Stationory evap. I cooler I Vent fon with I single duct I Vent system aport from I heating or A.C. I Mechanicol exhaust ! hood and duct Wood stove/heater I Heat Pumo I Air handler to I 10,000 CFM Air handler over I 10,000 CFM i NO. I FEE CHARGE NO. I Residence of Each single fixture Relocated building (new fix. additional) S.f. Residen~e (1 both) <q: ft. New circuits. alterations or extensions SERVICES Duolex (1 both) each Temporary Construction Additio"al balh Amps. Water iervice Sewer Stor,m Sewer FEEDERS Amps. , I r' I TOTAL CHARGES I . ISSUANCE OF ,PERMIT I TOTAL CHARGES TOTAL CHARGES WHERE SlATE LAW REQUIRES that the Electrical work be done by the E!ertrical Contractor, the electrical portion of this permit shall not be valid until a label has been signed by an Electrical Contractor and attached to the elecfrical panel. I HAVE CAREFULLY EXAMINEn Ihe completed application for permit, and do hereby certify that all information hereon is Irue and correct, and I further certify that any ond 011 work performed sholl 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 herin, and that NO OCCUPANCY will be made of any structure without the permission o( the Building Division. I furlher certify that my registration witll the Builder's Boord is in full force and effect 0 s required by ORS 701.055, that if ex~mpt 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. Basis for BUilder's~ ~xemPtion: ,,' NAME (pleose print) KWK LI\f\.se:N <;IGNATUR~ FOR OFFICE USE ONLY ~ DATE b-23-~1 Zon.. Fire Zone Flood Plain Type/ Const Bedrooms (tories 'Inits ,",ccy Load {'lecy Group "q. Ftg_ Main "q; Ftg, Access "q. Ftg. Other Value Valu,. Volue . TOTAL V ALUA TlON x x BUILDING PERMIT Charges and Surcharges Plan Ck. Comm/lnd 65~./ Bid" Per Fee Pia n Ck. Res 30%1 Blda Per Fee Sysrems Development Charae (1.5%1 PLUMBING PERMIT Charges and Surcharges /n.CXJ .4(j Fence Demo I Total Comb. Permit ELECTRICAL PERMIT Charges and Surchorges Sidewalk Ale Pavino I I TOTAL ID~ MECHANICAL PERMIT Charges and Surchorges Curb Cut ~ '....-.-....,~'.._...: ~ COMBINATION APPLICATION/PERMIT (CAP) I. Applica~ 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 gcis 2. exam ole-water heater, electrical/or solar E. Square footage or valuation, etc. 1. examole-1250 sq. foot house, 500 sq. foot garage 2. exampie-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., examole-remodel existing garagf. into family room 3. exampie.convert single famiiy residence into restaurant (change of use) G. Val,ue of work as defined in Section 303 (a) of the Structl,Jral Specialty Code H. DESIGN TEAM AND CONTRACTORS To avoid design or COllstruction delays, Building Division Staff must be able to contact appropriate persons regarding design inforlTlGtion or job site corrections, etc. I!. Abb~eviated Plumbing, Mechanical & Electrical Schedules A. Except where blank 'spaces occur in the description portion at the Mechanical and Electrical Schedules, the applicant need fjll-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 fujl schedules C. BUILDING DIVISION STAFF WilL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES Ill. 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 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: " Additional Pro[ect Information: PLANS REVIEWED BY: namE" "iignaturf" PERMIT V ALIDA liON :. Permit Clerk r -iate - \ ( iQ n 1 ~ n n j n~' ~:~SOURCES: / : ~:: :::: ::~... . - Water He~ /,,--- Sq. Ftg. Other Range ~./" _Ne..... _Add _Alter _Rep. I.value ,~,f)'Ioik: ~ _._Fence_Dema_Change! Use I /' (,-- Olne;"" / - ~ ,. ~ Building Permit Info: Describe W';ik-.(i.c., Build Single Fam.l~ Resident.. With Attached Garaqe) J O~CtfA, I (!(NYlQ,CJ"I)/ I '(Iics. no.) .. INSPECTION LINE 726-3769 " ;' 3LO CO Job Address legol Description CITY OF SPRINGFIELD COMBINA nON APPLICATION 1 PERMIT ownr;irL~_n A J- N{)i! (f\? Address I ~~l 0 ( () (j Lv n t~ (f r7 /0 ~ Phone ~sl2 _ 0, lliJi r? -' -. 1)4 (n "( ~/ '7 Con'tructio~ t)nder Addren DESIGN TEAM (nome; Primary S ~ructu'oJ Electricol I Mechonical I CONTRACTORS 1- General . Plumbi"q ~ O~ ,~~ t I mt\ qnG , 0 (nome) Electricol Mechonicol PLUMBING NO. I F'~ c_ CHARGE NO, Eacn ,ingl!!' fixture Relocared building (ne..... fix. additio"oll S.F. Residen~.. (1 bath) Dualex (1 bath) each Additional bo.h Water service Sewer Stor,m Sewer r. I TOTAL CHARGES INFORMATION liNE 7'26-37 S3 ~ .c Q~_\ 1 _'fl ^_ ( Q 1.'11 V 'Y Phone (address' (address) {Iics. no.) (expires) (phone no.) [expires) (phone no.) 01.~)1..b..nlfJ)(J/l1' p ~ (ntf7~ / / O. C:IGNATUR~k fOR OFFICE USE ONLY ~ elECTRICAL F=~ CHARGE I NO. I I I qx')" -()(~(') I MECHANICAL FEE CHARGE Residence o~ sq: ft. New cirCUits. alterations or extensions SERVICES Temporary Construction Amps. FEED ERS Amps. TOTAL CHARGES furnace/burner to "-TU's Appliance vent separate Stationary evap. cooJer Vent fan with single duct Vent system apart from heating or A.C. Mechanical exhaust hood and duct I Wood stovel heater I Heat Pump Air handler to 10,000 CFM Air handler aver 10,000 CFM ISSUANCE ClF~peRMIT TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be done by the E!enrical ContraCTol, the electrical portioll of this permit shall not be valid until a label has b..." signed by an Eleerrical Contractor and attached to the electrical panel. I HAVE CAREFUllY EXAMINED 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 Stat.. of Oregan pertaining ta th.. work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I further certify that my regiSfTation with the Builder's Board is in full farce and effect as required by ORS 701.055, that if exempt the basi. far exemption is noted heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will b.. used on this project. Basis for 8uilder's_~ ~xemPtion: NAME (please print) K~C-K Lp..})SEV\1 Zon~ Fire Zone Flood Plain Type! Can.t. Bedroom. "torie' BUilDING PERMIT Charge. and Surcharge. PLUMBING PERMIT Charge. and Surcnarges I I I I I ---------1 /(),OO 4(j elECTRICAL PERMIT Charge. and Surcharge. MECHANICAL PERMIT Charge. and Surcharge. Units "'ccy load <1ccy Group ~q. ftg. M"in Sq; Ftg. Access Sq. ftg. Other Plan Ck. Cammllnd 65~~I Blda Per Fe" Plan Ck. Re. 30%1 Bid" Per Fee fence Demo Side.....alk "I C Pavina Curb Cut DATE 10-13-21 .. Value Valut' Value x x TOTAL V ALUA nON Systems Development Charae 0.5%\ I Total Comb. Pormit I TOTAL D~ ~ .....:..-...,.'-'.~..............;. - COMBINATION APPLICATION/PERMIT (CAP) I. Applica~ to furnish A. Job Address B. legal Description 1. exomole-tax lot 100, lane County Map Reference 17 ( 2. examOle-Lot 1. Block 3, 2nd Addition to Springfield Estc C. Name, etc. of owner and construction lender D. Energy Sources 1. examole-heat/electrical ceiling/or forced air qas 2. exam ole-water heater: electric'al/or solar - E. Square footage or valuation, etc. 1. examole-1250 sq. foot house, 500 sq. foot garage 2. examoie-jf new project, check ~-if addition, check add. etc. F. Building permit information: 1. examolp.-construct single family house with an attached garage 2. examole.remodel existing garagE> into family room 3. example.convert single famiiy residence into restaurant (change of use) G. Value of work os defined in Section 303 (a) of the Structvral Specialty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction delays, Building Division Stoff must be able to contact appropriate persons ~egardin design inforlm,tion or job site corrections, etc. II. Abbrevioted Plumbing, Mp.chanical & Electrical Schedules A. Except where blcnk 'spaces occur in the description portion ot the Mechanical and Electrical Schedules, the applicant need fjll.in only the No. Boxes adjacent to the appropriate item(s) to be installed B. Full Plumbing, Me-chaniccl, and Electrical Schedules . are available at the Building Division . 1. To conserve space an the permit form the schedules have been abbreviated 2. If the item(s} to be installed are not covered on the cbbr ated schedules you should consult the fuil schedules C. BUilDING DIVISION STAFF WilL FILL OUT All FEES AND CHARGES ON THE SCHEDULES III. Applicant to sign and dote Whenever possible. the initial application will be used as a worksheet only. Where possible, Building Division Stoff will prepare a typewritten copy cnd return it to the applicant at the time the actual permit is issued for his signoturE.. IV. Fees and Charges PIon check fees are due and payable ot the time of the application, and no plans will be processed until these fees ore paid. All other fees and charges are due and payable when the permit is issued. ( +- V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: '" Additional Project Information: PLANS REVIEWED BY: namp cignalurE' CITY OF SPRINGFIELD '3 City Hall Springfield, Oregon Department of Public Works OFFICIAL RECEIPT No. B S 6 7 8l Date ~Q_~,~ 19~ \ R.,' d ",om \,y'i, ,\), ~ '- N\ \1l''Jl Add,... ~ ,GY,' ~ ::0 \ s:;C\ ~ Received For: \ \~ \DH ~1J\~~ (~JJ\Qj /() , ()() ~ .4() / \ /"I , (: ( BY I() .4(j ~ (rrt ) AUTHORIZED SIGNATURE ( ~IO Amount Received ( SHELTON-TURNBULL PRINTERS. EuGENE OR 97401 513511-8 .. Permit Cler\.- r dote