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Home My WebLink AboutPermit Mechanical 1981-3-30 INSPECTION LINE 726-3769 CITY OF SPRINGFIELD . COMBINATION APPLiCATION/PERMiT INFORMATION LINE 726-3753 II Sq. Ftg. Main ~:::t'l . . "'-'l. Sq. Ftg. Access. ~ D. . Sq. Ftg. Other ~ . New ~Alter__Rep. :T, _]ence__Demo_Change/ Use 0 ~ ~ Q If) O()rrhnfl.i()Q,~ \ I l') 3LJ()4.~~ I jl - 1<1 ()()~ I owner~c:::ni.IL~S;;J\o .r~lAn tl f\ I Address --q; n ~ tf1 to!1 n /0 . Phone n_ rr.~Ol\t i I)Dl_0~. 'It.! J.. /1LJq Construction letde) Legal Description ENERGY SOURCE~ Heat \.9.'"") . \I Water Heater Range Value of Work: Jab Address ,'35Q{ex) Building Permit Info: Describe Work (i.e., Bvild Single Famil~ ~~~~de~~~ W.~.~Att~~hed Garca!::) DESIGN TEAM (name) (address) \.,,-=x"'~-'rl ~. <9 (rl#llf7d ~ N ~?o; ~)\t-,;~'f'...I. (phone no.) Address Phone Primary Structural Electrical Mechanical 1.(1 R t-~ (address) (lies. no.) l o4() '0. I [)t7I 00 t (expires) (phone no.) ~O~ CONTRACTOflS _ (name) General\...~ ~ Plumbing . D 3 f?,9 fX' _ n <...--- Electrical J\\echanicol PLUMBING / ",yL' /i / Temporary Construction I /1 / / / / / / ~ CH^,GES ElECTRICAL MECHANICAL q/ARGE Y / 1/ Duolex (1 both) each I, Additional bath / / Storm Sewer / / / / / I 1/ r' If NO. i FEE NO. I NO. FEE CHARGE Each single fixture Relocafed building (new fix. additional) S.F. Residence (1 bath) sq: ft. furnace/ burner to !\TU's Appliance vent separate Stationary evap. cooler Vent fan with single duct Vent system apart from he<Jting or A.C. Mechanical exhaust hood and duct Residence of New circuits, alterations or extensions SERVICES Sewer Woad stave! heater I I 00:) Amps. Water servke FEEDERS Heat Pump Air handler to 10,000 CFM Air handler over 10,000 CFM Amps. , TOTAL CHARGES i I ISSUANCE OF PERMIT I TOTAL CHARGES I ~. CC) I I (). ex:) WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall not be valid until a label has been signed by gn Electrical Contractor and attached to the electrical panel. I HAVE CAREFULLY EXAMINED the completed application far permit, and do hereby certify that all information hereon is true and correct, and I further certify that any and all war\: p,,,farmed sholl be done in accardonc" with the Ordinances of the City of Springfield and the Laws of the State of Oregan pertaining to the 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 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 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 Board exemption: NAME (please print) L e. <t::. ..J-ra c. R fJJ'I ~UV SIGNATURE ~ Q ?~. c . +<~ .....j "' DATE 3/3oJ gj / / FOR OFFICE USE ONLY Zonp Typel Canst. Units fire Zone Bedrooms Occy load Flood Plain c;torie" 0ccy Group BUILDING PERMIT Plan CIe. Comm/lnd Charges and 65%/ Bldg Per Fee Surcharges Plan Ck. Res 30%/ Bldg Per Fee PLUMBING PERMIT Charges and Fence Surcharges Demo ELECTRICAL PERMIT Charges and .Sidewalk Surcharges Alc Pavina MECHANICAL PERMIT --1 S.CD _ Charges and Curb Cut Surcharges (0(') 'iq. Ftg. Main ~q. Ftg. Access Sq. Ftg. Other x Value Value Value x x TOTAL VALUATION. Systems Development Charae (1.5%) Total Comb. Permit I I I TOTAL 1 ~ l</) COMBINATION APPLICATION/PERMIT \"-,.,,P) I. 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. o'r owner and construction lende}\ D.. Energy Sources 1. example-heat/electrical ceiling/or forced air gas 2. exa mpie-water heateri electrical/or solar E. Square rootage or valuation, etc. 1. .exomple.1250 sq. foot house, 500 sq. foot garage 2. example-if new project, check new-ir addition, check add. etc. F. Building permit inrormation: 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 or use) G. Value or work as defined in Section 303 (a) of the Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS Ta 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 description portion or the Mechanical and Electrical Schedules, the applicant need rill-in only the No. Boxes adjacent to the appropriate item(s) to be installed B. Full Plumbing, Me<hanical, and Electricol Schedules . are available at the Building Division 1. To conserve space on the permit form the schedules have been abbreviated 2. Ir the item(s) to be installed are not covered on the abbrevi- ated schedules you should consult the rull schedules C. BUILDING DIVISION STAFF WILL Fill OUT ALL FEES AND CHARGES ON THE SCHEDULES III. Applicant to sign and date Whenever possible, the initial application will be used as a work~heet only. Where possible, Building Division Staff will ptepare a typewritten copy and return it to the applicant at the time the actual permit is issued for his signature. IV. Fees and Charges PIon 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: AdditionQI Project Inrormation: PLANS REVIEWED BY: nam€" . ~ignature Permit Clerlr PERMIT VALIDATION ~. :... date INSPECTION LINE 726-3769 CITY OF SPRINGFIELD COMBINATION APPLICATION/PERM" INFORMATION LINE 726-3753 Job Addren GJG 01 Mflfii (1 g ,&xJ.' ~:::GY S\~~E.~ Sq, Ftg. Main ./::>S> Sq. Ftg. A"eu. ~. D.-.....' Water Healer Sq. Ftg. Other ~ Range _New ~_Alter __Rep. ~ Value of Work: _JencL_Demo_Change/Use b , . ~ ~. & . n (J e() f:-Oihei"- .A owner\.c.::nt~~ctQ.fH~ M{J.f"', ,~~5_~{..u ./ I ---n;n () ...L" I Building Permit Info: Describe Work (i.e., Build Single Addre.. '-1 l ' 0 h1 '" (! In n / n Phone Familv lIe.idence Witn Allached Garaqe) , co".~:J:?t{ 1"'fj' 10 1 0 . . r;u /-l1tjq ,~ ~ '{' . U"'{.#-Nr!l I ~ ci ~(\ Q . -"C'J\.C".\ ~}'f'\ .I.. Legal Description Address Phone DESIGN TEAM (nome) (address) \ \Iics. no.) (expires) (phone no.) Primary SlTuclurol Electrical Mechanical In ltrre. (address) _ . (lics. no.) [Q9() 'r, I JjtJI 00 t (expires) (phone no.) 14l:l5o~ CONTRACTORS _ (nome) Generol\.....r "-~. .. Plumbing . 0 B:?'~CO Electrical Mechanical NO. i /1 FEE :!ARGE I I ) I 1/1 ! I /1 /1 / I Storm Sewer / I / ! / / / 1/ If PLUMBING m ~INO /1 / Temporary Construction ! / / I / / / / / / J' I~TAL CHARGES ELECTRICAL MECHANICAL NO. FEE I CHARGE Residence of furnace/ burner to ~TU's Appliance vent separate Stationary evop. cooler Vent fan with single duct Vent system aport from he"ting or A.C. Mechanical exhaust hood and d~ct I ..~O:) Each singie fixture Relocated building (new fix. additional) sq: ft. New circuits, alterations or extensions S.F. Residence (1 bath) SERVICES Duolex (I botn) each Additional botn Amps. Water service Sewer Wood stove/ heater FEEDERS Heat Pump Air handler to 10,000 CFM Air handler over 10.000 CFM Amps. ISSUANCE OF PERMIT I (). CO , TOTAL CHARGES TOT AL CHARGES ] ~ ,ex) WHERE STATE LAW REQUIRES that the Electrical work be aone by the Electrical Contractor, the electrical portion of this permit shall not be valid until a label has been signed by on Electrical Contractor and attached to the electrical panel. I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that 011 information hereon is true and correct, and I further certify that any and 011 wor~ performed shoil be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the worle. described herin, and Ihot NO OCCUPANCY will be made of any structure without the permission of the Building Division. I further certify that my registrolion witl> the Builder's Boord is in full force and effect os required by ORS 701.055, that if exempt the basis for exemption ii 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 Boord exemption: Cf-h NAME (please print).I e. c a C. ~NkI~ SIGNATURE ~ Q ?tiCJJ.. C . +<Q~ ,_.J " DATE 3/3()LRL ~ / FOR OFFICE USE ONLY "q. Ftg. Moln "q. Ftg. Acces'. Sq. FIg. Other Value Value Value TOTAL VALUATION x Systems Development Chorae (1.5%1 Total Comb. Permit I TOTAL t~l9O COMBINATION APPLICATION/PERMIT (C;o.r') I. Applica~ to furnish A. Job Address B. legal Description 1. example-tax lot 100, lane County Map Reference 17 2. exam ole-lot 1. Block 3, 2nd Addition to Springfield Est. C. Name, etc. of owner and construction lender D. Energy Sources 1. example-heat/electrical ceiling/or forced air gas 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. exam ole-if new project, check new-if addition, check add. etc. F. Building permit information: 1. example-construct single family house with an attache garage 2. exomple.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 (0) 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 regardi design information or job site corrections, etc. II. Abbreviated Plumbing, Mechanical & Electrical Schedules A. Except where blank spaces occur in the description partial of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriat. item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedules . are available at the Building Division 1. To conserve spcce on the permit form the schedules have ceen abbreviated 2. If the item(s) to be installed are not covered on the obi 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 work~heet oniy. Where possible, Building Division Staff will prepare a typewritten copy and return it to the applicant at +-- the rime 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 Proiect Information: PLANS REVIEWED BY: name . signature -iate _ (~. PERMIT V ALIDA liON .. CITY OF SPRINGFIELD City Hall Springfield, Oregon Department of Public Works OFFICIAL RECEIPT No. B 5 618 4 DatEt'.J0\<\ )\ . ~ C')9 R \ Rec'd Fro&fth- fIo..oX t .{\ Address QJ(J rQ.rUo~ ~_ .# ( c ( Received For: ( ( '.. t l')C~~~~ e 4-0/TJ \~.co . .ld) c ( (' ( Amount Received \~,loO ~/L ( BY ~2", ( ( ( SHf;L TON-TURNBULL PRINTERS' EUGENE OR g""OI 88511-8 '. .. Permit Clerk