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Home My WebLink AboutPermit Building 1987-9-25 """" INfORllATION L1N~ 726-3753 Sq Ftq IIa1n S:q t"tg Access Sq Ftq Other -.rlew_Add_Al ter_Oep Fence Demo Change/Use Other - - , INSPECTION LINE . 726-3769 Jab Address j J 4 n AJo, :z Is/ , Legal De>mptlOn I ?-O'?-2}j-So':::S . a/9<::'107"'~ , CITY Uf SPRINGFIELO COMBIIIATlON APPLICATION/PERMIT E'IERGY SOURCES Heat \~ater Heater Range ValUE of ~Iork 300= BUllolnQ Perm,t Info Descr;be Work(l Phone 7~.....6"~; _ FaMll y nesldence l~, th .Attached GaraQe) Owner J'fEfJ/fL. Ac:,:;-yrk/A) V /JFho 0 . I Address / /41[) A Jo ( -:2/ :; T ~PJ!)AJGF/E~L/ ~ ?7477 L .,"or CC'</I';f.4- PI!!' ~5 <0 1..1 M,J..,t1:?VIV ,c:-L.I),....JJ?:~o,-;JJ e . BUlld Slngle \1D 'J \) "- tv ~ J V.,., /I LL '?A-UP ~nlZ )-!AvPICA .v",- V - ~~ .. Addre5s<r/o Do, ;t: c::;r/-f DESluN ItAM (name) Phone7.Zt -o~9. (addres s) (l,CS no' (exnlres) (ohone no Pnmary Electrlcal <J \'1 \ I.d1 I I _ ,.,,-7l u.- I Structural Mecham ca 1 CONTRACTORS (name) (address' General /l.e-rl-l/ZL .k5:5'f_,dLy /OFb~O PlumblM (11C~ no) (~xDlrps) (nhonp no ) Electrlcal ~1echanlcal PLUllBING ELECTRICAL MECHANICAL NO FEE CHARGE Nn FFF r4ARr,F NO FFF rHA.Rc,F SO FT furnace/burner to BTU's Each slng1e flxture Resldence of Relocated bUlldlng (new f,X addltlonal) New clrcUlts alts or extenslons Floor furnace and vent S F Pes1dence (] bath) Duplex (l bath) each SERVICES Recessed wall SDac.e henter ann vent Storm Sewer Of C0I111 IIND FEEDERS Install/alter/relocate Ol~trlb feeders amps Apollance vent seDarate Statlonarv evao cooler ~ Vent fan wlth slnole duct Vent syste~ apart from I heatlno or A C Mechanlcal exhaust hood and rlur:t ~lood s tove/hea ter Sewer Temporary Constructlon Change ln eXlstlng rps.1 rI~nr:e multlfam1ly, comm or Tnouc:.trlal Addltlonal bath ~Iater serV1ce Of amps. TOTAL CHARGES WHERE STATE L\W REQUIRES shall not be vallj untll the TOTAL CHARGES ISSUANCt OF PFR'HT TOTAL CHARGES that the Electncal work be done by an Electncal Contractor, the electncal portlon of th,S perr.nt label has been slgned by an Electrlcal Supervlsor and returned to the BUlldlng D,vlslon I HAVE CAREFULLY EXNiINED t1e completed apnllcatlon for nermlt. and do hereby certlfy that all lnformatlon hereon 1S true and correct, and I further certlfy that any and all work Derformed shall be done 1n accordance w1th the Ordlnances of the C1ty of SDnngfleld and the Laws of the State of Oregon oertalnlng to the work descnbed hereln, and that IlO OCCUPAllCY wl11 be made of any structure wlthout the permlSSlon of the BUlldlng D1V1Slon I further cert1fy that my req15tratlon w1th the BU11der's Board 15 ln full force and effect as requlred by ons 701 055, that lf exempt the baS1S for exemptlon lS noted hereon, and that only subcontractors and employees who are 1n comollance wlth OPS 701 055 w111 be used on th1S DroJect HAlIE{please Prlnty%LtI/V neJw6,RO~A.J Flood Plaln Unlts Occy Load OCCY Group srnIAT~...;:~~ Fon OFFICE USE OI~L Y So Ftg Sq Ftg Sq Ftg Q-__r- om~-Z~87 Zone LD.R. CCJP Tyoe/Canst Flre Zone Bedrooms Ston es rialn x Value Access x Value Other j/~.J/7P PAl '- Y Value ::?.:;),P TOTAL VALUATION - BUILDING PERMIT Charges and Surcharges ~ PLU'1BING PERMIT Charges and Surcharges , IQ = 'Plan Ck ___Jl_~_____ 65%/Rlda c-/ Plan Ck . k 0 30%/Bl do Call1lllI nd Ppr Fpp Res Per Fee 6S0 ISystel1s Development I Cha roe (1 5r) Fence Demo ELECTRICAL PERI'IT Charges and Surcharges 11ECHAN I CAL PERMIT Charges and Surcharges Sidewalk AIC Pav1 ng Total Comb rermlt Curb Cut TOTAL /0, 90 ~ .. ,. COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION Appllcant to furnlsh A Job Address B legal Descrlptlon 1 example- Tax Lot 100, Lane County Map Reference II 03 43 2 example- Lot 1 Block 3, 2nd AddItIon to Sprlngtleld Estates C Name, etc of owner and constructlon lender o Energy Sources 1 example- heat/electrlcal celllnq/or forced alr qas 2 examyle- waterneater/electrical(or solar E Square footage or valuatlon, etc I example- 1250 sq foot house, 500 sq foot garage 2 example- If new proJect, check new - If addltlon. check add, etc F BU11dlng permlt lnformatlon 1 example - construct slngle famlly house wlth an attached garllge 2 example - remodel eXlstlng garage lnto famlly room 3 examOle - convert slngle famlly res,dence lnto restaurant (change of use) G Value of work as def,ned 1n Sectlon 303 (a) of the Structural Speclalty Code H DESIGN TEAM ANO CONTRACTORS To avo1d des1gn or construct1on delays, BUlldlng 01vls1on Staff must be able to contact approprlate persons regard1ng deslgn lnformatlon or Job s1te correct1ons. etc II Abbrev1ated Plumblng, Mechanlcal, & Electrlcal Schedules A Except where blank spaces occur 1n the descrlptlon port1on of the Mechan1cal and Electr1cal Schedules, the appl1cant need flll-ln only the No Boxes adjacent to the appropr1ate ltem(s) to be 1nstalled B Full Plumb1ng. Mechan1cal, and Electrlcal Schedules are ava1lable at the BUlld1ng 01v1s1on 1 To conserve space on the permlt form the schedules have been abbrev1ated 2 If the 1tem(s) to be 1nstalled are not covered on the abbrevlated schedules you should consult the full schedules C BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES o As noted on the CAP, the label must be del1vered to the electrlcal contractor for s1gnature by h1S electr1cal superv1sor The general contractor 1S not author1zed to slgn the electrlcal label - III Appllcant to s1gn and date Whenever poss1ble, the 1nlt1al appllcat10n wlll be used as a worksheet only Where poss1ble, BU1ld1ng D1v1s1on Staff w11l prepare a type wr1tten copy and return 1t to the appl1cant at the t1me the actual perm1t 1S 1ssued for h1S s1gnature IV Fees and Charges Plan check fees are due and payable at the t1me of the appl1cat1on, and no plans w1ll be processed unt1l these fees are pa1d All other fees and charges are due and payable when the perm1t 15 1ssued V FOR OFFICE USE ONLY Permlt Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY Permlt appllcant exempt from reglstratlon wlth the BUllder's Board because Addltlonal ProJect Informatlon PLANS REVIEWED BY name slgnature date .. :''''''<f"'' ," INSPECTION LINE 726-3769 'Job Address / / 4 n /1)0, :z /ST , Legal De>trlptlOn /?-O-;;'-2,)-S':::<'" C;?/9c:'t?7o~ ~ I CITY OF SPRINGFIELD COtIBHIATlON APPLICATION/PERMIT EIIERGY SOURCES Heat Hater Heater Range INFORIIATION LINE J 726-3753 Sq Ftq lla,n ~q Ftg Access Sq Ftg Other flew Add Alter Pep Fence _Demo_Change/Use _Other Owner J'5~-r/lfL A-<:.;"Y-<-J'A) V . ) Address / /40 A fa ( '2/ $ T aPhO 0 Phone 7#..,b~ . ValUE of Work I 300~ " BUllCilnQ Pernllt Info Descnbe Work{l e FaMllv nesldence W,th ~ttached Garaoe) . BUlld SlOgle % f5 ""- IN Ut ~"'PK)f..JGF/E?/.? ~.-Y< ?7477 ItJ<;",-ALL. V,U.J'.P -:E.-...~... ~ Il )Tldgr c.o,l.//-;r...4- r t:!-A!5 to jJ H.J.~J//.u F~_""...J~1I::.r:>ft;'.J) Addressq/o 1)0' ;t C::TJ-I. Phone7.Zt c';y9. UI:.~l(;jN Tl:Af1 lnamel (address) (11(':$ no 1 .c-nl< IIAvP/C.A ,v",.9 (exrnres 1 (ohone no ) Pnmary Structural El ectn ca 1 Mechanlcal CONTRACTORS {name} laddrpssl General /le--r///ZL k55.eH.5Lv rOP6~O (llrc;,. no.) (pxnlrpc;,) (ohoop one 1 Plumblna Electncal ~lec ha n1 ca 1 PLUIIB I NG ELECTRICAL MECHANICAL NO FFE CHARGE NO FF~ rHARr,~ NO. ~~~ nlARr,~ Each slngle flxture Resldence of SQ FT furnace/burner to BTU's Relocated bUlldlng (new flX addltlonal) New clrcults alts or extensions Fl oar fu rnace and vent S F Pesldence (] bath) Oup1ex (1 bath) each SERVICES Recessed wall Sn~rp hp~tpr ~nrl vpnt Storm Sewer Of amps Apol1ance vent seoaratp Stat10nary evap cooler I Vent fan W1 th slngle duct I Vent systerl apart heatlnQ or A C I Mechanlcal exhaust hood and dud. I Hood stove/heater I I I from Addltlonal bath ~Iater serVlce Temporary Constructlon Change 1n eXlst1ng res.l dpnce multlfamlly, comm or loou<;tnal Sewer COMII /I NO FEEDERS Install/alter/relocate dlstrlb. feeders Of amps. TOTAL CHARGES WHERE STATE L'W REQUIRES shall not be vallJ unt11 the I TOTAL CHARGES that the Electrlcal work be done by an label has been slgned by an Electrlcal ISSUANCE OF PFRIIIT , TOTAL CHARGES Electrlcal Contractor, the electrlcal rortlon of th1S permit Surerv1sor and returned to the BUlldlng D1vlSlon I HAVE CAREFULLY EXM1INED t~e completed appllcatlon for permlt, and do hereby certlfy that all lnformatlon hereon 1S true and correct, and I further certlfy that any and all work oerformed shall be done In accordance wlth the Ordlnances of the Clty of Spnngfleld and the Laws of the State of Oregon oertalnlng to the work descnbed hereln, and that IW OCCUPAIKY wl11 be made of any structure wlthout the permlss10n of the BUlldlng DlvlSlon I further certlfy that my reQlstratlon ~Ilth the BUllder's Board 1S 1n full force and effect as requlred by ORS 701 055. that 1f exempt the basls for exempt10n 1S noted hereon, and that only subcontractors and employees who are 10 compllance w1th OPS 7nl 055 w,11 be used on th1S proJect HAIIE(please pnntyt;",V f /J ne>w'6RO~ AJ Flood Plaln Stones Um ts Occy Load Occy Group SIGHAT~,-c"-" FOP OFFICE USE DIlLY ,n Ftg Sq Ftg Sq Ftg "/".d~>-<--,-Q. __ ,-- DATE2' -:2~ 8' 7 Zone0,l? <:'vP Tyoe/Const Flre Zon;' Bedrooms Haln x Access x Other ~p PAl L Y TOTAL VALUATIDrI Value Value Value ~"".P ...-- BUILDING PER~\lT Charges and Surcharges ___A:;;:L~~__' ~~~~B~~O ~/ Plan Ck - "C> 30%/Bl dQ Co","/I nd Ppr FPfl Res Per Fee 6.)0 Systems Development Cha roe (1 5~) PLU'1BING PERMIT Charges and Surcharges Fence ELECTR I CAL PERI~IT Charges and Surcha rges Demo I Sidewalk I A/C Pav' ng I Curb Cut I Tota 1 Comb Perm1t 11ECHANICAL PERMIT Charges and Surcharges TOTAL /6, 90 , 11'7 '-....'" . '-.J COMBINATION APPLICATION/PERMIT (CAP) Appl1cant to furnlsh A Job Address B Legal Descrlptlon 1 example- Tax lot 100, lane County Map ReferencE II 03 4j 2 example- Lot I Block 3, 2nd Addltlon to Springfleld Estates C Name, etc of owner and constructlon lender o Energy Sources 1 exam21e- heat/electrlcal cell1nq/or forced alr 2 examDle- waterheater/electrlcal/or solar E Square footage or valuatlon, etc ----- 1 examole- 1250 sq foot house, 500 sq foot gara 2 example- If'I1ew proJect, check-new - If add,tlo check. add, etc F BU11dlng permlt lnformatlon 1 example - construct slngle famlly house wlth an attached garage 2 example - remodel eXlstlng garage lnto faml1y n 3 exam~le - convert slngle faml1y resldence lnto restaurant (change of use) G Value of work as deflned In Sectlon 303 (a) of the Structural Speclalty Code H DESIGN TEAM ANO CONTRACTORS To aVOld des1gn or constructlon delays, BUlldlng Dlv1s1on Staff must be able to contact approprlate persons regardlng deslgn lnformatlon or Job slte correct10ns, etc II Abbrevlated Plumb1ng, Mechan1cal. & Electr1cal Schedules A Except where blank spaces occur 1n the descr1ptlon port1on of the Mechanlcal and Electr1cal Schedules. the appl1cant need f111-1n only the No Boxes adJace to the approprlate ltem(s) to be lnstalled B Full Plumblng, Mechan1ca1, and Electr1cal Schedules are avallable at the BU1ld1ng Dlvlslon 1 To conserve space on the permlt form the schedul have been abbrev1ated 2 If the 1tem{s) to be lnstalled are not covered 0 the abbrevlated schedules you should consult the full schedules C BUILDING DIVISION STAFF WILL FILL OOT ALL FEES AND CHARGES ON THE SCHEDULES o As noted on the CAP, the label must be dellvered to the electrlcal contractor for slgnature by h1S electrlcal superv1sor The general contractor 1S not author1zed to slgn the electncal label - III Appllcant to s19n and date Whenever posslble. the lnltlal appl1cat10n wlll be used as a worksheet only Where posslble. BU11dlng Olv1s10n Staff wlll prepare a type wr1tten copy and return 1t to the appllcant at the tlme the actual permlt lS 1ssued for hlS S 1 gna ture IV Fees and Charges Plan check fees are due and payable at the t1me of the appl1catlon, and no plans w1ll be processed unt1l these fees are pa1d All other fees and charges are due and payable when the perm1t 15 1ssued V FOR OFFICE OSE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY CITY OF SPRINGFIELD ..- Clly Hall Springfield, Oregon Department of Public Work. OFFICIAL RECEIPT No. B Date f:15Zf!., 'Z~ 19~"7 RecdFrom '&-~h~,!"or ~c,J) . tNt> hT~ ~I ~ 5r. Address ~ p _ 07.<. 97'i/ 7'> ~- /' Received For r J.:::3~& 7o/.2~ YUfr/~A", 6<~o E-r. / o. <>- ~C> 67857 o/'c::? df /,<- 90 Cd# /6/9 ~ ~~ "70 /) ~-:;;:., /. - - ,,-<- - ~ ~ ~AlZEOS NNTlJAE 7" r r Amount Received ft'untler aUSINESS FORMS INC (50313.2 eU9 '6353 Permlt Clerk . Permlt appllcant exempt from reglstratlon wlth the BUllder's Board because Addltlonal ProJect Informatlon PLANS REVIEWED BY name slgnature . I date