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Home My WebLink AboutPermit Building 1981-5-19 '~ INSPECtiON lJNE 726-3769 CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT '--- , " INFORMAflON LINE 7'26-3753 Owner <rl0 '(~ ~ f'Jrl.!)S2....-' r Y\ n \ C' Ql\hl\ ~ \ r~ Pho", Q') CCA () _ - '1 L\ 'l-d ILl:; " RanQe I Volve of Work r,nn co Sq fig MOII~ Sq fIg"':. Accen Sq fig Other ,_New_Add _Alter _Rep _ _Fence_Demo_Chonge/Use _Other Legal Oeseflohon \f'\\,) \ LJ602, ~5\-nN\ \ Ii \)./ n()3253'1' ENERGY SOURCES Addre" BUIlding Perm,l Info Fcmtlv ReSldl"n '':" W,tf, Describe Work (I e Attached GoroQe' BUild S,ngle cP @ ..c I 1 I Job Address Heat Woter Healer CO",IMI'O~.ill Addren Phone ...1., H -\'\ F'I f" 0 \) (l,u no) (expires) (phone no ) DESIGN TEAM (nome, (address) Prlmory Structural Electncal v,echonlCol Plumb,nQ '~ (address) m ~--U,\J\9.\\.., ~ (l,es no) (e;o;p,res) (phone no l CONTRACTORS Q-I.c \l (nome) General ~\\Q""rt\"1\ tog~ -lo(f)() ele-drleDI Methorl,col PLUMBING ELECTRICAL MECHANICAL -, Eoen \'I'lqlll f"uure Ro}loccted budding (new fiX add,tlonol) 5 f R<!sldllnce (1 bOlh) sq ft New CIrcuits olteral1ons or elllenSlonl CHARGE NO I I furnace/burner .0 -------1- ~TU's 1 Appflonce vent separate Stationary evop cooler Vent fan With Single duct Vent system oport from heatlnQ or A C Mechanical exhaust hood and duct ree ! CHARGE I I I NO , FE!: CHARGE I NO FEE Residence O. SERVICES Duale..: (1 boll'll eoch Temporary Construcllon Aod,llot"tol bOTh Amps Waler service Sewer Wood slovel heater Storm Sewer FEEDERS Heof Pump Air handler to 10000 CFM A" handler over 10000 (FM Amps r I TOTAL CHARGES I TOTAL CHARGES ISSUANce-OF,pI:RMIT I TOTAL CHARGES WHERE STATE LAW REOUIRES Ihat the Electrical work be done by the Elertrlcal Contra no?, the eledncal portloll of thll permit shall not b. valid until Q label hos been SIgned by an Electrical Contrador 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 thot ony and 011 work performed shall be done In accordance With the Ordmances of the City of Springfield and the Lows of the State of Oregon pertammg to the work descrloed henn and that NO OCCUPANCY Will be mode of any structure Without the permiSSiOn of the Budding DIVISiOn I further cerllfy that my registration WIll,. the Budder's Board IS In full force and effect as requlfed by ORS 701055, that If exempt the baSIS for exemption IS noted heron, and that only subcontractors and employees who ore In comphance With ORS 701 00505 -"I be used on thu prolect 80m f., 8,dd.,', Boo,d 27"0" - ~ ~ NAME (pl.o,. .,,",1 pM <; r. L" E I'll Y4,f;;1'A'!~'GNATURE -zfLo~-pI. FOR OFFICE USE ONLY DATE 5,ICf-r;\ x Value Value Value Zone fLr8 Zone Flood PlaIn Type/Canst ~drooms "Iofles Unlts t"'\ccy load "'ccy Group 5q ftg Mam "-q Ftg Access 5q FIg Other x x TOTAL VALUATION BUilDING P!:RMIT Charges and Surcharges tp"oo 3& Plan Ck Comm/lnd 65",,/ Blda Per fee Plan Ck. Res 3o"{,/Bldg Per Fee Systems Development Choroe (I 5"',,1 PlUMBING PERMIT Charges and 5urcnarges Fence Demo Total Comb P"rmlt ELECTRICAL PERMIT Charges and Surcharges Sldewalk Ale Pavlntl MECHANICAL PERMIT Charges and Surcharges TOTAL 0'6'2..... Curb Cut ~~" ..... :.. ~ COMBINATION APPlICA TION/ P~~,--:1T (CAP) ApphcorU to furnish A Job Address B legal Description 1 example-tox lot 100, lone County Map Reference 17 03 43 2 exompJe,lot 1 Block 3. 2nd Addition to Spnngf,eld Estates C Name, ete of owner and constructIon lender o Energy Sources 1 exomole-heot/electncol celhnq/or forced elr gas 2 exomole.woler heater, electrical/or solar E Square footage or valuatIOn, ete 1 exomole.1250 sq foot house. 500 sq foot garage 2 exampie If new prolect. check new-If additIon, check add. efe F Budding permit .nformatlon 1 examole.construct single family house with an ottoched garage 2 example-remodel eXisting garag~ Into family room 3 exo"'pie convert single family reSidence mto restaurant (change of use) G Volue 01 work os defined In Seclton 303 (0) of the Structural Specialty Code H DESIGN TEAM AND CONTRACTORS To aVOId deSign or constructzon delays, Buddmg DIVISIon Stoff must be able to contact appropriate persons regarding deSign Informarlon or lob site corrections, ete II Abbrevloted PlumbIng, Mechcnlcol & Electrical Schedules A Except where blank spaces occur In the deSCription portion of the Mechenlcal and Electrical Schedules, the applicant need fill-In only the No Boxes odlocent to the appropnate Item{s} fa be Installed B Full Plumolng. Mechanical. and Electrical Schedules I]re avadable at the Budding DIVISion 1 To conserve space on the permit form the schedules have been abbrevloted , If the Itemls) to be Installed are not covered on the abbrevl~ aled schedules you should consult the full sc:hedules 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 worksheet only Where possIble, Budding DIVISion Stoff 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 ore 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 o Additional Project Information PLANS REVIEWED BY nam~ ..Ignatur.... PERMIT VALIDATION PermJt Clery <' ;ot- --, >~ / .. > . , . Job Addreu \ 0\')\ 0~,\\T~\'\'(\\r, C' , CITY OF SPRINGfiElD COMBINATION APPlICATlONJPERMIT I' ENERGY SOURCES Heat I. Warer ~ea~ter Ranqe ~ INFORMAflON LINE 7'26-3753 INSPECTIO,tl LINE '12~769 O""ner , Yalue of Work. I <f,fJn co Sq FIg MaIn 5q FIg Accen Sq ftg Other _New_Add _Alter_Rep _ _fence _Demo_Change I U~e _Other 00 ~ r legal Oe~c"phon ~"\.. 'r c:, '( \:i.J \ C"0.f"I x...., Add..., \ 'i\ n \ \' lL\nt\ ~ \!',--<.L Phon' Con",",hO~'~ r" (0-\ CO 'I L\ r) -;] ILI~ Budding Perm.t Info DescrIbe Work (I c BUIld SIngle Fomdv Res,dpnce W,th Attached Gorooel Address Phone ,i., "- Q ,c-'l fl f' 0 I \ \ \ DESIGN TEAM (namel (oddressl (lIes no) (expires) (phone no) Prlmory Structural Electncal v,echonJcol plumb,110 , I () (address) m ~'w.. \\r\Q\\. ,t<l\\ (lIes no) (e:ll:pues) (.,hone no) CONTRACTORS \>'-\- Q (nomel General "-\t, \'\H\ '). I.0fS'G, -(00')( ) .' Elt!clrl/::ol I MlI'!ch<:ln.col I I I I I I I PLUMBING ELECTRICAL MECHANICAL NO , F~" C\-lARGE I NO FE!: CHA~GE l NO SEll:VICE5 rurnace/burner '0 llTU S AppllorH:e "lI'!nt separate StatIOnary evap cooler FEE ,I CHARGE I I ReSIdence at Eocn slnqlll'! f,ltlurll'! R.!locofed bVlldln9 (nltw hit add,tional) S F Reudence (1 balh) sq ft New crrcv,h alterations or eJdens.ons Aod'llonal bOIr. Amps VeM fan with Single duct Vent system apart from heotlnq or A C Mechonlcal exhaust hood and duct Duolll'!lt (l bolhlll'!ocn Temporory Construchon Watll'!r service Sewer Wood stove I heater I I I I I I t I TOTAL CHARGES I Storm Sew.r FE!;DERS Heat Pump Atr handler to 10000 CFl,4, AIr handler over 10000 CFM Ampl TOTAL CHARGES ISSUANCE OFlI"PERMIT f TOTAL CHARGES WHERE STArE 1.AW REQUIRES that the Electrical work be done by the E1ertrlcal Cantracto7, the electncal partloll of thiS permIt shall not be valid ",ntll Q label hos be.n Signed by on Eloctrlcal Contractor and attached ta tho ~Iectrlcol ponel I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby cerllfy that all ,nfarmotlon hereon IS true and correct, and I further certtfy lhot ony and 011 work performed shall be done 1M accordance With the Ordinances of the City of Spflngfleld and the Lows of the Stafe of Oregon pertaining to ,he work desCfloed henn Clnd thot NO OCCUPANCY will be mode of any Jtructure w,thout th& permiSSIon of th& BUlldmg DIVISiOn I further cerhfy that my regIstration wlfh the BUilder's Boord IS In full force and effect as requlteO by ORS 701055 that If exempt the boSls for exemphon II noted heron, and Ihot only subcontractors and employees who are In complIance- With ORS 701 O~I be used on thIS prOlect ~::f~~I:O,,,~d::::I~.~~'o~ /< E n~Y4~1~~IGNATURE :tf~~1J~~ DATE 5.IQ-r;\ FOR OFFICE USE ONLY / Zon- Type/Canst Ilmh '^ "g M>1ln fire Zone B.edroorns neey Load Sq "g Aeeess Flood ploln ",Iorre- Oeey Group Sq FIg Other BUILDING P~RMI7 ~ 00 Plon ek CommJ lnd Charges and 65001 BldCl Per Fee Surcharges '-..j(l Plan Ck R" 300f,1 BldQ Per fee PLUMBING PERMIT Charges and Fence Surcnarges Demo ELECTRICAL PERMIT Charges and SIdewalk Surcharges Alc POVlno MECHANICAL PERMIT Charges ond Curb Cut Surcharges -------- x Halue '/alue Vol",e TOTAL VALUATION x I Syuems Development Chortle fl 50o) Total Comb Permit I TOTAL (!)'3'L "'-' , ~ COMBINATION APPliCATION, ~IT (CAP) I Applicant to furnish A Job Address B legal DescrIption 1 exam ole-tax lot 100, lane County Mop Reference 1 2 exornole Lot I Block 3, 2nd Addition to Springfield E C Name ete of owner and construction lender o Energy Sources 1 examole-heat/electrlcal cerllng/or forced 01' oas 2 exorncle.woler heater, electrical/or solar - E Square footage or valuation efe - 1 eXQmole~ ~ sq root house. 500 sq foot garage 2 examoie If new prOlect, check new-If additIon, cheel aCId, ete: F Budding permIt Information 1 examcle-construct single family house with an ottO! garage 2 exam ole-remodel eXisting go ragE:.. Into famtly room J exo-nple convert single family residence rnto restaurant (change of use) G Value or work os defined In Section 303 (0) of the \ Structural Specialty Code H DESIGN TEAM AND CONTRACTORS To aVOid deSIgn or construction delays. Buddmg DIVIS\ ( Stoff must be oole to contact appropnate persons reg deSign InformatIon or lob site corrections. ete II Abbrevloted Plumbing, Mpchonlcal & Electrrcal Schedule' A Exeeot where blank spaces occur In the descnptlon pc: ot the Mechanical and Electrrcal Schedules, the applic need fdl~ln only the No Boxes adlccent to the approF Item(s) to be Installed B Full Plumolng, Mechanical, and Electrical Schedules ore available at the Budding DIVISion 1 To cOI1s.erve space on the permIt form the schedul! hove been aobrevlated 2 If the ItemlsJ to be Installed ore not covered on th ated schedules you should consult the fud schedu/ C BUILDING DIVISION STAFF WilL FILL OUT ALL FEES ~ CHARGES ON THE SCHEDULES ,re , I CITY - --.. ..... " ^, II"'\^Ttrl'1\J OF SPRINGFIF.LD CIty Hall Sprongfleld, Oregon Department of Public Works OFFICIAL RECEIPT M N~ B 56534 Dote \\\\\ t;\ \ q 19X \ :::~e::om ~~l~~. ,"'~\~( ~Y '---~_I",\\r\o\ . },I\ (J. Received For "-~\ \\C\ I'L " I' j o/c' Bee '..2., I \ -lC! ( ( ~unt _Received A .08-.-' ~~f\-:- AUTHORIZED StGNATURL- S><UTQ" TU~"8UlC ....'..TIr..S El1GE'.., 0.. ""0' III. Applicant to sign cnd date Whenever pOSSible the 100tlol applicatIon will be used (+-. worksheet only Where pOSSible, Budding DIVISIon Staff Will prepare 0 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 ore due and payable at the time of the application, and no pions will be processed untd these fees are paid All other fees and charges ore due and payable when the permit IS Issued V FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY , Additional Prolec:t Information PLANS REVIEWED BY name slgnatur"" \ " ~ (~- S8S"8 PermIt Cieri- t I I I I I j .Jot...