HomeMy WebLinkAboutPermit Building 1981-5-19
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INSPECtiON lJNE
726-3769
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
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INFORMAflON LINE
7'26-3753
Owner
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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
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LJ602,
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ENERGY SOURCES
Addre"
BUIlding Perm,l Info
Fcmtlv ReSldl"n '':" W,tf,
Describe Work (I e
Attached GoroQe'
BUild S,ngle
cP
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1
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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
~~" ..... :..
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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
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Job Addreu
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CITY OF SPRINGfiElD
COMBINATION APPlICATlONJPERMIT
I' ENERGY SOURCES
Heat
I. Warer ~ea~ter
Ranqe
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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
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legal Oe~c"phon
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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
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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
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,
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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
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Received For
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~unt _Received A .08-.-'
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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""
\
"
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S8S"8
PermIt Cieri-
t
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