HomeMy WebLinkAboutPermit Building 1980-1-22
'? ...01
. .~, ',: > NOTIFIED _ rEB ~ ~
",' CITbOF SPRINGFIELD. " INFORl1ATION liNt. ,
' ~OMBINATION~ APLIC'ION/PERMIT ,'" 726-3753
, Q\ - U c:? \ ' : EflERGY, SOURCES: Sq. Ftg. r,1a i nO~ 7~'I
~~ ~4 C"....fjeatCL.t:c./' ~q. Ftg. Access$~~
, \~ater Heaterr/~C7 . Sq. Ftg. OtherC:./~cO'::>
Range ~~ .x..rje\~_ Add _A lter __:...J~ep.
.. 3~QD Fence Demo Change/Use
.,~ ~. I?e-i) ';;;~~~;~:/::~~h~.YD -Other- -
B~ildino Permit Info: Describe Work(i,e., Build Single
Phone 7cf').:..~~ I~mi 1 y r\es i dence l~i th j.\,ttached Ga raoe)
~C:>:P .,,' O~F/C~ ~~
---
S-~rLE rc>"i" / /-'0QE??
I Of '100
'" 'j cor~r'1. / I ND. FE EDERS
I Install/alter/relocate
distrib, feeders
I 10f ZQ7
1
1
1 ISSUANCE OF PFRrm I{!).d!
TOTAL CHARGES 36'.00. TOTAL CHARGES S /),00 I TOTAL CHARGES 58tJO
, WHERE STATE L'W REQUIRES that tile Electrical work be done by an,Electrical Contractor, the electrical portion of this permit
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXA~1INED 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 0~ork performed shall ,be done in accordance,with the Ordinanc~s of , the City
of Spri ngfi e 1 d and the Laws' of the State of Oregon oertai ning to the work descri bed herei n, and that NO OCCUPAfKY will be made
of any structure without the permission of the Building Division. I further certify that my registration ~/ith 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 hereon, and that
.001y "bo,ot',oto" ,od ,mp10y", who '" io oom,li,oo, with 'R' 70 .'?' will ~~d 00 ~ 1\,;,ot.
,rW1E(please pri~rJ ~,^-I SIGWITURE ,(J-... ~~, _'~~ bATE~2-z.k
FOR OFFICE USE ONLY ,
, Sa. Ftg. r1ain '~'~l...~ x((,-/;iD Value ,;/(,,9(,1),1/0
.-t'}",M~I"o:,~a TAJ 'IrA,-
Sq., Ft!J. Access"'R.J7-:-TdJ!LI---,,-~"~i"J Value---J:,I. ~,(;'
Sq. Ftg. Other~q?lle x ~-45' Value ~ .ZD
, e".II, II~ ~"2,C/i) TOTAL VALUATION J/8;tJt:J!J.I.D
JQ~ ,,~ ''1'
'iai. 3S~\ \,2.}..'1~~~~~s(~~5~jopment 1 1171.25, I
"(i~.1() Di1~) , '
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./1' INSPECTION LINE
726-3769
Job Address ~~C1~
Legal Description
~,.....)
Owne~
Address ~ L::", '"\ c"
~~c.....~.
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...., - 'U.
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Construction Lender
Address
DES I GN TEAr~
I Phone
: "y..-_l..Y ,dd"" 1
.
.
(name) ,1).' · , ~
Primary
, Structural
El ectl"i ca 1
r~echanical
CONTRACTORS (name)
Genera 1 ' c:..r-LF ~
(address)
: Plumbino
: Electric,al(lt.rp.P,,~{L!0.d ~
~1echani ca 1
PLUf1B I NG
ELECTRICAL
, NO.
FEE CHARGE, NO
,1
Each single fixture
Residence of
L"':ao 2.~_
~ 0J'0;J . "'l.o
SQ. FT.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
SERVICES
Temporary Construction
Change in existing
residence
multifamily, comm. or
Industrial
Hater service
Sewer
Storm Sewer
amps.
amps.
Zone M-3
Fi re Zone....1Jl:,
Flood Plain NO
Tyoe/Const. v!'-J/..t/f'-ItJUnits
,
Bedrooms ~ Occy Load
Stori es 't. Occy Group B~2. u.+
.
BUILDING PER~1IT
Charges and
Surcharges
, , Plan Ck.
_____3ns.0l> 65%/Bldo
Plan Ck,
J ~ .2.0 30%/Bl do
_ _ _ _ _ _ _3S.~_ Fence
III D@mo '
,...,0
Comm/Ind
Pp.r Fee
Res
Per Fee
PLUf1BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERMIT
Charges and
Surcharges
, SlJ.f!JOSidewalk
-- --- -- - :J. .,,; 'A/C pavin"7ZJ.io
".Sl'.~ I Curb "Cut I
--------~.~;tl I
MECHANICAL PERMIT
Charges and
, Surcharges
,
'.
~
()
o
o
1:.
.L
(lics, no.)
(ohone no:)
(exoires)
~
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!
(lies. no.)
(exoires)
(ohone no. )
I
MECHANICAL
, .
FFF rHAR(;F NO, FFF rHAR(;F
furnace/burner to
BTU's
Floor fu'rnace
and vent
Recessed wall
Soace heiltpr ilnd vent
Appliance vent
seoarate
Stationary evap.
cooler
~ Vent fan with ~.a:, t-.<<J
sinale duct
13$00 Vent system apart from
heating or A.C.
, I Mechanical exhaust
hood and duct
1 Wood stove/heater
I/s.oo S" ~P"'''E' jJ6.Arc~ t",.Df) 3O.t:tj
I ~ HA9r PI/M'S ~~ IZ,n'J
(~
I -
'10.00 ITotal Comb. Permit I S'3:J.8~
I ' #~'3~4{,1) 7 ' J
I TOTAL .
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COMBINATION APPLICATION/PERMIT (CAP)'
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description ' " ,
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. examp1e- Lot 1. ,Block 3, 2nd Addition to
. Springfield Estates "
,C. Name, etc. of owner and construction lender
D. Energy Sources . .. .,
1. examp1e- heat/electrical ceiling/or forced 'air qas
2. example- waterheater/e1ectrical/or solar
E. Square footage or valuation, etc.
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- 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. examo1e - 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 (a) 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 regarding design information or job site
corrections, etc. '
II. ' Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except whe~e blank spaces occur in the desciiption
po~tion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxe~ adjacent
to the ap~ropriate 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'schedu1es
have been abbreviated .
2. If the item(s) to be installed are not covered on
the abbreviated schedules you'shou1d consult the
full schedu1 es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is not authorized
to sign the electrical label.
III. Applicant to sign and date
Whenever possible, the initial application will be used as
a worksheet only. Where possible, Building Division Staff
wi 11 prepa re a type written 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.
I,
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V. FOR OFFICE USE ONLY
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
./)...: ~...___ . '/] .."1-. I~~",,~~O
AV'...__-ry- ~n- ~ .
~~A.~ ;~JdNli C'O??'7.ml.l)),{lJnJ AiA.u.f ,tOt.A.
J~:J.D /?bA.M, A /?U ~ ~ {)
.
Permit applic,?nt exempt from registrat~on with the Builder's Board because:,'
.
.
Additional Project Information:
4
3~
R~.~'
pc:;r ~
. .
~a~f-O~
PLANS REVIEWED BY:
name
signature tt.!Ja~-~-~~
date 2-~-Yo
.~
, ."".
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.
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Construction Lender
.~;;~:'-;". ,'. - ..;, .' ., .:~'iJ::-;{.~;'r~:::/~.<v'v
""""-" ,'0""(:-, '..,,:i.,..,~',' rEBlg.q'
", "... I("\TIFI:-Da ,-- ..'- --"- '
-., ' ,J'" '..~' I, ','" ,____ .. _..__~'___,__.,.......__
CITY'~F SPRINGFIELD
CQtlBIrlATION APPLICATION/PERMIT
, ,'" -, ~ ')' --~ ~'~~J' E!IERGY SOURCES: .
, t~' '. ... C'"', ' ...z:= ''/ T .
~l~"',- I ~,""" ,,)-iea~,-c:~ '
< \'
, ,!1ater Heaterr/ e-C7 .
Range
3 ?,QD r"" -- 'II.
'. ,'J \, ~al~(_of H,or::it~,,~.Y!J
.~ c:: \ ~ \/ ,~",~92, . "
l{ .., Bu'ildina Permit Info: Describe l10rk( i.e., Build Single
. '>'~' _ j Phone 7f?,,~~ql!amilv l1esidenceHith ,Il,ttached Garaae)
~ -- --- _.~. ...,.
~c>;p "1' O,z--.F/~~ ~~
- '
57hPLETory, '/ /~pE?f
.
lNFORllATION LlNE ,I
726-3753
Sq. Ftg.r'lainO~ 7~'I
~q. !"tg. Access$<.c-V::
Sq. Ftg. Other'c:-/~cO~
-4!leN_ Add _A 1 ter -,~ep.
Fence Demo Change/Use
-Other - -
:0
a
o
o
1:
.L
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"
1 IrISPECTlON LINE
7,26-3769 , '
Job Address ;"'-""/'::'r' r.;,
~t..__i I~
Legal De5cri~tion' ,
/7 - 0;;" -- 3 -,;;,/
OwneF::: ' ' y~'
'. .~,."
--'" - ...... I
Address "'< c.: ~ S' r.
-~ ~(..... ---.J......
'-
Address
DES I GN TEArI
.. .
(name) -\ '\.
....,... _ . LA..:.,--_(L')
I Phone ' ,
: L~~<~Ydd"" )
--<
(lies. no.)
(expires)
,
(phone no. ),
1
I
I
.,
1
I
1
(phone no. ) ,
I
,
Primary
, Structura 1
Electrical
!1echani ca 1
CONTRACTORS (name)
Genera 1 '~LF.
(address)
(] ics. no.)
(expires) ,
Plumbina
, E;ectrical(J t1'()(i (,;' 1::".(1 a
_ , I 6.
/,lechani ca 1
PLUflB I NG
ELECTRICAL
MECHANICAL
NO. '
, FEE . CHARGE NO,
'FFf rHAR~F NO,
, P'F -. rHAR~F .
'1
Each single fixture
Residence of
~-: [..V :.:,.~,,..
._.:J.~
SQ. FT.
furnace/burner to
BTU's
Relocated building
(new fix. additional)'
S.F. Residence
(1 bath)"
Duplex (1 bath)
IAdditional bath
IHater service
I Sewer
New circuits alts;'
or extensions
Floor fu rnace
and vent
SERVICES
Recessed ,wa 11
50ace heater and vent
,
I
I
I
I
I
I
I
I
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r
ITempOrary Construction I
IChange in existing I
residence '
I Imultifamily, comm. or
, Industrial
I / 10f 91)0 amps.
I -', j cor~r~1. /IND. FEEDERS
I Install/alter/relocate
distrib. feeders
, I Of 2.~ amps.
I
I
I
..,
.::." .
Appliance vent
separate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatino or A,C.'
Mechanical exhaust
,hood and duct
Wood stove/heater
~.O:>
/ .../l ~
.~.,';A.J ij
each
Storm Sewer
135. 01)
I
I
1,.5.00
I
I
I
,-
.~
'S P 11 C. E' w.F..4:f"p, 1?
H 6I?T ,P!/M I's,
I., .!'..tJ ?o.a:: ~
c:(
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,
I:?m:
ISSUANCE OF PFRflIT
I h.,/Yl
52-tO
this permit
TOTAL CHARGES
WHERE STATE LAW,REQUIRES
shall not be valiJ until the
~co TOTALCHARGES
that tile El ecfri ca 1 work be done by an
label has been signed by an Electrical
~ ~r-!J , .1)0 TOTAL CHARGES
Ele~trical Contra~tor, the el~ctricalportion of
Supervisor and returned to the BUilding Division
I HAVE CAREFULLY EXMlINED the completed application for permit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and a 11 \~ork performed shall be, done in accordance with the Ordi nances of the City
of Springfield and the Laws of the State of Oregon oertaining to the work described herein, 'and that NO OCCUPArlCY will be made'
of any s,tructure without the permission of the Building Divi,sion. I further certify that my registration ~Iith 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 hereon, and that
,".'y "bco""""''"' ,m, 1 OY'~' wbo '" i" com.' li '"" with oe, 70 ::055 will b':2' '" '~1',.: f\O;', ct.
''''IE ( P "", Pd~,J C~rEJ;::Li;;JJ.)~f . "'''ATVRE . ',,,, ~~~. ~ -. ".TE~iZ- z k ..
FOR OFFICE USE ONLY 1
J So. Ftc]. t1ain !y,'; x 7'/.:"~!J Value
i:J"(J~ 'So..;: t~ ItI. =f~"i.~ I : . .., cJ'
Sq. FtIJ. Access;TI')~J7~,,"yU'_';' ,{_, ". ~ . Value
Sq. Ftg. OtherE!i JI.f,(,P,/" x .45' Value
(r:J.P. IJ~. ~~~.,,~ TOTAL VALUATION
1//%/"',. ~~'i\ '\.') 7J.'\ystems Development
o . ..7~'\l." v-ICharqe (1.5r.)
.-(lfJ.~')() I..~~,;.)I . , "
IC.co I
Zone t.-\ . :\
Fire Zone 7Tr
FlOOd PlainlYO
Tyoe/Const. , 17> ;,f,d-wUnits
~
Bedrooms...... Occy Load
Stori es z.. Occy Group i'l~2 , U.4-
t';? !". '8/;/). ~O
7d1.) 'J U"<:. --
J , ~ ."'!-~""
l.~,1.J.1 . /..."
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.-
BUILDING PER~lIT
Charges and
SurCharges
J;;l,. . ;).0
Plan Ck.
65%/Blda
Plan Ck.
30%/Blda
Comm/Ind
Per Fee
Res,
Per Fee
J 771.J..5'
_ _ _ --' _ _3 os .Ct')
PLU~~BING PERMIT
Cha rges and
Surcharges
_______~3s.a?_
Fence
-
" :r; e .00 Sidewa 1 k I
-------~----
d .00 I AlC pavi;n~?(,,7 21.Z;!J I
___~_:..~j~.a?_lcurb Cut, I
',,' J.3;t.1 I
40.00
I
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ITotal Comb~ rermit I
I,L/O
D6mo
ELECTRIC~,L 'PERrm
Cha ryes and
Surcharges
MECHANICAL PERMIT
Charges ~nd
Surcharges
TOTAL
-
,..::., ., ~ ~ '
....,..-- ,; . ~ cJ..
'#~304{.t) 7
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City Hall
, ,Springfield. Oregon .,'
Department of Public Works
OFFICIAL RECEIPT "
No.8 S355~ (
( c~' .
Date~-' '7,'1;. , ,19n\.-; ',I "~ .,',., fro
. <f1/j,;/^() \)(/J n;Jr;6'OYJ, "
,(' Recd From. '{~l (j'l _~'_", ',.Ir"
, ' , 'cJA/)C'- /JL"4y(J/J('l.Y)r/f~{:',al.ll ./
Address ~J.A..'< ), _ /_ {1.1,. ,Jt:u.df1 "' " "
(
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'CITY' OF SPRINGFIELD
City Hall ,
'Springfield. Oregon
Department of Public Works
OFFICIAL RECEIPT,
, , No.8 53557 f
DatePf> -~P>.. . ..'915()~.. .. ?? ",. .
..' ;d' F", A '.! ,r, (,~,)Z m.r1,.., ~/j...m"lJ( ,(.-lTD\(,
'Rec ro'rTY.Lf.-4;A... ~-' , , ' , '7fT'"
',' '.,', .,,-;~, il'L'J (j (llf}~11rn,lr?~1 Ct~v i '
Address,,:, _,__ _ , .....'.,,.. , , . ('
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CITY OF SPRINGFIELD,
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Received For:
(" .t~y)~,.u af7~i?, () L,\ ." ,~"",
( 0ynnl I--:Tla,el ttL f,pp -" '
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, Received For:
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( Amount Received 185f~ ./':--)
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[ AUTHORIZED SIGNATURE
5HE:\.TON'~UANBULL PRINTI[~S . EUGENE. ~R 97401
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, - (-c SH~LTON'TU"N..h.L' PR'NTER5 ' EUGENE. O~ 9740:
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.I- , ., , ' ." : .. '" - -~.. ~Vl-'J QIlU r:~ c~rrl : It' to the ~.
" . appllcant at the tlme the actual permlt 1S lssued for h': .
signature. ' h...
'IV. Fees and Charges
Plan check fees are due and.payableat:thetime of the
application, and no plans 1'1i1l be processed until these
,fees are paid: ,All other fees and charges' are'~ue and
payable when the permit is issued.
l" '
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.. '
. .
'. . ~
v. FOR OFFICE USE ONLY
Permi t Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,
AD ~~~.~r.?.~ '1,~.J2A".jv.:LJ...J /\i.4-u,;,~ _C'~-.'!.:> .
t\ rr ' , , ,II
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.':~"',,'\Pef.mit applicant exempt from registration with the Builder's Board becau,se:
-
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Additional' Project Information: _,~.4.:'" A.A.....-:'~......::.r....A..-t~....-(',...~-U''?
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l..:A:f'r'....-'C/~ ~.//.......?--t...~_~.A_..:, ,_ c_."..,'...' -0.......
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PLANS REVIEWED BY: "
name
, ' /'"'
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signature AL"a......:... ~L.
,
date ,:}.-L.j-Yc
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