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Home My WebLink AboutPermit Building 1981-1-13 o . CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT . INSPECTION LINE 726-3769 .J\. INFORMATION LINE 726-3753 Job Add"" \ C)\.\ S G~1 Q U,:n _0 V kf P . ~~:RGY SOURCES, ~::::: :::". \..C'. ~ 1\ i'\ Wole' H.o'" Sq. F'g. O.h" legal Delcriptian_ ___'l._^-ll J.. 0 )\.1 H 1 Ranoe _New_Add_Alter_Rep. 2~' .no ~ 2- ~ -z...O Vol;oo! Wo,k, ~, D.mo_Chong./Uw - C ~ ,,3200c..l Oth" Own.. ~, ' fJ '1\'\\0. i\h(\C:\ ~\"'~ . ttf::)CD I . , " Building Permit Info: Delcribe Work (i.e., Build Single Address Phone Familv Residence With Attn...h..rl Gnr,,"'~l II -0 J'\rr' \'\. '~'f\O)" (\ ~ 0 ~ Construction lender , I Add"" Phon. C ~po . M \ I ~ DESIGN TEAM (nome) (addrenl (liu. no.) c \:'It) _<D t- W I (J') ~ 'Y'... \JOn ., ,~\ "(\0 \ \5- -(\\~ Primary Structural Electrical Mechanical I CONTRACTORS (name) I G..."Hrtt'J. Q -t ~ I I ~ Plumbina I Electrical if\ '0 (address) p., ~1?:Q. (lies. no.) Mechonical PLUMBING ElECTRICAL NO,I FEE Water len'ice CHARGE I I I I I I Amps. NO, FEE CHARGE Residence of \q: ft. New circuits, alterations or extensions Each single fixture Relocoted building (new fix. additional) S.F. Residence (1 bolh) SERVICES Duplu'(1 balh) each Temparory Construction Additional both Sewer Storm Sewer FEEDERS Amps. I r- '1 I TOT At CHARGES I TOTAL CHARGES ,^O ,~U~('X-~. ,I 'I il CHARGE I 'I I ,I (expires) (phone no.) ~.. ~t ~ FEE 'I WHERE STATE LAW REQUIRES that the Electrical work b. don. by the Electrical Contractor, the .Iectrical portion of this permit shall not b. valid until a label has b_n signed by an Elemicol Contractor and attached to the electricc!! panel. (excires)' (phone nu,) I HAVE CAREFUllY EXAMINED the tDmpleted application for permit, and do hereby certify that all information hereon is true and correct, ond I further certify that any and all work performed shall be done in accordance with the Ordinancas of the City of Springfield and the laws of the State of Oregon pertaining to the work described herin, and that NO OCCUPANCY will be made of any dructure without the permission of the Building Division. I further certlfy that my registration with lhe Builder's Board is in, full force and effect 0 s required by ORS 701.055, that.if exempt the basis for exemption is noted horan, and that only subcontractors and employees who ore in c:amplianee with ORS 701.055 will be used an this project. Basis far Builder's Board exemption' -/ ~ / L ~ <>? // " ..--- ---- NAME (please print' IlZov,' C:IGNATURE 14vAS 5 FOR OFFICE USE ONLY ~ lon- Fire Zone flood Plain Type! Const. Sedroam' Sq. Ftg. Main Sq. Fig. Accen Sq. Ftg. Other Unih "ccy load ......"y Group Ctori~" BUILDING PERMIT Charges and Surcharges Plan n. Comm/lnd 65%!BldQ Per Fee Plan Ck. Res 30%/ BldQ Per Fee \O.CD PLUMBING PERMIT Charges and Surcharges fence I Total Comb. Permit Demo ElEaRICAl PERMIT .Charges and Surcharges Sidewalk I I I I TOTAL AI C Povinn MECHANICAL PERMIT Charges and Surcharges I ---------1 Curb Cut MECHANICAL NO. furnace! burner to :lTU's Appliance vent separate Stationary evap. cooler Vent fan with single duct Vent system apart from heating or A.C. Mechanical exhaust hood and duct Wood stave/heater Heat Puma Air hondler to 10,000 CFM Air handler over 10,000 CFM ISSUANCE OF PERMIT TOT At CHARGES DATE Value Value Value TOTAL VALUATION x x Systems Development CharQe fl.5%1 ~ - 13-<6\ tD.oc0 ." . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant 10 furnish A. Job Address B. legal Description 1. example-lox lot 100, Lane County Map Reference 17 03 43 2. exomple-Lot 1. Block 3, 2nd Addition to Springfield Esloles C. Name, etc. of owner and construction lender O. Energy Sources 1. example-heat/electrical ceiling/or forced air gas 2. example-water heater/electrical/or solar E. Square footage or valuation, etc. 1. example-1250 sq. foot house, 500 sq. foot gorage 2. example.if new project. check new-if addition, check add. etc. F. Building permit information: 1. example-construct single family house with on attached, garage 2. example-remodel existing garage injo family room 3. example-convert single family residence into restaurant (change of use) G. Value of work os defined in Section 303 (0) of the Structural"Specialty Code H. DESIGN TEAM AND CONTRACTORS To ovoid 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 of the Mechanicol and Electrical Schedules, the applicant need fill~in only the No. Boxes adjacent to the appropriate item(s) to be instolled B. Full Plumbing, Mechonicol, and Eleclrical Schedules are available at the Building Division 1. "To conserve space on the permit form the schedules have been abbreviated 2. If- the item(s) to. be installed are not covered on the abbrevi~ ated schedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON'THE SCHEDULES , III. Appiicant to sign and date Whenever possible, the initial application will be used as a worksheet only. Where possible. Building ~ivision Staff will prepare a typewritten copy and return it to the applicant at the time the actual permit is issuad 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 Project Information: PLANS REVIEWED BY: nam--:- ~ignatur"" , Permil Cler~ . ,.. . PERMIT VALIDATION " "'ate . INSPECTION LINE 726-3769 ,'"\ . , ""<'~:' '. INFOIlMATION LINE 726..3753 CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT Job Add"" \8'-\ S G{\ 1: Q L~ TI 0 p tsI 0 l.gol O",,;pl;on \\ 01 j rO ) \. ~ A I ENERGY SOURCES: Sq. Ftg. Main Sq. Ftg. Access. Sq. Ftg. Ot"'er _New_Add_Alter_R.p. ~~ O.mo_Chong./U.. Other. ~. ~' .J Her' Water Healer . Addreu Phone Ranqll' Value of Work: 320.009[,(, CO 'I Building Permit Info: De~~ribe Wo;k (i.e.. 8uild Single Familv Re5idl!nc:n With Attached Gorogel ..(') n(0' f'\ \ ~C \ (\~10 J ( f->p0 , 0(1. \ Own.. (\ n. \\ r I {'\ n (\\0-)\ b (\ <::\ ~~~"1' Address Phone Construction lender DESIGN TEAM (name) (address) (lies. no.) (expires) (phone no.) Primorv Structl,lral Electrical Mechanical CONTRACTORS (nome) G.n..~ttt\!. 01. f)'{\. l (address) (lies. no.) (upi,e,) (ahone no.) Plumbinq V\ \S <c:.2 c< rv.r. C) ,l'/:"(\ "~JDt'Q~n_')I."n\0.~~ \' Q \~, .1\ (1 2,UsA(,,-~' Eleclrical Mechanical PLUMBING ELECTRICAL MECHANICAL I NO. j I i FEE I CHARGE NO. FEE CHARGE NO. FEE CHARGE Residence of furnace/burner to ~TU'5 Appliance vent separate Stationary evap. cooler Vent fan with sinqle duct Vent system apart from heotinq or A.C. Mechanical e.llhoust hood and duct / EClth single fjxture Reloc:oted building (new fix. additional) S,F. Residence (1 bOlh) -,:ft. New circ;uits, alterations 01 extensions SERVICES Duplu'(1 both) each .Temporary Construction Additional bath Amps. Water service Sewe, Wood stove/heater Storm Sewer FEEDERS Heat Puma Air hondl.r to 10.000 CFM Air handler over 10,000 CFM Amps. I -t I TOTAL CHARGES I ISSUANCE OF PERMIT TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES thai the Electricol work be don. by the Elutrical Contractor, the electrical portion of this permit shall not be valid until a label has b_n $isned by an Electrical Contractor and attached to the electrical PQneJ. 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 that any and all worl( performed sholl be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining to the work described herin, and that NO OCCUPANCY will b" made of any structure without the permiuion of the Building Division. I further certlfy that my registration with the Builder's Board is in full force and effect as required by ORS 701.0SS, that ,if exempt the basis for exemption is noted heron, and that only subcontractors and employ"s who are in compliance with ORS 701.oS5 will be u.sed on this project. NAME (please print" T,",~ ~VAS 5 .-- ~~...... ...... ) /" C"~NATUR~ ~ /~7 .~~ FOR OFFICE USE ONLY ~ DATE t - (3-<6\ Basis for Builder's Boord exemption. lon- Fire lone flood Plain Type/Canst Bedrooms Ctorier Ilnits I"'\ccy load Occy Group Sq. Fig. M~in Sq. Ftg. Access Sq. ftg. Other x x '.'alue "olue Yalue TOTAL VALUATION BUilDING PERMIT Charges and Surcharges \ () .CD Plan CIt. Comm/lnd 65%/ Bldq Per Fee Plan Ck. Res 30%/Sldq Per fee Systems Development Charae C1.S%) . '-- PLUMBING PERMIT Charges Clnd Surcharges Fence Demo Tolal Comb. Permit ElECTRICAL PERMIT Charges and Surcharges I I I ---------, Sidewalk AIC Pavino MECHANICAL PERMIT Charges and Surcharges I TOTAL to. ,OcJ Cufb Cut A. Job Address B. Legal Oescri ption 1. example-tax lot 100, Lone County Mop Reference 17 03 43 2. example-Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example-heat/electrical ceiling/or forced oir gas 2. example-woter heater/electrical/or solar E. Square footage or valuation, etc. 1. 'exomple-1250 sq. foot house, 500 sq. fool garage 2. example.if new project, check new.if addition, check odd, etc. . F. Building permit information: 1. example-construct single family house with on attoched garage 2. exomple.remoJel existing garage inio family room 3. exomple.convert singie famiiy residence into restaurant (change of use) G. Volue of work os 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 contect appropriate persons regardin design information or job site corrections, etc. . COMBINA nON APPLlCA nON/PERMIT (CAP) I. Applicant 10 furnish II. Abbreviated Plumbing, Mechanical & Electrical Schedules A. Except where blank spaces occur in the description portion .of the Mechanical and Electrical Schedules,.the applicant need fill-in only the No. Boxes adjacent to the appropriah item(s) to be instolled B. Full Plumbing, Mechanical, and Eleclrical Schedules ore available at the Building ~ivision 1. To conserve space on the permit form the schedules have been abbreviated 2. If. the item(s) to. be installed are not covered on the ab oled schedules you should consult Ihe full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES III. Appiicant to sign and date .. Whenever possible, the initiol application will be used as a worksheet only. Where possible, Building Division Stoff will prepare a typewritten copy and return it to the applicant O. the time the actual permit is issu~d for his signature. IV. Fees and Charges Plan check fees ore due ond payable at the time of the apl. and no plans will be processed until these fees ore paid. A other fees and charges ore due and payable when the pel is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: PLANS REVIEWED BY: nam"':' ",ignaturp' · PERMIT V AL'I~tic:N ( CITY OF SPRINGFIELD City Hall Springfield, Oregon Department of Public Works OFFICIAL RECEIPT ( c ( \ No. B DOle/>\(\n " \ ~ 19'K\ Rec.J ~l-l~ ~ \_~ '. \(") , Add:... ~>23~~t\~l~\~(( _Received For: 55571 (., ( (\\r~ \:') ~ (;;)\ if'\CQ ~- ( r ,( ( ( ( " ( ( ( ( --'._.-.~_.- : A (~ mau~! Receiv~d ~_) ~ ----.r _L---- ( ~, ~ '\~\f'f'~ ."[~TO'" TUN".U: 1ol0lllr D srG"'A,TURE Q ~ ~''''OT['',.. IUGI..!, 0.. 9"'''0' ..511.1 c_ in. ~ a... --CI C +- (I J ...late