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Home My WebLink AboutPermit Building 1981-2-2 INSPECTION LINE 726-3769 . . ~ITY OF SPRINGFIELD CO~TION APPLICATION/PERMIT I ENERGY SOURCES: Heo'~""'.N'. I Water Heater ........../,t"J.- Ranqe '" Ir~ I Value of Work: ,S't ~ """". c.o Job Address ~O~ "It ~-n;:l.I,JA 1./ Loo~ :;. crOll ,., - 03 -2.2.-2.0 legal Description Owner 'foo. r"',.,\"'$n,,'e~ (.....,l:+ C'. h ""lID- r ~ (I",,' 0,", Phono 1-43-1..003 Building Permit Info: Describe Work (i.e., Build Single Familv Residente With Attothed Goroce) ~5e- Address Construction lender tJDr ;l?~,~< ~CC=. Address Phone DESIGN TEAM (address) (Iics. no.) (namel Primary '5otS<.,1'" Structural Electrical Mechanical CONTRACTORS (nome) (address) Wes. no.) General b,' /I !-be: l:M" '" 2 ~1..1I PArl-1(; "2-4- 2.~ Plumbinq Electrical ~ell(lft, >../e CTL/C . p.I>' Bov ).:;).1. Methonical PLUMBING ELECTRICAL NO, FEE FEE I CHARGE NO. I CHARGE NO. I It I Residence of sq: ft. New circuits, alterations or extensions' Eoch sinQle fixture Relocated building . (new fix. additional) S.F: Residence (1 both) /.5.05! J50~ SERVICES Duplex (1 both) each Temporary Construction Additional bath Amps. Water service Sewer Storm Sewer FEEDERS Ampl. I I I 'I (, . INFORMATION LINE 726--3753 w Sq. Ftg. Main Sq. Ftg. Access. Sq. Ftg. Other _New_Add~Alter _Rep. _Fence_Demo_Changel Use _Other. - o ~, , , \_i ~ b "'\ o~~/c oS:' . (expires) (phone no.) (expires) {phone noJ q -/<;,-BJ L ~t-tf()9 '" '=W;' ,.-t- q,,('. Jut MECHANICAL FEE CHARGE furnacel burner'. to I~TU's Applian~e vent sepora Ie Stationary evap. cooler Vent fan with sinqle duct Vent system aport from heatinq or A.Co Mechanical exhaust hood and duct Wood stove I heater Heat Pumo Air handler to 10,QOO CFM Air handler over 10,000 CFM ISSUANCE OF PERMIT TOTAL CHARGES - 0- TOTAL CHARGES 15.0!J TOTAL CHARGES o~ WHERE STATE LAW REQUIRES thot the Electrical work be done by the Electric;al Contrador, the elec;trical portion of this permit shall not b. valid until a label has b_n signed by an Electrical Contractor and anached to Ihe electric;al panel. I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that all information nereon is true and carrect, and I further certify that any and all work ~rformed shall be done in occordan,ce with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work delcribed herin, and that NO OCCUPANCY will be mode of any structure without the permission of the Building Division. I further Qlrtlfy that my re-gistration with the Builder's Board is in full forQl and effect os required by ORS 701.055, that if exempt the basis for exemption is noted heron. and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. Balli for Builder'l Boord exemption' NAME (please print) \lI. I~NA ,J SIGNATURE jlJ~ ~ DATE 2--2.-11 FOR OFFICE USE ONLY Zone c..q(~~t...,,~o.'1~ype/Const.~"i Fire Zone Bedroom' Flood Plain Ctori... Units "ccy load --L.4 Occy Graup ~ .:-J Sq. Ftg. Main Sq. Ftg. Acceu Sq. Ftg. Other BUILDING PERMIT Charges and Surcharge 1 Plan Ck. Comm/lnd 65~ol Bldq Per Fee Plan Ck. Res 30%1 BldQ Per Fee 5,~b 8 <>0 .- 432 PLUMBING PERMIT Charges and Surcharges I I I I o I ---------1 Curb Cut o Fence Demo ELECTRICAL PERMIT Charges and Surcharges / 5. 09 .100 Sidewalk Alc Povino MECHANICAL PERMIT Charges and Surchargel x Value Value x x Volue.q' TOTAL VALUATION r?DC. ~ Systems Development Chortle 0.5%) Total Comb. Permit f!,oJ;;{, do. I, TOTAL _ ._>ri.~. I. Applicant to furnish A. Jab lddress B. legal Description 1. example-tax lot 100, lane County Map Reference 17 03 43 2. example.lat 1, Black 3, 2nd Addition to Springli, , C I T Y 0 F S P R I N G FIE L 0 C. Name, etc. of owner and construction lender ( D. Energy Sources 1. example-heat/electrical ceilf~g/o-~' forced air gas 2. examole-water heater/electrical/or solar E. Square footage or valuation, etc~. .- 1. example.1250 sq. foot house, 500 sq. foot gorag 2. example-if new project, che:ck :;;;Waif addition, cI c-' add, etc. . ( '. F. ,. Building permit information: 1.. ..examp/e.construct single family house with an a g9rage" ( 2. example-remodel existing garage into family rOI 3. .example-cC?nverf 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 con'struction delays, Building Oh C. Staff must be cble to contact appropriate persons n design information or job site cor:rections, etc. , 1,,,\""', COMBINATION APPLAION/PERMIT (CAP) II., Abbreviated Plumbing, Mechanical & Electrical Schedu: A. Except where blank spaces occur in the description of the Mechanical and Electrical Schedules, the app need fill.in only the No. Boxes adjacent to the appr item(s) to be installed B, Full Plumbing, Me<:hanical, and Electrical Schedules are available at the Building Division 1. To conserve space on the permit form the schedl have been abbreviated 2. If the item(s) to be installed are not covered on t ated schedules you should consult the full schedl C. BUilDING DIVISION STAFF WILL FilL OUT ALL FEES CHARGES ON THE SCHEDULES III. Applicant to sign and dale Whenever possible. the initial application will be used .,worksheet only. Where possible, Building Division Staf prepare a typewritten copy and return it to the applicc the time the actual permit is issued for his si~nature. IV. .] . PERMIT VALIDATION ( City Hall Springfield, Oregon Department of Public Works OFFICIAL RECEIPT ( ( .. C1 {NO. 8 5 5 7 4 0 ( Date 2 ~3 190 Rec'd Fr~ U):~1t'_' ( Address 1 A 2 'j P (l}..}ll yt- "'-?, ,. Received QA-~ ~~ (" ( ( ( bf--J ( '2) .00 ~2 15.60 .100 cc-p 4O)/) {a ~)D C I (' /)'fY) PC r:: c c t=) zn ( c ( ~mount Received '2R,J1- (' J? Ln ( ~t BY , --C" ( AUTIf:JI:IIU:O SIGNATURE '''I!:~TO''.TUIII''.Ul~ ..I'''TO<IIIS . [UGU.[. 0111 IUO' I ...".& \... Fees and Charges .. Pion check fees are due and payable at the time of thE t;.p' and no plans will be processed until these fees are poi+-:- . . . . 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: ( .'0 Permit Clerk ~ .'. I' ". . '" -;~ . ~...r__..... "/, (""'," ", ~:r .'.. :~ ;j 1 . ~. , 7 : .;!~:;...;.: . .:-?-, Y. ,. ... "..".. .~ '. '':fl '~l , -r1 M"! nom.... -r::...... 5\~<1"rb.J:.o\- 1'-~ 1 ;-,,,^-- A l ~ S.,) 1..'2~ I~ f", I " 'iignature date - .'~' . . . .f.: . ~ :..'>~~ :-~: c.:L:: " . -, .:.t ;~:{j~~%E~~':;",>:.'._d~Li -~ '.