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Home My WebLink AboutPermit Building 1981-5-5 ~ I I I INSPECTION LINE 776-J769 r.->....,. ." ,. CITY OF SPRINGFielD COMBINAJlON APPlICAJlON/PERMIT . INFORMATION LINE 716-37,53 IG\) Job Add,... ~ 3 :j..CJJJUJ Uw Dr L'goID,,,,;pHon I 00 I. II n 3 21 4 :f- . I ENERG~jl!'RCES' Heat ~ I Water Heoter Ranqe _ I Value of Work: . Sq. Fig. Main Sq. Fig. Acceu. Sq. Fig. Other _New_Add._Alter_Rep. ___Fence_Cerna_Chonge' Use _Other I Building Permit Info: Describe "York (i.e.. Build Single D Familv Residenc"'! With Attl'lched Gerace\ -S( fJoto u) ((t-D / ----crJaY UOJ I {2\ Ll) l~ 0 ) ~. D (jJ Own" ~l1 Kt(Ul IV I Add,... P1n~ 1-D:t>> lm) Phon' : C:;~'~d~~~I-e ctJiDk-- I Add,eu ! DESIGN TEAM ~ Phone (nome) (address) (lies. no.) (expinH) (phone no.) Primary Structural Electrical Mechanical CONTRACTORS (nome) G""ol (l-h"Y\. JlJQ. y" (address) (lies. no.) (expires) (phone no.) H()~ Plumbinq Electrical Mechanical II I I I I I I I I I I I I I I r I TOTAL CHARGES I WHERE STATE LAW REQUIRES that the Electrical work be done by the Elertrical Contractor, the .Iedrical portion of this permit shall no. b. valid until C' - _. label hos been,ignod by an Electrical Contractor and attaeh.d to tho oledrieal panel. -_._.._=--_~~~~_____ -I~____~~~_..__,. ,l_..__. ~:~~-=IC~~_~__-~-' NO. I FEE . CHARGEtNO~ ' . . FEE CHARGE I NO. I HE . CHARGE I I Re,idence of . furnace/burner to Each lin~le fixture ..,: ft. D..TU'l Relocared building I New dreuih. alteralionl Appliance vent (new fbl. additional) or elltenlions ,eparatlt S.F. Relidenj:e I Stationary evap. (1 bOlh) SERVICES cooler I ~ntfonwi~ Duotel( (1 bafh) each . Temporary Conltructian ,in~le duct Vent sYllem aport from . heating or A.C. M.chanical OllhaUll hood and d~ct Additional bath Amps. Water service Sewlllr Wood llove/healer Star.m Sewer FEEDERS Heat Pump Air handler to 10,000 CFM Ampl. Air handler over 10.000 CFM TOTAL CHARGES ISSUANCE OF PERMIT I TOTAL CHARGES I HAVE CAREFULLY EXAMINED the campleted erpplicertion far plllrmit, and do hereby certify thert erll informertion hereon is true ernd carrlllcl, ernd I further certify that any and all work performed ,hall b. done in accordance with the Ordinances of Ih. City of Springfield and th.e Laws of the Stat. of Oregon pertaining to tho work deluibed herin, and thai NO OCCUPANCY will be mad. of any sfTuetur. wilhout Ih. permission of the Building Division. I further cerllfy thai my re-giltrolion with Ihe Builder's Board ii in full foreo ond effect as required by ORS 701.055, that if u,empt the bali, for uemplion ii norad heron, and that only $l,rbcontroctors'and employees who ore in complioneo with ORS 701.055 will be uad on this project. Basi. for Builder's Board e}lemplion: NAME (pl.o.. p,;nt) X/)tJ;' fP /1> Y 13 t9 A- ) S" / "'''NATURE.a)~ ~a_ DATE , ,J FOR OFfiCE USE ONLY p/ Zone Typel Canst '!nih Sq. Ftg. Main Fire Zonlll Bedrooms _ r ""cey Load O:;;q. Ftg. Access Flood Plain Illorie- nccy Group Sq. Ftg. Other BUilDING PERMIT 1..:5.00 Plan n. Comm/lnd Charges and 65%/ Bldq Per Fee Surcharges Plan CX. Res 30%1 Bldq Per Fee PLUMBING PERMIT I~ ()O Charges and Fence Surchorgei (/7() Demo ELECTRICAL PERMIT J n.OO Charges and Sidewatk Surcharge. "40 AI C Pavino MECHANICAL PERMIT Charge, and Curb Cui Surcharges .------- x Vol",o Valu. VO/Ub x x . TOTAL VALUATION Systems Development Charqlll (1.5%) I Total Comb. Permit '1 TOTAL 5100 COMBINATION APPlICATION/P.IT (CAP) 'I. Applicarit ta furnish A. Job Address B. legal Description 1. examole-tox lot 100. lane County Map 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 air gas 2. exomple4water heater/electrical/or solar E. Square footage or valuation, etc. 1. example-1250 sq. foot house. 500 sq. foat garage 2. example-if new project, check lieW.if addition, check add. etc. F. Building permit information: . 1. example-construct single family house with an attached garage 2. example.remodel existing 90r09& 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 ~orrections, etc. II. Abbreviated Plumbing. Mechanical & Electrical Sched~les , A. Except where bl~n:k sp~ces occur in the, description portion of the Mechanical arid Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate. ite.m(s) 10 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 schedules hove 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. Applicant to sign and date Whenever possible, the initial application will be used as a worksheet only. Where possible. Building Division Staff 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 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, nom'" "iignatur~ ." PERMIT VALIDATION ~. . ,/ Permit CierI- j -fatl"" INSPECTION UNE 726-,3769 .~ ~. CITY Of SPRINGFIELD COMBINAJlON APPlICAflON/pERMIf. . Job Add.... eL> 3 .::}cwU.J cW.J Or L'901 D,,,,;pt;on I 00 (I 11 n 3 21 4/_ I ENERGUQJJRCES, Heat \- ~ Water Heater Range Value of Work: Own.. ("v,vntYL( 1 ~ (lJJ r\... Add"" ~n~ 1--n pM l.tLl) . Phon' I c:n:r:,:::B'-f'-R a) i Q~ I Addr.1I I DESIGN TEAM I Primary I StruC'turol I Electrical I Mechonicol I I G<!'nerol I plumbina I Electrical INfORMATION LINE 126.3153 ,0\) . Sq. Ftg. Main Sq. Ftg. AC'cen. Sq. Ftg. Other _New_Add _Alte' _Rep. ___fence_Demo_ChongeJ Use _Oth<!'r or--,. , D OJ - () Building Permit Info: --De,cribe \york (i.e.. Build Sing I. Familv Residence With Attached GoroQe) 0.LYloR 0 (A) I r1..P -' ----aJQhf UQJ \4 In l~l 0 ) " I I r I TOT At CHARGES I WHERE STATE LAW REQUIRES that .h. Electrital worle b. done by tho Elertrical Contractor, the electrical portion of this permit .holl no. b. valid until C!l label hos b_nsignod by an Elec.rical Contractor and attached to the .I.drieal panel. Phone _ (addreu) (lies. no.) (name) (addreu) (ljC's. no.) (namel CONTRACTORS (f toY\. iDfL ..v f-l. nY'f\-.R.. Mechanieal PLUMBING ELECTRICAL NO. I FEE CHARGE FEE , CHARGE NO. Re,idence of faeh sin!=lle fixture Relocoled building (n.w fix. additional) S.F. Re,iden~. (1 bath) Sq: ft. New cireuih, alteration, or tllltensien, SERVICES Duolu (1 bath) each . Temporary Con,truction Additial1al both Amp,. Water ,.r...ice Sewer Stg,.m Sewer .FEEDERS Amot_ TOTAL CHARGES (upiru) (phone no.) I I (upire,) (l:Iha,;o no',) r ! i~ MECHANICAL ;'''''1 / I NO, FeE I I I I I I I I I furnoeel burnor to BTU', Applianee ....n. separate Slotionary e...ap. cooler Vent fan with 'Ingle duct Vant system apart from . heotinq or A.C. Mechanical ellhou,' head and duet Wood sta...e/heator Heat Pump Air handler 10 10.000 CFM Air handler o....r 10.000 CFM ISSUANCE Of PERMIT I TOTAL CHARGES I HAVE CAREFUllY EXAMINED the eampleted application for permi., and do hereby certify that all infarmatian hereon is true and correct, and I further certify tho. any and all work performed 1hall be done in aecardance with the Ordinances of the City of Springfield and the' laws of the State of Orogan per.aining to tho worle de,cribed herin, and that NO OCCUPANCY will be made of any ,tructure without the permission of the Building Di...i'ian. 1- further certify that my regi,tration with the Buildor's Board is in full force and effeC't os required by ORS 701.055, that if u.empt the ba,i, for uemption Is noted heron, and that only ,ubeanfrac1ors and employees who are in compliance with ORS 701.0.55 will be ulad on thi, project. Basi, for Builder's Board exemption: __ /J - fl _ A NAME (pl.o.. p,;n,jx./)tJJQ/ II> V 8t5/A- ) S" "GNATUREtJ7/~~ ~DATE / -' fOR OFFICE USE ONLY /' _ Zon~' Typel Canst I!nits Sq. Ftg. Main Fire lone Bedrooms n "cy Load Sq. Fig_ Aceeu . Flood Plain c.torie ""ccy Group Sq. fIg. Other BUilDING PERMIT 1-5'00 Plan Ck. Comm/lnd Cherges and 65~.1 B/da Per Felt Surcharge, Plan Ck. Ros 30%1 Bldo Per Fee PLUMBING PERMIT I~ bO Charge, ond Fence Sureharge, ( t'7() Demo ELECTRICAL PERMIT I n. 00 Cho'ge, ond Sidewalk Surcharge, "10 Alc Pa...i",~ MECHANICAL PERMIT Charge, and Curb Cut Surcharge, -------- . Value Valu. Valu. . . . TOTAL VALUATION Sy,tem, Development Char.,. (1.5%1 Total Comb. Permit I I '1 TOTAL 5100 -::~....,.....>._=_..~.;.c:;;".~':'--:;:"':X"..:~;~r-r>.::..:::.:....;'':''''''''''''-''-''''''._~'- . . COMBINATION APPLICATION/PERMIT (CAP) 'I. Applicarlt ti> furnish A. Jab Address B. legal Description 1. example-tax lot 100, lane County Map Reference 17 03 43 2. example-lot 1. Block 3, 2nd Addition to Sprir ". . . - C I T Y 0 F C. Name, etc. of owner and construction lender ( D., Energy Sources L example-heat/electrical ceiling/or forced air 2. example.water heater/electrical/or solar E. Square footage or valuation, etc. 1. example.1250 sq. foot house, 500 sq. foot go. 2. example-if new project, check n;w.if addition add, etc. (' F. Building permit information: . . L example.construct single family house with or garage ( 2. example.remodel existing gorag& into family I '- 3. exomple: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 Oi q.ol Staff must be able to contact appropriate persons I design information or job site ~orrections, etc. II. Abbreviated Plumbing, Mechanical & Electrical Scheele A. Except where blan'k sp~ces occur in the. description of the Mechanical and Electrical Schedules, the app need fiB-in only the No. Boxes adjacent to the appr il,,",(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Division. . L To conserve space on ~he permit form the schedu hove been abbreviated 2. If the item{s) to be installed ore not covered on tt ated schedules you should consulttlie full schedu C. BUilDING DIVISION STAFF Will Fill OUT All FEES) CHARGES ON THE SCHEDULES . , ..-.. ',r;. . I.~ PERMIT VALIDATION L/'" ' .~~.t~~:,:.~.;:. ..:..~ :.... " ~, (. S P R IN G FIE to City Hall Springfield. Oregan Department of Public Works , OFFICIAL RECEIPT No. B 56431( 5-.~,' 1Ar \' Dat~ ' 'fYlr(l{-/(\l1t\.QC\01\), ( \ Recd Fr:;r\~' Il()-, if J )/ Q)R ') DC- ' Addre5'f_l... .J....}...J l,b^ - ( ( (. Received For: mtt f;P -- ( p~ ~OJ() . ~o n ( '1K ' ~01o ( \ I I 111. Applicant to sign and date Whenever possible. the initial application will be used Q: worksheet only. Where possible, Building Division Staff , prepare Q typewritten copy and return it to the applicQm the time the actual permit is issued for his signatur(.. ( Amount Received V) t O~ c.&---- ( ( ., U (\p 1 AUTHOIII:U:D SIGN.t.TUIU: 'H~LTO"'TU""'UI.L ~.'''TI''S . CUGIlNIl. Oil 1,..0' ( ...".s c IV. Fees and Charges Plan check fees ore due and payable at the time of the OJ fCc and no plans will be processed until these fees ore paid. .+-1 . other fees and cnarges.are due and payable when the perml1'- . . is issued. t: --_....-- '-. V. FOR OFFICE USE ONLY Permit ClerJ, ,. PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ~. . Additional Project Information: PLANS REVIEWED BY: name signature date . .... " . ..' ~~~~~~~;:itL\.~;:r:.;;1~_;~~~ -,;~~~;a~~~t~~~ ",~~~:":~'~~4;;.:{~i.,~~ . '-:-:':".~-"'~',,-"'.::.,;:;-~:' .".- , - , < '. ~~