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Home My WebLink AboutPermit Building 1989-8-8 :- 1"- , ..... . ~(\ '- 1\\')\ \) \ ;) 1"i? . CITY Uf SPKINGffELO COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat liater Heater . INFORJ1ATlON LINE 726-3753 Sq. Ftg. Hain ~q: Ftg. Access. Sq. Ftg, Other Ilew Add Alter Pep. --Fence Demo Change/Use Other -- - < Il~NSPECTION LINE 1)1726-3769 Job Address \~(,'i ') . Address DES I GN TEAl1 (name) Phone (address \ Range_ ValUE of Hark: '9f~2 . ""'= B~1(til~Q Permit Info: Oescr1be Work(1.e.. Build Single Family Residence Hith Attached GaraC'el M<~"/L<' ~.P ~..4/77'~.?, ~A41s:.c? / ...v-?v~r""""__ ~ ~~""..1'''5".__ <; k/j '2ft7F'-~ Eu:&.(, U?i'ce-r75. . (lies. no.l (expires) (ohone no. ~ I~ IV) Legal Description Owner \-\ A Q ,,s-p. Address EJ'\O u.. ") . '-<Ut \' 1\.\ J( n.. 'I Phone const~:S;~t') I (( J,A Q r Oi-4il Primary Structural Electrical Mechanical CONTRACTORS (name} (addrpss \ General ~:J?:.J"LZ:>~ ~.Ar7~ ~~/'5>'"~ Plumbino Electrical ~Y'N~ C/~. {lies. nQ.' lexniresl ya>-D 5~a.E >""' :::l'- . -'5i"'~u, ......,....-< . (' (nhnnp nn.' ?5I'd:.- :i;>/Cl::> ~1echani ca 1 PLUliB I NG ELECTRICAL MECHANICAL " NO. FEE CH4RGE Nn FFF r"ARllL NO, FF~.tHAB.G.E. SQ. FT. furnace/burner to BTU's Each single fixture Residence of Relocated building (new fix. additional) S.F. Residence (1 bath) Duplex (1 bath) each Additional bath New circuits alts. c:- or lliensions -.L <fl'f ~ SERVICES ~~ Floor furnace and vent Recessed wall ~O~CP hp~tpr ~nrl vpnt Storm Sewer Of amps. Appl iance vent _ _ ..ie.D!,rat~ Stationary evap. c('nler Vent fan with sinale duct Vent system apart from heatinq or A.C. Mechanical exhaust hood and duct Wood stove/heater Sewer Temporary Construction Change in existing r~s 1 d~_nce multifamily, COI11t1. or Tndustrial Water service CD~~./IND. FEEDERS Install/alter/relocate distrib feeders Of amps. TOTAL CHARGES WHERE STATE L~H REQUIRES shall not be vali1 until the I SSUANCF OF PFRIlIT ~ TOTAL CHARGES -z?-.sO ' , TOTAL CHARGES that the Electrical work ,be done by an, Electrical Contractor. the electrical portion of this permit label has been signed by an Electrical 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 all work oerformed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of OreCJon pertaining to the work described herein. and that NO OCCUPAr~CY will be made of any structure without the permiSSion of the Building Division. I further certify that my registration with the Builder's Board is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on 'this project. )0"/"//"; ~ ~5tC;: SIGIIATURF.~ J d FOP. OFFICE USE DIlLY Sq. Ftg. Sq. Ftg. Sq. Ftg. IWIE(please print) DATE cY'~?-t:?1 , Value Value Value Zone Fi re Zone Flood Plain Type/Canst. Bedrooms Stories Units Occy Load Occy Group Hain Access Other , , BUILDING PERfiIT . ___.8?~-S<!:> ' Pl an Ck. Conm/Ind Charges and 65~/Rldo Pj'r Fpp Surcharges 4"-t:P5 Plan Ck. Res 3D%/Bldo Per Fee PLUt1BING PERMIT Fence Charges and ------------ Surcharges D/jfi1O ELECTRICAL PERliIT , -z::<-So 'Sidewalk Cha rges and ------------ Surcharges 1~13 A/C Paving MECHANICAL PERMIT Curb Cut . Charges and ------------ .Surcharges TOTAL VALUATION 'syste.ms. Development' ~/ A' CharQe (I. 5~ " /V ___ Total Comb. Permit TOTAL (C:;B '/6 , " . . ., c .' ~' '--1.'f , . PERMIT VALIDATION COMBINATION APPLICATION/PERMIT (CAP) " I, Applicant to furnish A. Job Address B. Legal Description I. example- Tax Lot 100, Lane County Map Reference II U3 43 2. exam~le- Lot I. Block 3. 2nd Addition to " 'sprlngtield Estates " -~, ',,>,,.,, C. Name. etc. of owner and construction lender D." Energy Sources " " " ...: ~l. examele- he~t/electr;cal ceilin9/or forced air Q3S ,'" 2. examDle~ waterheater/electrlca Ilor solar .... E. Square footage or valuation, etc. -. I. exam~le- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project. check new - if addition, cneck add, ete. ,F. Building permit information:, 1. exam~le - construct single family house with an attached garage ' 2. example - remodel existing garage into family room '3. examele - convert single family residence into restaurant (change of use) G. .yalue of work as 'defined in'Section 303 ,(a) of,the ., Structural Specialty Code ........ '"7'., ~. H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays. Building Division Staff must be able to contact appropriate persons regarding design infonmation or jOb site corrections, etc. 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 appropriate 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 schedules have been abbreviated 2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the' full schedules " 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. --- Ill. 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 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. . '(' . :'.' V. FOR OFFICE USE ONLY Pennit Cl erk . . I PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: , 1 Permit appl i cant'e~empt' from, regi strati on with th'e Bliil der I s Board' because: Additional Project Infonnation: PLANS REVIEWED BY: name I / '-a. -':zS .//' ~ ' t.-e:Fb'~c~.~~ signature"./,......~~.4_ ' V/ ~r" ~'date g-~~_ " Address Ol:.~ I [iN TEJU1 . CITY UF SPRINGFIELO . INFORliATlON LINE .1 _ COMBINATION APPLICATION/PERMIT 726-3753 ~ ---.. i ,\) EIIERGY SOURCES: Sq. Ftg. 1,lain ~ \--(\ \. '5\\')\ \) \ t -)J. lC Heat ~q: Ftg. Access. Water Heater Sq. Ftg. Other !lew Add Alter Rep. l'\ Ranqe -Fence Demo Change/Use \:)' ValuE of Work: Other-- -- rI\ 7'7'~2.'=-= Y\J Builoino Penna Info: Describe WorklLe.. Build Single I" Familv Residence With Attached Garaoe' tI) .oYr:/L<" ~.P ~,4-4?~?:> Ctr..fip?c.? . - '. - . - I /u-:>v,;;Qr~_ J%;:. ).1'~~"",0'~.~___ S ~j)2it~:D ,Eu:c-/, C/??ce-/75..1 (lies. no. \ lexoiresl (ohone no.\ t',,-.j INSPECTION LINE , 726-3769 Job Address t:J'f'l ') Legal Oescription Owner \-\ ~ (' ,~p. Address ?1'\O u." . ~() \ 1\\ II 01. ') Phone const~~~;;~ I (U1\ Q r Cn4il (namel Phone (address' Primary Structural Electrical Mechanical CONTRACTORS (namel {address' General ~;I?:.f/LZ:>~ /~........~~ .,..~rs>-~ Plumbina Electrical ~~.N'~ C/~. flies. no.' (pxnirpsl 10--_ D 5~c.~ >- ~ ' -:y.'"",,",,7), ~/'? ? (ohnnp nn \ 7Yb- =<;"/CO ~l~~hanical PLUIIB I NG ELECTRICAL MECHANICAL NO. ' FEE CIl~1\llL JI{l . H~..t:l:iABf.r: NO_ . FF,,"-'.cJJAIlliE. SQ. FT. furnace/burner to BTU's Each stngle fixture Residence of S.F. Residence (J bath \ Duplex (1 bath) each Additional bath 'New circuits alts. ~ ~ or ~ensions -1 d'?f ~ SERVICES ~5-) Floor furnace and vent Relocated building (new fix. additional) Recessed wa 11 ~p~rp hp~tpr ~nrl vP~t Storm Sewer Of amps. Appliance vent sp.oarate S.tationary evap. cooler Vent fan wi th sin~le duct Vent, system apart from heatina or A.C. Mechanical exhaust hood and duct Wood stove/heater Sewer Temporary Construction Change in existing resj;p"nr,: multifamily. camm. or Tnduc;trial Water service COMfI./IND. FEEDERS Install/alter/relocate dic;tr1h. fppdprc; Of amps. I I ISSUANCF OF PFRlIlT TOTAL CHARGES TOTAL CIlJ\RGE'S --:z?-~' TOTAL CHARGES WIlERE STATE L,\W REQUIRES that the Electrical work ,be done by an' Electrical Contractor, the electrical portion of this permit shall not be val11 until the label has been signed by an Electrical Supervisor and returned to the Building Division 1 HAVE CAREFULLY EXN1INED 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 work Derformed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Orel]on pertaining to the work described herein. and that NO OCCUPAllCY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Board is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon. and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on 'this project. jo,,/,,//~ ,,/ d.5LC-i? SIGNATURE.~ ~ d FOP. OfFICE USE DIlLY Sq, Ftg, Sq, Ftg. Sq. Ftg. IWIE(p1ease print) DATE d"-,?-"PJ Stories Units Occy Load Occy Group llain Access Other , Value Value Value TOTAL VALUATION Zone Fi re Zone Flood Plain Type/Cons t. Bedrooms , x PLU!~BING PERMIT Charges and Surcharges P1 an Ck. , ___.8:?~::5::<:?_ .,ill/B1do // <" Plan Ck. '7 - t::P ~ 30%lB1do Fence COI111lII nd P,.er Fp~ Res Per Fee Systems Development Charqe tl.5~) , --x/.#- BUILOING PER~1lT Charges and Surcharges I Oomo ELECTRICAL PERIIIT Charges and Surcharges , -z-:<-SOSldewa1k ------------ 1-(3 A/C Paving Total Comb. Permit MECHANICAL PERHIT Charges and Surcharges Curb Cut TOTAL I C'JB ./6 . " .' . .. COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Description I I. examp,le' Tax Lot 100, Lane County Map Reference II U3 43 2. example- Lot I. Block 3, 2nd Addition to Springfield Estates C. Name. etc. of owner and construction lender 0, Energy Sources I. example- heat/electrical ceilinc/or forced air ca! 2. example- waterheaterjelectrlcal/or solar Eo Square footage or valuation, etc. - 1. example- 1250 sq. foot house, SOD sq. foot garage 2. example- if new project. check ~ew - if addition, cneck add, etc. ,F. Building permit information:, 1. exam~le - construct sing~e family house with an attached garage 2. exam~le - remodel existing garage into family roan J. examele - 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 ~ivision 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 Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate 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 schedule! have been abbreviated 2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the fu 11 schedu I 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. --- Ill. 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 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. V. FOR OFFICE USE ONLY PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY: CITY OF SPRINGFIELD . " : .J f'. . ,,~~ - City Hall Sprlngfteld, Oregon Office 01 Community and Economic Development OFFICIAL RECEIPT 'I 14589 Date ~ -1? 19 g:;;;- , , , Rec'd From ~/~S ~<" -1"L., 1__; 1$f:?.::.!?, ~$-' 77' Address .;" -c.'P.- /&'~. r '. Received ForJ-"5~ jY &"7-o8/7ff///?J-' E.'?, "~ I7.P. ~o X'6.SO ij-65' ..-( L -'52:=> /-/"S, /' //~L , /88.../6 ~~//5~ Amount Received / c:/B... /6 ~~~___ ''0_ yr AUTHO"ZEO SIGNATURE ,;" I IlUSINESS FORM$. INI: t503I:142-1141 !!L ".n -.--- Pennit Clerk . Permit appl icant exempt from regi strati on with the Builder's Board because: Additional Project Infonnation: PLANS REVIEWED BY: name i-C>?3'~Rc-5~?f' ~.~ signa ture -- /.....-Jf~ ~ _.' ?// If -, , date g-r.;.- .:::?-~_