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Home My WebLink AboutPermit Building 1986-1-3 . . CITY Uf SPRINGFIELD COMBlIIATION APPlICATIONIPERMIT E!lERGY SOURCES: Heat ~~IE.c:... I~ater Heater I!I-Ac.. Range l!....lI:c.. .r~I~~'Nt 726-3753 Sq. Ftg. 1,lain I~"(J Ip ~q. Ftg. Access. Sq, Ftg. Other -1lew){Addl5Al ter _Rep. Fence Demo ChangelUse -Other- - \. ..r I INSPECTION lINE '., 726-3769 , Job Address ~ \lJ f'1l1/t...llt!-1U .R.... Legal Description 17.()~.27.t{II)()lal Owner I4Dv.,Hl. .Q"~b~lT"'l' (I.ANrI:. ee,vNT"t \ Address 1"1"1 'p,..y \~ ~,qN.c. ~b Phone&!l1- Evc.l!.Ne.. oQ... lf1'tol ~~I Construction lender No/ Fl I HVC> ') Address Ut~ lliN T 1:1\1., lnameJ Phone (address) Primary r41!:N." ~ /'oJ 11M :> .Q2.l..H'T'l!:o..r-'S, ~ OL/V~ eU~Nt!; g~s. 3397 Structura 1 Electrical f1echan; ca 1 CONTR~CTORS (name) General ,&M,g:j LANn./ Plumbina (address) ~ 8 I$. ValUE of Hork: ,1:'~ 9~. ...e> BUlld1na Permit Info: Describe Work(;~e.. Build Single Familv nesidence l'Iith /l.ttached Garaoel ApPI T"I /IN ~,. l'lt J,J 'S'ro ~AC.L. ~ ItIl!NoJ~"'I"N /IF IN~I"'A- 1I~r1L. Slrl!-.. IU"~"" (1 ics. no.) (1 ;r~_ no.' '3~~y..56_t!Ei4~.E ~>~ I " Nn I ~1'Res i dence of SQ, FT, ,/1'New circu~ts alts. or extenSlons 2. dR Nt6$!41 I SERVICES I Electrical ~'echani ca 1 PI.UIIBING ELECTRICAL NO, 'I Each single fixture Relocated building (new fix. additional) S.F. Residence (J bath) Duplex (1 bath) e,ach Additional bath ~Iater service Sewer Sa' Storm Sewer FFF rHARr.E 7.'"~ ~- ITempOrary Construction IChange in existing rec;.j4eflcP Imultifamily. comm. or Tnduc;.tri<tl IOf ICOMM./IND, FEEDERS Install/alter/relocate di<:.trih_ fpprlpr<:. I I I / Of I~ amps. Il~- I I I I I I ~ - TOTAL CHARGES n -!iO TOTAL CHARGES M#Y, /:/:>. 0_ 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 Zt'..oO TOTAL CHARGES WHEnE STATE I.~H REQUIRES shall not be vali~ until the ~I="I=" rH~ Nn k2J'D I I 2 I I I amps. , (exni res) (o,hone no. 1 (P)(I);I"pc,' (nhnnp nn , ?~7-~~"3";a. MECHANICAL """ r JIARliE. furnace/burner to BTU's I' Floor fu rnace and vent Recessed wall SO<trp hp~tpl" ~nrl vpnt Gh",. #<!!!""t ~.,..".. Appliance vent <:.eoaratp Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from heatino 01" A r. I Mechanical e'xhaust hnnrl nnd durt I Hood stove/heater I I I 6....IZ.- ,,- '3.- ISSUANCE OF PFRIIIT I HAVE CAREFUllY EX~'INED the completed aprlication 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 Soringfield and the laws of the State of Oregon pertaining to the work described herein, and that IJO OCCUPAIlCY 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 ORS 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. SIf,IIATURrJ" ~ b.J.' ~ FO~ OFFICE USE OIIL Y Sa, Ftg, 11ainJ':i/'f/""~>>4</Value '3/, ~ ' Sq. FtlJ. Access x Value Sq, Ftg. Other~&>csl-x value~q{/....... , TOTAL VALUATION J 8~O.-' 1.~,:/i'7 ( .1 . ,f,.;,"3' ,,_,- I r ~ syste. ms Development (A I, 'f' V-- Charoe (L5~) NAI,IE(please print) \....l-6VJ> tRIN Zone P L Fire Zone Flood Plain TyoelConst, ~-~ Bedrooms Stories Units Occy Load OCCY Group 1/ ~ 2 , ~ I BUILDING PERfIlT Charges an~ Surcharges . -:2/::>1 #'Q Plan Ck, Conm/lnd ~_ ~.. 65%/Rlda Ppr Fp~ --- -- -~2- Plan Ck. Res I ~, 30%181 do Per Fee _ n __~ ~ ~ J FenceoU''''lY UNII( ;Z , - Demo , .::!2.- {;"6 'Sidewalk - --- - I ~f:o- AIC Paving _____L~~":J Curb Cut . 60 I PlU!1BING PERMIT Charges and Surcharges ELECTRICAL PERI~IT Cha rges and Surcha rges 11ECHANICAl PERMIT Charges and Surcharges 5.~o DATE 1/,}/8d' ~.?~ 3 .~ I JTotal Comb. rermit f/,7. /"2- 1/ ~/(). lf6 I I I TOTAL I. COMBINATION APPLICATION/PERMIT (CAP) 1. Applicant to furnish A, Job Address B. Legal Description 1. example- Tax Lot 100. Lane 'County Map' Reference 11 03 43 2, example- Lot I, Block 3, 2nd Addition to Sprlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example. heat/electrical ceiling/or forced air Gas 2. examyle- waterheaterjelectrlcal/or solar E. Square footage or valuation, etc. - I, example- 1250 sq, foot house, 500 sq. foot garage 2. example- if new project. check new - if addition. chec k add, etc, F. Building .pennit information: 1. example - construct single family house with an attached garage 2. exam~le - 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 TEM~ 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 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 Scheaules 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 cons'ult the full schedules C. BOILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES D. As noted on tne 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 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 CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: e. /' " 'y. ~' , PERMIT VALIDATION , " ; Permit Clerk . Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: . ;~'. . , PLANS REVIEWED BY: name L~c 7Z~~ Signatur.d ?.se-..-" ~~ ~ da te :z -Z '3'~'-'::::- .~ \ \. - ~ CITY UF SPRINGFIELD CDMBIIIATlON APPLICATION/PERMIT EIIERGY SOURCES: Hea t 1t."1L<:.. Ilater Heater I!I-l!.... Ranne l!.,-lEc.. Val UE of l'lor~: 1;9 9~.-=' BujlG~Q Permit Info: Describe Work(i.e., Build Single Familv nesidence l~ith J\.ttached Garaae) ApJ>IT"ION r!JIP l'ItJ d ~"ror.eA'-E.... ~ ~a!NoJ)ll.T"I"N of /N~lo~ lSor1L S/'/-t!-.. U..l"~"" t:.,,, N T"t Phone<01- '!';it' / \ i ~\f.fJ, I~TlON Ll<1t 726-3753 Sq. Ftq. 1,lain l~ytJ" ~q. Ftg. Access. Sq."Ftq. Other -'lew )(Add]g.l ter Jep. Fence Demo Change/Use Dther- - ,,' I INSPECTION LINE " 726-3769 , Job Address :s~o u..l rill ft.v' 1t!.v..J ..!:::Ie.. , Legal Dmription 17.0~-27.~'. a(:J'(:J' r ~ ,8 IS I-+::- II fohon~ no.) Owner J./"V"'~l. flll nlO~I,..-y (!,..AN'IJ:. Address 1'1"T PA"\' \ ~ 1-.,q"U~ ':'1:> ~\Jc.I!.N~ of2.... '11'1"01 Construction Lender N. /1=1 (HVC> ') Address Ul:.~ lliN I tAr' lnameJ Phone (address) (1 its. no.) (exnires) Primary rt~""r!JN J.i.FII'~ fle.u+lr.!:c..r-'$ ~ OL/VI5' €U~ , ~ilS- 3397 Structural Electrical /1echanical CDNTRI,CTORS (name I General .&M~ ~~'I Plumbina (addrpss) llir'.c:; nn) (pxoirpc;l (111'101'11" "n, ) 11 ~~r: ,5'6,I!:i4.6voE .,>~ , . , , ?~7-~"'3'~ Electrical ~lechanical PLUllB ING ELECTRICAL MECHANICAL S.F. Residence (1 bath) Duplex (1 bath) , FEF 'cHIlB!;L.J:lll....1 IReSidence of 7.'"~ ~- SQ. FT. ""I New circuits alts. or extenSl0ns 2. dXZ M6Sl!~ I SERVICES 1-ITL'..cHAllliE "0 't't't' , I r"~ 110. 'I Each single fixture Relocated building (new fix. additional) furnace/burner to BTU's 22SD Floor furnace and vent I I I ~..' IZ.- Recessed wa 11 ~n~rp hp~tpr ~nrl vpnt each Storm Sewer 2t1,oO Temporary Construction IChange in existing , rp'S; rlJ'"rp Imultifamily, corm!. or lnrluc;trial IOf Icor~'I./lND. FEEDERS I Install/alter/relocate d;c;trih. fppdprc; Of J~ amp..1 amps. :2 (/,lYoIr #~"oI ~.,..,' I Appl iance vent c;eoa l"'i'l tp I S"tationary evap. cooler I / Vent fan with 5inole duct / Vent. system apart frl;>m I heatlno or A.C. . I Mechanical exhaust hnnd and dUl'"t I \'!ood stove/heater. I a-/3.- I I I I I I So' I I I I I I 1 ~~-I I I I I I I I I / I I ISSUANCf OF PFRlm TOTAL CHARGES ~ -I TOTAL CHARGES 37. 601 TOTAL CHARGES MNY' /5."'~ WHEnE STATE L~W REQUIRES that ti,e Electrical wor~ be done by an 'Electrical Contractor, the electrical portion of this permit shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division ~Iater servi ce Additional bath Sewer / I HAVE CAREFUllY EXm1INED 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 wor~ oerformed shall be done in accordance with the Ordinances of the City of Soringfield and the laws of the State of Oregon pertaining to the work described herein, and that UO OCCUPAIlCY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exernotion is noted hereon, and that only subcontractors and employees who are in compliance with OP.S 7Ql.055 will be used on this project. 1JM.IE(please print) \...L-o VI> e.l'lIN Zone_ Pi. Type/Const. 5-/Y Fire Zone Bedrooms Flood Plain Stories J . SIr.NATURf~'.t FOr. OfFICE USE OilL Y Sq. Ftg. Sq. Ft9. Sq, Ftg. '". DATE 1/~/6tf Units Occy Load Occy GroupJ"'Z 11ain-l':1-;/:>" ~"AcoI Value '3/, 6~ Access x Value Other ~&>~x Val ue ~ 91/. ..... , TOTAL VALUATION . R40, ... 1 I..k:ti?:,:. I ~ ~ Systems Development' ~-?J!:>..3 CL. ';II. J:) "f" V- Charoe (1.5~) 7 /~. T I - I 5.~t:)1 I I BUILDIrlG PER~IIT Charges an~ Surcharges "2/=-'1'0 Plan Ck, Conm/lnd ~_ ~. 65%/Bldo Per Fpe --- -- --:"--:2.- Plan C~. Res I';;:. ~ 30%/Bldo Per Fee Stt:; ~ I Fence4N"'1Y UN-t" ------2~H--1 De_o _..:__~~~J Sidewal~ J . (;0 I A/C Paving _n__L~~_11 Curb Cut .60 'Total Comb. rermit I. I TOTAL , '137. /'2- J '1/ <tIt>. '16 PLUt1BING PERMIT Charges and Surcha rges ELECTRICAL PERI~IT Cha rges. and Surcharges MECHANICAL PERMIT Charges and Surcharges ".,- COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B, Legal Description L example- Tax Lot 100. Lane County Map' Reference 11 U3 43 2, examele- Lot I. Block 3; 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. examole- heat/electrical ceilinq/or forced air Qa~ 2. examole- waterheater/electr;cal/or solar E. Square footage or valuation, etc. ------ I. examele- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project. check new - if addition, check add,' etc. F. Building permit information: L example - 'construct single family house with an attached garage . 2. examole - remodel existing garage into family roar 3. exam21e - 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 TEAI,I 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 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 " "0, 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 will prepare a type written copy and return it to the applicant at the time the actual permit is issued for his signa ture. 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 pa)d. All other fees and charges are due and payable when the permit is issued. V, FOR OFFICE USE ONLY .. I"~ - - ~ CITY OF SPRINGFIELD . City Hall Springfield, Oregon Depertment of Public Workl , ' . .' ", OFFICIAL RECEIPT No.8 Date Pq 27. 199~ " Rec'dFrom ~,-;!, .....-:~g7_ Ce>~ ~~~X I~~t:> Address ~.IIt~ C-. "'It' ~7"Y'?($ _ _ , - i- '~ .-1 " (. .... ......,':. -"'. ( 66039 ( ( Received For,:h,r.#=~~~ </ //""iW""";_ C 3,,:1'. ~J', - ~ l':l.~ (.-Rf~ ~.-- . . r~' c::.- ~~ ' ~7.~ 1~ {..>o /7!-f. 1Jt:;;'.- PI'~. .{;a ( .~ ~ -'spc:: . q~~~ J'6,~1 ~ /~. Y'~ ( ( ( CAt"m~/6/ , 9/~,,~6 Amount Received ( .!!...' \ ( " 4.~~ ~~-"> " AUTHORIZED SIGNAl . ,..... ,.' " r, ,_ BU5lNE$$ FORMS. INC. 15ol131:M2.".' '" Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: nameLt:>Ji?Nc ~CZ;;~ Signatur~~~ da te 2 -Z :7'~t:::