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Home My WebLink AboutPermit Mechanical 1982-2-24 ~UEST f6l2- UJGllID6I:olJ1:, ~e~il ,1M,. ~l/ -I?~ f!~) I INSPECTION LINE ~ CITY OF SPRINGFIELD...... INFORllATlON LINt I 726-3769 COMBIIIATlON APPLICATION/PERMIT 726-3753 V E!IERGY SOURCES: Sq. Ftq. Hain Job Address -r H t < Ft A , ea. .q. g. ccess. Legal Oescription LDT 3 1D(1Jt/2.. I ILL5' A$ PL/fnt.1) Hater Heater Sq. Ftq. Other f'V\ ~ New Add Alter Rep. ~' AND Ql&:;ot2./)/3!1 TN FJ{f TZJ 5Uf)f.,1Q tAf"f!g,~ Range Fence_Demo_Change/Use C/..) ownerY-oD t 'DAt2DA{2i'\~WI6~:,':C-'":~;ValU(OfH4\q~ . _Other ~_ Addressll7 ;::. '^6t?MO''''''' , ,I..i /J Phone BUI!a,"o P~nl11t Info: Descrlbe Work(,.,e., Build Single a~ L->lJ [j JV I LAJIIT Fam,ly ResIdence 1(Ji ~ched Garaoel - 1 1147-711't .s C'h)) ,9 t I ~, ') ,. 'd (') Construction Lender OuJt-F.J2..-- Address ~ME- UI:.~Il:iN TE:.Ar~ (name) Phone (address) (lics.no.) (exoires) {ahOM no. Primary Structura 1 Electrical Ijechanical fZo:D (jJA(;.~-, CONTRACTORS (namel J /7 ~D6eAA0JJ1 (address) (lics.no,) (expires) bXCJ-777Q (ohone no.) , Genera 1 Plumbina Electrical ~'echanical PLUllO IrIG ELECTRICAL MECHANICAL' Each single fixture I FH I CHARt';F Nn I t FFF I rl-111RG.E. :HQ:T"'~"'" I ~FF - Tr~ARGf_ Residence of furnace/burner to SQ. FT. BTU's' NO. I Relocated building (new fix, additional) New circuits alts. or extensions Floor furnace and vent Sewer ISERVICES I ITemporary Construction IChange in existing r8!i j (!eJlcF. Imultifamily, C01l1Tl. or Indu<;trial Recessed wall Snacp he~tpr and vpnt S.F. Residence (] bath) Duplex (1 bath) each Additional bath Storm Sewer 10f I COMfI. /lND. FEEDERS I Install/alter/relocate distrib. feeders IDf I I I amps. Appliance vent separate Stationary evap. conler Vent fan with simIle duct Vent system apart from I' heatinq or A.C. Mechanical exhaust I h.9o.d---'lnd ~uct CW;;d s t~';>hea ter _. I JJr;\,IJ It.J5TtJiA 77t.Jr.J ~Iater service 1 SSUANCf OF PFR'lIT '0:.; t~. ' I I I 1 (),a:- IS ,CJ..J (. amps. TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L,\H REQUIRES that the Electrical work be done by an, Electrical Contractor, the electrical portion 'of this pemit shall not be vali1 until the 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 Spri ngfi e 1 d and the Laws of the Sta te of Oregon perta i ni ng to the work descri bed herei n, and that NO OCCUPAUCY 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 OPOS 7Ql.055 will be used on this project. IIAl,IE(please print) 1-S~12.F-~e.~ p Zone Fi re Zone Flood Plain Tvpe/Const. Bedrooms Stories Units Occy Load Occy Group SIGrIATUR~^ FO~ OFFICE USE DilLY Sq. Ftg. l10in Sq. FtlJ. Access Sq. Ftg. Other W~tA DATE ~ .GJLj. ~~, A Value Value Value' x x TOTAL VALUATION i BUILDING PERfIIT Charges and Surcharges Plan Ck. Comm/Ind ____________ 65%/Rldo Pj'r Ff>p Plan Ck. Res 30%/Blda Per Fee Fence Systems Development Charae (1.5~l " PLU!1BING PERMIT Charges and Surcharges I Domo hidewalk ---- -------- I A/C Paving , ,,15 o.J I Curb Cut ",'- ~(Qrr-I I I I- I I I I ELECTRICAL PERr:1T Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges ITotal Comb. Permit I I TOTAL 15/~ \. -. COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A, Job Address B, Legal 'Description 1. examole- Tax Lot 100. lane County Map Reference II oj 4, 2. example- Lot 1. Block 3, 2nd-Addition to Spr,ngt,eld Estates ' C. Name. etc. of owner and construction lender 0, Energy Sources 1. example- heat/electrical ceilinQ/or forced air Qas 2. examole- waterheater/electrlca(ior solar E. Square footage or valuation, etc. ------ 1, examole- 1250 sq. foot house, 500 sq. foot garage 2. example~ if new project, check-new - if addition, check. add. ete. F. Building permit information: 1. example - construct Single family house with an attached garage 2. examole - remodel existing garage into family room ~. examjle - 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 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 ne~d 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 Buildi~g 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 ' O. As noted on the CAP, the label must be delivered to the electrical contractor for signature by his electrical supervisor. The general conl'"i.ctor' is .not authorized to sign the electrir.al label. --- III: A~plicallt to sign and (j1te . Whenever possible, the initia] appl :cation will be used as a worksheet only. Wher'e 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 penmit is issued. .. V. FOR OFF! CE 'USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: '" .'~. .. . PERMIT VALIDATION ,..' \ Permit Clerk Permit applicant exempt f.rom..registration with the Bu'ilder's Board because: ' Additional Project Information: PLANS REVIEWED BY: name signature r .' date .....-. ~UtST fbCL UJ~~LI(; 0:;e_~ui-r ., INSPECTION LINE -'W::4' CITY OF SPRINGFIE~D ~ INFORlIATION LINt .1 1726-3769 COMBIIIATION APPLICATION/PERMIT 726-3753 Job Address '1J.l.EJ)GF.!0()IJi-- \ AI !tV ~~;~GY SOURCES: ~~: ~~~: ~~~~ss. Legal Description WT3 ro1UEo I i JI.I.C:' I'.~ PLA71t,T) !iater Heater Sq. Ftg. Other ~ LI<' -r _,.. New__Add__Alter--yep. 11 /JD "(T-uJlZ.I/i3i> II'" F,{r; '2 SLI;'~riq L4/v;;WiJ'Ir'..; Ranqe_ -- Fence__Demo_Change/Use n V /, / Pu' ,,J :r>C~ ./.. ValUE of uorr~:' q -'" ' Other Owner J?-()i) , + lJAl2oAJ2i4 1)J,tv:.~l:f2';-"~'-'-'"'' , n~ \ ~ I -- Address-"717 ;::. ,(\/'t?, JLI',.,- I"AU Phon Bu'lo,"o P~rnl1t Info: Descrlbe Wcrk(1.e., Build Single I ,--,UDCjfVI WI VV , tJ47- ~ I/? Fam~ nrh?)(i ftO~:r~\) . d . Construction Lender OW~J2-- ,,' Address ~tVlE- Ut~luN TEAM (name) Phone (address) ~ g 15 1(') I (lies. no.) (exoirf~s ) (ohane no. Primary Structural Electrical Mechanical ?OX> UJA6A-t";;-- CONTRACTORS Inamel 1/7 7;fX:;eMo,Jr (address J (lies. no.l (exoires) bX'7-777Cj (ohane no.) . . Genera 1 Plumbina Electrical Mt;~~~ni ~~ 1 PLUI1B IIIG ELECTRICAL MECHAN I CAL ' Each single fixture , FEE 'CHARGE Nn~' Residence of I FFF t rHa _NO. . . ~~~ - TrHJ\R!iE. furnace/burner to SQ. FT. BTU's' / ....!JQ." Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent ;-, S.F. Residence (] bath! Duplex (1 bath) each Additional bath SERVICES Recessed wa 11 ~na~p hPAtpr anrl vpnt ." Appliance vent seoar.1tp. Stationary evap. coder Vent fan wi th s1nole duct I Vent system apart from heatino or A.C. I Mechanical exhaust ~oq,rl .and ~~~t ~~-~~heater I I l-R;t.U I/J5Tp.LU, 77t:.) I I I <).(X... , Sewer Temporary Construction Change in existing res.itLenee multifamily, comm. or I ndus tria 1 " '\: Water service Storm Sewer Of amps. cor~I./IND. FEEDERS Install/alter/relocate distril:l. f~~d~rs Of amps. , 1 (),a:. IS,OJ WHERE STATE U\I REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division , I HAVE CAREFUllY EXM11NED 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 performed shall 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 herein, and that UO OCCUPAIKY will be made of any.st~ucture without the permission of the Building Division. I further certify that my registration with the Builder1s Board lS 1n full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and.that jonly subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.. . TOTAL CHARGES '. TOTAL CHARGES '.. lSSUANCF OF PFRlnT I TOTAL CHARGES IWIE(please print)fig,Rf.\e.~ \AJ A.~NEP Zone Fire Zone Flood Plain Tvpe/Const. Bedrooms Stories Units Occy load Occy Group SIr,:lATUR~1ll..6LJV'L Wl'l"'-(\ 4.A FQ~ ~rF! ~~ n~~ (im: V V Sq. Ftg. Hain x Sq. Ft~. Access x Sq. Ftg. Other x DATE .;1.~L/- ')('.} Value Value Value' TOTAL VALUATION I BUILDING PER/lIT Charges and Surcharges Plan Ck. Comm/Ind 65%/Blda Per Fep. ------------ Plan Ck. Res 30%lBldoPer Fee Fence syste,rns Development Charqe tI.S~) , PLU'1BING PERMIT Charges and Surcharges Demo ELECTRICAL PERI~IT -Sidewalk Cha~esand ------------ Surcharges A/C Paving Total Comb. Permit MECHANICAL PERMIT Charges and Surcharges " ., ~~lS~CJ2:<j__ , (nIl Curb Cut TOTAL 151~ " " I ' - "'---...-- ---,~. . .. ~.... . '. COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION III. I. Applicant to furnish A. Job Address B. Legal Description 1. examRle- Tax lot 100. Lane County Map Refere. II 03 43 2. example- Lot 1, Block 3, 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examQle- heat/electrical ceilinqlor forced a ~a' 2. example- waterheater/electrlcal/or solar E. Square rootage or valuation, etc. ------ I. example- 1250 sq. foot house, 500 sq. foot g, 2. example- if new project, check new - if add; ~ cneck add, etc. ' F. Building permit information: 1. examele - construct single family house with (' attached garage 2. examole - reinodel existing garage into fami1: 3. example - convert single family residence in' restaurant (change of use) G. Value of work as defined in Section 303 (a) of tl (, Structural Specialty Code H. OESIGN TEM1 AND CONTRACTORS To avoid design or construction delays. Building Division Staff must be able to-contact appropria, ( persons regarding design information or jOb site corrections, etc. II. Abbreviated Plumbing, Mechanical, & Electrical Schedl A. Except where blank spaces Occur in the descripti( ( portion of the Mechanical and Electrical Schedul( the applicant n~cd fill-in only the No. Boxes ad~ to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedul ( are available at the Buildi~9 Division 1. To conserve space on the permit form the sche have been abbreviated 2. If the item(s) to be installed are not cover. ( the abbreviated schedules you should consult fvll schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES A~ CHARGES ON 'THE SCHEDULES , { D. As noted on'the CAPi' the label must be delivereij . . electrical contractor for signdture by his electr supervisor. The general conll'actor' is ,not author to Si9n the electrir:al label. '-.;~ - A~plicant to sign and (.i'lte \":;:' Whenever possible, the initial appl~~ation will be us a worksheet only. Wher'c possible, Building ~ivision will prepare a type written copy ,and return it to, the applicant at the time the actual'C-permit;;S: issue..d;ffor', signature. ' C-. '. IV. Fees and Charges Plan check fees are due and payable at the time of th application, and no plans will be processed until the fees are paid. All other fees and charges are due an~ payable when the permit is issued. - . . . ( CITY OF SPRINGFIELD ( City Hall Springfield, Oregan Department of Public Works OFFICIAL RECEIPT I , No. B 5 8119 ( Dole '<11Lb j,lt 19 ~ ' ' Rec'd Fro~ r::03\n:u.n..-L\1^.Lf1M ( Address \\\ ~I-~ ( Received For: ( \~cdl~ I S. .CO . /1'0 ( /, ( .-:~~." i!; .:-;1. . ( (' Amount R~ceived fS.C7() (!IG ;j), ftJl JY1'J :> -.u~:.~~f,;~ -c 1', _ , ,w~<' { ( ."ILlO"'lU~".ULL ~~I"ll~. . IUOIE..I, Oil .'.01 ...".. ( \ '..... c, V. FOR OFFICE USE ONLY Permit Cl erk = PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: i , Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: .' . J PLANS REVIEWED BY: name signature da te -', " -