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Home My WebLink AboutPermit Building 1982-7-12 \IILI ,~ PECTlON LINE 726-3769 . Sq. Ftg. Main IbUb Sq. Ftg. Aceeu. -5.5! Sq. fIg. Other----3.3.f\ XXNew _Add _Alter_Rep. ___Fence_Demo_Chonge I Use 64 967.00 I-O'h" Building Permi' Info: Describe Work (i.e., Build Single Family Residence With Attached Goraoe) L..sin(llp F~rnily with ~tt~rhed Garage I w/woodstove I ,..~ .,,~. . CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT Job Add"" 4395 Forsythi a l.goIO",dp';on Lot 27. Ravenwood Subdivision ENERGY SOURCES: H.o....Elprtrir J::~ Water Heater -El rr.t.ri r: Ranqe _Elertri r I Value of Work: Owner .1.e.s..s...-R _ Rr('lnkc:: Address p n Rnv 11~ Soringfield. Oreoon Construction lender O. D. V . A. Address DESIGN TEAM (nome) Primary Structural Electrical Mechoniral CONTRACTORS (nome) G.n"o; Jess R. Brooks 21umbinQ nrl n Mprnpr Electrical n;:tVpc:: I='lprt.rir: Mecbanical Marsl'J.a.ll s PLUMBING _"..,__u.._~ NO. ; -fEE x Each sinqle fixture Relocated building (new fix. additional) S.F. Residen!=e (l both) 25.001 I 1 10,001 10.001 10.001 I I I I I Ouoln (1 bath) each Additional balh Waler service 1 Sewer Stor,m Sewer Phon. 747-~On9 Phone (address) (Iics. no.) (address) INFORMATION LINE 726-3753 (Xl ...... o <.n ...... ...... . (expires) (phone no.) C1ics.no.) (expires) (phone no.) 8537 1-5-B2 747-5009 Wfllil 6-29-=.8.2 689-4992 2fi5A.4 6-10-=.82 lli-,,5640 2~I9lL'T"_12-21-.aL._, _._~4Z:.l.41L..._... "'-TI;~;; I ~;l:;;;;~~:"^'-'"- .d I 1 Appliance vent 3.00 I separote I Stationary evap. cooler 10.001 3 I I I 1 I 1 x Rtsj..dA~e of . ..llll' sq. ft. New circuits. alterations or extensions P.O. Box 116 2.l.filLAmi r~ntp PO Box 21 4131l'~' S~~~L ~~:RIC~I~- CHARGE NO. I I I I 10.001 37.501 WHERE STATE LAW REQUIRES that the EI.drical work b. done by the EI...trical Contractor, the .Iedrical portion of this permit shall. not b. VAlid until a I label hos been signed by an Electrical Contrador and attached to the electrical panel. SERVICES Temporary Construction Amps. FEEDERS Amps. Vent fan with single duct Vent system apart from . heating or A.C. Mechanical exhaust hood and d~ct 3.00 9.00 4.50 5.00 I I Wood stovel heater Heat Puma Air handler to 10.000 CFM Air handler over 10,000 CFM TOTAL CHARGES 55.00 I TOTAL CHARGES ISSUANCE OF PERMIT 35. 00 I TOrAl CHARGES I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true and correct, arId I further certify that any and all work performed sholl be done in accordance with the Ordinances of the City of Springfield and the Laws of the Stat.. of Oregon p..rtaining to the work de"riblld herin, and that NO OCCUPANCY will b. 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 ex,lImpt the basis for exemption is naiad ::']. ond ,hot only ,ub~n"o"onond .mploy... who 0" In ~mp';on'" w;,h ORS 701.055 wm b. uad on .h;, p.oi.". l:f(:,.:u,~d::::.~:L-;;~ dB{JCI(r~ SIGNATURE d~ //it~ ' OATE_~/j. -~- FOR OFFICE USE ~- o 1 Typel Canst. ~ N Bedrooms 1 ? Zone Fire Zone Flood Plain Ctorillr Units 1 .....ccy load rleey Group Sq. Ftg. Main --160.'5- <q. Ftg. Access -5.5.? Sq. Ftg. Olher-3.3.1=: x <.5 <LVolu.$~fl, fl91 RO x 10 00 Volu. 5.520.00 x R ?O Volu. ? 7~~ ?n TOTAL VALUATlON$fl4; qfl7 nn BUilDING PERMIT $217.00 plan Clt. Comm/lnd Systems Development $ 974.51 Charges and 65%1 BIde! Per Fee Chorae (1.5~':'\ Surcharge, Plan CIt. Res 65.10 Pd 8-2 ,-B1 #57135 8.68 30%1 Bldq Per Fee PLUMBING PERMIT 55.00 Iremo Elee Label f5?,c11 R .20 Charges and Fence Surcharges I 1R?,04 2.20 Demo Totol Comb. Permit elECTRICAL PERMIT Charges and 1~,OO Sidewalk. 80' 9.60 Surchatges I 1 An Ale Ptlvin~ MECHANICAL PERMIT I Charges and ._____37~0 Curb Cut 18' 14.16 Surcharges I TOTAL 1. 50 $ 1,356.75 0< COMBINATION . APPLICATION/PERMIT (CAP) j ,-. 'I. Applicant ta furnish A. Job 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 Springfield Estotes C. Name, etc. of owner and construction lender D.. Energy Sources 1. example-heat/electrical ceilinq/or forced air gas 2. example-water heater/electrical/or solar E. Square footage or valuation, etc. 1. example,1250 sq, foot house, 500 sq. foot garage 2. example-if new project. check new-if addition, check add, etc. F. Building permit information: 1. exam ole-construct single family house with an attached garage 2. example-remodel existing gor09& into family room 3. example-convert single family residence into restaurant (change of use) G, Value of work as defined in Sectien 303 (0) 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., Abbrevigte.d Plumbing, Mechanical & Electrical Sched~les ,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 adiacent to the appropriate item(s) to be ins lolled B, Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Division 1. To conserve space on the permit form the sched'ules have 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 0 typewritten copy and return it to the applicant at the time the octuol permit is issued for his signaturE.. IV. Fees and Charges Plan check fees ore 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 ore due and payable when the permit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: '-^ , Additional Project Informotian: PLANS REVIEWED BV: . PERMIT VALIDATION ..:... Permit Clerk I \ \ I I I I .;~.,o,.1J\l:\ ~rfu jJJu ,...ilil~~,~\ " ~Q) 0 ' nom'" t\ ' f \- -H'4SPECTION LINE 726-3769 I Job Addr!!_. I Legel Description I I Owner .1p('c: R I Addren I I Construc.tion lender I Address I DESIGN TEAM I Primary . ....... 1-.._ . INFORMATION LINE 77~7S3 4395 Forsythia Lot 27, Ravenwood Subdiyision CITY OF SPRINGFiElD COMBINATION APPLICATION/PERMIT I ENERGY SOURCES: Heat ~l prt",i~~ I Water Healer Fl ~(':tr; r. Ronqe ~J Ar.tY" r I Value of ~~rk:' ,. p n Rnv 11 h Sorinafield. Oreaon Phoro!! 747-'i00q u 564.967.00 Building Permit Info: Describe Work (i.e., Build Single Familv Residence With Attached Gorooe) Sq. Fig. Main l"OUO Sq. Fig. Access. -55' Sq. fig. Other----3.3.&:;: XXNew _Add _Alter_Rep. ___Fence_Demo_Chonge I Use _Olher co ~ o <.n ...... ...... RrQf\Itc:. O.D. V.A. SinalI' Filmily w/woodstove with ilttilchpn hilrilOP Phone (nome) {addren} (lies. no.) . (expires) (phone no.) Structural Electrical Mechonkal CONTRACTORS (name) (addreu) (lies. "no.) (exoiresj (ohonp. no_\ Ge",,"1 Jess R. Brooks Electrical [)aJ1j1t>rnt>r [)ilVP' Flpctr:.ic P.O. 216fl PO Amirantp Rnx ?1 Box 116 SERVICES fiflq-4qq2 ill-..5.6..4 0 _ ,__.l.4?:,L44L.._ j MECHANICJ.l F"-CH"AiiGE 'NQT' .....--....---, --I fEE CH6A.ROGO' I 25.00 I' 1 I J.'5'1f:/d1'f5~~;~" 1 I Appliance vent 3 ./00 I separate I Stationary evap. 1 cooler 3. 00 9. 00 1 1 8537 2llillil ~4 25Z!lll~ __11=..21-81 1-5-82 fi-2q-fl2 fi-10-fl? 747-5009 ~Iumbinq _~;~arsha 11 s PLUMBING NO. I 4131 ?.'.'...s.tre.g,L_._,__ I ElECTRICAL CHARGE NO. FEE I I I X 1 I I, I 1 Duolu (1 both) each x 25.001 I 1 10001 10,001 10,00 Rl'ifo~'. of _ ___ Sq: ft. New circuits. alterations or extensions Each sin tile fixture Relocoled building (new fix. additional) S,F. Residen!=e (1 both) Temporary Construction 3 Vent fan with single duct Vent system oport from heotinq or A.C. Mechanical exhaust hood and d~ct I I 4.50 I 5.00 I I I Additionol bOlh Amps. 10.00 I 1 1 I 1 I I I I Wood stove/heater Water service Sewer Stor.m Sewer FEEDERS Heat Pump. ,. Air handler to 10,000 CFM I Air handler over 10.000 CFM Ampl. I I I r I TOTAL CHARGES I I I 1 I I 55.001 TOTAL CHARGES ISSUANCE OF PERMIT 35.00 I TOrAl CHARGES 10.001 37.501 I WHERE SlATE LAW REQUIRES Ihat the Electrical work b. done by the Elertrical Contractor, tho electrical portion of this permit shall. not be valid until a label has been signed by an Electrical Contradar and attached to the electrical panel. I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that all information hereon is trUG and correct, ~otld I furthel. certify that any and all work ~rformed sholl be done in accordance :with .the Ordinances of the City of Springfield and the laws of the Stat. of Oregon pertaining to the work described herin. and that NO OCCUPANCY v.:i!l~be.made of any structure without the permission of the 8uilding Division. I further ~"jfy thot my registration with the Builder's Boord is in full forc4 and effect 0 s required by ORS 701.055. thot if eX,empt the basis for exemprion is noted heron, and that only subcontractors and employees who are in compliance- with ORS 701.055 will be used on this project. i. Basis for Builder's Boord exemption: . I CC NAME (please print)~E _~__7 Moolrc, ,? SIGNATURE ~ ~ FOR OFflC' US, 9Nl Y 1 /ir~ " - OAT' _-':"/;J. -'i?1J..- Zone R Fire Zone Flood Plain Type/Const..Jl..:.tJ Bedrooms 1 ? Units /"'lccy load "Jccy Group R'1 Sq. Ftg. Main -1.6..0.6 Sq. Ftg. Access~? Sq. Ftg. Other--3.3.F: x '1~ '1n Vclu.$~h, hQ1 RO x 10 00 Volu. 'i,520.00 x II ?0-Volu. ? 7~~ ?n TOTAL VAlUATlON$fi4; qfi7 00 f:torie- BUilDING PERMIT Plan Ck. Comm/lnd Syslems Development Charges and $217 . 00 65%1 Blda Per Fee Charae fl.5%1 $ 974.51 Surcharges Plan Ck. Res 8.68 30%1 Bldq Per Fee 65.10 Pd 8-2 ,-81 #57135 PLUMBING PERMIT I Terno (;:F11 R Charges and 55.00 Fence Elee Label .20 Surcharges I Total Comb. Permit ?,20 Demo 1R?,04 ElECTRICAL PERMIT Charges and ._____35,00 Sidewalk 80' q.fiO Surcharges An AI C Pavino MECHANICAL PERMIT Charoel and ,_____37,,50 Curb Cut 18' 14.16 Surch-arges I TOTAL 1. 50 $ 1 ;356. 75 -ignature \y\ f\ ~ I'm j VItI. date (\ ~ \ Q -9 ~ \ , . &0) ~ I . ~ '_4 ./'. COMBINATION APPLICATION/PERMIT (CAP) I. Applicant ta furnish '.;, ~I..:'.~--=-':"'. A. Jab Address B. legal Description 1. example-tox lot 100, lane County Map Reference 1 2, exampJe,la. 1. Black 3, 2nd Additian to Springfield I C. Nome, etc. of owner and construction lender D. Energy Sources 1. exomole.heat/electrical ceiling/or forced oir qas 2. example-wofer heater/electrical/or 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 odd, etc. F. Building permit information: 1. exam ole-construct single family house with an cttod garage 2. example-remodel existing garog~ into faniily room 3. example-convert single family residence into r~stourant (change of use) G. Value of work as defined in Sectic.n 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 regarc des.ign information or job site corrections, etc. II., Abbrevi<;lted Plumbing, Mechanical & Elect;ical Sched~les A. Except where blank spaces occur in the description partie of the Mechanical and Electrical Schedules, th,\ appiicant need fill.in only the No. Boxes adjacent to the appropria item{s) to be installed B. full Plumbing, Me<:hanicol, 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 ab ated schedules you should consult tlie full schedules C. BUILDING DIVISION STAFF WilL Fill OUT All FEES AND CHARGES ON THE SCHEDULES 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 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 appli, 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, naml'" ~ .....,..,... i . CITY OF SPRINGFIELD City Hell Springfield, Oregon 'Department of Public Works OFFICIAL RECEIPT \ No. B ( Dat~h~I,\ \0-19<i$Q.- ( Rec'd Fro~ \\sj NJ ~ ~ .!l 1 (' Addres& _ P (\) ~CJC \ \\:"\ ~ I Received For. '~\D~\1 ' , \..~6\f\[} 6)\\ 001 (J ~II""" _ ~ ,!..Do ~ 'C' 00 ( \i"'\'-.\ ) _"'; - ") , 4DJr. /J.61U -;::2<' c:O ( <-~)...J _ ( 40 ',' ( ~ I, ,-;:.r) , ( :So rO~,r'j{n (, C\ '\~ .8)_ (I ~?5_Q.f-; :\fCL AUTHORIZED SIGNATURE '1 ( (-.,....:- '....^ ,I r::;o !l'O 8 ~.......... , (f ~'. \, ( 'v-~ \:' 0 ~.--rl ( v 40n ( \.---.1\'\ ~, t__.\~ c 4..-Cjf-, , [)~ ~ ')4 rt' .. , -' - IY'\ r _ ( Amount Recei~ (f (i BY / ~. ( "'" (I BRIGGS PRINTERS'l.ITHOGRAPNERS, EUGENE. OREGON , ~- No. B o~4U~( ,",~ITI}'L,,'lL. d ( Rec'd Fro~ r-::Y:} b,' \~ ~fuu1 () Add;eSll k1._}~ ill;~ If t' ( ~ $)'S\l ( . G~ Received For. ~. t- (} ( Cl~ ~ ~ Q $ r I ~'-'\ '\ ,,;J( ~' c <L "" ([ ( .' " c- . (~ (l~: ( t""""""''''' c{ 0 _IT). G c-- , ~ 0 BY " - AUTHORIZED SIGNATURE to.;- \,' (' BRIGGS PRINTERS/LITHOGRAPHERS, EUGENI:, OREGON -'- :1::: 'i1 ri ;.... ~ :;, ..,.', I ;.~~ L,