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Home My WebLink AboutPermit Building 1981-5-7 \ INSPECTION LINE 72~769 I. Job Address I Legal Description I I Owner , CITY OF SPRINGfiELD COMBINATION APPLICATION/PERMIT ~ INFORMATION LINE 726-3753 .;. - , ENERGY ~OURCfS, H t Heat t. ecr.- ea E E Pump I Sq. Fig. Main Sq. Fig. Access. Sex Fig. Other _New_Add_Alter_Rep. _Fence_Demo_Changel Use _Other l:>UO 517 5 (Xl ..... o '" 00 W 5007' Lot Forsythi a 7, Arnb 1 i s Drive Subdivision Water Heater Range Value of Work: Address Ron Brvant 5028 Forsythia Street Pho"o Springfield, Oregon 97477 55,132.65 746-5836 Building Permit Info: Describe Work (Le., Build Single Fomil" Residence With Attached Garaqel Construction lender Buildino Sinal e Attached garage Familv Residence Address Phone DESIGN TEAM (nome) Rod Ki ng (address) (liu. no.) (expires) (phone no.) Primary 454 Water Street Messaqe (David King) 726-0219 Structural Electrical Mechanical CONTRACTORS (name) Go"o,ol Drapery Bout i Que (address) (lies. no.) (ex');res) (.,hone noJ 645 Main Street 17211 fi-10..:.81 747-q71h PlumbinA Electrical Mechanical PLUMBING ELECTRICAL MECHANICAL NO, FEE CHARGE NO, FEE I CHARGE NO. FEE CHARGE X R11!l'Otl' of furnace/burner to Each single fixture .~. ft. 25.00 lTU's , Relocated building New circuits, alterations I Appliance vent (new fix. additianal) or extensions separate S.F. Residence Stationary evap. X (I bath) 7" nn SERVICES cooler 4 Vent fan with 3.00 12.0C Duplex (1 bath) each Temporary Construction ~,O nn single duct Vent system apart from Additional bath 1n_nn Amps. heatir.g or A.C. 1 Mechanical exhaust 4.5( Water service hood and duct 1 Sewer 1n.nn Wood stove/heater Storm Sewer FEEDERS 1 Heat Pump 6.0C Air handler to Amps. 10.000 CFM Air handler over 10,000 CFM ISSUANCE OF PERMIT 10.00 TOTAL CHARGES 45.00 TOTAL CHARGES 35.00 TOTAL CHARGES 3?5('1 WHERE STATE LAW REQUIRES that tho Electrical work be done by the Eledrical Contractor, the electrical portion of this permit shall not be valid until a label has been signed by an Electrical Contrador and ahached to the electrical panel. I HAVE CAREFULLY EXAMINED 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 wark performed sholl 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 herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Boord is in full force and effect a s required by ORS 701.055, that if exempt the basis for exemption is noted heron, and that only subcontractors and employees who ore in compliance with ORS 701.055 will be used on this project. Basis for Builder's Boord exemption: v :O~/.t1 ,I/. hAler NAME (please printlJ c:.IGNATURE ~ ~;(/.~ DATE G?$A'/ FOR OFFICE USE ONLY ZO"O R-1 Fire Zone----HA Flood Plain Type/Canst. Bedrooms <:'torill'- V-N '1 Unih_1 o,'cy Load Occy Group Sq. Ftg. Main c:-:. Ftg. Accou Sq. Fig. Other 1_508 x_33--3.0'/0Iuo 50,1'16 dn ~1-7-.-5- x -9..50Voluo -4-,91€. ~E x Value 55.132.65 TOTAL VALUATION BUILDING PERMIT 199.00 plan Ck. Comm/lnd Systems Development Charges and 65%/ BIde Per Fee Chorpe (1.5%1 Surcharges 7.96 Plan Ck. Res 59.70 PD 4-22-8, 30%/ Bide Per Fee REC# 56355 PLUMBING PERMIT 45.00 Temo Elect Charges and Fence Lahe Surcharges 1.80 Demo Total Comb. Permit ELECTRICAL PERMIT 35.00 62' 6.20 Chorgel and Sidewalk Surcharges 1.40 Ale Pavine MECHANICAL PERMIT Charges and ______32~0 Curb Cut 18' U._8_Cl Surcharges 1.30 TOTAL I I 826.99 .?n 141 _ C'fl 1,169.15 ..' APPlICATION/PERICAP} '''' \~,J "\, :,'::()'- .- ,'COMBINATION :.~ '-.; , ; . ,L Applicant.' t.a furnish 'J A. Jae ACldress " .' B. Legal Description 1. exomple.tax lot. 100, Lone Count.y Map Reference 17 03 43 2. example-Lot. 1. Block 3, 2nd Addition t.o Springfield Est.at.es C. Name, etc. of owner and construction lender.: .'. -: \: ~ D. Energy Sources 1. example-heat/electrical ceiling/or forced ciir gas 2. example-.water heater/electrical/or solar: ~". E. Square footage or valuation, ete:. .\.:.; ~~:'" ~ ,J 1. example-1250 sq, foot. house. 500 sq. foot goroge 2. example-if new project, check new-if addition, check add, etc, ~. Building permit information:. . " 1: . example:c6nstriict single fo'ri1i1y'house with an"attcich'ed .~. :. ;-~. garage 2. example-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 t.he Structural Specialt.y. Code ., H.' DESIGN TEAM AND CONTRACTORS'.,.' To avoid design or construction delays, Building Oi,vision Staff must be able to contact appropricite persons regarding design information or job site. corrections, etc. " J_ - . ,. ~. '" -'., , .'\. ~,''; .,..' , II. Abbreviated Plumbing, Mechanical & ElectricolSchedules .A. . Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules. t.he applicant need fill.in only the No. Boxes adjacent to the appropriate item(s) t.o be installed B. Full Plumbing, Mechanical, and EI';ct.rical Schedules are available at the Building ~ivision 1. To conserve space on the permit form the schedules have been abbreviated 2, If t.he it.em(s) t.o be instolled are not. covered on the abbrevi. \;", ated schedules you should consult. t.hefull schedules C. BUILDING DIVISION STAFF WILL FILL' OUT ALL FEES AND CHARGES ON THE SCHEDULES ".111. Applicant. to sign ond 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 poyoble ot. the time of t.he applicotion. ond no pions will be processed unt.i1 these fees are paid. All other fees and chorges ore due ond payable when the permit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY, , .'. \-',\"',\' \ Additional Project. Informat.ion, \,. . PLANS REVIEWED BY: nam"" 'DAN SMITH <;i9natui~ ., aERMIT VALI:A:IO~ ,~I . . ~i ;':"\.'1',>'; ',\ \ l.. '_..' l~'" " '. . !, T , ~, . . .' .:,.. ,. -;tl: 5'(04 tfZ "::. '... 5:. 7-:81 "'-.' ,. ..... ....... :i., .,;'. .: '!, '. ,,\~ , ,', -' .' ...;.1',-;, ;',',' " ',-, ~. ~ '*1,110'\.15. ..... J .;l'.t'; ,~': \. , , .'..\..;.. Permit Cler~ {> .JJ I ~ . I.. ',. " ',' .'... ._, , '. iate 4-27SCl , , ~'< , ,'-' ,~. I ! .' I INSPECTION LINE 726>-3769 I Job Add,.n IlegaIOe1CriP'ion I I Owne' CITY Of SPRINGFIELD COM61NAflON APPLICATION/PERMIT , 'NERGY ~OURC<S, H t H t.eC1;- ea ,at E Drive Subdivision Forsythia 7, Arnb 1 i s 5007 Lot Woter Healer " Ranqe I Value of WO,rk: 55,132.65 . Ron Brvant 502B Forsythi a Street Phon' Springfield, Oregon 97477 Building Single Attached garage f_ X,:' -")~.'.~',~. ..:.. . .-..." ~:::"JNFORMATION LINE 726-3753 . Sq. ftg. Moir J.;)\JO Pump_ Sq, Ftg. A'un, 517 5 S~ Fig. Olhar ; _New_Add--:-Alter_Rep: _Fence_D~mo_Chong.1 Use _Other ex> I-' o N cr. W , Address 746-5836 I:luilding Permit Into: Describe Work (i.e.. Build Single F~mjJ... Rtnidence With__~tt~ched Garage) Familv Residence Conitfuction Lender Address Phone DESIGN TEAM (name) (address) JJics. no.) Message (David King) 726~0219 Primary Rod Ki ng 454 Water Street Structural Elec.tricol Mechanical CONTRACTORS (nome) Gen..al Drapery Boutique (address) (lies. no.) 645 Main Street 17211 Plumbino I Electrical I I I I I I Mechanical PLUMBING ElECTRICAL FEE . CHARGE NO. FEE I CHARGE NO. I I X R,;5'o8' of .~. ft. ~5.00 I New circuits, alterations or extensions ?" nn SERVICES NO, x Each sin!:lle fixture I Relocated building (new fix. additional) S.F. Residence (1 bath) Duplex (1 both) each Temporary Construction In nn Additional bath 1n.nn Amps. Water service 1 Sewer lO.OO Storm Sewer FEEDERS Amps. TOTAL CHARGES 45. DO TOTAL CHARGES 35. DO TOTAL CHARGES '. "l ? ,'i.(L . (expires) (phone no.) (expires) (.,hone no.) 6-10-81 747-Q716 MECHANICAL / FEE I CHARGE 4 furnace/burner to IlTU's Appliance vent separate Stationary evap. coaler Vent fan with sin!:lle duct Vent system aport from heotir!:l or A.C. Mechanical exhaust hood and duct 4.5C 3.00 12.0C 1 Wood stove/heater 1 Heat Pump Air handler to 10.000 CFM Air handler over 10,000 CFM 6.00 '- ....,.., .' . " ." ISSUANCE OF PERMIT .."..,.,',J.'. 10.00 ,,; WHERE STATE LAW REQUIRES thai tho Electrical work b. done by the Electrical Contractor, the electrical portion of this permit shall ~;;t be valid until a label has bHn signed by an Electrical Contractor and attached to the .Iectrical panel. .~~ ,,'Ii- I HAVE CAREFULLY EXAMINED 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 sholl be done in accordonce with the Ordinances of the City of Springfield ond the Laws of the Stat. of Oregon pertaining to the work described herin, and that NO OCCUPANCY will b. mode of any structure without the permission of the Building Division, I further certlfy that my registration with the Builder's Board is in full force and effect os required'by ORS 701.055, that if exempt the basis for exemption is noted heron, and tha,t only subcontractors and employees ,who are in compliance with ORS 701.055 will b. used on this project. Basis for Builder's Board exemption. . ~( 2:l4v'ILJ #- hAlt?- NAME (please print1, c:.IGN'ATURE y. fOR OFFICE USE ONLY :aztk~,d~q DATE .~~/ , R-1 I 'nits n'Ccy load Occy Group V-N ~ 1 Sq. Ftg. Main c:"... Ftg. Access Sq. Ftg. Other 1 ",OR ~-l.7 . : Type/Const Bedrooms 10n- Fir. Zone--NA Flood Plain ~, 'ri8'* BUilDING PERMIT Chargel and Surcharges Plan Ck. Comm/lnd 65%/6Id~ Per Fee Plan Ck. Res 30%/ Bide Per Fee 59.70 PO 4-22-8 REC# 56355 lemo Elect Lahe ,20 '141 QIi 199.00 7.96 PLUMBING PERMIT Charges and Surcharges 45. 00 Fen,e ------1.80 35.00 I Sidewalk 1.40 lAIc Pa'lino .. .' .32.50 I Cu,b CuI '--:.::~::C30-1 . '"e. 11.80 Demo elECTRICAL PERMIT Charges and Surcharges 62' 6.20 MECHANICAL PERMIT Charges and Surcharges 18' " x 1:1: 1:nYalue 9.5{}Value Valu. "0,'1640 1,91f:.2& 55.132.65 , x x TOTAL VALUATION Systems Development Charae /1.5%\ 826.99 Total Comb. Permit . .' *~. .. h' TOTAL I ,'{..;;.';ii;~ ~'ft ~. .... :,:""':' , .' ".-' . ~.." .::-- 1,169.15 . ""..., (;~'~~~:~ ." "'~t..: ..~':~~,~ :'~Jli:;:-,,~~t~r~~!i!~~~)i~~,'J,~~;,,;:~~,:,:;.~,,::..'!Ji:~b,~~~~c!k~:.:.rt;;~&':::"::7;~'~~Z<, ",,~.,"~,.,~~!\l~,<' COMBINATION APPLICATION/PERMIT (CAP) I. Applicant'ta furnish A.' JaD Address ',B. Legal Descriptian 1. example-tax lat 100. Lane Caunty Map Reference 2. example-Lat 1. Black 3. 2nd Additian ta Springfield C. Name, etc. of owner and construction lender: D. Energy Sources 1, example.heat/electrical ceiling/ar farced air gas 2. example-water heater/electrical/or solar. E. Square footage or valuation, etc. . '" ~ . 1, example.1250 sq. faot house, 500 sq. foot garage 2. example-if new project, check new-if addition, chel add, etc. F.. Building permit information:, "1. "example-construct single family house with an"'attc garage 2. example-remodel existing garage into family fCOIT 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 Divis' Staff must be able to contact appropriate persons reg design information or job site,. corrections, etc. II. Abbreviated Plumbing, Mechanical & Electrical 'Schedule, A.. Except where blank spaces occur in the description pc of the Mechanical and Electrical Schedules, the applic need fill.in anly the No. Boxes adiacent to the approF item{s) to be inslalled 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 cavered on thE :', ated schedules you should consult the full schedulE C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AI CHARGES ON THE SCHEDULES' . .111, Applicant to sign and dale Whenever possible, the initial application will be used a! worksheet only. Where possible, Building Division Staff, '. prepare a typewritten copy and return it to the applicani .. 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 0\-; 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, . .,.. ... .-,... . J, ~ .' ""::.. '-,'" ."., ..... ," Additional Praject Information: ., , ..... '.'-" PLANS REVIEWED BY: name DAN SMITH . , ",ignatur:":' PERMIT VALIDATION ;:;. lat CITY OF (\ SPRINGFIELD ( City Hall Springlield, Oregon Department of Public Works OFFICIAL RECEIPT C] ( (/ (' '. ( ,-\U0 c 7I.J (I . .t:-IO)A , 40){J ,~ _Sl ~ ) > if .J L:,1=: (" ~ ( m~ (I ,.', \,1 <', , Amount Received I t (0 Cl ('J) ( ,v ~ &-'UTHOIIIIZlEO SIGNATUIU ...l[nO...Tu....U~L ~.'''TI[." IUGI.... 0. '''.0' ....,.. C,., ( (I - .-. 'I' Permit Clerlo ',' . : ~ ' ," - \" ,.,. r , -,' ("' , ,......... 4-27001 ..late