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Home My WebLink AboutPermit Building 1981-7-6 -......... CITY OF SPRINGFIELD ~iHATIt.~N APPLICATION/PERMIT /' '4oeJJ~I.'n) ~:::G~iAf~~ QQ..cr Waler Heater L1I901 O.,uiptio_" RonQe '-...... --""/ .\r) U~d. ~L\l.) ~~IVOI"'OfWO'k' OW"" ~- ~~ {")"('\ \\Il ,c\,\ \ (\ 'l( Il 'i\ "' Add,." .~ If(. JI '2-l lil\ L I\ pllo", co",,~:3:.~~ Qp ~ 0 Electrical I Mechonical I CONTRACTORS (namel (address) ! G,"".'YQ"'I\ \10 \~t'L\\~b rv~) plumbinQ \j ~ INSPECTION LINE 726-3769 '. ~1'7 Job .Addrl!11 Add,... DESIGH TEAM (nomei Primary Structural Electrical Mechanical PLUMBING NO. , Each .;"gl. filltur. R"locor.d building ("lIW fill. additionol) S.F. Ruiden~. (1 both) Oualu (1 bothl eoeM Additionol bo,h Wal., ,.,,,ice I s'w.. I 510r,m Se.....r I I JYI 'foJ TOTAL CHARGES .. INFORMATION LINE 7'26-37 S3 Sq. fIg. Main Sq. Fig. Accen. Sq. fIg. Oth.r _New_Add._Alt.r_Rep. ___fence_Cerna_Change I U ie ~ ::;::::--Olh.;r-. " ,- ./ Sui/ding Permit Info: Describe Work (i,e., Build Single Familv Residelu:e With A.ttoched GoraQe\ Phone IL 11 f\~L \\-."ic\Q.~~ . (addreu) (lies. no.) . (e.pires) (phone no.) ." (ljcs. no.) (phone no.) (expires) , " ELECTRICAL MECHANICAL fEE I CHA.RGE I NO. fEE CHARGE I NO. C-HARGE I I I /1 I i I j I FEE I , I I I I I I i I/~OJ I I Residence of furnace/burner ta IlITU', Appliance vent separoto Stationary ovap. cooler Vonl fan with single duct Vent system apar' from heatinq or A.C. Mechanical exhaust hood and duct Sq:ft. Now circuits, olteratioru or extensions SERVICES Temporary Construction Amps. Wood stove/heater FEEDERS Heat Puma Air handler to 10,OOr) CFM Air handler ovel 10.000 CFM ., Amps. J JrLH / (),c '.) I 'A,cO I 10. Od TOTAL CHARGES ISSUANCE 'OFtlPfRMIT TOTAL CHARGES WHERE STATE LAW REQUIRES Ihot the Eltctrical work be don. by the E!er1ricol Controcto1, the electrical portion of this permit shall not b. valid until a label has b_n signed by on Electrical Con'rador and attached 10 th. .I.driccl panel. I HAVE CAREFUllY EXAMINEe the completed application for permit. and do hereby certify that 011 information hereon is true and ~rred, and I further celt;fy that any and 011 work performed sholl be done in accordance with the Ordinances of the City of Springfield and th_e Laws of the State of Oregon pertaining to the .....ork descrii:Md herin, and that NO OCCUPANCY will b. made of any structure without the permission of the Building Division. I further Cltrtify that my rcgistTation .....itn the Builder's Board is in full force and eoffect 0 s required by ORS 701.055. that if .J(.~mpt the basis for exemption is noted,' heron, and that only lubcontrocfors and employees .....ho ore in complian~ with ORS 701.0~5 .....ilI be used on this project. Basil for Builder's Board exemption; NAME (please print) ..,:, Ov :.v e. Zone Fire Zone flood Plain .' BUILDING P~RMIT Cholges and Surcholges PLUMBING PERMIT Cholges and Surcharges ELECTRICAL PERMIT Charges and Surcholges MECHANICAL PERMIT Charges and S...rc/'orgel -r <''<../< </ " I~~ ""t / OATE 7- 6-lrl c:.1GNATURC fOR OfFICE USE ONLY Typel Canst ~dlooms "- v-\ Sq. ftg. Main Sq,: fIg. Accen Sq. Ftg. Other Value Value Value TOTAL VALUATION Clolie' qnih ;)ccy load "ccy Group x x c!JSCD Pion Ck. Comm/lnd 65'l;'/ Blda Per Fert Plan Ck. Res 30%/ Bldq Per Fee Syslems Development Char"e 11.5~1 \"::;00 (PO In.OO , 4n Fence Demo Total Comb. Permit Sidewalk Ale:. P,:,vin.. Curb Cut O\.CO 1 TOTAL COMBINATION, APPlICA_MIT (CAP) I: - ~ PERMIT VALIDATION I. ApplicarU, to furnish A. Jab Addre;s B. legal Description 1. examole-tax lot 100, Lane County Map Reference 17 03 .43 2. exompie-Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D., Energy Sources 1. exomole-heot/electric:al ceiling/or forced oir gas 2. exam ole-water heater: electrical/or solar E. Square footage or valuation, etc. - 1, examole-1250 sq. foot house, 500 sq. foot garage 2. examoie-ji new project, check ~.if addition, check odd. elc. F. Building permit information: 1. exomole.construct single family house with an attoched garage .2. exomo/e.remodel existi.ng garagE:- into family room 3. example.convert single family residence into restaurant (change of use) G. . Value a/work as deiined in Section 303 (a) of the Structural Specialty Code . . H. ,DESIGN TEAM AND CONTRACTORS . To avoid design or construction delays. Building Division Stoff must be able to contact appropriate persons re99rding . design information or job site corrections, etc. II. Abbreviated Plumbing, Mechanical & E:lectrical Sched~les ~', Except where blank spaces occur in the description portion or 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 . ore available at the Building Division . 1. T oconserve,space on the permit form the schedules have been abbreviated 2. If the item(s) to be instal/ed are not covered on the abbrevi~ oled, schedules yuu should consult the full schedules C, BUILDING DIVISION STAFF-WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES " " .- '. , \ \. . III. Applicant to sign ond dole .Whenever poss(ble. the initial applicotion 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 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 are due and payable when the permit is issued. :, V. FOR OFFICE USE ONLY _ Permit Cler~ r PROJECT CONDITIONS TO BE -SATISFIED BEFORE OCCUPANCY: ~ Additional Project Information: PLANS REVIEWED BY, "amf" ",ignatur- ..Jatf" :.~ INSPECTION LINE 726-J769 'IP.,"' , . , ~ CITY OF SPRINGfiElD . , . ~IN'ATir:::N APPLICATION/PERMIT INFORMATION LINE 726-J7SJ bJ .. '. ,!)/~ ) 0 '10l2 lJ\&\~I.'n ') , EN ERG>: S"';)lCES, Q ---V, H.a. ~/f-l ,,0 0" f'_ \ Watf!'r Heater Ow." ~~-,~ ~\()\i rw !'" {\\(C li / I AddT~~CA ~~ ~ 6\LV\ t..r. Poan. I Conu'uClion leWr CONTRACTORS (no".,.1 (address\ ~ \ - -"--- ' <:O..,~I'-----'. Q n 'iI \ '0' \-3\ ~ \\~ J, 1011 ' PlumbinQ \~ Job Add,'!u legal Description Addr." DESIGN TEAM (nomei Primary Structural Electrical Mechanical EI..ctricol Mechanical PLUMBING l'o.lC).1 I Eocn ,inqle filltur" -lll:dIOCOI.d bl"lilding (I\ew fill. additional) I S.F. R.,;d.n~. (I both) I Duolu: (1 bOlh\ .od, I Additional balh I Waler ,.r...ic. I S.w" I St::lrm Sew., I ( )/iN I I '.1- f' I TOTAL CHARGES I f~r:. I CHARGE i Sq. fig. Main . I Sq. fIg. Acun. Sq. Fig. at".' j _New _Add _Alte' _Rep. ~._Fenc:-:oema_Chan9"i Ui. _Other ~ /" Building P~rmit Info: Oelc,ib" Work ii.!!., Build Single Fr-rnily Re,idf!nce Wi,... AthlCh!!d Garooel ........ r-" J ..c: ..r::: LJ\ I i I I i I I I i IhsOP I I I I~pj Ronqe _ Value of Work: Ptla",' L)\ f\['\\.. 'L ,,\-.".'~.C\. Q {J ,,\~ (addren} (li($. no.) (upires) (phone no.) f1ie" no.) (upir.,) (phon!! no.l , ~'.: I ElE"CTRICAL MECHANICAL NO. FEE ; CHARGE I NO. FEE I CHARGE -..1/ Relidence of furnacel burne' to i3TU', Applianc& ...ent s.parato ~Q: ft. New circuits, alterationl 0' elltensiens SERVICES Stolionary ....op. cooler Vent fan with ,ingle dud V."t system aport f,om heatinq or A.C. M.chanical "xhaust hood ond duct Temporary Construction Amp,. Wood $fo...e/heoter FEEDERS Heat Pume Ai, handler to 10.0M CFM Air handler a...'" 10,000 CFM Amp,. J _nlN /()C 0 WHERE SlATE LAW REOUIRES ,hot Ih" Elecl,icol wo,k b. dono by the E!er-t,jcol Cont'GU07, the .I.ctricol portioll of this permit sholl not b. valid until a 10b.1 has be." signed by on Electricol Contractor ana attached to Ih. .Iectricol ponel. I TOTAL CHARGES I 10. od ISSUANCE OF..PfRMIT I TOTAL CHARGES I HAVE CAREFULLY EXAMINED the completed Clpplicotion for permit, and do hereby certify that 011 information hereon is true and correct, and I furth", certify thor ony and 011 ....ark performed ,hall b" don" in accordgnce wit" the Ordinances of the City of Springfield and '"e Lows of the State- of Oregon perloining fa ttle work de,crio.d tlerin, and that NO OCCUPANCY will be- made of any struetu'. without the perminian of the Building Divilion. r further certify that my ,egistration with the Suilder's Boord is in full fore" and e.ffect os required by ORS 701.055, that if u."mpt th" baiis for "x"mption is noted. h.ron_ and that only ,ubconlractoll Clnd employees who or. in compliance with ORS 701.0.5.5 will be uurd on this project. SOlil for Builder, Board exemption I NAME (please print) ..(', 0.': u e.. Zone Fi,. Zone Flood Plain ." BUILDING p~RMrT Chorgel and Surcharge, PLUMBING PERMIT Charges and Surcharg., ElEOl{ICAl PERMIT Chorge' and Surc"arge, MECHANICAL PERMIT Cho,ge, and Surcharges IV':"/<'<'/ Typel Conn Q.edroom, " ""-\ Clori., ~co \s,oo (s)O In.OO 4n <IGNATU" . I~ ~~ ~..L-.. fOR OFfICE USE ONLY CATE _7- 6-?1 "nih n-cy Load Occy G,aup c:~. ftg. Main Sq; Ftg. Accen Sq. Ftg. Other Value Value Value . . . TOTAL VALUATION Pia" Ck. Comm/lnd 65~~J Bldq Per Fen Plan Ck. Re, :30%/ BIde Per Fee Syuem' Dev.lopment Ctlora" (1 .5% \ Fenc" Demo Total Comb. Pot,mit Side.....olk A'e Pc>y;no Curb Cut 0~.CO TOTAL I .. COMBINATION APPLICATION/PERMIT (CAP) I. Applican:. ta furnish A. Jab Address B. legal Description 1. examole-tax lor 100. lone County Map Reference 17 C 2. examoie.Lat 1. Black 3, 2nd Addition ta Springfield Estc C. Nome, etc. of owner and construction lender D.. Energy Sources 1. examole-heat/electrical ceilinq/or forced oir qcis 2. examole-worer hearer: electrical/or solor E. Square footage or valuation, etc. 1. examoie.l,250 sq, faol hause, 500 sq. foot garage 2. e)(omole.if new project. check new-if addition, check odd. ele. F. Building permi. information: 1. examole-construc' single family house with an ottochec garage 2. exam ole-remodel existi.ng garagE; into family room 3. example-convert single family residence into resfaurant (change of use) G. ,Value ai-wark as defined in Sectian 303 (a) af the Structural Specialty Cade , ,H. DESIGN TEAM AND CONTRACTORS . To ovoid design or construction delays, Building Division Staff must be aolc to contact appropriate persons regardir design informc:::tion or job site corrections, etc. 11. Abbreviated Plumbing. Mechanical & Electrical Schedules A. Except where blcnk spaces occur in the description portion or the Mechanical and Electrical Schedules, the applicant need fill.in only the No. Boxes adjacent to the appropriate . " item(s) to be: in~lal1ed --"B.' Full Plumbin,g;Me<hanicol. and Electrical Schedules. "..n__ are available at the Building Division 1. To cons.er_ve space on the permit form the schedules hove been abbreviated 2. If the ite~(s) to be installed are not covered on the abb oted schedules you should consult the fuil schedules C. BUILDING DIVISION STAFF,WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES Ill. Applicant to sign and dote .Whene\ller possible. the initial application will be used os a worksheet only. Where possible, Building Division Stoff will prepare 0 typewritten copy and return iJ to the applicant at .the time the actual permit is issued for his signaturE.. Fees ond Ch'orges' f Plan check fees are due and payable at the time af the applicl- and no plans will be processed until these fees ore paid. All .. otherfees o.nd charges ore due and payable when the permit is issued. IV. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE'SATISFIED BEFORE OCCUPANCY: Additional Project Information: PLANS REVIEWED BY: name. signotur- , CITY OF SPRINGFIELD City Hall Springfield, Oregan Department af Public Work. OFFICIAL RECEIPT \ No. B Date':\. \ ~\. \ lQ 19P\ I 00. - - Rec'd Frornq~>\ U\~ \,"""::c\CQA, Address ,~\~ ~m,~_l~htC0 !' ....-.l ~ ~- PERMIT VALIDATION ( ~, l " ( ," " I !!Ii ( ( 56858c; e ( Received For: \J\\ }\ \ ~1 f\~\ ') \\ ~y() ,O()C:U- \,' ~.oO ( l~oU ,loO ( IO.oD ,4(j ( ( ( y~ ( f;- ( ( , ~:. \~\ ,O() ~(}J AUTHORIZED SIGNATURE S,":UO".TU""'Ull .."".TIlIIS. IlUGun Oil '-"0' Amount Received '. ,Permit Clerk , '.' ~ote - , . ...'---~- , 0X='. . ~..".. ( ,I ., I I