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Home My WebLink AboutPermit Plumbing 1980-10-7 Cloo<; 70~ . I INSPECTION LIIIE 726- 37 69 Job Address fo?ii ~ cJLu~ ' Legal Dmript;on tDt t,4 ~~ J..I-J!.fA, JJo , ,cn~,Uf SPRINGFIELD COMBHIATIUN APPLICATION/PERMIT EIIERGY SOURCES: Heat !~ater Heater INFORlIATION liNt 726-3753 Sq. Ftq. 1.lain ~q. Ftg. Access. Sq. Ftg. Other flew Add A iter Rep. -Fence Demo Change/Use -Other- - Owner Address KIlO o^ , I (5 D.J.iVI. 0 Range ValuE of Hark: iA--I, (' h ()fl 0 ) Phone BuiltiinQ Pennit Info: Oeser.be \~ork(Le.. Build Single Familv Residence With Attached Garaael ::::-'11 .LlO if {',{"JY'. VI P tTA ~ . 14103'35 Construction lender Address Phone Ul:.::d Gl'~ T tArl (name) (address) (l ics. no. ) (exoires) (ohane no. , Primary Structural Electrical f1echanical CONTRACTORS (namel (address) (1 ;('<;. no. ) (exo; res) (ohnn#) nn \ Genera 1 / Plumbina (')11 'YVI OY". Electrical t.1echani ca 1 PLUIIBIrIG ELECTRICAL MECHANICAL NO. FEE rHARGF 'Ifl r:~L-.C..l:iA.RG..E NO Each single fixture Residence of furnace/burner to BTU's SQ. FT., Relocated building (new fix. additional) IS.F. Residence (1 bath) IDuplex (1 bath) each IAdditional bath ~Jater service New circuits alts. or extensions Floor furnace and vent I SERVICES I Recessed wall ~D~r.P hp~tpr ~nrl ypnt ITempOrary Construction IChange in existing rp<;idenr:{' Imultifamily. COlTlTl. or Inrluc;trii'll Of amps.1 COMM./IND. FEEDERS I IInstall/alter/relocate I rli<:trih_ fppdprc; IOf amps.1 I I I Appliance vent <;pOilri'ltp Stationary evap. cooler Vent fan wi th s.inole duct Vent system apart from heating or A.C. Mechanical exhaust hood and dur:t Wood stove/heater Sewer Storm Sewer ISSUANCE OF PFR!llT TOTAL CHARGES WHERE STATE L,\II REQUIRES shall not be vali1 until the TOTAL CHARGES TOTAL CHARGES that the Elecfrical work be done by an,'Electrical Contractor, the electrical portion of this pemit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAt1INED 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 Derformed 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 rw OCCUPArKY 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 OP.S 7~1.055 will be used on this project. 11N-IE(please printY< V'-ck.i'e-> '-L.L (. k.u) I~ ( l fM) oATE-I.IO.7.80 AJ II 'eS SIGIIATURE'X Zone Fi re Zone Flood Plain FOr. OFFICE USE DIlLY Sq. Ftg. riain Sq. Fta. Access Sq. Ftg. Other x Tyoe/Const. Bedrooms Stories Units Occy load Occy Group x Value Value Value x TOTAL VALUATION BUILDING PER~llT Charges and Surcharges . Plan Ck. Conm/Ind 65%/Rldo Ppr Fpp ------------ Plan Ck. Res 30%/Bldo Per Fee ___jQ._~__ Fence '" 0 D6mo 'Sidewalk I A/e-Pav; ng ITotal Comb. Permit 'Systems Development Charqe tl.5~) , ~ VI ::::'0 II LDIr /00.00 PLUt1BING PERMIT Charges and Surcharges I ELECTRICAL PER!~IT Charges and Surcharges r1ECHANICAL PERMIT Charges and Surcharges I I Curb Cut I I TOTAL 11000 loQ jJ G U <<< i~ I I I I I I I I I I I I .. r - . ~_.~ ,-~ . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Appl icant to furnish A. Job Address B. legal Description 1. exarnple- Tax lot 100. Lane County Map Reference 17 03 43 2. example- Lot 1. Block 3, .2nd Addition to Sprlngtield Estates , C. Name, etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinq/or forced air qas . 2. examole- waterheater/electr;cal/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. examole- if new project. check-nfw - if addition, check add. etc. F. Building pemit information: 1. example - construct single family house with an attached garage 2. examole - remodel existing garage into family room 3. examole - 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 fu 11 schedu 1 es C. BUILDlilG DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES D. 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 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 ON,Y Pennit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because:' Addi.tional Project Information: . ~ .,' PLANS REVIEWED BY: name signature date' I ClODS '7 0"'. , . I WSPECTIOII L1I1E 725-3769 Job Address bent ~ legal Oe5cription: civy , I I I Ranqe .ValuE of Hark: " Owner K\ ~Qb iA--llr hr, 0 () / IlIfORlIATION Utlt 725-37S3 Sq. Ftq. r.lain ~q. Ftg. Access. So. Ftg. Other lIew Add Alter ~ep. -Fence Demo Change/Use Other- - oQ o ~ o - --- Address -5 Cur", 0 Phone. Builcina Pemllt Info: Describe Hork(l~e.. Build Single Familv nesidence l-lith f\.ttached Garaqe) SI' I U.o PI ({')--r\ VI 0 (T.l t'i'V\ . i4l 0 "3::> "j Construction lender Address Phone UtSIGH ItAII (name) (address) 11 ics. no. ) (exoires) (phone no.) Primary Structural Electrical r1echani ca 1 COli TRACTORS (name) (address) (1 i cs. no. ) (exnireo;) (phone no.) Genera 1 Plumbina Ou ')'VI (lV" Electrical flechanical PlUltBlilG. ELECTRICAL f:O. fEE ce. rHARr,~ NO. CHARGE 110 Each single fixture Residence of SQ. fT. Relocated building (new fix. additional) New circuits aIts. or extensions S.F. Residence (l bath! Ouplex (1 bath) each SERVICES Additional bath Temporary Construction Change in existing rp<:;J d~.nr:'" multifamily, comm. or Inrluc:;triill ~!ater service Sewer Storm Sewer Of amps. COI~H./IIIO.. FEEOERS Install/alter/relocate rli~trib. fe~ders Of amps.1 TOTAL CHARGES WHERE STATE U\I REQUIRES shall not be valiJ until the TOTAL CHARGES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pemit label has been signed by an Electrical Supervisor and returned to the Building Division MECHANICAL I FFF I rHARr,F I I I I furnace/burner to BTU's Fl oor fu rnace and vent I Recessed wa 11 Soace heater and vent I I I I I I I I I I I I I TOTAL I App 1 i ance vent seoarate Stationarv evao. cooler ~ . Vent fan with sinole duct Vent system apart heatino or A.C. Mechanical exhaust hood and dud. I ~~ood stove/heater I I I from ISSUANC, OF PFR!HT CHARGES I HAVE CAREFULLY EXAtHtlEO the completed aprlication for permit. and do hereby certify that all information hereon is true and correct. and 1 further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Srringfield and the laws of the State of Oregon pertaining to the. work described herein. and that riC OCCUPAfKY will be made of any structure without the permission of the Building Division. 1 further certify that my registration with the Builqer's Board is in full force and effect as required by ons 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. rlAHE(please printY< V,'C k.i",_, >J / . , S IGtIATUREt' l__.-:~{ ck.CQ') FO~ orFICE USE OilLY Sq. Ftg. Hain Sq. Ftg. Access Sq. Ft9. Other IJi l'e~ Zone Fi re Zone Flood Plain Tyoe/Canst. Bedrooms Stories Uni ts Oecy Load Occy Group BUILOIlIG PERI.lIT Charges and Surcharges Plan Ck. Comm/Ind 65%/Bldo Ppr Fee ------------"""""Pfan Ck. Res 30X/Bldo Per Fee J Q CO Fence --- -.------ " 0 Demo I Sidewalk ;--0,';1,\(\) l om -/, 10.7.8'::> x x Value Value Value x TOTAL VALUATHil1 Systems Development Charoe O.5~) , c...n V I ::-;'0 II l{1 Jr PLUI.IBlrlG PERMIT Chi! rges and Surcharges ELECTRICAL PERI~IT Charges and Surcha rges A/C .Pavi n9 IIECHAIII CAL PERI1lT Charges and Surcharges Curb Cut 100.00 I I Irotal Comb. rermit I I TOTAL {/ooo Applicant to furnish A. Job Address B. legal Description 1. examole- Tax Lot 100. lane County Map Referl e- 17 03 43 \ 2. examole- Lot I. Block 3. 2nd Addition to Springtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. examDle. heat/electrical ceilina/or forced; 2. examDle- waterheater/electrical/or solar . E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house, 500 sq. foot 2. exa~Dle- if new project. check~~ - if add check add. ete. F. Building permit information: 1. example - construct single family house wit attached garage 2. examole - remodel existing garage into fami 3. examole - convert single family residence i (' restaurant (Change of use) G. Value of work as defined in Section 303 (a) of Structural Specialty Code H. OES I G:l TEAI'l AIIO CONTRACTORS ( To avoid design or construction delays, Buildin Division Staff must be able to contact appropri persons regarding design information or job sit corrections, etc. Abbreviated Plumbing. Mechanical, & Electrical Sche A. Except where blank spaces occur in the descripr portion of" the Nechanical and Electrical SchedL the appl icant need fill-in only the No. Boxes a (_ to the appropriate item{s) to be installed B. Full Plumoing. Mechanical. and Electrical Schec are available at the Building Division 1. To conserve space on the permit form the s( have been abbreviated c- 2. If the item{s) to be installed are not COy! the abbreviated schedules you should consui full schedules C. BUILDIiiG DIVISION STAFF WIll FILL OUT ALL FEES ( CHARGES ON THE SCHEDULES D. As noted on the CAP. the label must be deliver! electrical contractor for s-ignature by his elel supervisor. The general contractor is not autt to sign the electrical label. Applicant to sign and date Whenever possible. the initial application will be a worksheet only. Where possible. Building Oivisil (tc BY will prepare a type written copy and return it to applicant at the time the actual permit is issued signature. Fees and Charges [" Plan check fees are due and payable at the time of ~ application. and no plans I.lill be processed until kw_.... fees are paid. All other fees and charges are due and paY~ble when the permit is issued. ~~---:=--- . COMBINATION APPLICATION/PEffi1lT (CAP) I. 11. III. IV. V. FOR OFFICE USE ON,Y ..',,& ~ .. PERMIT VALIDATION . CITY OF SPRINGFIELD . ( City Hall Springfield. Oregan Department af Public Warks OFFICIAL RECEIPT . 548318 ( N~ B .. Date I () - 7 19 '30 ( Rec'd From /LII(hO_~I;,"-nu2,1UJ ) Address !.oX75 C1LUj~ ~i, J PliLry\biJ(ldj _~l'. ~jo '0 'S Received Far: 1000 . '1(j (!l ) .<11 SCUf\ ~LLLQ r 100.00 (II (0 CIl (;; Amount 1\ 1),1 ~ (.b Received 110 '-\0 C.r ,? ~ 11 C;p (J (9 .tUTHO'-I"ZI!:D SIGNATU'-E 5HELTo...rUU'.ULl "'"..rll'.. (UG("~. 010 9UO, .....'. (, q, Permit Clerk , d 1 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAtlCY: Permit applicant exempt from registration with the Builder's Board because: I I I, Additional Project Information: PLANS REVIEWED BY: name signature I I J date