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HomeMy WebLinkAboutPermit Building 1981-8-12 L-. INSPECTION LINE 72~J769 ! .. . . INFORMATION LINE 726.3753 co 8 <€ CITY Of SPRINGFielD COMBINATION APPLlCATION/PUMIT Job Addren " D~ \ <"\; O~l An ~ (\) , -~ , , ~ - '-' Sq. ftg. Main Sq. FIg- Accon. Sq. fIg. Other _New _Add _Alter _Rep. _n _feMe _Demo_Change j U se _Olher Legal Description I ~:::GY S~?X Waler Heater Ronqe - Value of Work: 'r/ Own" [$t 1..1J)l'L-1. J. )&'t~~y Add''''~~~~~ r \('),a,~~\.l)_Q,) IS ~~~7;~gR:,~~:~t,~n;;'th ~::~:~:d::':~~;' 'uad Singl. Con...u";on l.~d.~ . I).... \\ (\C-yp) t I-J\d.Q J '("\\ \?\.. Address Phone Mechonicol CONTRACTORS (name) (address) I G.n.,al ~(\ I\oJLd \1\...(\, (JO)..... ~M.o t\ J I P1umb;"a L~~\J-... I BecHicol ~ Jr--...c_>- DESIGN TEAM (nome) Primary Structural Electrical Mechanical PLUMBINC NO. I i ! Eoeh sinqle f;;Jtlvre 'I' R~locorlld building (new fix. additional) I S.f. Residen!=l! 11 both) I I 1 i ! OuolellO 11 bOlh) eo en Additional both Woler service Sewer I Slor.m Sewer I I I I I \. \'M\ I TOTAL CHARGES -, I I (oddreul (lies. ~o.) (ellOpires) (phone no.) (l;cs. nC'.) I j I I .~,-l ! CHARGF I I I I I I I I I I (expire$) (phone no.) ELECTRICAL MECHANICAL .---~~--rFEE furnace/ burner to lITU's Applionce'vent separate Stationar:,' QVOp. cooler Vent fon with sinqie duct Vent .sY$tem aport from heatinq or A.C. Mechanical exhousl hood and duct f::J: CHARGE NO. FEE CHARGE I NO. Residence of SQ:ft. New circuits. alteratiolls or elllonsions SERVICES I ! I I I I , ! I I I \~,cj>-l I I I Temporary Construction Amps. Wood stove/healer FEEDERS Heat Puma Air handler to 10.000 CFM Air handler o....r 10,000 CFM Amps. \ -.1\\1:-\ \Dca ISSUANCE OF PERMIT . TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES Ihat the Electrical work be done by the Ele<"tticol ContraCTor, the electrical porlion of this permit shall not be valid until a label ha~ be.n $igned by on Electrical Controttar and a"oched to ,he electrical PQnel. I HAVE CA.,REFULLY EXAMINED the completed application for permit, and do her.by certify that 011 information hereon is true and Correct, and I further certify that any ond 011 work. performed shall be done in occordance with the Ordinances of the City of Springfield and the Laws of the Stote- of Oregon .pertoining to the work described herin, and that NO OCCUPANCY will be made of any structure without the perminian of the Building Division. I further certify that my registration with the Builder's Baord is in full force and effect as required by ORS 701.055, thot if exempt tho basis for exemption is noted heron, and that only svbcontroctors and employees who are in compliance with ORS 701.0~S will be uad on this project. Basis for Builder's Boord ellemption' NAME (pleose print) Lo....lA.J("Q... Zon- Fire Zone Flood Plain BUilDING PERMIT Charges and Surcharges PLUMBING PERMIT Charges and Surcnorges ELECTRICAL PERMIT Charges and Surcharges MECHANICAL PERMIT Chorges and Surcharges vJ;\4-'::l.€..Y c:.IGNA TUR~1\...A..J..Jt.J FOR OffiCE USE ONLY . (.I)~ om ~-I;;;l,-t ( -";'- ~ Typel Canst. "'-drooms K.-J J "Iorie- <:.~. Ftg. Main Sq. Ftg. Accen Sq. Ftg. Other Value Val\,le Value TOTAL VALUATION Units ""cy Load O"y Group x x 2J5?=' Pia" CIt. Comm/lnd 65':01 Blda Per Fee Plan Ck. Res 30%1 Bldq Per Fee Systems De...elopment Charae 11.5~..\ \~. cD LoO \D,CO ,40 '--~. J/l fence Demo Tolol Comb. Permit Sidewalk .A/e: Po...in.. Curb Cut 19.\ w TOTAL APPLlCA TI9N/&IT COMBINATION I. Applica~ to furnish (CAP) A. Job Add re55 B, Legal Description 1. exomple-tax lot 100, Lane County Map Reference 17 03 43 2. example-Lot 1. Block 3, 2nd Addition to Springfield Estates C. Nome. etc. of owner and construction Jender D.. Energy Sources 1. example-heat/electrical ceiling/or forced o;r gas 2. exomole-water heater/electrical/?, solar E. Square1fo,otoge or valuation, etc. ,'I , I 1. examole.1250 sq. foot house, 500 sq. foat garage 2. example.jf new project, check rJe;,-if addition, check add, etc. F. Building permit information: 1. examo/e-construct single family house with an attached garage 2. example-remodel existing gorag~ into faniily room 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 Cade H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction delays, Building Division Stoff must be able to contact appropriate persons regarding design inf~rmation or job site corrections, et~. II. ,Abbreviated P:lumbing, 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 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 hove 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 a typewritten copy and return it to the applicant at the time the actual permit is issued for his signatur&. 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 fe7~ are paid. All , other fees and charges are due ond payable when the permit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: , , .' , Additionol ,Project Infarmation: PLANS REVIEWED BY: name signaturf" . Permit Cler~ .;. \ ~-,. PERMIT VALIDATION , .' , . , J " , -". I " .Jeff" " ...AOI. , 'w, INSPECTION LINE 72t..316f . \~ CO' 8 ce . INFOIl:MATlON LINE 716-37.53 CITY OF SPRINGFIELD COMBINAJlCN APPLlCAflON/PEIlMIT Job "'ddr~u " 5~ \ <}('. O~l ~<~ r0 -) \\ - '-" I ~:::GY S~?)t S Waler Healer Ronqe _ Value of Work: i Sq. Fig. Main I Sq. fig. Ac't8n. Sq. Fig. O,h.r I _Ne.... _Add _Alrer _Rep. _.. _Fencl! _Oemo_Chongei U lit _Oth.r Legol Description Own.. t r. 1 \ \"\Cl.__ l 1- J &t ~Q.... Y I Add,... \r;y;; \ f\ ~ f'i ~ ~(' ~j,o{..) I S~N. ~T'J(~ ~\_' f\\l\('-QS Ie:., I COIHlruction lende~ I Addren ~ DESIGN TEAM Structural I Electrical' .1 Mechanical I CONT~ACTORS (Mme) (oddress) I G...,oi ~(\ \\~ \1\..("\, \\Q J....... ~M.D t:;,,) I P1umb'nq, ~'"1<\. U'-. I electricol~)t'...o>- (nome; Primary Mechanical PLUMBINe I -I 1 I 8uilding Permit Info: DetCribe Work (i.e., Build Single Fomil... Re,idOl!l'''~e With Attached Goreu:!!!!l Phone {\l f\rVp ) l "J\~<.LJ '("'\\~ (oddren) (lies. no.) (u;pirln) (phone no.l (lies. no.) (expires) bhono no.l ELECTRICAL , I CHARGE I NO. fEE CHARGr:, MECHANICAL FEE NO. I F::1O CHARGE I NO. WHERE SlATE lAW REQUIRES that the EI.drieal work b. done by the Elllo1,ieol ContracTor. the electrical portion of this permit shall not b. yalid until a lab.1 ho,. been signed by on flecflicol Controctor and attached '0 the elec:tricoJ panel. I HAVE CA,REFUllY EXAMINED ,h. completed application for permit, and do hereby certify that 011 information hereon ;1 ,r\,llt and correct, ond I f""rth.r certify that any and all work performed ,hall b. done in accordance with the OrdinanUI of the City of Springfield and the Law) of the Stot. of Oregon pertaining to the work de1Crii:M,G herin. and Ihat NO OCCUPANCY will b. made af any structure without the permiuion of the Building Di'tision. 1 furth.r atrtify that my registration with the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt th.. bash for exemption is noted. heron, and that only subcontractOfl and employees who are in compliance with ORS 701.0.5.5 will b. usad on this project. Basis far Builder's Board exemption: NAME (pl.ose print) Lo...u....ra... i i Eocn sin"le fill.lure 'I' R~locared building {new ti.ll. addilionoil I S.F. i1:<!lid.n~e (1 both) ! I I i ! , I I I i I , ! I I I \~,cl>-l 01,101_..: 11 bod,} eoc;, Additional balh Wat.r senice Sewer I Stor.m Sewer I I I , \ iN\1\ I TOTAL CHARGES Residence of fu,nQcol burner !o . ~TU's Appliance vent separate Stationa,;' e'top. cooler Yent fOil wilh singie duct Yent system oport from heoti~q or A.e. Mechonicol exhaus' hood and d~ct /, Sq: ft. New circuits, eherolious or eXlenliQns SERVICES Temporory Conslruction Amps. Wood stove/heelor FEEDERS Heat Puma Air handler 10 10.000 CFM Air hondler 0.,., 10.000 CFM Amps. I I \ J\\~ I I I I TOTAL CHARGES \DCD I I I ISSUANCE OF PERMIT I TOTAL CHARGES <IGNA YURcJJf"J.AJJ'lJr1.. fOR OFfiCE USE ONLY . \J;\~~e...y lJ)~ "Q- OATE ~-I;;l.-tl. Zono Fire Zone Flaod Plain Typel Canst. ~drooms r-:.J J <::toriel BUILOING PERMIT Cl-lI;1r9_s and Surcharges ~5~ - PLUMBING PERMIT Charges and Surc;,arges \~.co loD \D,CO ,40 elECTRICAL PERMIT Charge, and Surcharge, MECHANICAL PERMIT Charges and Surcharges Units ()ccy load ("leey Group Sq. ftg. Main "q. Ftg. Accen c:.q. Ftg. Other Value Value Yolue TOTAL VALUATION . . pIon Ck. Comm/lnd 65~~/ Blda Per Fen Pia" Ck. Res JO%J 8ldq Per Fee Systems Development CharQlI (1.5~) Fence LJDL. J/J Demo Total Comb. Permit Sidewalk Alc Pavina Curb Cut ~\ w TOTAL ( . APPLICATION/_Mil (CAP) COMBINATION I. Applica~ to furnish A. Jab Address B. legal Description 1. eXam ole-tax lot 100, lane County Map Referer 2. example-lot 1. Block 3. 2nd Addition to Springf C. Name, etc. of owner and construction lender D.. Energy Sources 1. example-heat/electrical ceiling/or forced oir go 2. exomole-water heater/electrical/or solar E. Square footoge or valuation, etc. - 1. example- ~ sq, foot house. 500 sq, foot gara! 2. example-if new project, check new.if addition. c add. etc. F. Building permit information: 1. example-construct single family house with an a gorage 2. exomole-remodel existing geragE:: into family rOI 3. exam pie-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 ovoid design or construction delays, Building Div Staff must be able to contact appropriate persons fe design inf~rmation or job site corrections. etc. II. Abbreviated Plumbing, Mechanical & Electrical Schedul, A: 'Except where.blank spaces occur in the description ~ of th.e Mechanical and Electrical Schedules, the appli need fill.in only the No. Boxes adjacent to the appro 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 schedul have been abbreviated 2. If the item(s} to be installed ore not covered on th aled schedules you should consult the full schedul 'C. BUilDING DIVISION STAFF Will Fill OUT All FEES A CHARGES ON THE SCHEDULES III. Applicant to sign and date Whenever possible, the initial application will be used 0: worksheet only. Where possible, Building Division Staff, prepare 0 typewritten copy and return it to the applieanl the time the actual permit is issued for his 5ignatur~. IV. ( I- 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 ore due and payable when the permit is issued. V. FOR OFFICE US,E ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY, Additional. Project Information: PLANS REVIEWED BY: name signatur.... ~ I . .i \ ..... PERMIT VALIDATION ( I CITY OF SPRI NGFIELD City Hall Springfield, Oregon Department of Public Work. 'OFFICIAl RECEIPT r I , '( r No. B S 7 0 6 2 Date (\m C'\ \ k 199<) \ - :d:~:om ~\~~_\~ ~ \J \J- -( ( Received For: ( ( \~.LV r :::, .00 (cO [(;.DO ( .4l\ . {.J{) ( c, ~\N\~ t ,~.Lrf\ \f)~ - J - \ '-171\ ,Mild- , ~ . 0 l,L.$ Da~ ( " ~t, ( ( .".. Received lQj~~ dq~p- AUTHO"IU:O SIGNATURE ...'[LTO...Tl,J"......LL ~"'''T,[''S. '[uQE'n. 0" 17.0' ~..".. ~ JJ-J I '. Amount ( ~ ( ( :,' '/ .. .. Permit Cler~ , r ! I I I ~at....