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Home My WebLink AboutPermit Building 1981-9-28 -, l' , . ~ ~7" CITY UF SPRINGFIElD ~ CDllBlIlATlON APPliCATION/PERMIT E!IERGY SOURCES: Heat \~ater Heater Ran!}e INFOR/IATlON liNe 726-3753 Sq. Ftg. Ha,in ~q. Ftg. Access. Sq. Ftg. Other -1le,,_Add)!.AI ter -,qep, Fence Oemo Change/use. Other- - I INSPECTION liNE 726-3769 Job Address /8' tG () "AU /Cf4 . ~.8vI.._ P~~;."" ~ ... ,/{ , . ~~ I Build;nQ Permit Info: Describe Work(i.e., Familv nesidence With Attached GaraQe) Build Single ~ (). ~ I~ ~ o I I I . Legal Description Owner;zAd1'!"1II4MnA/AoL. &tAc;.. Address p, (). & ',( 13b I IJI2.. ValUE of Work: ~ 3j60a "'''''4''''' tJ., Construction ~ender 1 471./<./0 ~1ClZi!.."~. 7~;1J4.. Address UI:.~lliN II:.AI-' (name) Phone (address) (lies. no.l {exoiresl (ohone no.) *., I ! , t " I' II Primary 11echanical CONTRACTORS lnamel General OW AlE;; 2. (address) (lics. no.) (exo;res) i ~ I ,I Structura 1 Electrical (ohone no.) ! Plumbina Electrical ~lechanical . =----~~....-=-.'..;, -'._.-~~=~~- PlUllBlNG ElECTRICAl MECHANICAl -ND.'~"~~-- -~FEE-CH~ .1<<I..J_' Each Single fixture I Residence of SQ. FT. INew circuits alts. or extensions ISERVICES I -~~~~AW' NO_ :."""-----~ ~ m,_.l:JiABllf., furnace/burner to BTU's Relocated building (new fix. additional) Floor furnace and vent S.F. Residence 11 bath) Duplex (1 bath) Recessed wall S~~rp hp~1er ~nrl ypnt each Water service jTempOrary Construction IChange in existing rp~ j qp.IU'-P ImUltifamily, COI11ll. or Industrial 10f amps. ICOMfl./INO. FEEOERS I Install/alter/relocate distrib. fee~pr~ IOf amps. Appliance vent Sp.Darate Stationary evap. cooler Vent fan with sinole duct Vent system apart from I heatina or A.C. Mechanical exhaust hood and duct I I I Additional bath Sewer Storm Sewer Wood stove/heater I I I I I TOTAl CHARGES WHERE STATE l~W REQUIRES shall not be vali1 until the ISSUANcr OF PFRIHT TOTAl CHARGES TOTAl CHARGES that the Electrical work be done by an, 'Electrical Contractor. the electrical portion of this pennit label has been signed by an Electrical Supervisor and returned to the Building Oivision '\)' \I \:; I:J i' I HAVE CAREFULLY EXN1INED 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 shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Oregon oertaining to the work described herein, and that I/O OCCUPAIICY 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 ons 701.055, that if exempt the basis for exemption ;s noted hereon, and that only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project. IIAl'lE(please print) ~ SIGIIATURE FO~ OFFICE USE OT/L Y Sq. Ftg. Sq. Ftg. Sq, Ftg. DATe Zone-M - I Fi re Zone Flood Plain I '\ TYOe/con~\t. ~--~Units Bedrooms ./ Accy load Stories ~ Occy Group~~ Imin Access Other x Value x Value x Va 1 ue TOTAl VAlUATIOII~m"lW 'Systems Development Charqe (I.5~) BUIlDING PERmT Charges an':: Surcharges , ,,' Plan Ck. _______~~c20 65~/Blda Plan Ck. .'t(", 30~/Blda COIll11/1 nd PPl'" Fpp Res Per Fee PlU'1BING PERMIT Charges and Surcharges Fence ElECTRICAl PERr:IT Cha rges and Surcha rges Demo 'S1dewalk AIC Paving Total Comb. Permit TOTAl ,~tf~b\. MECHANICAl PERMIT Charges and Surcharges Curb Cut J. " . . ,....::l I ~ ~ , COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax lot 100. lane County Map Reference 11 U3 43 2. example- Lot 1. :Block 3, 2nd Addition to Sprlngtield Estates C. Name. etc. of owner 'and construction lender O. Energy Sources 1. exam~le- heat/electrical ceiling/or forced air Qas 2. examole- waterheater/electrlcalJor solar E. Square footage or valuation, etc. - 1. examole- 1250 sql. foot house, 500 sq. foot garage 2. examole- if new project. check-new - if addition, check add. etc. I F. Building penn it information: 1. -example - construct ,single family house with an attached garage i . 2. exa~~le - remode1 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 TEAM AND CONTRACTORS To avoid design or construction delays. Building DivisiOil Staff must be able to contact appropriate perso~s regarding ~esign information or jOb site corrections. etc. II. Abbreviated Plumbing, Mechanical, & Electrical Schedules .A. Except where blank spaces occur in the description portion of the Mechan~cal and Electrical Schedules. the applicant need fi~l-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 spaceion the permit form the'schedules have been abbreviated 2. If the item{s) tOlbe installed are not covered on the abbreviated schedules you should consult the full schedules C. BUILDING 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 signa ture. 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 iSI issued. " i . "j j :I 'I , ,1 I , -; 'r . .: ....... V. FOR OFFICE USE ONLY Permit Clerk . "' 'II, , . PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: , Permit applicant exempt from registration with the Builder's Board because: . . Additional Project Information: name signature date 9-,2 g.- 'if PLANS REVIEWED BY: J'" ":~.[',"";' ;:E!ti~' ""iT 'i""'''~~, ...... '. . " "'.....; ". .".,...... . . , , I IrlSPECTlOII L1IIE 726-3769 Job Address /8'1c7 (J J.AuRA s.r' CITY OF SPRIIlGflELO COtfBWATlON APPLICATION/PERMIT ~ EilERGY SOURCES: Heat Hater Heater Ranqe INfORIIATlON LINt 726-3753 Sq. Ft9. 1.lain ~q. ~tg. Access. ~ Sq. Ft9. Other ~ -1'ew_Add)tAI ter -,~ep. 0 _Fence_oemo_change/use'l r.... Other '1:0 ' Oescribe Work(i.e.. Build Single I ~ .A.ttached Gar3Cle) ~ I~ (;I legal De$cription Owne'7.N~4ncw~l.. ,g"".... Address .ca.e.", <;;. p~);.. 'V ~ ... " ~ r-..-...: Valu, of Work: ~ 3,CJOO BU11riinQ Pennit Info: Familv nesidence With ~ ~ ~ 1 "'. ~ ~~ ~~ lLnLi!J2.a... Construction lender lname) Phone (address) I Address OESIGrI TEAll (1 its. no.) (expires) (phOMno.) Primary Structura 1 Electrical ,/ i !1echani ca 1 CONTRACTORS lnamel General OWN{; 2. (addres~ ) (lies. no.) (exDires) (chane no. ) Plumbina Electrical t.1ech'anical ,",",- - _....._.6_...... ..-----..,....--..... <<< I I r"'IRIlf. :':'.1 ,', i'" /i PLUIIBJlIG ELECTRICAL MECHANICAL i -1!Q,. ~. FEE I rHARGF Nn .. ~ - ~~L....c..I::iA.B. NO =-------.-" Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) New circuits alts. or extensions I' Floor furnace and vent . I Recessed wall ~n~~p hp~tpr ~nrl vpnt Is.F, Residence II bath 1 IDuPlex (I bath) each IAdditional bath Iwater service "I Sewer r I Storm Sewer ISERVICES I I I I ~'I ITempOrary Construction IChange in existing ,r"p'S-jcjpnrp Imultifamily. camm. or Induc:tria,l IOf amps. . ICD~~./INO. FEEOERS I Install/alter/relocate rl;~t~ih fpprlp,.~ 10f amps.1 I I I I I I I I I I TOTAL I Appl iance vent ~oar;ttp I Stationary evap. cooler I Vent fan with , ~inale d~(':t. I Vent system "apart, from I heatina or A.C. I Mechanical exhaust hood ;tnd durt I Hood stove/heater I TOTAL CHARGES WHEnE STATE L'W REQUIRES shall not be valiJ until the TOTAL CHARGES ISSUANcr OF PFRtlIT 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 1 HAVE CAREFULLY EXA~lINEO 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 oerfonned shall be done in accordance with the Ordinances of the City of Soringfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAUCY 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 com~liance with OP.S 7nl.055 will be used on this project~ IIAHE(please print) S IGrlATURE FOr. OFFICE USE OiIL Y Sq. Ftg. 110in Sq. Ft9. Access Sq. Ftg. Other OATE Zone~Tyoe/Const. ~--~Units Fi re Zone Bedrooms Occy Load Flood Plain Stories Occy Group)S-.2 x Value x Va 1 ue x Value TOTAL VALUATION ~.CO'iW ;J BUILOIllG PERr.nT Charges an~ Surcharges ., Plan Ck. Comm/Ind _ _ _ _ _ _ _ ~.!if2a 6S%;/BJ do P.rr Fpp Plan Ck. Res . "114 3D~/Bldo Per Fee r Fence ------------ I 0_ I Sjdew~~ I A/C Paving I Curb Cut ------------ I Systems Development Charqe (1.5~) PLU'iBING PERMIT Charges and Surcharges I HI ELECTR I CAl PERI~IT Cha rges and Surcharges Irotal Comb. rennit I I TOTAL ,~7(~b.,. . 11ECHANICAL PERMIT Charges and Surcharges . ~ COMBINATION APPLICATION/PE~~IT (CAP) I. Appl icant to furnish A. ,Job Address B. Legal Description 1. example- Tax Lot 100. Lane County Map Refe: 17 U3 43 ' ( 2. example- Lot I. Block 3. 2nd Addition to Sprlngtield Estates . C. Name. etc. of owner, and construction lender O. Energy Sources 1. examole- heat/electrical ceilinq/or forced 2. exa~ple- waterheater/electrlcal/or solar Eo' Square footage or valuation. etc. - ,~ 1. example- 1250 SQ. foot house. 500 sq. foot tae 2. example- if new project. check-new - if ad! check add. etc. F. Building permit information: 1. example - construct single family house w;~ a.ttached garage 2. examole - remodel existing garage into fam" 3. examole - conver't single family residence' restaurant (change of use) G. Value of work as defined in Section 303 (a) of Structural Specialty' Code H. DESIGN TEAI,j AIID CONTRACTORS To avoid design or construction delays, Buildi, Division Staff must be able to contact appropr: persons regarding design information or jOb si1 corrections, etc. . 11. Abbreviated Plumbing. Mechanical. & Electrical Sch. (e' A; Except where blank spaces occur in the descript portion of the Mechanical and Electrical Schedl the applicant need fill-in only the No. Boxes c to the appropriate item(s) to be installed ( B. Full.Plumbing. Mechanical, and Electrical Sche< . are available at the Building Division 1. To conserve space on the permit form the's< have been abbreviated ( 2. If the item(s) to be installed are not cov, " the abbreviated schedules you should consul full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES r CHARGES ON THE SCHEDULES O. As noted on the CAP. the label must be deliver, electrical contractor'for signature by.his elec supervisor. The general contractor is .not autt ,.It. to sign the electrical label. - "- Applicant to sign and date Whenever possible. the initial application will be a worksheet only. Where possible, Building Divisic /'to'" will prepare a type written copy and return it to t \ applicant at the time the actual permit is issued f signa ture. Fees and Cha rges ,.' Plan check fees are due and payable at the time of ( application. and no plans will be processed until t~ fees are paid. All other fees and charges are due ana payable when the permit is issued. I I I. . IV. V. FOR OFFICE USE ONLY . "l... PERMIT VALIDATION CITY OF SPRINGFIELD (I ,.' City Hall Springfield. Oregan Department of Public Works OffiCIAL RECEIPT (I Q N~ B 573601 /-;J.. r- 19 r:;' I /J an' Rec'd Frnm~& ......'e4 r::r-~ Address j 3(,0 ~ 411 Date Received For: !(~p ~% --- f. (I .If, <I ()! l ( .1 (I <. (I 2~(!Jn .. 9.-6 ~maunt;c~ ~..I' s..nTO...Tu.....U:~::~~~~:D, :~:::,TUO:E.,.o, ...".. (.. Permit Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ~ Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature /"'\ f/l + J date 9--2 lJ- 2' (