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Home My WebLink AboutPermit Building 1982-3-5 rJ IINSPE~19N l1Jli~7 726-3769 I Job Address I legal Description . CITY OF SPRINGfIELD COMBINATION APPLICATION/PERMIT . INFORMATION LINE 726-3753 ENERGY SOURCeS: Sq. Ftg. Main Sq. Ftg. Access. Sq. FIg. Other _New_Add_Alter_Rep. I_Fence_oemO_Chonge/use _Other ~1 ~00.0(l Building -P;r';'it Info: D~scrjbe Work (i.e., Build Single Forni)." Residftnce With Attached Garace) co N o - "" o 363 LJn.daJ p nyo; Vp , Z-03:2Z:10_LL-48n1 Heat Water Heater RonQ'" Value of Work: Address 1_ i,nda-l-e-Apa-l'tments 3.63 I ;nrl~lp [)r;vp SDri.n9f; p ,rl_ n.R---9BI17 Owner Phone 74~<Ll Stor:a.se-roDrn Construction lender Address Phone DESIGN TEAM (expires) (name) (address) (lies. no.) (phone no.) Primary Annp'" rnnc:tY'llrtinn rnmr::an}' Structural NA Electrical NA Mechanical NA CONTRACTORS (name) (address) (lies. no.) {expires} (phone no.) General .6ng01('\ rnnc:.rV'lIt"'i-;?n Comp?,n..~1 Plumbing N A Electrical NA Mechanical NA PLUMBING ELECTRICAL MECHANICAL NO FEE CHARGE NO. FEE CHARGE NO. FEE CHARGE Each sin~le fixture Relocated building (new fix. additionall S.F. Residence /1 bath) sq. ft. New circuits, alterations or extensions furnace/burner to ATU's Appliance vent separate Stationary evap. cooler Vent fan with single duct Vent system apart from heoting ar A.C. Mechanical exhaust hood and duct Residence of SERVICES Duplex (1 bath) each Temporary Construction Additional both Amps. Water service Sewer Wood stove/heater Storm Sewer FEEDERS Heat Pump Air handler to 10.000 CFM Air handler over 10.000 CFM Amps. ISSUANCE OF PERMIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall not be valid until a label has been signed by an Electrical Contractor and attached 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 thot 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 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 certlfy 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 heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. Basis for Builder's Board exemption- NAME (please print). ..:r;, I, ~'" w hi II V ., C.~ Zone R ] fire Zone flood Plain Type/Const.J-N Bedroom' Storio" 1 Units l"'Iccy Load f"lccy Group SIGNATUR~~J FOR OFFICE Up-6NLjI) ~Main Sq. Fig. Access Sq. Ftg. Other -i<J ~TE1/1J";V1 M1 x Value x Value x Value TOTAL VALUATION $1,500. [)[) Oouble fpp - ~t~rtprl BUILDING PERMIT Charges and Surcharges _____$3'O"._QD- 1. 20 wirhnl\t rAl"mi-f- Plan n. Comm/lnd 65%/ Bldg Per Fee Plan Ck. Res 30%/ Bldg Per Fee S9_]~ Pn <-4=8') #B58156 Systems Development Charae (1.5%) PLUMBING PERMIT Charges and Surcharges fence Demo Total Comb. Permit elECTRICAL PERMIT Charges and Surcharges Sidewalk AI C Pavina MECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL $31. 20 .~' l' APPllCATIONIRMIT (CAP) COMBINATION " , 'I:. Applicant ta furnish :';.A. Jab Address _' B, legal Descriptian 1. example-tax lat 100, lane County Map Reference 17 03 43 2. example-lot 1. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender ",~ D. Energy Sources 1. example-heat/electrical ceiling/or forced air gas 2. example-water heater/electrical/or solar.- ;:"~. E. Square footage or valuation, etc. 1. example-1250 sq. foot hause, 500 sq. foot garage 2. example-if new project, check new-if addition, check add, etc. F. Building permit information: 1. example-construct single family house with an attached 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 the St'ructural Specialty Cade H. DESIGN TEAM 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. E'xcept 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) ta 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 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 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 ONLY j PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . ,. Additional Project Information; , . PLANS REVIEWED BY, nam"'" ~ignaturl? . Permit Clerk " , ~, <', , . , -'-~~~-.t .-:.. ./ PERMIT V ALIDA T16~ -" ;. . .' ;',' ,";: \: - .,. " '., ,.' " '. .-." -., {i ..: ~, .. ; ....~ ',-, .' riot,.,. r '.!.7::~;'--"''' .:'~~,,:.,. .. ',~~.:":'~:;'~.:"J:.";"":~;' ',"' ":,: \ \ "'" "':r -.........."... ....___ /,1' . ....... - , W' .-. \, '.'--"~"" ..; '.--- -" /INSPECTlON LINE 726-3769 I Job Addrel~ 'legol DIII~(rpti~n I CITY OF SPRINGfiELD COMBINATION APPLICATION/PERMIT INFORMATION LINE 726-3753 Address Phone 747-1234 / ENERGY SOURCES: Heat I Water Heoter Range I Value of Work: $1. 500.00 Building Permit Info: Describe Work {i.e., Build Single ~y Residence With Attached Garaael J Sq. Ftg. Main Sq. Ftg. ACton. Sq. Frg. Other _New_Add_Alter_Rep. _Fence_Demo_Chongel Use _Other_ 3QLLilli1aJ" n...i"" 1l:m=.ZZ=.10_LL_480 1 Owner - - -- "'.- - .-. .- I. i :'lda-1e-AP<W-tment: 1.63 I ; "ria I" Od I'e.. .., ~oringfield. OR q7477 St01'..age ronIT' CanHr\J(':tion Lend.r Addr.n Phone DESIGN TEAM (nome) (address) (expires) (lies. no.) Primary Angpln rnn<:trlJrtinn rnmp;:tny Structural t\lA Electrical "JA Mechanical t-.lA CONTRACTO~,~ (namo) General .Q.ngp 1 n rnnC}trlf('ti (H) C'om~:ar''':~1 Plumbino '" A Electrical NA Mechanical NA (ph~ne no.) (addr~~!l (lies. no.) (expires) (phone no.) PLUMBING ELECTR ICAL MECHANICAL NO.1 I FEE I CHARGE I NO. I FEE I CHARGE I NO. I FE _I I , Residence of I -' I I furnace/burner to Each sinAle fixture .- ~.ft. _ J:TU's .. .. Relocated building New circuits, alterations Appliance vent (new fix. additional) or extensions separate S.F. Residence Stationary evap. , (I batM SERVICES cooler Vent fon with ---.J Dualu :! !'ath) each Temporary Construction sin~le duct .. .. - I Vent system aport from I Additionol bath Amps. heating or A.C. - - I Mechanic;al exhaust Wat", ".,..:.... hood and duct - - I Sewer Wood stove/heater - I Storm S.,......., FEEDERS Heat Pump - I Air handler to Amps. 10,000 CFM -I Ai, handlll, oVllr I .. 10,000 CFM -I .-. - . I I - .. - .. I J .. - , - -, I ISSUANCE OF. PERMIT - >T AL CHARGES TOTAL CHARGES TOT At CHARGES I WHERE STATE lAW REQUIRES that tho EI.mr,al wo,k be don. by .h. EI.",;,al Con'.a"o" tho .I.".;,al po.t;on of thl. p..mi. .han not b. .alid until a I Ibel has been sign.d by an EleCh'ical Contractor and attached to the .rectrical pan.l. I HAVE CAREFUllY EXAMINEO tho <ampl.t.d epplkotian fo, p..mlt, and da h.,.by ",tify thet ell inre.metion h...on ;, t.u. end ''''.<1, end 1 fu.th.. "tify the. eny end ell we.k pe.fam..d .hell b. den. in a'<a.dan,. with tho O.dinan,.. ef tho City of Sp.inOfJ.ld end tho lew. ef tho Stat. af O..oen main;no te tho wa.k d.",ib.d h..;n, end thet NO OCCUPANCY will b. med. ef eny ,t'u<lu,. wltheut tho p..ml..ion ef tho Buildino Div;,'en. I fu.th.. "t1ry that my ',,;,"etion with tho Build.r. "e.d I, ;n full fa"a end off.<I e. ...ui..d by ORS 701.055, thet if .x.mpt tho be,I, fe, ex.mption ;, nated lran, and that only subcantractars and employeel who are in compliance with ORS 701.055 will be used on this project. ail for Builder's Board exemptior' .ME (pleale print) ..'7:, I, ,0../ SIGNATURQ~J FOR OFFlCE~ - -, - S g. Main co '" Ftg. Acceu Sq. Ftg. Other hid (/ ( ~~~ IV ~TE --w '.;o/f/J".?/ , , I ,. R 3 .Type/Canst.......J/...=..N Bedrooms (':tori.. Units Zone ,d Plain '1ccy Load Occy Group---M,! Value Value - Value 'x x Double fee - startpri .DING PERMIT rgel and harges withnllt PP\"mit Plan CIe. Camm/lnd I 65%/Bld Per Fee _ '$9 Plan CIe. Res 30%/ Bldg Per Fee TOTAL VALUATION .~BING PERMIT ges and larglll ---__$..3J2,..QlL 1. 20 Systems Development Charqe (T .5%) 75 Po 3-4-82 #858156 Fence --------- fRICAl PERMIT ;Jel and larglls Demo I Sidewalk ---------1 :~: ~::na ---------/ I TOTAL I $31. 20 Total Comb. Permit I {ANICAL PERMIT Jes and argll' " " ex> N o ..... <.0 o , I . a " :i / E CHARGE j I I I I I I I I I I I I 1 ;.;~,,~~70;;;::::,:j"\i:~-:~=~~:O": s P'RI ~ G FIE L 0 City Hall Springfield, Oregon Deportment of Public Works OFFICIAL RECEIPT No. B ~ -,.,- 19 g2. C Reed From ~,,~ t!" O~. Address .3L~ ~.~.d /I/~. ~A~ C ) "::';~:~''''~-~~-''..,:,". .....-..- -_.".~"", " COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. exomple-tax lot 100, Lone County Mop Refere'nce 2. exomple-Lot 1. Block 3, 2nd Addition to Springfield C. Name, etc. of owner and construction lender D. Energy Sources 1. example-heat/electrical ceiling/or forced air qas 2. example-water heater/electrical/or solar ., ;' E. Square footage or valuation, etc. .- .' 1. example-1250 sq. foot house, 500 sq. foot garage 2. example-if new project, check new-if addition, chec add, etc. . F. Building permit information: 1. example-construct single family house with an otto garage. Co, 2. example-remodel existing garage into family room 3. example-convert single family residence into restaurant (change of use) G. Value of work os defined in Section 303 (aJ'of the Structurol Specialty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction delays, Building Divisi Staff must be able to contact appropriate persons regl design information or job site corrections, etc. ( ( Dote ( Received Far: '~'/~ , . ;.\' c ( II. Abbreviated Plumbing, Mechonical & Electrical 'Schedules ( A. Except where blank spaces occur in the description po of the Mechanical and Electrical Schedules, the applic. need fill-in only the No. Boxes adjacent to the approp Ie item(s) to be instolled:" ' \; Amounl Received 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) 10 be installed ore not covered on Ihe oted schedules you should consult the full schedule ( 'C. BUILDING DIVISION STAFF WilL Fill OUT ALL FEES All- CHARGES ON THE SCHEDULES ' .. , . ... (] '. III. Applica~t to sign ~nd date . Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Division Stoff will prepare a typewritten copy and return it to the applicant at the time the actual per!"1it 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 ore paid. All other fees and charges ore due and payable when the permit isissu~. - . V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: -' .-,' ..... . ,. :.~" Additional Project Information: .n' PLANS REVIEWED BY: /"I /U name pan Sm.i..th signature ",.1 ( (J 58159q q CI ~f{/..2}) (I (fA .I J.-, M AUTHORIZI[D SIGNATURI[ ""I:LTON'TU"N'ULL ....'NTI:.... I:UGI:Nl. Oil '7.01 ""11" (I C':- (I . - - ,'~ :.... . i "'-'.;" . . . , . ," :. ~- . . '!: Permit Cler~ .~. " ' '. ; .,' -1-;..., .; I (:.:;"1 Cd .~, q"'':l. ..::1 LI'-':L; r..: ..- . ,. ,.1 data 3-4-82 ',""' '. q' ,. ,- ":.:. '. .'\: ..... .1 ", ,'. '.. '. f' ,v .-J