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Home My WebLink AboutPermit Electrical 1982-4-12 ,,-c~-, .to::: < '-' \',~. I INSPECTION LINE 726-3769 I Job Address .;< J It, I Legal Description I ugf)f}. . . ENERGY SOURCES: Heat Water Heater Range Value of Work: INFORMATION LINE 726.3753 . CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT ~j}1(L~1 !dhjf 17-()~-:l,C;~q7~ I Sq. Fig. Main Sq. Ftg, Access, Sq, Fig. Other _New_Add_Alter_Rep. _Fence_Demo_"'1ongel Use _Other ~ t 'l:\ ~ Owner ~nH>/ ...f.r.d//,,'7':0'/h .:2.. II.., -ntr.; "', J:rx u * phone Building Permit Info: Describe Work (i.e., Build Single Familv Residence With Attached Garo!Je) Address Construction lender ~u.u-J)> IV..I",~ //. ' ' -, Addren Phone DESIGN TEAM (name) (address) (lies. no.) (expires) (phone no.) Primary Struc:t....ral I EI..drical I r I I I Med.....niml rnNTRACTORS (nome) ~~nerol CJ~.J- (addren) Wes. no.) (expires) * (phone no.) j.L. ()-Uhf t>A _ PlumbinQ Electrical Mechanical PLUMBING ELECTRICAL MECHANICAL NO FEE CHARGE NO, FEE CHARGE NO. FEE CHARGE __ Each sin91. fixture Relocated building (new fix. additional) S.F, Residence (1 both} Sq. ft. New circuits, alterations or extensions furnace/ burner to ~TU's Appliance vent separate Stationary evap. cooler Vent fan with sin!=lle duct Vent system apart from heatinR or A.C. Mechanical exhaust hood and duct Residence of I I I I SERVICES DUDlex (1 bath) each Temporary Construction Additional bath Amps. Water service Sewer Wood stove/heater Storm Sewer FEEDERS Heat Pum') Air handler to 10.000 CFM Air hondler over 10,000 CFM Amps. ISSUANCE OF PERMIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES that the Elemical work be done by the Electrical Contrador, the electrical portion of this permit shall not be valid until a label has bMn signed by an Elemical Contrador 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 that any and 011 work performed sholl be done in occordance 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 mode 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 a s required by ORS 701,055, that if exempt the basis for exemption is noted heron, and that only subcontractors and employees who ore in complia,n,"'GNWAT"uhROE R~S 70:~SS wHI be "grOiect, Basis for Builder's Board exemption. , ~ NAME (please print) DATE '1-/;2-8'"~ FOR OFfiCE USE ONLY Zone Type/Canst. Units Fire Zone Bedrooms "'ccy Load Flood Plain C:tori~- nccy Group BUILDING PERMIT Plan Ck. Comm/lnd Charges and 65%/ BldCl Per Fee Surcharges Plan ek. Res 30%/ BldR Per Fee PLUMBING PERMIT Charges and Fence Surcharges Demo ELECTRICAL PERMIT J(t) I Charges and Sidewolk Surcharges Alc Pavina MECHANICAL PERMIT Charges and Curb Cut Surcharges --------- > Sq. Ftg. Main c:~. Ftg. Access Sq. Ftg. Other x Value Value Value TOTAL VALUATION x Systems Development Charae fl ,5%\ Total Comb. Permit il 7. /Jt) fl 70-0 TOTAL /17.rJt> ~. ).,,- :. ".~"'~'; ~ <'" -.(,."" '\::.... .."'" . 7'\"; .. !'...., ,>' ;,( -' --,~_. '-'-;'; COMBINATION APPLICATION/PERMIT .> ...... - I. Applicant to furnish A. Jab Address B. Legal Description 1. example-tax lot 100, Lane County Map Reference 17 03 43 2. example. Lot 1. Black 3, 2nd Addition to Springfield Estates C. Nome, etc. of owner and construction lender D. Energy Sources 1. example-heat/electrical ceiling/or forced air gas 2. example-water heaterl.electrical/6r solar. E. Square footage or valuation, etc. 1. example-1250 sq. foat house, 500 sq. foat 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 Structural Specialty Code' H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction delays, Building Division Staff must be able to contoct 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 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 tim~ 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 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: " ' . . Additional Project Information: :t PLANS REVIEWED BY, name-:;-:- signaturo ~.~ l... 1,1, J', . ~ . ~',~'. "\l:'.l:~; .. ....~,_ .,'1... ~ ..................... ..tv\IT ~~L1DATION Permit Cler~ -fate -7 ""I .'.""- ."i INSPECTION LINE 726-3769 .- CITY Of SPRINGFiElD COMBINATION APPLICATION/PERMIT . INFORMATION LINE 726-3753 Job Addreu ;1. J It, ~/JI a./..~I ~fA..pj 'f ENERGY SOURCES: Heat Water Heofer Range I Value of Work: Sq. Ftg. Main Sq. fIg, Access. Sq, Ftg. Other _New_Add_Alter_Rep. _fence_Demo_Chonge/UstI _Other ~ N 'Cl I~ I I LeAol Description Owner ~-/j? )" I/', 71[ft ;," L~(/ A 'z';;../ /" . ),"';* Phone Building Permit Info: Describe Work (i.e,. Build Single Familv Residence With Attached Garaae) Address Construction lender Ad ~.IJh<j..l I/, , M..I..;..L 1 Address Phone DESIGN TEAM (nome) (oddreu) (lies. no,) (expires) (phone no.) Primary Structural Electrical Mechanical CONTRACTORS (nomel 11 t ^ .. General U.........__L ,: L- (address) (lies. no.) (exoites) (ohone no,' fJ-{1hlV.h", Plumbing Electrical Mechanical PLUMBING ELECTRICAL MECHANICAL NO. FEE CHARGE NO. FEE CHARGE NO. FEE CHARGE Additional both Amps, furnace/burner to III,TU's Appliance vent separate Stationary evap. cooler Vent fan with single duct Vent system apart from heatinp or A,C. Mechanical exhaust hood and duct Residence of Each sinQI. fixture Relocated building (new fix, additional) S,F. Residence (1 both) SQ. ft, New circuits, alterations or extensions SERVICES Duplex (1 bath) each Temporary Construction Water seryice Sewer Wood stove/heoter Storm Sewer FEEDERS Heat Puma 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 Contrador, the electrical portion of this permit shall not be valid until a label has be.n signed by an Electrical Contractor ond attached to the electrical panel, I HAVE CAREFUllY EXAMINED the completed application for permit. and do hereby certify that 011 information hereon is true and correct, and I further certify that any and 011 work performed sholl 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 mode of any structure without the permission of the Building Division. I further certlfy that my registration witt. the Builder's Board is in full force and .;Ffoct as required by ORS 701.055; that if exempt the basis for exemption is noted heron, and that only subcontractors and employees who ore in compliance with ORS ~701:/'L35 will be_M_' Basis for Builder's Boord exemption: p NAME (please print) C'IGNATURE DATE "t-/2 -S~Z FOR OFFICE USE ONLY Ion. Fire Zone Flood Plain Type/Canst. Bedrooms Citarie- Units n!cy Load "ccy Group Cq. Ftg. Main Sq, Ftg. Access Sq. Fig. Other Value Value Value TOTAL VALUATION x x BUILDING PERMIT Chorges and Surcharges Plan Ck. Camm/lnd 65%/ Bldq Per Fee Plan Ck. Res 30%/ Bldq Per Fee Systems Development ChorQe (1.5%) PLUMBING PERMIT Charges and Surcharges Fence Demo Total Camb. Permit 1/ 7. Do ElECTRICAL PERMIT Chgrges and Surcharges Sidewalk } 10 n 7 0-0 A/C PavincJ MECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL 117Pt> - aJ COMBINATION APPLICATION/PERMIT I. Applicant ta furnish A. Jab Address B. legal Descriptian 1. example-tax lat 100, Lane County Map Referenc 2. example-Lot 1. Block 3, 2nd Addition ta Springfie~ C. Name, etc. of owner and construction lender . D. Energy Sources 1. example-heat/electrical ceiling/or forced air gas 2. examoJe.water heater/electrical/or solar E. Square footage or valuation, etc. 1. example-1250 sq. foot house, 500 sq. foot garag' 2. example-if new project, check new~if addition, ch add, etc. F. Building permit information: 1. example-construct single family house with an atl garage 2. example-remodel existing garage into family roo 3. example-convert single family residence into restaurant (change of use) G. Value of work as defined in Section 303 (aJ of the Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Oivi Staff must be able to contact appropriate persons ret design information or job site corrections, etc. II. Abbreviated Plumbing, Mechanical & Electrical 'Schedule A. Except where blank spaces occur In the description p of the 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 are not cavered on th ated schedules you should consult the full schedul C. BUILDING DIVISION STAFF WilL FILL OUT ALL FEES A CHARGES ON THE SCHEDULES ~ '-, -- ---.;.:;:--..'.----..~{ CITY OF SPRINGFIELD t......,-' .ItYHaU Spnnglield, Oregon Department 01 Public Worle. OFFICIAL RECEiPT No. B 58871( (' ( I; ( Dale 4- f'2. 19J'L Rec'd From j,wu~j'1' -c---Iv, ALUAL-tJu ',,, ( Address 6l.1t> Ihab... 'SIAo 1- ( ( ( Received For: ,:,jd~, tl~. Ij" I ,(4 7. Oz> ( ( ( ( c ~;, c \", c -C 1;7.h Amount Received t..tL<J-'--- - c c krrv (....t. I '. ( ( ~(I "'"'' AUTHORlZEO SIGNATURE BRIGGS I"RINTERS/UTHOGRAPHIIRS. l[UGl[NII. ORaGON 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 af 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 USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: PLANS REVIEWED BY, nom.... signatur'" Permit Clerr ..late ,