HomeMy WebLinkAboutPermit Building 1980-8-14
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Address _"/ r.-r, /1_ ~~.~ un-. / _ Ph 7./'''' IBuil";ino Pennit Info: Oeser,be Horkli',e" Build Single
ey r r l-/,.-Y-J e,-#"V" J '-C Cf#1 one )(ob'l!.,..,;a.. Famil V R.esidence Hi th .A.ttached Garaoe)
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Construction Lender ;x!.,-.-J{F ,g-/J-pc:.<!>~GFL'1 t.c>a4Gg- -or- ;fk77Ja>".,
1 INSPECTION LItlE
726-3769 r
H
Job ,l,jdress, ~ ( t:59.'
Legal Description
Owner ~I'Y<:'
Address
U!:.:::I1l:iN tEAr~
Primary
Structural
Electrical
.
.
G/7l'J. l<J~
I
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
I EilERGY SOURCES: A /.
L"."""., Heat €~E'c7: '7,<:' .
i Uater Heater EJ(,;;r
Range
ValuE of Hark:
(name)
Phone
(address)
(l ics, no,)
r1echanical
CONTRACTORS (name) (address) (1ir:o;.. no,)
Genera I <:::::::::;,., f":>"-':' 1/--N..fJ tftJe-7&S _ ~a:riJ ~
Plumbina c::5k1' ';,r, P~II'k~""""'?
Electrical (! y-- d E' c:..C?~ 7C7Zo'c-
~lechan;cal ~~ ~ a~
PLUI1BIrIG
I Relocated building
(new fix, additional)
IS,F. Residence
(] bath I
IOuplex (I bath) each
IAdditional bath
I ~'a ter serv; ce
I Sewer
Istorm Sewer
NO.
"3
Each single fixture
I ':1'
I
I
I
",
ELECTRICAL
FEE [HARr,E
NO I
I Residence of
SQ, FT.
o:? INew circu~ts a1t5,
;1' or extenslonsA~
1 .iII..-.... '2 -..J.".....
I SERVICES
I
vs- ~c
I
I
I
I
I
INFORlIATlON LINt
726-3753
Sq, Ftq, 1.lain
~q. Ftg. Access.
Sq, Ft9, Other
ilew Add Alter P.ep,
--Fence Demo Change/Use'
-Other- -
~
()
\A
VJ
o
FFF
r\.jAR~j: rm
(exnires)
(ohane no.1
~/Soe
ITempOrary Construction
IChange in existing
rp~ ; dpn(:p
Imultifamily, camm. or
Tmill<;trial
IOf
ICOMM./INO. FEEOERS
I Install/alter/relocate
rli"trih^ fpprlpr"
Of amps.1
amps.1
(pxo;rp<;)
(ohnnp nn.)
MECHANICAL
FFF
n-lAQ(:J:'
I
furnace/burner to
ACV. BTlI's
60
Floor furnace
and vent
Recessed wall
SOi'll"_P hptltpr .::Inrl vpnt
I
Appliance vent
seaa ra te
Stationary evap,
cooler
Vent fan with
sinole duct
Vent system apart from
heat;na or A.C.
Mechanical exhaust
hood nnd duct
Wood stove/heater
I
1300
I
I
I
I
/4?-
TOTAL CHARGES I s-.~ TOTAL CHARGES IS'. - TOTAL CHARGES /9.-
. WHERE STATE L'I~ REQUIRES that the Electrical work be done by an"Electrical Contractor, the electrical portion of this permit ,
shall not be va1;1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
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 all work performed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of OreC:lOn pertaining to the work described herein, and that NO OCCUPAIKY 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 is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 7Q1.055 will used on this project.
I~Al'IE(please
pri nt at AC--tJlZ.L7
c--:s-~ SIG;lATURE
,A'(m OFFICE USE Q;ILY
Zone
Fire Zone
Flood Plain
BUILOING PERt,llT
Charges an~
Surcharges
PLU!~BING PERMIT
Cha rges and
Surcharges
ELECT~L PERI:IT
Charges and
Surcnarges
MECHANICAL PERMIT
Charges and
Surcharges
Tvpe/Const.
Bedrooms
Stories
Units
Occy Load
Occy Group
Sq. Ftg. t1ain
Sq. Ft9, Access
Sq, Ftg, Other
"2-:< 0,," PI an Ck.
L_' 65%1Bldn
---- nnS
. /. ~ ib~~B~~~
_____LS' Co. I Fence
. ~'6 I Demo
~ - I Sidewalk
_un ~~c;l AIC Paving
~. 00 I Curb Cut
----- -:~-I .
Conm/lnd
Ppr Fpf!-
R-es
Per Fee
ISSUANCF OF PFRi1IT
~-
t2 /~f,1
j
r
I
/
x
x
Value
Value
x
Value
VALUATION,~.txr),CV
TOTAL
-"~..&lc:> Systems Oevelopment
.........., Charoe (1.5%) .
ITotal Comb, Permit
I
I TOTAL
/ tJS': 0'--1
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
8. Lega 1 Description
1, example~ Tax Lot 100, lane County Map Reference
17 U3 43
2, example. Lot I, Block 3, 2nd Addition to
Springfield Estates .
C. Name, etc. of owner and construction lender
D. Energy Sources. ,..~' .
1, examole- heat/electrical ce;l;n~/or forced air qas
2. examoJe- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
I. examole- 1250 sq, foot house, 500 sq, foot garage
2, exam~le- if new project. check~w - if addition,
check add, etc.
F. Building permit 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 TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information Dr 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 fil1.1n only the No. Boxes adjacent
to the appropriate item{s} to be installed
8. 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.
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. -
Ill, 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 is issued.
V, FOR OFFICE USE ONLY
J'
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
Permit Clerk
Rermit applicant exempt from regjstration with the ,Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
~
.
.
'\
\.
,J
.
'\.' "; . ~
,',',',...,
.',';1'>"'_"\0 ;
"{, ,',I ~.'
e
I INSPECTION L1IIE
726-3769
CITY Uf SPRINGFIELD
COIIBIiIATIOII APPLlCATION/PERMIT
( EilERGY SOURCES: A /.
."'~'P Heat e~t!:<T. /7/< ,
i t.tater Heater~r
Range
ValuE of l'lork:
Job ~ddreso i ~
legal De5cription
Gr"f7'>. iU !'t-L'l
I
lAP.
..i.!
Owner ~f'yc f,( (('J,=;c,&.~ -..)/U,"'7C k.l(,,'Z<.IJ
Address <,">.1 1--[' ?J,,~.. Wr>-'] loot.? Ph~neJ4.r",-"
, I
S~,C, Ai G F/C:,z/J tf/.ec?GD-<.J
Construction lender A'(rN~
INFORllATION LINt II
726-3753
So, Ftg, I.lain
:q. Ftg. Access.
Sq. Ftg, Other
Ilew Add Alter Pep,
--Fence Demo ChangelUse
Other - -
~
()
VI
W
II 0
I
/BUilt:inq Permit Info: Descr be \1ork(i..e., Build Single
Familv ~esidence IHth JI..ttached Garaqe)
~h-nd /-J Sn/'.A-<r~ ~_
&F/Jo-;p{ocC/(i'l:'J (c)Ct'dC'7<!r -<>I'-- ;(-tS;7i1:m'T>
I
I I J SSUANCF OF PFRm T
IS:- I TOTAL CHARGES IS: ~ TOTAL CHARGES
that the Electrical work be done by an. Electrical Contractor, the electrical portion of
label has been signed by an Electrical Surervisor and returned to the Building Division
Address
UESIGN ItAll
Phone
(address)
(lics. no.)
(name)
Primary
Structura 1
Electrical
l1echani ca 1
CONTRACTORS (name) (address)
Genera I Co<"> (")r< ;HY~0 ((-)&--7'lFS
Plumbino ~k..( ';Jr Pt.-~<.,;.. ~-i"''''''''?
a y-cf EC:cC';:C~~/C-
/~~
(lics. no.)
_.5/'k'-77J
I El ectri ca 1
~lechani ca 1
~i/J./2..t/c"
'l:--
PLUllBlIlG
ELECTRICAL
NO.
FEF CHARGE NO
FFF rHARr.F Np.
'3
Each single fixture
Residence of
~ ISoe
SQ, FT,
Relocated building
(new fix. additional)
New circuits alts.
or extensionsA_~~
I NSH,- ~ .N4f~
SERVICES
IS'" I~d
~.
S.F. Residence
(J bath)
Duplex (1 bath) each
Add it i ona 1 ba th
Temporary Construction
Change in existing
re"lidr.nc~
Imultifamily, comm, or
Industrial
IOf
ICOI1l'l./lND. FEEDERS
I~~~;~~~~a~;:~~~~locate I
Of amps,l
Water service
Sewer
Storm Sewer
amps.1
TOTAL CHARGES
. WHERE STATE L,'H REQUIRES
shall not be vali~ until the
(exoi res)
(ohone no"
(exoire<;)
(ohnne nn,)
MECHANICAL
FH rHAQr,F ~
I
furnace/burner to
4-C,-, - BTU's
be>-
Floor furnace
and vent
Recessed wall
Soace henter and vent
I
Appliance vent
seaa ra te
Stationary evan,
cooler" .
Vent fan wi th
sinale duct
I Vent system apart
heatinq or A.C,
I Mechanical exhaust
hood and duct
1 \'Jood stove/heater
I
I
I
I
I
I
I
I
1&-
/9.-.
this permit
I
3<><>
from
I HAVE CAREFUllY EXNlINED 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 oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Dre~on pertaining to the work described herein, and that no OCCUPArKY will be made,
of any structure without the permission of the Building Division, t further certify that my registration 'tlith the Builder's
Board is in full force and effect as required by ons 701.055, that if exempt the basis for exem~tion is noted hereon, and that
only subcontractors and em~loyees who are in compliance with OP.S 7n1.055 will used on this project.
IlAI-lE(please printa,;:::VtpIZLJ ~Ut:"'Z'ry SIG;I.~TURE
kb~ OFFI CE USE O;lL Y
Zone Type/Const. Units Sq. Ftg. riain
Fire ZonE' Bedrooms Dccy Load Sq, Ft9, Access
Flood Plain Stories Occy Group Sq, Ft9, Other
BUILDING PERI-lIT
Charges aoc
Surcharges
, . 7-:< o~' Plan Ck.
____.L__!...___ 65%1Bldo
/ :<>8 Plan Ck.
. 30%/Bldq
IS;: 00. I Fence
------ -.-~';'-I D~mo
/<::'"" 0'" Sidewalk
-----~~----
6. 0. AIC Paving
~ a (>> Curb Cut
-----F-f-"----
-~
I TOTAL
Comm/l nd
Per Fee
Res
Per Fee
---<~ ---
/!jj
t;/-L-t / ~-",
/ I
I
x Va 1 ue
x Value
x Va 1 ue
TOTAL VALUATION
"'70..ao 'Syste~s Development ' I
.... Charqe (1.5")
PLUI1BING PERMIT
Charges and
Surcha rg}s
ELECTR I e'AL PERr:IT
Cha rges and
Surc~arges
r1ECHAtlICAL PERIIlT
Charges and
Surcharges
Total Comb. rermit
IC/~O'f:
--
COMBINATION APPLlCATION/PERMIT (CAP)
I.
I!.
Applicant to furnish
A. Job Address
B. legal Description
1. examole- Tax lot 100. lane County Map Reference
17 U3 43
2, examDle- Lot 1. Block 3, 2nd Addition to
Sprlngtleld Estates
C. Name, etc_ of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceiling/or forced air oas
2, exa~~le- waterheater/electrlcal/or solar
E. Square footage or valuation, etc, -
I, examole- 1250 sq, foot house. 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
a ttached gar~ge
2. exa~ole - 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. OESIG~ TEAl.: AIID CO~TRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
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
full schedules
C. BUILOING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGeS 011 THE SCHEDULES'
D. As noted on the CAP, the label must
electrical contractor for Signature
supervisor. The general contractor
to sign the electrical label.
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,
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,
be delivered to the
by his electrical
is not authorized
I I J.
['I,
'I,
FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,
I
I
I
I
.
11
.",'
PERMIT VALIDATION
-
~ T Y 0 F S P R I N G FIE L 0 ()/
City Hall
Springfield. Oregan '.
Department of Public Warks
OFFICIAL RECEIPT
No. B 5 4 3 21.0
<is - ,4:- 19~O ,
From ~'K rt\: Q \ ,--'XT\? ~ r{I f
S5 l~Y:,?< (\(\ tfl t 'CU t. ~Lp ,
I' ~. (
..., \1
'ed
For:t1 r\ f\ __ \ ~)E) 00 (
.. !j <i.L~~ I , O?,
1\\\"\\ h. \:-:l .{) 0
\ \' - 'tt/r, - ,(00
O~\~IS (":'),00
I.. 4-CP,:), &,10
\Y\Q C'Jrl \q, 00 (
407r-,: ,/ to
(! f'0hrO{),K(] (
i ,\--.J
. \ i) Ou,---r):J- (
Received \ Pl. :.---=
dU1'J
AUTHOR1Zli:O SIGNATURE ..."., (
.,..(L.TO"'TU,,,,'ULL ~"'NTI["" , I[UGlUOl_ 0" ,'.0' ~
.unt
,.
Permit Clerk
I
I
j
l ~
I
1
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
,
\
"
,
date