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Home My WebLink AboutPermit Building 1984-5-3 IIlISPECTION LINE 726-3769 Job Address 335'D (c;a.. 'fe (J.j~ Legal DeseriPtion\\1 (')~?2?r\ lO\'\('{) ( -,-~I ~ C (~ 3 l( S- Co C; 1.(0 fT?...) ,1'-16 ')- SicS 7 -. ()J If~ WofZf<. _ CITY UF SPRINGflE 4IIt COMBItIATION APPLICATION7~ERMIT EilERGY SOURCES: Heat Hater Heater INFORlIATION UN" 726-3753 .Sq. Ftg. Hain ~q. Ftg. Access. Sq. ftgo Other Ilew Add A Her ~ep. Fence_Demo _Change/Use _Other \j--- ~ M ~ 1- _" ~ ~ Owner j t2Pe:i!. Le.e. Address .9... 9 7 ,5" C:(lt,. <<A. t<,..{ Ranqe ValUE of wor~~~ LI. Builriinq Pennit Info: Describe \~ork(;-.e., Build Single Phone /gq,f'>,' ~mi1v nesidence 1.lith Attached Garaael . -. u t1dJ1-h9-n., w hcvU CUlJuL.J, Construction Lender ~~ Address DESIGN IEAM (namel Primary K t't lJ e:< ('.p Structural Electrical Phone (address) (lies. no.l (exo;res) 7JAI."'~a~'" <L""'C (!?R<:.'1""u.---4"'.... ~,^V/,("') f 1,/ {ohane no. Hechan;cal CONTRACTORS Inamer General n"l. ...., Plumbina ~<..A....e:;.p~ (/ Electrical _<; lGlLn, r ~'echan;cal NO. (address) ke",,-~~-. ,;('i?775'G......T'VIOf(l'oo<. p ('-'-"'-< 11,0: r '(L.., Co. ,5"'0 C"'Nt.I',,^,,- < t-...L e (<:. <: (j 21,/:;0 l?'-<.< l--c Sf (lies. no.) (pxpi res' ,/,2r~c,- (ohnnp nn ) 2 7 f?~ <: 7"3'-t: 9';/0 Lfq</-7~tfo L/9Lf-72 7Z: PLUllBI NG l MECHANICAL IILT1 furnace/burner to BTU's Floor furnace and vent 'i I I I I I I I I I ELECTRICAL fEE r.HARr,E ~L Residence of Each single fixture SQ. FT. 3 ,c:..., \5P~ Relocated building (new fix. additional) S.F. Residence (1 bath) Duplex (1 bath) Additional bath I ~Ia ter servi ce I Sewer I Storm Sewer I I I I I I INew circuits alts. or extensions ISERVICES I Recessed wall ~n~rp hp~tpr ~"rl ~pnt \5 'Oco each ITemporary Construction Change in existing rp"" 1 drJH"p multifamily, comm. or IndlJ""tr;~l I App 1 i ance vent seoaratp I Stationary evap. cooler I Vent fan wi th sinole duct I Vent system apart heating Dr A.C. I Mechanical exhaust hood and duc-t I ~'Jood stove/heater I I I Of COI1f1. IIND. FEEDERS amps.1 from I Install/alter/relocate rlic;trih. f",,,,rlprc; IOf amp~1 I I I I \ ~.lX> .1 TOTAL CHARGES Electrical Contractor. the electrical portion of this permit Supervisor and returned to the Building Division ISSUANCE Of PFR!IIT TOTAL CHARGES \ ~.Q::l TOTAL CHARGES WHERE STATE L'I/ REQUIRES that the Electrical work be done by an shall not be valid until the label has been signed by an Electrical \l\~ 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 oerformed 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 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 ORS 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 701.055 will be used on this project. ~~....., ,- SIGIIATURE 9 ~.. FO~ OffICE USE OilY) So. Ftg. Ilain Sq. Ft9. Access Sq. Ftg. Other ~ Valu:~ TOTAL VALUATIDtr:") fr)O -' ,-- IWIE(please print) ,..j ~V(-('-o Zone C r Fire Zone ------ Flood Plain _____ BUILDING PERmT Charges anC: Surcharges PLU!lBING PERMIT Charges and Surcharges ELECTRICAL PERI:!T Charges and Surcharges 11ECHANICAL PERMIT Charges and Surcharges /~'-' DATE 68/8' .y , /' Tyoe/Coost\..!- \....ft Bedrooms Stories Units Oeey Load Oeey Group ~-~ , Value Value , r/~ td..l. Plan Ck. LU. 65%/Bldo -----,u'C[--'"""i'ian Ck. . 30%/Blda \S CO I fence ----~>-~(j)--I O/lAlO \ ~,co I Side';alk -------.-i:O--r A/C Paving _ __ _}, '\ !_~__ -' Curb Cut I &3~g7 f5fJ1h.~ ee..- I V ,-..,.r\ Systems Development O. dI ) CharQe 0.5%) / "- ')\ ~ I Co"'"lInd p.pr Fpp Res Per Fee ~'I ITotal Comb. Permit I I TOTAL Co(j:~~ '---- . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. legal Description I. example- Tax Lot 100. Lane County Map Reference II uj 4J 2. examole- Lot I. Block 3. 2nd Addition to Springfield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. exa~le- heat/electrical ceilinq/or forced air Qas 2. exa~le- waterheater/electr;cal/or solar E. Square footage or valuation, etc. ------ !. example-. 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check new - if addition. check add. etc. F. Building pennit information: 1. example - construct single family house with an attached garage 2. exam~le - remodel existing garage into family room 3. exam~le - 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 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 Noo 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 penmit 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 O. 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 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. 65;2 i I PAID (?> ;;q-gS V. FOR OFFICE USE ONLY Permi t Cl erk ~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: :\ (' ().. v;.,,~ \. 'I ('"~ \t"\\. '\ . ~QE.~ ~ \?oF. ~Q\::)."Gr'\ ~\o-\ M,~~ \; . ~Q" ~ [:r'~ ncc .\ \\:)~\. \"\ t::..9r-, 'b. "'l"" '\1 r f"'\\,,\"O( r.:'\,(',.\.., (\~ l\ ~LL y~\. '1'\O~.lI ,,~'&:>~'\(:)~ "\r") ~ ("'\'t\.)(\.bC)..@A. , \ <4.~<,,\~ , " 'c'\t"'~l\"e.. (""'("of' \.. "",Cl~, ""If'" \...... C">~ . " . . Permit applicant exempt from regi~tratio~ "-~\ U ~~ r-;~ with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: na~ ')\~. .., " '\ ~\ ,~ Signatc-\...-r'-~ ~ate~~! ~~ IrISPECTION LINE ; 726-3769 ( c c~ 3 Cf ~- C'1 yo trU ,~'-I"&: S"- SicS 7 -- . ' ()J ,h WotZk, ~ CITY UF SPRINGFtELD ..., COMBINATION APPLICATION/PERMIT E!IERGY SOURCES: Heat t~ater Heater Job Address '- JNFORl1ATION u."lt. ~i , 726-3753 ! Sqo Ftqo Hain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter ~ep. Ranqe ~ -Fence Demo Change/Use ValuE of wor~587)-- Other-- ~ Bui16inQ Permit Info: Describe Work(i.e.. Phone 1J5'l./. f'<'",' .Ea.rnily Residence Hith ,o.ttached Garaoe) . ... · ~ u- l1d.d-1.+-I~ w hcvU 3 :}5'D (.;<:1 'fe (~-'D ~ L.egal oescription\\] rY~) ? 2 ?n "*)\~('() / ',Owner j t7Pd<. Le.e. Address.;l 97 S U:(Jtc;~ Construction Lender Address Ul:.~lur. rl:.Ar~ JJ c/'-V. - K,{Gld,'p (name) hAt.~u.,..,atACI\ Phone [address) flies. no.) (exo;res) a:-......c r I? '" <. -r,~<>. "'- "t ~ '^- v", (... ') I' 1./ i Primary Structural Electrical Mechanical CONTRACTORS lnamel General n"l....1 Plumbina ~t.A.....e.P"""""; C/ Electrical _<; T'GLJ1_, ( Il"'{ (addrp~"l ke",-~-,<--. :<'6S7S"G.....r-"",{(,fO-< P(u........iJ,~; ~ (J:..,c. ,{""O ('Nt.,'''1All< 7u._ e (<:. c. i/ 21.~o Ru..c. h:: sr (l ic~. nn.) 2 7 f?~ I~ '::;:- I ~ .l (ohnI"Je no.) (pJ!:nil"pc:.1 ~27"~"-- (ohnnp I'm.) <: 7"3'-t{ 5'C/O 4q</.:;7~c/o ~5?~-72 78': ITemporary Construction IChange in existing rps5 dynl"'P Imultifamily, camm. or lnrluc::tri",l ~ -lCoMfI.IINO. FEEDERS l'Install/alter/relocate rlic:.trin fppnprc. IOf amps.! I I amp~1 I I ELECTRICAL I r:EL I J:I!A&liE. ! MECHANICAL r.HARr.F NO Nn , I eec " Residence of furnace/burner to \SCD SQ. FT. BTU's New circuits alts. Floor furnace or extensions ",- DCO and vent \.,j SERVICES Recessed wa 11 ~n"'I"'P "p~tpr ~nrl ~P"t ~ IW.IE(please. print) ..J ~"f.-('-L I I I I I -I I I \ c::,.qJ TOTAL CHARGES I Appl ;~nce vent 'Seoaratp I Stationary evap. cooler I Vent fan wi th "inole dlJrt I Vent system apart from heat;na or A.C. I Mechanical exhaust hnnrf ;Inn "11rt I \'J~~d ~t~v~/~~ater I I I I I I I I I ISSUANC, OF PFRIIIT \ C, :X.:- I TOTAL CHARGES \. '\ \ '?t ' , WHERE STATE L\IJ REQUIRES that tile Electrical work be done by an Electrical Contractor. the electrical portion of this pemit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division " Zoop r r Fire Zone --- Flood Plain _____ TOTAL CHARGES 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 wor~ performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Orel]on pertaining to the wor~ described herein. and that NO OCCUPAr~CY 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 compliance with OP.S 701.055 will be used.on this project. BUILDING PERMIT Charges and Surcharges PLUI~BING PERMIT Charges and Surcharges ELECTRICft.L PERI~IT Cha rges and Surcharges 11ECHANICAL PERMIT Charges and Surcharges ~IGllATURE_~_ /r_",-" FQr. OFFICE USE mll'.(' .-r- / Sq. Ftg. fiain .'Ii Value Sq. Ftg. Access ~ Value Sq. Ftg. Other x value, . _~ &3 -5(') ISHIIn~, Cc.. TOTAL VALUATIOtl ~ f.nO /1?',.-.,.r\ [systems Development ~ '\~. . O. r:=A ) Charoe (1.5~) ,,) '\ / I \ J.et.r ~ '-7 Type/Const).J- ,'-'" Bed rooms Stori es Units Occy Load Occy Group ~ -~ ~/~ c.:w Plan C~. Corrm/Ind <-.~--~. 65%/~l~n PP~ fPA -----,-"\C[-- ~~~~B~~~ ~:~ Fe: \ S. '::;0 Fence -----;;;.".------ , (,;:J I Dljl!lo -___~~c.~_J S1dewalk ,\~;) I A/C Paving -___l,}Jj~~_J Curb Cut , I DATE3B/S Y I Irota 1 I I TOTAL Comb. rermi t CoCJ'"6?- ~- . . .. COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION . L Applicant to furnish A. Job Address B. Legal Oescription 1. example- Tax Lot lOO~ Lane County Map Reference II oj 43 2. examele- Lot I. Block 3, 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. exam~le- heat/electrical ceilinqlor forced air Qas 2. exam~le- waterheater/electrlcal/or solar E. Square footage or valuation, etc. ------ 1. examele- 1250 sq. foot house, 500 sq. foot garage 2. exam~le- if new project, check new - if addition, check: add. etc. F. Building pennit infonnation: 1. example - construct single family house with an attached garage 2. example - remodel existing garage into family room 3. exam~le - convert single family residence into restaurant (change of use) G. Value of work as defined in Section 303 (aj of the Structural Specialty Code Ho DESIGN TE~l 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. 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 fu 11 schedu I es Co BUILDING DIVISION STAFF WILL FILL OUT.ALL FEES AND CHARGES ON THE SCHEDULES Do 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 Signature. IVo 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 Permit Clerk , PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: \ (' (\.. \:;..,,,> t" r-" \("'\\. \ ~v E~ ,"" nC( \. \~\~\ \\ ~'Vr- ~ '- ,,- '\\. '\l .--,- -~<,">...._-,"", \.-,t-_ ':"~-":-'\.~.....~ \ ~.~\, !~\- 1 ~'?1J ~ ~r\, W1:\ \\ \ -... - ,......vC'o. ~ !"-o:- , r ~'\-\'"O( r\\('\~'\ ('\~ ,i\ GlL vc:::-c:~\. \'\Qc,n ,-.~c..,Y(=(-~'\(''')\..k-. ~~t') \?-F., C\'1'..l:\",\",pA ~ ~~t"\\r-s'> , , ~c"~l\,C_ rr-,., ",'\;"':\":2, \ r '-..\ ()<;;. '- ~\ \. ~ ~"V l,';::':.. , , Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: narile'\~ '\'''' . '\ , '. ,r:=--\"'~ ~ .~\~ ' signat~re\~ }"',._r" \~ '- Y--date,)\ 7-(" I ~~