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Home My WebLink AboutPermit Building 1982-4-15 l4l.. 03~8. CITY Uf SPRINGFIELD . INFDRfIATIDN UNo COMBlilATION APPLICATION/PERMIT 726-3753 f) E!lERGY SOURCES: Sa. Ftg. 1,la i n a./..d <,/ s.GI?d"'~};.r, 1 Heat ~a. Ftg. Access. 4Je>CI ~ 'oiee::. l'later Heater Sq. Ftg. Other Y-..J 7' #) n flew Add Alter Rep. Range -Fence Demo Change/Use s::::> Va 1 ue: of I-/ark.: -Other - - y\) Owner J~T~,77?,,-r/""Y1A~ D",,.,.< ~/'7/7(? C.AJ Add Phon BuilriinQ Penl11t Info: Deser.be Work{;..e., Build Single . ," res~~q.... <;<../ r..'4~/7~i'?1!t ;" ],,<1_ '!:J97-/9h Family nesidence Hith Attached Garaoel ~ () ji:Hi..f-n...'l12.-""J?~ c;,;:7 74- &.../ R~._~ .4#{,hC. ~ ~~;..t~ Construction Lender -z; ~~ # /7 """+_"'".:0--./ AI'!) ~~"'4P~.d '4 J /l1 1'1 I a tl;;~J (lies. no.) ,,/ ,- \ 1 IrISPECTION LIIIE 716-3769 . ,Job Address ~ 5 6-0' (.?,L2 TP' Legal Description p" A1 /J .lA/A'" /7-""3-~<.;;zo, ;r.c., //&1'0 Address Ut~ 1 (iN T E.Ar~ {name! Primary /9e"JY7.cA' I Structural , Electrical i Mechanical , CONTRACTORS (name) General Ah.J~ Iff : Pl-umbina Electrical P.'echan; ca 1 PLUIIBING -710. rEE / Each single fixture ~.;q VA-rB'r /f'. IRefocated building I (new fix. ad~~t;onal) Is.F. Residence I (] bath 1 IDuPlex (1 bath) each I IAdditional bath 1 1 Water service Sewer Storm Sewer TOTAL CHARGES , WHERE STATE LAH REQUIRES shall not be valid until the rHARr,F s:~ I I I I 1 I I I I I I I I I s-:-- Phone (address) (exnires) (ohone no. I , Ii I' fj (nhon~ no. ) I , " I , "I .1 >Ii I ! I ~ I I I I 1 I I .' '- ' 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 (address) (1 i~". no. (exnire,,) I HAVE CAREFULLY EXAMINED the completed application far 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 OCCUPAI~CY will be made of any structure without the permission of the.Building Division. I further certify that my registration with the Builder1s 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 ORS 701.055 will be used on this project. ,) ;;797-/9'r/ (!d7'1r-4"" tZw!'-;;s -feNot'/!... // IlAI-lE(please print)/"J,.rJ..r41h1 I. 6Jr?~~Jhr SIGrl^TUREd/~ ~//:'<~~DATE ~.//';;-/92 FO~ OfFICE USE DIlLY Sa, Ftg, Ilain Sq. Ftg, Access ~~~ Sq. Ftg. Other Zone <. - 0/ Fi re Zone Flood Plain Tyoe/Const, :xz:~ N Bedrooms Stories BUILDING PER/oHT Charges and Surcharges PLU'~BING PERMIT Charges and Surcharges ELECTRICAL PERlilT Cha rges and Surcharges MECHANICAL PERMIT Charges and Surcharges I ELECTRICAL MECHANICAL Nn ------.'"""-----=-= NO >>> r~AQr.1=' Residence of furnace/burner to BTU's SQ. FT. INew circu~ts alts. or extenSlOns ISERVICES I !remporary Construction Change in existing reo;jn..r.ncp multifamily, COnlll. or Tndu<;.trial I Floor furnace and vent I' Recessed wall , C;ni'Jrp npi'Jtpr ~nrl vpnt Appliance vent seoarate I' Stationary evap. cooler I Vent fan with sinole duct 1 Vent sys tern apa rt from heatina or A.C. I Mechanical exhaust hood and durt I ~Jood stove/heater I i I 10f ICOMM./IND. FEEDERS IInstall/alter/relocate I rlic:trHL fppf'fprc:. IDf amps.1 I I I amps.l ISSUANCE OF PFRIHT TOTAL CHARGES TOTAL CHARGES Units Occy load Occy Group x Value x Value b6J~ x Va 1 ue TOT^L VALUATIOII ~.~~ -tI.r:;:l~~{ ~ Syste, ms Development 'q__. .,..,. l;.?_~_"n </-/5-82 Charoe 0. 5~) /t::.-'. M-j 7' /.01> ' Plan Ck. C01ll11/1nd 6)0. 65VBldn Ppr Fee ------------ Plan Ck. Res I. '1'1 30%/Bldo Per Fee 6~- I Fence ------~:.i~-I Demo !'S1dewalk lAIC Payi n~ ~___________: Curb Cut I I I Irotal Comb. Permit I I TOTAL '12. .~</ /"J2.G~ ." , ( ~. ( , '. . .,..... " > . . '. u I COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description 1. examole- Tax lot 100. lane County Map Reference '17 oj 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 ceilinq/or forced air QdS 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq, foot house, 500 sq, foot garage 2. example- if new project. check-niw - if addition. check add. etc. F. Building permit information: 1. examole - construct single family house with an a ttached garage 2. example - remodel existing garage into family room 3. examj)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 TEAl4 ANO 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 fil1-Jn only the .No,: Boxes ~djacent to the appropriate item(s) to be in'stalled ' 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, 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 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. '~.' " . '-"."'1" V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: I, ..,~ , '\.'- " . . PLANS REVIEWED BY: 'name 6::v:1HE -;":) ~ - '" ~ ,..<~ _'~~ignature ~/ _-'~!l"-'" , ,. date '-1-/ ..-~ 2. . '. . "1 !rISPECTION LINE 726-3769 Job Address ~ ~ ,?-Q rJL1 TY Legal De<cription I?, ",/1 /A}/9C/ ~ .- ,~ '-.'.1' ~ ,~~y-- .. <. ~'", , INFDRlIATION liNt 726-3753 Sq. Ftg. 1.lain ~q. Ftg. Access. ~~ U Sq. Ftg. Other rlew Add Alter Rep. -Fence Demo ChangelUse Other- - ~ $0 t3 CITY UF SPRINGFIELD COMBHlATION APPLICATION/PERMIT - /J EIIERGY SOURCES, b/""~ S4f'''1f~;''"'') Heat 'tJ~t': Ilater Heater ~ Ranqe " ValuE. of Work.: , t?/.?/2('7 , , " Ph BU11GlnQ Permlt Info: Oescrlbe Work.(l.e., BU11d Slngle on':;? 97-r.irJ Family Residence liith Attached Garaae) _ ().' e" / R~~// A4u,c. ~ ~_{' ;..lK'~ I , ,S:,/.4>9 :r~~,;o-'?y..!I 7.-1..-,"-' Owner d _/~,? 7'7..4.r/IC.'''r? AJ. 17-~"3-<<.;;zo. r.-c... /:?~c:> .Q4'....., ~ ~ Addres~ ~q-<" <:L.J r.; 4/? /2~,rl (fi ;, ,. ),4..,.- l?.eTi4n1/') ,..,p-r ~;:J7~- 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 Oregon pertaining to the work described herein, and that rlO 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 ORS 701.055. that if exempt the basis for exemption is noted hereon. and that only subcontractors and employees who are in compliance with ORS 71')1.055 will be used on this oroject. ~) 479?-/~// (tftrl1r46'-' ,eV'~~ f(H!"'i.. // rW-1E(please print)/., j,,</,. /4-Y1-> I. tJ)r?,~.1!./;Y SIGIlATURE4/~__./ ~~.d#'.\&K DATE ,,(//./8/97 FOn OFFICE USE Q;IL Y Sn. Ftg, Sq. Ftg, Sq. Ftg, Construction lender _ Address Ut'I~N T<Ar~ (name) Primary ~on<f"";(' Structural . El ectri ca 1 .! Mechanical . CONTRACTORS (name) General A/".J~,{{ Plumbina ; Electrical ~1echanical PLUIIBIrIG NO, / Each single fixture ~~ VII-Tor fr)7-f Relocated building (new fix. additional) " S.F. Residence (] bath) IDuPlex (1 bath) each IAdditional bath jwater service I Sewer I Stann Sewer I I I I I I I I I I I I TOTAL CHARGES , WHERE STATE L.\ll REQU I RES shall not be valij until the Zone <. - LT Fire Zone Flood Plain Phone (address) --z; 4VJ1~ i /? A +_ -::;. -R /l1 f'..! I a tJ..;;w') (lies. no.) (pxnires) (ohone no.') (address l II Ii \I ~ ~ I , I I (lies. no.) (flIxnirp.~) (nhonp nn, i I ~ ELECTRICAL MECHANICAL FFF CHARr.F I FFF Np r"'l.Illll:. NO, FFF r"ARliE. I i /~ Residence of furnace/burner to BTU's s;- SQ. FT. New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall ~n~~p hp~tpr ~nrl vpnt " Temporary Construction Change in existing rp'i j qPflcP Imultifamily. comm. or Inriu"trial 10f ICO~1,/IND, FEEDERS Ilnstall/alter/relocate rlidrih. fpprlprc:, Of amp~1 Appliance vent spoaratp Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from " heatina or A.C. Mechanical exhaust hond And l1urt I I I I I I I I I s-:- . TOTAL CHARGES TOTAL CHARGES that the Electrical work be done by an, 'Electrical Contractor, the electrical portion of this permit label has been signed by an Electrical Supervisor and returned to the Building Division . amps. Wood stove/heater I I I I I ISSUANCE OF PFR!lIT ',' Tyoe/Const, ~- N Bedrooms '"7./.e> Plan Ck, COllll1/1nd "0'. 65%/Bldo Per F~~ ------------ "'Pian Ck. R-es f. <('I 30\/Blda Per Fee _____Q-;~__ Fence . -;2.P I Demo I Sidewalk I A/C Pavi ng I Curb Cut ------------ I Stories BUILDING PE~IIT Charges and Surcharges PLUMBING, PERMIT Charges and Surcha rges ELECTRICAL PERI~IT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges I IJnits Occy Load Occy Group #1-1 x Value x Value hS= x Va 1 ue TOTAL VALUATION hi~ , , ,:' ~ Systems Development 'I '-In 4-/,-R2 Charae tI. 5~) f1ain Access Other 5'0 'T "7cP. ...... "'~~i.::J~o.l..'I'-J' ..~lit.,...I- -:c.!!'."..~I~]I,.II!I"'LI&:""'.~J.:..."~"'i. L-.i.-l~~.~~,~ ~ ITotal Comb. Permit '('2, .~<f /J'2.Gi",1 " I I TOTAL , '.. ~ ("' 1- ,J CIn.DF SPRINGFIELD .- City Hall Sprlngl/eld, Oregon , 'Departmant of Public Works OFFICIAL RE'CEIPT No. B 58899. ~ r!!!!!' . .. . COMBINATION APPLICATION/PERMIT (CAP) ( I, Applicant to furnish A. Job Address B. Legal Description ( I. examole- Tax Lot 100, Lane County Map Refe, '. 17 oj 43 2, examole- 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. examole- waterheater/electrlcallor sorar-- .E. Square footage or valuation. etc. - ( I, examole- 1250 sq. foot house, 500 sq. foot 2. examp.le- if new project. check-new - if ae cneck add, etc. F, Building permit information: 1. exam~le - construct Single family house W' attached garage 2. example - remodel existing garage into fal 3. examOle - convert single family residence (0 restaurant (change of use) 'G: Value of work as defined in Section 303 (a) 0 Structural Specialty Code H. OESIGN TEM4 AND CONTRACTORS To avoid design or construction delays. Build Division Staff must be able to contact approp persons regarding design information or jOb S corrections, etc. ( II. Abbreviated Plumbing, Mechanical, & Electrical S, A. Except where blank spaces occur in the descri portion of the Mechanical and Electrical SchE the applicant need fill-in only the ,No.. Boxe, {ja to the appropriate item(s) to be installed B. Full Plumbing,' Mechanical, and Electrical Scl are available at the Building Division 1. To conserve space on the permit form the ~e( have been abbreviated 2, If the item(s) to. be installed are not c the abbreviated schedules you should con full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FE 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. ---- Applicant to sign and date Whenever possible. the initial application will b~ 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, Dale 4-/1 19.r> :2 Rec'd From ,.)..,,7/;....., .f, i., h;J' k./ A A ,0",-- Address 3::; q;;- ::).(/.) L), A', """"-<'> I,r ~'" (J ( = Received For: r Wi ~~:M;;+ '-4;" -'}1 k....~ :i.JI./u~,;';' II . ' 0,) +b~'A"~dhYM~ J (. .'1 . . (!o I. tj.i.J. .<;: /!t) .~ 90, HI (I ( c . (c. ,( 'l... ~mount Received (I L ~ t' ' J 3:16 'I / -~ = (.. ( ~(' , AUTHORIZED SIGNATURE \. ( .BRIGGS PRINTERS/LITHOGRAPHER.. EUGENe. OREGGN . III. IV. V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: .', Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: --.... .".-.- ..~_.- -'. PLANS REVI EWED BY: 'name ~HE '":;::) ~ -,.,' 4 ,..<~ ~'7-?signature ~____/ ____<;;;;i~......., , ;or date '-1-/ ~-S 2 .