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Home My WebLink AboutPermit Building 1981-2-18 CONTRAcrORS . G,"e'a~O Plumbinq --~-~- --. ---- NO, I I I I I 1 1 1 I 1 I I I I'q I TOTAL CHARGES I ---., INSPECTION LINE 726-3769 . CITY Of SPRINGfiElD COMBINATION APPLICATION/PERMIT . Ow,",\ lis> m 9SL ~'{''', , Q B-~irdi;;-g--Permit Inf,: Delcribe Work (i.e.. Build Single Family Rel;~':,,~-: W!lh Atta~hed Garooe) b 4-~ ~ -0 - () l(fl I INFORMATION LINE 726-3753 Job Addreu 'q::\-~ NOll On i) m (1632..266 Z50 J Heat ~ Volue of Work: ~ I!:J. I ENERGY SOURCES: ~ I Sq. Ftg. Main Sq. Ftg. Accen. Sq. FIg. Other _New <:: Ad~te'_R.p, _Fenc ~Dema Change/ Use _Other. legal DelCription k.J Addrou Phone flU l\-7<.,~~ ..... Construction lender 'CI~\d.oJlf'Q i\t!~e.~ ) ) (phone no.) "f\.I;)~- Addrou (m (liCit. no.) Phone DESIGN TEAM (nome) (address) Primary J -i I I Structural . Electrical Mlchanictil (nonle1 f\ (~iO~RJ..... (oddre~l) (Iics. na.) Dn l~?SJ~ (char.n nc.) U ~'S~ (OO~~ (excinn) Eledrictll Mechanical PLUMBING ELECTRICAL MECHAI-liCAl FEE I CHARGE N~. Residence of ,---;--:-._--_.~.~. .. ,'. ,fEE furnace/burner to ~TU's . Appliance vent separate Stationary evap. cooler Vont fan with sinqle dud Yent sYltem aport from heatinq or A.C. Mechanical exhaust hood and duct . CHAP'r::~'-1 'CHARGE FEE NO, Each single fixture Relocated building (new fix. additional) S.F. Relidence (1 both) -,:ft. Ne..... circuits, alterations or extensioni ,I I SERVICES Duplu (1 both) each .Temporary Construction Addition01 both Amps. Water service Sewer Wood stove/ heater Storm Sewer FEEDERS Heat Pumc Air hondler to 10.000 CFM Air handler OVer 10.000 CFM Amps. I ISSUANCE Of PERMIT TOT At CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical'Contractor, tho electrical portion .of. this permit . shall not be \,C',lia until '0 label has be.n signed by an ElectriCCJI Contrador and attached to the electrical panol. I HAVE CAREFUllY EXAMINED the completed opplication for permit, and do hereby certify that all information hereon. is true,' and. corract, and I further certify that any and all work performed shall be done in accordonce with the"Ordinances of the City of Springfield. and the lows of the State of OregC'ln pertaining to the work delcribed herin, and that NO OCCUPANCY will be mode of any structure without the permiision of the Building Division. I further certIfy that my registrotion with tlie Builder's Boord is in full fora, and. effect cu required by ORS 70L055,' that if exempt the basis for exemption is notod heron, and, that only subcontroctors and employees who are in compliance with ORS 701.0.55 will be used on this project. Basis;for Builder', Board exemption: <IGNATURE -e,A/I""""~ ~~;..'~_ FOR OfFICE USE ONLY DAT&JR-8:1 NAME (please print) Kff'/ fro 'I t? R.. Zone Fire Zon~ Flood Plain Type/ Canst. Bedrooms Cjtorie" ,I( Yalue TOTAL VALUATION . ValiJe "alue Units ""'ccy load Occy Group Sq. .Ftg. Main Sq. ftg. Access _ Sq. Frg. Other BUilDING PERMIT Charges and Surcharges I /. oc) 1 - Systems Development Charaa C1..5%1 Plan Ck. Comm/lnd 65%/ BldQ Per Fee Plan Ck. Res 30%/ BldQ Per Fee PLUMBING PERMIT Charges and Surchargel FenC:fI Demo Total Comb. Permit ElECTRICAL PERMIT ChargflS and Surcharges Sidewalk AIC Pavino MECHANICAL PERMIT Charges and Surcharges Curb Cut !. 00 TOTAL , t' , .1.'- --, COMBINATION APPLICATION/PERMIT (CAP) 'L, ~Iicant IQ furn!sh A. ~ob Address B. Legal Description 1. example-lax lot 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.heot/electricol ceiling/or forced air qas 2. example-water heater/electrical/or solar . if " E. Square footage or valuation, etc. 1, example-1250 sq, foot hause, 500 sq. foat garage 2. example-if new pr~iect, check new-if addition, check add, etc. F. Building permit information: 1. example-construct single family house with an ottached garage j 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 (a) of the Structural Specialty Code H, DESIGN TEAM AND CONTRACTORS To ovoid design or construction 'delays, Building Division Stoff must be able to contact appropriate persons regarding design information or job site corrections, etc. II. Abbreviated Plumbing, Mechonical & Electrical 'Schedules A. Except where blank spaces accur 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 ore available at the Building ~ivision 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. Applicont,to sig'n and date Whenever possible, the initial application will be used as a worksheet only, Where possible, Building Division Staff will prepare 0 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 ore 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: 1. " 'f..' , . PLANS REVIEWED BY, nam"'" ..ignatur"'" . -.~ . ~ . '- -'--C-" PERMIT VALIDATION Permit CierI- \), -iatf" , . i" INSPECTION LINE 726-3769 . CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT . INFORMATION LINE 726-.3753 legal Description " . ENERGY SqURCES: Heat ..---- Water~_*". ~ - --------- I Sq. ftg. Main Sq. ftg. Accon. Sq. Ftg. Other __New~Alter_Rep. _Fenc( _Dem~)-Change/ Use _Other. ~-,.. ~ c5' - () I(j) I I I Job Addreu ..q <.00 NOfl On i) f(i (addreu) I Value of Work: I lj/~ Buildin~' 'P;-;;jt-lnfrO~'s'~rib'e W~;k-{i..e., Build Single Family Residence With Attached Garagel ~-7\'~~~) (n", no,) t!~"1 .; Owne.! 0 Q m 1l\L ~'" ~, <) \.. ~ Addren Phone C\U fl- ~C:(i)"t u Condruction lender Addren Phone DESIGN TEAM (nome) (phone no.) Primary Structural Electrical Mechanical CONTRACTORS Gen.,a~O Plumbina (namd f\ l-jOlJl,QJ = (j (address) (/ics. no.) \)(} 1C1.?S)~ (expires) (phone na.) U <6'S~(oO~~ Electrical Mechanical FEE r I CHARGe" I ElECTR ICAl MECHANiCAL PLUMBING NO: NO, I FEE I CHARGE NO, FEE I CHARGE SERVICES furnace/ burner to ~TU's Appliance vent separate Stotianary evap. cooler Vent fan with sin!:!le duct Vent system aport from heatinq or A.C. Mechanical exhaust hood and duct Each sinale fixture Reloca'ed building (new fix. additional) S.F. Residence (I both) New circuits, alterations ar extensions" Duplex (I both) each .Temporary Constructian Additional both Amps. Water service Sewer Wood stave/heoter Storm Sewer FEEDERS Heat Puma Air handler to 10,000 CFM Air handler over 10,000 CFM Amps. I I' TOTAL CHARGES TOTAL CHARGES ISSUANCE OF PERMIT I TOTAL CHARGES WHERE STATE LAW REQUIRES that the Elernical work be doce by the Electrical. Contractor, the electrical portion of this permit shall not be valid until ell label has been signod by an Elech'icul Contrador and attached to the eledrical panel. I HAVE CAREFULLY EXAMINED the compfeted 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 sholl be done in accordonce with the- Ordinances of the City of Springfield' ond the lows of the State of Oregon pertaining to the work. described herin, and that NO OCCUPANCY will be made of any structure withaut the permission of the Building Division. I further certlfy that my registration with die Builder's Boord is in full force and. effect (JS required by ORS 701'.055, that if exempt the bosis for exemption is noted heron, ond. that only subcontractors and employees who are in complionce with ORS 701.055 will be used on this project. Basis ,for Build.r's Board exemption' SIGNATURE ~A-1/~ -f.'1:- ~~_ FOR OFFICE USE ONLY DAT&fR-~\, NAME (pleo.e pdnt) _K E fV fro 'ILl?.. Zon,. Fire Zon.' Flood Plain Typel Canst. :l.edrooms Units n.-'Cy load Occy Group Sq. Ftg. Moin Sq. Ffg. Act.u _ Sq. Frg. Other Value J( Value Value TOTAL VAlUATlOt-' ~torie. BUilDING PERMIT Charges and Surcharges II dc)' I - Pion n. Comm/lnd 65%1 BIder Per Fee Plan Ck. Res 30%/ BldQ Per Fe. Systems Develapment Charae 1l.S%1 PLUMBING PERMIT Charges and Surcharges Fence Demo I Total Comb. Permit ElECTRICAL PERMIT Charges and Surcharges Sidewalk MECHANICAL PERMIT Chorges and Surcharges I I ---------1 Alc Po vine TOTAL /. 00 Curb Cut COMBINATION APPLICATION/PER. (CAP) ,I. Applicant 19 furnish '!, 'b 'A:'-iJo Address B. legal Description 1. example-tax lot 100. lane County Map Reference 17 ( 2. example.lot 1, Black 3, 2nd Addition to Springfield Estc 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. fOOl house, 500 sq. foot garage 2. example-if new project, check new-if addition, check add, etc. F. Building permit information: 1. eXQmp~-construct single family house with an attache( garage 2. example-remodel existing garage into family room 3. example-convert single family residence into restaurant (chonge of use) G, Value of work os 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 regardi design information or job site corrections, etc. '" " II. Abbreviated Plumbing, Mechanical & Electrical 'Schedule. A. Except where blank spaces occur in the description partial of the Mechanical and Electrical Schedul~s, the applicant need fill-in only the No. Boxes adjacent to the oppropriot. item(s) 10 be insrolled B. Full Plumbing, Mechanical, and Electrical Schedules ore available at the Building Division 1. To conserve spece on the permit form the schedules hove been abbreviated 2. If the item(s) to be installed are not covered on the ab 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 ond dale Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Division Staff will prepare a typewritten ccpy 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 appUo-_.._ and no plans will be processed until these fees are paid. All other fees and charges are due and payable when the permit is is~ued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: PLANS REVIEWED BY, name _ . signature .PERMIT VALIDATION CITY OF SPRINGFIELD City Hall Springfield, Oregan Department af Public Works OFFICIAL RECEIPT ( (\ No. B 5 58 4 5 ~ - \~ 19K \, Rec'd Froff\O{"'\ G.nl~'l 0/\ Address \)~). \f\{~~ )~~_ ,.- ~ V Date ! ( Received For: ( .( ~". ~ ~~J'i\ ~ ( \~O <. (i ( ( {iIu ( Amount Received l W _'- ~ "'UTHO~IZI[D SIGP\lATUltE 1I..I[HO...YU.....UlL .""n,u.. -IIUGl"l. 0" 117"0' ( ~' ( ..",. ( c '. Permit Clerk I , i ! dale