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Home My WebLink AboutPermit Signage 1980-6-6 Job Address CITY m'SPRINGfIElD . CO/IB IllATION ;.i2...T ION/ PERM IT \ D \ C'l \\'C\.. ')\. 'l Go \..") m 1~;~GY SOURCES: \.Ia ter Hea ter Range Valu€ of Hark: Y] ()(). 00 Buitt:inq Permit Info: Familv Residence With Oescribe Work{i.e., Build Single JI..t tached Garaoe) 'jINSPECTION liNE 7~6-3769 . INfORlIATION LlNt 726-3753 Sq. Ftq. 1.lain .'~:U ~q. Ftg. Access. Sq. Ftq. Other New Add Alter Rep. _Fen.>e_Demo _Change/Use J::et11 e r legal Description I Owne{-\C) 1;\4l..Q'o ._ ~$,,('JJ fu\.m~l<l.. Address \n \n \'\~\\ (J ("LQ..) Phone ~~:~~ ,ax ~ ffi.\(\ , , \i(" t' Q \ ('('&0- "S5.ciU\ \\ ,\,\ flies. no.) (exoiresl Johone Address Ut~lGII ItA',' (name) Phone (address) Primary Structural Electrical , Hechanical Ii CONTRACTORS I name) r address ) General~$~\'\ (\\~ 0dl~. PlIDI Sf. : Plumbino l) (lies. nn.) \4~\\ (pxoirpc;) ~'t).~ lohonp nn ~ Electrical , . ~lechan;cal PlUlmING ElECTRICAl MECHAN I CAl. NO. .1 Each single fixture i I Relocated building : I (new fix. additional); S.F. Residence ~ I' (I bath) . Duplex (l bath) each '1 I I I I 1 Appl iance vent Sfloarate Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from I heatina or A.C. : Mechanical exhaust hood and duC':t Wood stove/heater 'ill.-I I Res i dence of SQ. fT. 'INew circu~ts alts. or extenslons ISERVICES I fEf CHAR(;f ... r H ARliE. ..l1O..... furnace/burner to BTU's Floor furnace and vent Recessed wall SoaC':p heater"ann vent ITemporary Construction IChange in existing res j q~nce. 'Imultifarnlly. CQ11Il1. or Industrial Of amps.1 COI~I'I./ I NO. fEEDERS I IInsta11/altertrelocate I di~trih. fppdpr~ 10f amps.j I I I I I I Additional bath ~!ater service Sewer Storm Sewer ISSUANCf OF PFRllIT TOTAL CHARGES WHERE STATE l,\11 REQUIRES shall not be valiJ until the I TOTAl CHARGES that tile Electrical work be done by an label has been signed by an Electrical I TOTAl CHARGES Electrical Contractor, the electrical rortion'of Supervisor and returned to the Building Oivis\on thi s permit , ! no. J 11 ~r~ I j I' _r r"ABfu', . ! I I HAVE CAREFULLY DAmNED the completed apfl 1 i ca ti on for permit, and do hereby cert ify tha tall ; n fonnat i on 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 Ore~on pertaining to the work described herein, and that IlO OCCUPAI{CY'will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Goard 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 ORS 701.055 will be used on this project. i 1\.0 ~CV\\O.:ii..0UL ~~,)\~d ~ '()U-~. 0'\.o-EC) IlAI,'E(please print) ~. SIGilATURE ~ DATE FO~ OFFICE USE DilLY Zone Type/Cons t. Units Sq. Ftg. riain Fire Zone Bedrooms Occy load Sq. Ft9. Access Flood" Plain Stories Occy Groun Sq. Ftg. Other x x Value Value Value x TOTAl VALUATION BUIlDING PERlin Charges an~ . Surcharges , , Plan Ck. COIllll/lnd ---Cl./:?_C?____ 65%1Bldo Per Fee Plan Ck. Res 30%/Bldo Per Fee Fence O~mo 'Systems Development ' Charoe (I.5~) PlU'~BING PERMIT Charges and Su!"charges ElECTRICAl' PERI:n Char,ges and Surpharges 'Sidewalk A/C Paving ITotal Comb. rermit I1ECHANICAL PERMIT Charges and Surcha rges I I TOTAl 'loC) Curb Cut I ',.. . ,-,1 " . COMBINATION APPLICATION/PERMIT (CAP) J. Applicant to furnish A, Job Address B. Legal Description 1. example- Tax Lot 100, lane County Map Reference 17 03 43 2. example- Lot I. Block 3, 2nd Addition to Sprlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceili~q/or forced air qas 2. example- waterheaterfelectricaJ/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. 'r. Building permit information: .: 1. example - construct sing'lefamily house :with an a ttached garage 2. example - remodel existing garagp. i~to family room 3. example - convert single family residence into restaurant (change of use) .' G. Value of work.as .defined in Section 303~(a) pf the Structural Specialty Code' ; H. DESIGN TEN! AND CONTRACTORS ' I ' To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding des'ign information or job'site corrections. etc. ,,' II. Abbreviated Plumbing, Mechanical, & Electrical ~fhedules A. Except where ~lank spaces occur in the desc~iption 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 c:overed on the abbreviated schedules you should consult the full schedules C. BOILOING 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- app 1 i ca t ion, and no 'p lifrfs w'i 11 be' 'processed un t il these fees are paid. All other fees and charges are due and, payable when the permit is issued. V., FOR OFFICE USE ONLY PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY: . ~'."," . PERMIT VALIDATION ..\ ..~. '~..""'" . .... - ~:~ ,., -,,' . ,- ,. ,"! ~i 'I :i i :! :1 :1 , , :~ , ..,; i' :1' 1 ~ . ~ .\' :i 3 ! :l 1 , ~~ . " i1 . ,~ . - . '-----..--. , j 1'" Permit Cl erk a Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: .... signature date ~\ name II 'I ,'0 \, \ n_ _ _. 1 IrISPECTIOII LINE . CITY ~, SPRINGFIELD . 726-3769 COIIBIIIATIONjPPLICATION/PERMIT ' Job Address \ C') \ C'1 \'\"'-. <;\ \J \'\ \" VN . , ., ~~;~GY SOURCES: legal Description - -~ -------- - -- r Hater Heater I , Ranqe I -. \) r. ValuE of Hark: owne($\ 1~uo.Q'Q o~~ \(\1(\,()'e-f\\,mnllQ '/()('JOO Address \,,\r--.. \_\-' '" ["\..... 1 Ph \ Buittino P~rmit Info: t , l .' \ \' ',\ '$ ~ ~t ) one Far.l1'1v nesldence 1'11th ~\\'\\ +-\ r\ , ()\ CDnstr~t;on L~~r INFORtIATION UNo 726-3753 Sq. Ft9. 1.lain ."~:U :q. Ftg. Access. Sq. Ftg. Other flew Add Alter Pep. _Fense_Demo _Change/Use ~er 8 ~ Single ,C5'Q Describe Work{i.e.. Build Attached Garaael Address UESIGIl TEAll ~f\~~ '. , \\ r- Q ,\ t "C9...\)"Q.'~JCt\1\ (1 ics. no.) (exoiresl Tohone no. ) (name) Phone (address) Primary , Structura 1 Electrical !1echanical CONTRACTORS Inamel j GeneraA~Q.~c)\\ ~ PlumbinQ ~ (3ddress) C\\('~ C' ~'l \i. P/lDI (1 if's. no.) Sf" ,4<:\G (flxoi fE'S \ ~\-)Q,\ lohnnp nn.1 Electrical r.lechani ca 1 PLUIIBIliG ELECTRICAL MECHANICAL -'!Q.,. Each single fixture i FFF rHARt;F: -1!.O....-1 F}'~ IResidence of SQ _ FT. New circuits alts. I or'extensions SERVICES I' rH'.RIiE. NO, cr,,- .cHARGE. furnace/burner to BTlI's .' I Relocated bui ldir:g ; I (new fix. additional): Is.F. Residence I (1 bath) , IDuplex (1 bath) each I IAdditional bath I I ~!a ter servi ce I I Sewer I I Storm Sewer I I I I Floor furnace and vent I Recessed wa 11 Sn~rp hp~tpr ~nrl vpnt ITempOrary Construction Change in existing rpc;;dtinr:~ multifamily, comm. or lnrluc;trinl I Apoliance vent c;eoarate Stationary evap. cooler I Vent fan wi th sinale duct Vent system apart from I heatino or A.C. . Mechanical exhaust hood and ntJct Wood stove/heater .' Of amps. COIIII,/IND. FEEDERS Install/alter/relocate di<;trih. fppdpr~ 10f amps. -I- I I TOTAL CHARGES WHEnE STATE L~W REQUIRES sha 11 not be va 1 iJ until the I I I TOTAL CHARGES that tile Electrical work be done by an label has been signed by an Electrical I SSUANC, OF PFRIIl T I TOTAL CHARGES Electrical Contractor, the electrical portion 'of Supervisor and returned to the Building Oivis\on , this permit Zone Fire Zone Flood Plain I HAVE CAREFUllY EXAf1WED the completed ap[llication 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 tlO OCCUPAtlCY'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 7nl.055 vlill be used on this project. \LO :S\CV\\~ b. ;Q;r""'~'f\~\~uu:i HM.1E(please print} ~ - __ _____ .. __._ _ _ SIGW\TURE 'O~ OFFICE USE DilLY S~. nq. 59. Fto_ Sq, Ftg_ ~c.. '()U-~. lo'\.o-eD \\ D~.TE Tyoe/Const. Bedrooms Units Occy Load Occy Group t1ain. Access Other x Value Value Value x Stories x TOTAL VALUATIO/1 BUILDltIG PERI.IIT Charges an~ Surcharges __ -Cl- 9g _ _ __ ~~~~B~~~ Plan Ck. 30%/Bldo 1 Fence ------------ I Demo I Sidewalk ------------ I Ale Pavlng I Curb Cut ____________1 Conm/l nd Ppr Fpp Res Per Fee Syste~s Development Charoe (1.5%) PLUliBING PERMIT Charges and Surcharges ELEC<ll"IC~.L PERI~IT Charges and Sur:.harges /1ECHANl CAL PERM IT Charges and Surcharges ITotal Comb. rermit I I TOTAL 7.00 i ._~.-l '1 < j I 1 . .N. COMBINATION APPLICATION/PERMIT (CAP) j' l 1 , j , I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100. Lane County Map Reference 17 03 43 2. examole. lot 1. Block 3, 2nd Addition to sprlngtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. example. heat/electrical ceiling/or forced air Qas 2. example- 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. Bui Iding permit information: 1.. example - construct single. family h\wse :~ith an attached garage . 2. exam~le - 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 TEAl-I MID 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 Sfhedules A. Except '-there b.lank 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. BUILDHIG DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES 011 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. I V. FOR OFFICE USE ONLY PROJECT. CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: J . 1,....__ .... __0_'_" I CITY OF SPRINGFIELD City Hall Springfield. Oregon Department of Public Works OFFICIAL RECEIPT 1'1 !! I I ( ( No. B Ie, L\H\~L a. 1@ ;'d F~~,~ ,'S\~ dress ~'1[,) \ (17 . \4~~ 53686( 1 I :eived For: t:_~ ~ . r -If1Jl t - -q 1Y2,~ [' .(1 .", ,'. ,( I I ,\\\ C'.-\)' ill ~ (f 1).00 G / d ., \' " f'f- .lount Received 1.00 ,~ ...:...",,:,. (I. .....'. (, T: ...UTHORIZI:D SIO,.....TURI!: $HIEL~OH'~U"".ULL "..,..~IE.$ . IUGI"1 0" .7.0' ., U '" l Permit Clerk Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature ~'..' ......~, j 1 ,I ~'". - date J i.