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Home My WebLink AboutPermit Building 1982-8-25 , 1 ~;5'a' ---- I ItlSPECTION lHlE. 726-3769 Job Address Soo !VL,r} h ."'-. . \=. . . '5"..1. Owner /fl D1 ' C/~tI tie- 1 a(3;'r/~ cJr Address ~~ ~lOe IfUI ~ raJUJ.. Construction l~,:rl:I . Phone 71f 7.. 1~" , :)0 QJ (}J ~ I legal Description , Address DESIGN TEAl,' (name) Phone (address) Primary Structura 1 Electrical Mechanical CONTRACTORS (name) General .""/Nt & I ~~.( (address) (lies. no.) (pxo;res) (ohane no. ) Plumbina Electrical ~lechanical PlUI1B ING ELECTRICAL MECHANICAL ---.lliL! FEF CHARGE NO FFF I CHARGF NO FFF rHARliE. Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (] bath I Duplex (I bath) each Additional bath SERVICES Recessed wall SD~Cf> hf>~tf>r ~nd vent Storm Sewer Of ;jrnps. Appliance vent s.PDrlrilte Stationary evap. cooler Vent fan wi th sinole duct Vent system apart heatina or A.C. Mechanical exhaust hood and duct Wood stove/heater from Sewer Temporary Construction Change in existing rp5 i denc~ multifamily, comm. or Innustr-ial \oJater service CO~~./JND. FEEDERS Install/alter/relocate di,trih. fppdJ'Or<: I I Of amps. ISSUANCF OF PERIIIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L\\~ REQUIRES that tile Electrical work be done by an<Electr;cal Contractor, the electrical portio'n of this permit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFUllY EXN1INED the completed application for permit, and do hereby certify that all information her~on 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 110 OCCUPAIlCY 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 701.055 will be used on this project. IIAHE(please print). C'L/tlJ/)ff G,[;RLAc.ff SIGIIATURE (?i/.4~.ulL 0 Jh, I ~ DATEX-~:)-gy FOR OfFICE USE DillY Zone Tvpe/Canst. Units Sq. Ftg. riain Fire Zone Bedrooms Occy load Sq. Ftg. Access Flood Plain Stories Occy Group Sq. Ftg. Other x Value Value Value x x BUILDING PERNIT Charges and Surcharges /- ----." " ( ~ 00 I PI~,Ck. COlllTIIInd __~,,-______~/8Jdo Ppr Fpp ^() Plan ~k. Res r--J 30%/81 do Per Fee F ;pte ~---------- -- --- . Demo TOTAL VALUATION Systems Development Charae (1.5%) A/C Paving , '\.1\ \ 0 t/ ,,'" ~:.1 TOTAL ~ !).O ~ I PlU!~BING PERMIT Cha rges and Surcha rges ElECTR I CAl PERI~IT Cha rges and Surcharges 'Sidewalk MECHANICAL PERMIT Charges and Surcharges Curb Cut . . :/. /. """'" " COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATIDN I. Appl icant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, lane County Map Reference II oj q3 2. exam~le- Lot 1. Block 3. 2nd Addition to Springtield Estates C. Name, etc. of owner and construction lender D. Energy Sources . 1. exam~le- heat/electrical ceiling/or forced air Qas 2. exa~le- waterheater/electrical/or solar E. Square footage or valuation, etc. 1. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project. check new - if addition, cneck add. etc. F. Building permit information: 1. example - construct single family house with an attached garage 2. exa~~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. OESIGN TEM~ 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 full schedules C. BUILOING 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. --- 111. 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. V. FOR OFFICE USE ONLY Permit Clerk 1 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: 1 name s i gna.tl:lre .---- . date ..--.....- __--..i.;...;...._,.", --_:"""..-,..~ .. ..=..-;.':"'..!:2r..::=::::;or- '-;:: ;,j.~;-;,,:i~r . .'-. :" tI5?' -----. /r..# ~ . . -:\../. CITY OF SPRlilGFIELO INFORIIATION L1N" COMBIilATION APPLICATION/PERMIT 726-3753 EilERGY SOURCES: Sq. Ft~. 1.lain Heat ~q. ~tg. Access. ~ater Heater Sq. Ft~. Other Ilel< Add Alter Rep. Ranqe -Fence Demo Change/Use ValUE of iW,oO Other-- Builciinq Permit Info: Describe ~Iorkli-.e., Build Single Familv nesidence Hith J'l.ttached l1araoe) Phone 7Jf 7 .. :'1') ., (;,/I~-I:r-/.{J- IT,... om-/- c.ud/s ;qIIJt'/j 12,(J 11MII oj hIdE 1)n r,kfff9 r;,-t:- PrtJDer-f'1. 1 ' (lies. no.) :;<) C}J ./ OJ r,<I 1./ \. D I I IrISPECTIOII LIIIE. 726-3769 Job Address SeD M", I h Legal Description Owner If} P1 ' C/atl J e. 1 {;er!?t c.t, Address ~'S ~(Veu'U\el{)- fiiJlJJ.. Construction L~~(~ . .... Address OeSl~11 ieNI (namel Phone (address) (@xpir@s) (Dhona no. I Primary Structural Electrical Mechanical CONTRACTORS Genera 1 :r; IfYl (name) J-.l-.df~t"..( (addre~~) (lies. no.1 (exnirps) (ohona no. Plumbino Electrical "lechanical PLUllBI IlG ELECTRICAL MECHANICAL NO. Each single fixture FEE CHARGE ND :Fr rH~ "0 Residence of furnace/burner to SQ. FT. BTU's rrr rH~ I , Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S, F. Res i dence II bath) Duplex (1 bath) each SERVICES Recessed wall SOn~e hentpr nnd vpnt Storm Sewer Of C0I11.1. / lND. FEEDERS Install/alter/relocate rHd_rih_ fppdprc; amps. Appliance vent ~@Darat@ S'tationary evap. cooler Vent fan wi th ~inale duct Vent system apart from heatinq or A.C. Mechanical exhaust hood nnd duct. I I I I I Additional bath Sewer Temporary Construction Change in existing re5.i d~.r\ce multifamily, COlTl!l. or lndu$trinl ;!ater service Wood stove/heater Of amps. 1 SSUANCF OF PFRIH T TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be vali~ until the TOTAL CHARGES TOTAL CHARGES that the Electrical work be done by an. Electrical Contractor, the electrical portio.n of this perr.lit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXNlINED the completed application for permit, and do hereby certify that all information her~on 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 110 DCCUPAIICY 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. IIAI-IE(please print) C'L11 tJ I)f -- / G([iRLA'-tf SIGilATURE t?/aI.uU 1\ ~ DATEX-.<S--g Y FOr. OFFICE USE Oi~L Y Zone Type/Canst. Units Sq. Ftg. Hain Fire Zone Bedrooms Occy load S~. Ftg. Access Flood Plain Stories Occy Group Sq. Ftg. Other x x Value Value Value x BUILOIllG PERI.IIT Charges and Surcharges ./ -------. ~OO ) ( --~~~------ ~() \ TOTAL VALUATION PLUI1BING PERMIT Charges and Surcharges Plan Ck. Comm/Ind 65%IBlda Ppr Fee Plan Ck. Res 30%/Bldo Per Fee F@nce Systems Development Cha roe (1. 5%l ELECTRIC~.L PERI:IT Charges and Surcharges Sidewalk AIC Paving \~ '\r\ \ 0 L./ \\j\J l\ \ \ Total Comb. rermit~ --,--------- --- - D.elrlo ' 11ECHAfllCAL PERMIT Charges and Surcharg@s Curb Cut TOTAL -5 .!).O ~ I . COMBINATION APPLICATION/PERMIT (CAP) ~ I. Applicant to furnish A. Job Address B. Legal Description 1. examole- Tax lot lOOt lane County Map Refer la II 03 4j 2. examEle- Lot 1. Block 3, 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. examDle~ heat/electrical ceilinqjor forced 2. exa~le- waterheater/electrical/or ~ E. Square footage or valuation, etc. I. examole- 1250 sq, foot house, 500 sq. foot 2. examp'le- if new project, check-new - if add cneCk add, etc. F. Building permit information: 1. example - construct single family house wit attached garage 2. exam~le - remodel existing garage into fami fU,' 3. examJPle - convert single family residence;1 ~ restaurant (change of use) G. Value of work as defined in Section 303 (a) of . Structural Specialty Code H. DESIGN TEN1 AND CONTRACTORS To avoid design or construction delays. Buildin! Division Staff must be able to contact approprii persons regarding design information or job Sitf (' corrections. etc. II. Abbreviated Plumbing. Mechanical, & Electrical Schec A. Except where blank spaces occur in the descripti portjan of the Mechanical and Electrical Schedul the applicant need fill-in only the No. Boxes ad (en to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedu are available at the Building Division 1. To conserve space on the permit form the sch (le' have been abbreviated 2. If the item(s) to be installed are not cover the abbreviated schedules you should consult fu 11 schedu 1 es (, C. BUILOIrIG DIVISION STAFF WILL FILL OOT ALL FEES A: CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must be delivered electrical contractor for signature by his electl (~. supervisor. The general contractor is .nat authol to sign the electrical label. - Applicant to sign and date Whenever possible, the initial application will be u~ @s a worksheet only. Where possible, Building Division will prepare a type written copy and return it to thE applicant at the time the actual permit is issued for . \ IV. ~~~~a;~~eChargeS ( Plan check fees are due and payable at the time of tho 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. III. V, FOR OFFICE OSE ONLY . /~ PERMIT VALIDATION / ..,- CITY OF SPRINGFIELD City Hall , Springfield, Oregon Department 01 Public Works (I OFFICIAL RECEIPT 59601' No. B II Date A\ ~(\ ,Q.S19 S;f) _ , Rec'd From ('=\-.\) ~:"lXLri, 0 C\, I) h ')..(\[..\1. ,II q -"l () _ _ ' Address ~l~ 0 ,'::"'-\...Q...Lf' 1\ I : I, ~hJ...) (I ( ( ( 4 Received For: ~ Qf\~~<() c '4 r-_ \'. ,,).I'~,\ Ii"-I, \ r....... -""--' - /' \ ""-- .~~(. ..\_ ~ -.1\ \ ~~X.) .. 'r- f. E.~ 4 .~ 4 -.I . 4 c ( Amount R~celved \\\ ''!D'-h."Q,SL... ~ ' ?I'\ A ,DIG- ~- AUTHORlZfO SIGNATURE '.( ~(.l -,........ ,'" \.. c DRIOGS PRINTERS/LITHOGRAPHERS. EUGENE. OREGON -'-- , Permit Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: j Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature ~--:-:::::':=':;"'-:'..~ ~._._:=-.=.:::.~ ':':-;::'~'::.-:..~-=-=..:.:.;~_;::':;:";;""::':::.';~,:':::"=:-;~""'"7~~';''X~:==='''.;n::~.''':'~':~'':-'':::':::::;;:';;;:':''-::'=::::':''f.'".'''"..::.. ;:.:;..::-.-,::=;:::;::,..;,-..~::;:::::.:_-::::;:"...i:~,:'. date I