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Home My WebLink AboutPermit Building 1982-7-8 7;Z!i MA-/A/ legal Description \, ()3 ~ 5l.\ r2- OlqCCL ".... '"', k I INSPECTION LINE, 1726-3769 Job Address - - INFORlIATlON UNo 726-3753 Sq. Ftq. f,lain ~Cl. Ftg. Access. Sq. Ftg. Other Ilew Add Alter Pep. Range_ -Fence Demo Change/Use val~-~f~:~1 -Other- - BUllciinQ Pennlt Info: Describe WorklLe., Build Single Familv nesidence IHth Attached Garaael CIIY Of SPRINGFIELD COMBIilATlON APPLICATION/PERMIT EilERGY SOURCES: Heat !-later Heater ct: ~ a oQ 0' u1 Owner )1 Jt I Address ;:z:;z. 0 Jt/A-IJ:3A'C, E ~ h TJI f5Lf'ifelt/ t= 0/ 71t? '7 Phon~B' 5;'6BZ Construction lender Address OESIGN lEA,., Primary Structural Electrical Hechanical CONTRACTORS Iname) /~_ *" tU<..# /t.P....~//~ O~t- ~:<.(? k/M ~}I- ; (name) Phone ~. {address} (l ics. no.) (exo;res) (ohane no. 1t (address) (lies. no.' (exoires) (ohone no. ) ':2 8074-~fV Jf}) 10/0 ? A:'/;ldf~", 40 4Aoz /, 9'_ Plumbina General V AO/S A(')()P/,f/~ /.(.JC, Electrical "lpchanical NO.1 PlUflBING I FFL1_C.lIARGJ..I'O I ':EL' J:HAIlG.E. ELECTRICAL MECHANICAL I FFF I rHARGF "0 I Residence of furnace/burner to BTU's Each single fixture SQ. FT. Relocated building (new fix, additional) S.F. Residence (1 bathl Duplex (1 bath) each Additional bath ~Ia ter servi ce Sewer Storm Sewer New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall Sn~~p hPntpr ~nrl vpnt Temporary Construction Change in existing rps. i rl_p_n~p multifamily, comm. or TnrllJs.trial Appliance vent seoarate Stationary evap. cooler Vent fan with sinole duct Vent system apart from heatino or A.C. Mechanical exhaust honrl and dur:t Of amps, COMH./IND. FEEDERS Install/alter/relocate rli~trih fpprlpr~ Wood stove/heater Of amps.l TOTAL CHARGES WHERE STATE LAW REQUIRES shall not be valid until the ISSUANCF OF PFR!1IT TOTAL CHARGES I 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 I HAVE CAREFULLY EXArlINED 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 1m 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 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 7nl.055 will be used on this project. /Y" V ~"F- S IGiIATUR-;;:;;i;~R..../ A ~ ~.D--e.- FOR OFFICE USE mil Y Sq. Ftg. f1ain x Sq. Ft9. Access x Sq. Ftg. Other x Value Value Value fWIE(please print) /Y/~If~L DATE 7/g-/8".2 Zone Fi re Zone Flood Plain BUILDING PERMIT Charges and Surcharges PlUt1BING PERMIT Charges and Surcharges ELECTRICAL PERi:IT Charges and Surcharges !1ECHMIlCAl PERMIT Charges and Surcharges Tvpe/Const. Bedrooms Stories Units Occy Load Occy Group TOTAL VALUATIOII "1 ,~~ !:51 _______'11'.,. c?o I ~;2.. Plan Ck. Comm/Ind 65~/Bldo Ppr Fpp Plan Ck. Res 30%/Bldo Per Fee Fence Systems Development Charqe (1.5~) I D~mo _ ___ _ _ ___ __J 'Sidewal k I A/e Pavi n9 _ __ _ _ _ _ _ _ __ J Curb Cut L Total Comb. rermit ( JPoc: u----l T 8'. ~~ ,. - , , TOTAL ~ COMBINATION APPLICATION/PERMIT (CAP) . ' - I. Applicant" to furnish A, Job Address B. Legal Description 1, example- Tax Lot 100. Lane County Map Reference II U3 43 2, exa~le- Lot 1. Block 3. 2nd Addition to sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. exa~le- heat/electrical ceilinq/or forced air qas 2. examole- waterheater/electrical/or solar E. Square footage or valuation. etc. - 1. exam~le- 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. examyle - 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 jab 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. 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. V, FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: tI PERMIT VALIDATION Permit Clerk Permit applicant exempt from ,registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature .:~~.,~ .--............... .....---v:-..:::;~-~_~--...."'!.:::::::::...-...-...-- ;"-"-.........""'-'-""- ~--... , .. ., date 7~.f,g'.J.. ~----.:..' \.. --. ~~ ;" I HISPE'CTIOII L1IIE. 726-3769 Job Address 7 7: ~ /1,111-1 A/ Legal Description Owner A 11'/ Address ;Z:Z 0 . .- JI/A-'/EJI~ F. ~/, TIt ciJltY.E-!f/~ c;71tJ5 Construction Lender Address Dl, I 61< TEAl,' (name) Primary Structural Electrical 11echan i Cd 1 CONTRACTORS Inamel General l/ IIpl;": ArJ{)P/,{/';; Ii/C. Plumbina Electrical ~lechani Cd 1 PLUllBItIG NO. i CHARGE I I I I I I I I I I I I I FEE Each single fixture Relocated building (new fix. additional) S.F. Residence (l bath) Duplex (1 bath) each Additional bath IHater service I Sewer I Storm Sewer I I I I I I TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be vali1 until the .' ',' , . - " , ' ~' INFORIIATlON LINt ,I 726-'3753 So' Ftg. 1,Iain ~q. ~tg. Access. t>(? Sq. Ftg, Other !lew Add Alter Pep. ~ Fence_Oemo_Change/Use I ~ _Other " I~ CITY UF SPRIIIGflELD C0I1BIIIATlON APPLICATION/PERMIT ErlERGY SOURCES: Heat !'la ter Hea ter Range val#755:~ Buiidina Pernl;t Info: Familv nesidence I-Ilth Oescr.be Work(i.e., Build Single Jl..ttached Garaae) Phon~9' 5"tBl , I.- 1~<fA'_ ~ ,uul /(P/~b~.A!'. z:,....l - OC(nY~c."J_ 7;:< (') II/ M r .L~eA:.J. )4, Phone I ~. {address I (exo;res) I (ohane no.) (lies. no.) laddrpssl (1 ir:c;.. no.) (exoirp.<;) (ononp nn. \ '2 SO?4- C/lO/t/ jfJ) 'l~/~... 'Z,4.!!lOZA q Io/O?- ELECTRICAL MECHANICAL Nn < < ,,-I J:IlAIll3L " <<< r~ARG..E. NO. Residence of furnace/burner to BTU's ' SQ. FT. New circuits alts. or extensions Floor fu rnace and vent SERVICES Recessed wall So~rp hp~tpr rind vpnt Temporary Construction IChange in existing res.icieJlC'P I multifamily , COl11l1. or Indlldrial IOf amps.1 ICO~1./IND. fEEDERS I Install/alter/relocate rlio:.tl"'ih. fpprlpl"'(' Appliance vent seoarate Stationary evap. cooler Vent fan with sinole duct Vent system apart from heatina or A.C. Mechanical exhaust hnod ann duC"t, Wood stove/heater 10f I I I amps. ISSUANCf OF PER!11T TOTAL CHARGES 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 TOTAL CHARGES I HAVE CAREFUllY EXN1IfIED 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 HO OCCUPAUCY 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 7Ql.055 will be used on this project. UAI-lE(please print) /v//(" if-/fP-L A't'V ~17P; SIG'I.~TU~;~RLA'~.lr~ OATE ~/$'/S:z fOr. OFFICf USE O!IL Y Zone Tvpe/Const. Units S~. Ftg, t1ain , Value Fire Zone Bedrooms Occy Load Sq. Ftg. Access , Value Flood Plain Stories Occy Group Sq. Ftg. Other , Value TOTAL VALUATIQr' "1-r:#!\ ~ BUILOIIIG PER.,IJT Charges an~ Surcharges ~ (j Plan Ck, _______U-'-__~ 65%/Aldo ..., Plan Ck. I:' - 30%/Bldo Fence CommlI nd Pj'r F'pe Aes Per Fee Systems Development Charoe (1.5~) PLUt1BI!IG PERr1IT Charges and SurCharges ELECTRIC~,L PERI:IT Charges and Surcharges !1ECHANICAL PERMIT Charges and Surcharfjes Demo I Sidewal k I A/C Pavi ng ITotal I I TOTAL Comb. Permit ~8'. ~;< Curb Cut I ,., , " ~ - :L I COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION III. I. Appl icant to furnish A. Job Address B, Legal Description I. example- Tax Lot 100, Lane County Mar ft. II 03 43 2. example- lot I. Block 3, 2nd Additior ~prlngtield Estates C. Name. etc. of owner and construction lend ( O. Energy Sources 1. examyle- heat/electrical ceilinqjor f 2. examale- waterheaterjelectrlcal/or so E. Square footage or valuation, etc. - ( I. example- 1250 sq. foot house, 500 sq, 2. example- if new project, check-new - ; check add, etc. F. Bluilding Plermit information:l f '1 h C. . examp e - construct SlOg e aml Y OUS attached garllge 2. exa~le - remodel existing garage into 3. example - convert single family reside (ll restaurant (change of use) G. Value of work as defined in Section 303 (a, Structural Specialty Code H. DES I GN TEAl,! ArID CONTRACTORS ( To avoid design or construction delays. Bui Division Staff must be able to contact appr persons regarding design information or job corrections, etc. II. Abbreviated Plumbing, Mechanical, & Electrical A. Except where blank spaces occur in the desc portion of-the Mechanical and Electrical $CI the applicant need fill-in only the No. Boxl ~a", to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical $( are available at the Building Division 1. To conserve space on the permit form the I",' 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 FEI \N' CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must be deliv, electrical contractor for signature by his e"j 1"",: supervisor. The general contractor is ,not aL ~ to sign the electrical label. Applicant to sign and date Whenever possible, the initial application will b a worksheet only. Where possible, Building Divis wi 11 prepare a .type written copy and return it to applicant at the time the actual permit is issued signature. IV. Fees and Charges Plan check fees are due and payable at the time 01 application, and no plans will be processed until triese' fees are paid" All other fees and charges are due and payable when the permit is issued. -,- CITY OF SPRINGFIELD CilyHall Springfield, Oregon Department of Public Works OFFICIAL RECEIPT 59392 No.8 ( Date '1- ~ - 19'"J 2- Aec'd F;om "E,,'b. ~ """"\~/}ta:. , '" Ii (, "'74 11 'Y "'(I) ~/ Address -/. 0 u l.:J...t>&L ' (' , ,r " " ~ l~ ~ r r c Aecelved For. .!OsP~rlofl1{;~ ,?>,p, L/% 't.,.!)o I '3 '2.. X',~~ '0 l I I," '~6r'li';l1l C(~ t./ 'R. r .'" '1% ( ';&.&70 /.'Il... --rfft.L(1f. ( ('-~ 'i'lIl / c , ( .-/.. <fP 'I~ .~ &, " \" (S. ~, ( ,. ..." <: HERS EUGENE. OREGON BRIGGS PR1NTERS/LITHOGRAP '" (, ,.,.. , V. FOR OFFICE USE ONLY Permi t Cl erk I PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ! I ~ Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: ,;"ot""A il , --- .':.:::7:,::~-::.:::;,:-,;"~:: ":" ::::;;;-"=:'''::'_'':;'::-''-:::,"::.~,'.,'.~''': .::::::;::.::::~;,=:":":::.:::;.';;'~':':;';;:;!:'::=';~C;:::::_:-::':;::1.:~-:;::':-;.r=:::::::';:..:..."":'"'=:: ~.;.:-"::::;"',,,""-",,,-,,,,"..,;,' . I 1 name ~,;j~" ~.-,,-.: '-'::';..:C--".-:,; :.~,..',7:::.:=, ~. da~e 7~f'~.J..