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Home My WebLink AboutPermit Building 1985-11-25 . " 'I ,\J IltlSPECTIOtl LItlE 726- 37 69 e .~ (f) INFORJ1ATION LINt 726-3753 Sq. Ftg. 1,Iain ~q. Ftg. Access. Sq. Ftg. Other uew Add Alter ~ep. -Fence Demo Change/Use Other- - ~ ~ ~ ~ //31 /Yl~ Description 17.~'.'J~-"I<. 7S~~ ; 7l.<'e> CITY OF SPRINGFIELD COMBHIATION APPLICATION/PERMIT EIIERGY SOURCES: Heat Hater Heater Ranqe Job Address Legal , Owner d~ ~a.A/ 7JS1 /J1~ Address Construction Lender Address UI:~lliN ltAn Phone '7'1/ rY51;2~ (name) Phone (address) Primary _DaN' .(bL/ Structural Electrical Mechanical CONTRACTORS (namel General J)~ 1/./(, l.. Plumbina Electrical ~'echanical NO, (address) ValUE of Hork: '1~t:>t!) - T Builriino Pennit Info: Describe Work(;..e., Build Single Fam~ nesidence Ilith Attached Garaoel f:xp;:;::: Z~~~~ T<:>R.J7I-GtfLY' 7'$/ -1-?'-?7.N~.T:' , flies. no.l (exoiresl (ohane no.) -4( V (1 ire;, no. \ !pxoirpc;,) (ohnnr no , ~/-2-~ , ~~...". ~~LN. P.....~~.p '. PLUllB lNG ELECTRICAL FEE CHARr.F Nn Each single fixture $:06 Residence of / Relocated building (new fix. additional) ITemporary Construction IChange in existing rp'i i ctp~n('p Imultifamily, comm. or Indu<;.triill IDf amps,l ICOMr'I./INO. ~DERS [Install/alter/relocate rlic:.trih fppdprc:. 10f amps. I I I I I I I I I TOTAL CHARGES M/#. /~ <::lIP I TOTAL CHARGES /fi,- TOTAL CHARGES M/N. /~ ~ WHERE STATE L\1I REQUIRES that the Electrical work be done by an, 'Electrical Contractor, the electrical portion of this pem1t shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division 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 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 UC 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 ons 701.055. that if exempt e basis for exemption is noted hereon. and that only subcontractors and employees who are in comoliance with ons 7nl.055 '1 b used on this,prriFct. IlAlIE(please print) -vtl'"n ~. ):) E \A ~ SI'r,IlATUR .~. ~ L..I'-/ DATE 1/ -j Ii. -fr , , FOr. OFF I Ef USE Oirr:r Sq. Ftg. ftain :1 Value Sq. Ftg, Access x Value Sq. Ftg. Other ~~~~ Value V~.- 6 &:::> (psi TOTAL V ALUA TI 011 , /9:.20 IS.F. Residence (1 bath) I Duplex (1 bath) IAdditional bath ~Ia ter servi ce Sewer Storm Sewer I I I I I I Zone~ Fire Zone Flood Plain BUILDING PERNlT Charges and Surcharges PLU'1BING PERMIT Charges and Surcha rges ELECTR ICAL PER'~IT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges each ~INew circu~ts a1ts. or ex~~slons 'Z. d/'f; ~~' I SERVICES ' I Tyoe/Const.~ Bedrooms Units Occy Load '7~ Occy Group ~',~ Stories I --:7tfZ ...... Plan Ck. COllll1/1nd __~______.-2..2!/B'da p.pr Fpp /? Plan Ck, Res I." 30%/Bldo Per Fee ___/.p. - I Fence . &/0 I Demo /..? c::I:::> I Sidewalk --- n~60--1 AlC Paving ____/~_=_~J Curb Cut , y-o I ... 'MECHANICAL r"Jl.RGl: .JlO.....1 I furnace/burner to STU. s I Floor furnace and vent I Recessed wa 11 ~n~('p hp~tpr ~nrl vpnt I I I I I I I~ sz:' I I I I I <.EL '.cHAIlJiE SQ. FT. /' 15:" I Appl iance vent s~oar~tp I' Stationary evap. cooler I Vent fan with s.inale duct I Vent system apart heatina or A.C. V I Mechanical exhaust hood ~nd dur.t I '-load stove/heater I I I from ISSUANCf nF pmruT Systems Development Charqe tl.5~) " /V.# . I ITotal I I TOTAL Comb. Permit " ~55z I / , '" . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A, Job Address B. legal Description, 1. example- Tax lot 100. Lane County Map Reference 11 03 43 2. examDle- Lot I. Block 3. 2nd Addition to ~prlngfield Estates C. Name. etc. of owner and construction lender D. Energy Sources . 1. example- heat/electrical ceilinqlor forced air qas 2. examDle- waterheater/electrlcal/or sola~ E. Square footage or valuation, etc. -:-- 1. examDle- 1250 sq, foot house. 500 sq, foot garage 2. example- if new project. check new - 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. example - convert single family residence into restaurant (change of use) G. Value of work as defined in Section 303 (al 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 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. BUILDING 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. --- 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 penmit is issued. ( ',' '.' '. V. FOR OFFICE USE ONLY Pennit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: 1 ~7"" -' . 7;,~ ~-,~". -,. ~/~i:r )Y~I//~ 'z:b~ /Ya.7' /.H'< C' Q~ .~~/pt'tS,;:' S.rrE/~;A"o~-::-: },~, $~~' By ~ j);c.!'~~,,>~~ J~' / ---'R:.n'~#r:r-".>~ ,??,.c:= /t;!'.L"'~- ~~P. Permit applicant exempt from registration with the Builder's Board because: '. Additlonal Project Infonnation: PLANS REVIEWED BY: , ", . signature~......: ~-_? date 1/- 2:S'-a!;"" /' .- ~ . '- name ...L4.7f>UF 7ZC"ttf: ~ .' , . 4, !~ .\ . I IrISPECTION L1IIE 726-3769 . ~ (nampl CITY OF SPRINGFIELD , INFORlIATlDN LINE COMBIrlATlON APPLICATION/PERMIT 726-3753 EIIERGY SOURCES: Sq. Ftg. flain ~ Heat ~q. Ftg. Access. , Water Heater Sq. Ft9. Other ~ Ilew Add Alter ~ep. -........: Ranqe ~ Fence_Demo_Change/Use I ~ ValuE of Hork: _Other '1~ce>_ -, ~ BU11GlnQ Permit Info: Describe Work(i~e., Build Single ~ Fa~ nesidence liith Attached Garaoel :;~:;;/::! ~ /I~~~~ I rtt>R.I'#G'fL7" 711/ /l,.?'..p7.N o'Ji>.T: , - (lies. no.) (exoiresl (ohane no. \ Job Address '/11 1Yl~ . . . Legal Description 17'"'' ~~-'I< 7St?t? 1 7({;<,0 '/ d~ j}O~ / 7J.3 -; m ~ Phone '7'1/ n?51.;2~ Owner Address Construction lender Address Ut~ll;N [tAn Phone (address) Primary .DaiV .~LL Structural Electrical Mechanical CONTRACTORS I name I General ])~ /!/{. l... Plumbina Electrical Hechanical 'address) (lies. no ) , ~:;i(~ /"- ~>V..4r U, E~6J;':r '" ' r'/-2-~ fpxnirpo;.) fnhnnp no.....L- , PLUI1BING ELECTRICAL MECHANICAL NO.1 I' Each sin91e fixture Relocated buildin9 (new fix. additional) I'S.F. Residence 11 bath) IDuplex (1 bath) each I IAdditional bath 1 Iwater service' I ,lSewer I IStorm Sewer j 1 I 1 1 I I I I I I I I I I I I I ISSUANCE nF PERIIIT TOTAL CHARGES M/#. /C). -- TOTAL CHARGES , /t;. - ,I TOTAL CHARGES M/N. /~c.ri>., WHERE STATE L.\li REQUIRES tliat the Electrical work be done by an, 'Electrical Contractor. the electrical portion of this pemit shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division 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 cerformed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Ore1]on 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 ons 701.055. that if exempt e basis for exemption is noted hereon. and that only subcontractors and employees who are in comoliance with OP.S 7Ql.D55 '1 b u:ed on this pr11Fct. IW,IE(please print) \(IT\ ~. );) E..IP-. ~ SIGrl^TUR ~. \ .x.Q~^"", DATEJJ-l'i-f} , -. FO~ OFFICE USE OIIIT I Units So' Ftg. 11ain. Value Occy Load~ Sq. Ftg. Access . Value Occy Group ""'.=3 Sq. Ftg. Other~~~~ Value V~.- 13 fA:> (PS~ TOm VALUATION , I~. 20 Zone-C'_ Fi re Zone Flood Plain BUILDING PWIIT Charges and Surcharges PLUI1BING PERMIT Charges and Surcharges ELECTRICAL PERI~IT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges , FfF I fHhRr.F Nn.......1 Residence of I ~~~ 1...cJ:iAB.G.E. ~IO I ~~~ I r furnace/burner to BTU's ,J s:- SQ. FT. ~ New circu!ts alts. or ext~slons 'Z. .,'" NJ61;l~ ;5:<>4 Floor furnace and vent SERVICES Recessed wall C~aro h~~ro~ ~n~ \..,...r ITempOrary Construction IChange in existing rp~ j qpnrp Imultifamily. COImI. or lnduc;trial I Of, amps.1 ICDMH,/IND. ~DERS Ilnstall/alter/relocate I tiio::;t,.ih. f",,,,rl,,,,.o::; I Of amps.1 I I Appliance vent ~eoaratl' Stationary evap. r:.ooler Vent fan with 5inole duct I Vent system apart from I heatino or A_C. I V 1 Mechanical exhaust I hood and duC':t , I \iood stove/heater I I I I I I 1 I~ :;z:;. I I 1 I Tyoe/Const. Bedrooms Stories .~-N I ~.:z ....... Plan Ck. COllll1/1nd __~______ 65t1Bld(1 P.rr Fpp /? Plan Ck. Res I." 30%IBl do Per Fee / /) eH> I Fence - __./'.k' ~ ej 0--1 Demo /..'5'. eI:::> IS1dewa 1 k --- --~60--1 A/C Paving ____/.e-=_~_' Curb Cut . _ y-a 1 syste,ms Development L .t/ ~ Charoe t1.5~) " /y."., . I I ITota1 I I TOTAL Comb. Permi t ~ ~5.5z , ...-"...,..... :.~. :,.rC_k~,'..'~"'~~~~"=~ ..,. .."'.,' .: ...;::;, ,. .," " COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Description \ 1. example- Tax lot 100. lane County Map Reference II U'j 43 2. example- Lot I. Block 3, 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender O. Energy Sources . . 1. example- heat/electrical ceilinq/or forced air Qa~ 2. examole- waterheater/electrical/or solar. E. Square footage or valuation. etc. -. 1. examDle- 1250 sq. foot house, 500 sq. fDot garage 2. example- if new project. check new - if addition. cneck add, etc. F. .Building pennit information: . / . 1. example - construct single family house with an a ttached garage 2. example - remodel existing garage into family roo~ 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 TEAM 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. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANa CHARGES ON THE SCHEOULES 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 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 Cha rges , ' Plan check fees are due and payable at the time ot' 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 .TV OF SPRINGFIELD City Hall Springfield, Oregon ,Depertment 01 Public Work. ,_,. _..' OFFICIAL RECEIPT C No.8 Date Nov. 26' 1~~~ , ( Rec'd From 1i~ ;-'~ Addre.. n7 ~/N 57', ( iReceived FOr:,,) ~~.S!SS/G-, .~ ~ ( "~7? V 28.- .;.he> / .Iz ( ?p. /0.'- +~ #~.!> ( -' ~ .t<:" - C.r.. {I""- r'~ .'6 (I M.P. /"- _ , " I-#P)/? ' ,t6 (1-;;;;;;;;;00 - --- "'. '1'J./W '- ~'5:'. ~~ C; , ' ~#~~~ , Amount Received /-:76 ,C)'. ~ c.! ~'--./7-~ ~/ \'~.., 'h~ .' ~,' \ ' P'" AUTHORIZED SIGNATURE ". Ct '- -- ,{ c. i 65686 ;, --. -, T" " '," 'T '" Permi t Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: a , " --A"~T""'-' ?;4~ . ~,{"~" lftEl//~ 'Zbes- /yc,7' /Q<:;'~';>/)~ .?~/f?t"'c:P' ~.rc .~'"?"'ovb"...."'~, ; ~~ h"a:z,<::.rfrc=L.> by Z;;.e- pr;e:c~~';~T~ ~~ . ~-"~n'~"77~ ,?7c= /IY~~' /ib~.D. Permit applicant exempt from registration with the Builder's Board because: Additlonal Project Information: PLANS REVIEWED BY: " ~, .}~ name I-A'Jf>u,.c 7t~'!!;;-""F~ ;i.~~ '~~~q; 1;;, ..-, . .-\~ __, d... ,'~"'), .,....:. '.'-..' :\,\.' '\ - ......... \ "",\'. Signature~~_ ~ date-.U- '2.:5'-Ji>~ , .". , ,0