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Home My WebLink AboutPermit Building 1981-10-29 -J i ~ l (lies. nc.l. (exo;rp.~)_ (OhOM po. )__1; Q..~k.-"-\. ~..." c;."fJ ~"2.'P1S' '1ll~.l.all 'l.2k - \ :...Y-- "l- ij I , '7, '.~ . . INFORltATlON LINt 726-3753 Sq. Ftq, '.lain ~q. Ftg. Access. Sq. Ftq, Other Ilew Add,1l'A lter Rep. --Fence D~ Change/Use Other- - -..~ \ INSPECTION LINE 726-3769 CITY OF SPRINGFIELD COMBINATION APPLICATIDN/PERMIT EIIERGY SOURCES: Heat \~ater Heater Job Address ~\"7.. ff\ ~ 1"\ ~t, .~~ Legal De,cription 17-b~~!>S -4;\ TL. S"frOo RanQe _ \. () ValUE O~\oIOrk: Owner' \ {l ... ,),. ffi C.""........ <'l> V)! \ . ~(') D Add I' \\ \ Ph -:tHC""'''' ....BuilriinQ Permit Info: Oeser be Work(Le.. ress '-'t \.."..i...u...> '\ ~ one ~~' :\Familv l1esidence t~ith .A.ttached GaraQe) ~,~c l'JQ. ~ '"'\ \s"O'1-- Construct;on\L~nder Build Single ~<;"\I\~'iL- "":l.,- s;.' ~ ~i l ,:-,~\.V~ i,,-\.n l.10c;:.\- \ ~.~ Address. Ut~lliN rEAr~ Phone (address) (1 ies. no.l (exo;res) (name) Primary ~ ~ Structura 1 . Elech"ic(!l Mechanical CONTRACTDRS, _ (name) y-..\ , )CL P\umbin9--,_ t\i oL"00."P ,Electrical _ ~lSV\.~_ (address) (i l1'i\ Q~ l J.{ \1 ~. General _ ~_~~an.i,~!'.L__ ,,-J~.f'-~~~._~- .~~~.~~_-,~~"~~',n~~~~'~'_",~, _._ PLUMBING ELECTRICAL MECHANICAL. : NO:'~,~.." ,~~, T'F1T'--['HARGf "NO"~'~ Each Single fiyture --I Residence of Relocated buiiding I (new fix, additional) I each I I I I I I I I I I I ~-o~...a:.-.l,,",,~ ~-'._-"----,," =- ~=~--. .- '" r~ NO SQ, FT. furnace/burner to BTU's New circuits alts. or extensions Floor furnace and vent S.F. Residence (l bath) Duplex (1 bath) I I Temporary Construction I . Change in existing I res j tiepee ImultifamilY, camm. or I Industr;;;tl SERVICES Recessed wall Snace heat~r and vpnt Appliance vent seo8rate Stationary evap. cooler . Vent fan with sinale duct Vent system apart from heatina or A.C. Mechanical exhaust hood and duct Wood stove/heater Additional bath Water service Se'Wer Storm Sewer IOf amps,1 ICOMM./IND, FEEDERS I IInstall/alter/relocate I dic;trib. fppders IOf amps.1 I I I ISSUANCF OF PFRI1lT oQ - C) ....J tr.- 0\ (ahOM no. I "'''-=''-f- I r, HL..cHAB.G.E.1 I I I I --01---' I I I I I I I I :-1 TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L.\H REQUIRES that the Electrical work be done by an' Electrical Contractor, the electrical portion of this permit shall not be valid 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 th~t 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 NO OCCUPAIICY will be made of any structure without the permission of the"Building Division. I further certify that my registration with the Builder1s 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. IlAIt[(please print) JON.~\\N... \)\:>.~ \)t\~.(l_'t'l SIGrlATU~ \.'i\.N\. \;)~ FO~ OFFICE USE 0I1CY',\ Sq. Ftg. riain Sq. Ftg. Access Sq. Ftg. Other DATE \'0 'n-<\\~ Zone,_~~~ Fire Zone - Type/Const. Bedrooms Ilnits x Value Value Value Occy Load Occy Group x Flood Plain - I Stories x TOTAL VALUATION ?~"O CIa Systems Development Charqe (L5~) , BUILDING PER~IIT _______.I~f2(J Plan Ck, Comm/lnd 1~.,6' Charges an~ 65%/Bld~ ~~r ~~~ Surcharges Plan Ck. Res I . too 30%IBldo Per 'Fee \ PLUMBING PERMIT Fence I Charges and ------------ I Surcha rges D~mo 'ELECTRICAL PERrIIT Sidewalk I Charges and ------------ I Surcharges AIC Pavi ng , MECHANICAL PERMIT Curb Cut I Charges and ------------ I Surcharges ~. I I I ITotal Comb. renmit ! I I TOTAL ~ ;J.O~ ~.$""\ I , "-, , ~ . -p ~-I , , . ~l'. COMBINATION APPLICATION/PERMIT (CAP) , PERMIT VALIDATION Ill. I. Applicant to furnish A. Job Address B. Legal Description , 1. example- Tax Lot 100, Lane County Map Reference II 03 43 2. exam~le- Lot I, Block 3, 2nd Addition to Springtield Estates j C. Name, etc. of owner and construction lender D. Energy Sources 1. exam~le- heat/electrical ceilinq/or forced air Qas 2. examole- waterheater/efectrlcal/or solar E. Square footage or valuation, etc. - I. example- 1250 sq. foot house, 500 sq. foot garage 2. examyle- if new project. check:ruew - if addition, check add, etc. ' F. Building permit information: . 1. exam~le - construct Single family house ,with an attached garage ' 2. example - remodel existing garage into. f4mily roonl 3. .exa~le - convert single family residence into reHaurant (change of use) _ r,: Value of work as defined in Section 303 (a) of the Structurai Specialty Code H, DESIGN TEAll AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design infol~ation 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 tho 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 OIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEOULES 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. --- 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 , , j j ., ~ 'I '; 1 , j ; , . . i ~ . , , " .1 ~ /- " ~, . '. 1 " , V, FOR OFFICE USE ONLY Permit Cl erk . ' . ." 0;"'_' , '" .~lioio.' ,~.. ".~...~ ".I PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: , , , Permit applicant exempt from registration with the' Builder's Board becaus'e: . Additional Project Information: '-. ... PLANS REVIEWED BY: I. ,. .. name signature d date /0-.;27'-8-'/ CITY OF SPRI1IGFlELD INFORlIATIDN LINt corml1lATION APPLICATION/PERMIT 726-3753 'C, J',') I E!IERGY SOURCES: Sq. Ftq. Hain ";\,~ Heat ~q. Ftg. Access, . , I !"ater Hea ter Sq, Ftq. Other Tt. ..,'it00 .-rlew_Add,1l'Alter-.:~ep. Ranne __.. _ _. Fence Deiilb Change/Use ~ , Valu' O~HOrK: Other- - Owner \'?'f(" '^ ffic~",,",^f'o\:dl '\.~QQ, (, dd \ ' ~Ullc;lnc1 Permit Info: Oescrlbe Work. Le.. Build Single A ress U \ \..e..\.....,.;.,~ . Phone~~. ~~~~~y J1esidence Hith .A.ttached (;araqe\ r,. r ,-,D <\ '\ ~(] ')__ '\ {').:..L~:\L "':l.., - " 't 9:,' I ......;~::;Jr-.<.0..c.. Constructi~~~nder :\-.b . .--.,....,c..,\-. \ ,-.., \l,"il. ~,. .~. IIIlSPECTI 011 LI liE 726.. 37 69 . Job Address <;; \, 7 of\\. ,- ~ S\' Legal De<cription n-b"3:~~o:"_l./~ Mechanical CONTRACTORS _~1 Genera 1 ~-\ \ )C'.I.- Plumbino t\...\:,~..p Electrical __~t'S"V\ '-'<-_ - .l!s.'iW'.,ic~L..., ," ."N.~..--.. PLUlIBING Nii: -~-...~.., '-TFEfiCHAAGC 'j.n' , Each single firture I I I I I 1 1 I 1 1 I 1 Address Ut~llm TEAI~ lrt"'m~\ Primary Structural , Electrical IRelocated building (new fix, additional) Is.F. Residence (J bath I IDuplex (1 bath) each IAdditional bath Iwater service ISe-wer I Storm Sewer 1 1 -..-, -I I I Zone.A~~ Fire lone - Flood Plain - Type/Const. Bedrooms Stories BUILDING PERMIT Charges and Surcharges PLUIIBING PERMIT Charges and Surcharges ELECTRICAL PERIHT Cha rges and Surcharges MECHANICAL PERMIT Charges and Surcharges Phone (address 1 , ~ddress , (i l"N\ e:.\....,.l! ~~ f oQ - C} ....J IS' 0\ flies. no. \ (ohon@ no.') fexDirp.sl \.J.5~i.~ w.. "...." (1ir:~ 1'10 , ~ ~ ~;;\;jt~ '1]).~ ~hO~ \~~l[i L~. ""7 1.L.,.- , ,.JJ.-- 1- : , I.. .f , I I TOTAL CHARGES I TOTAL CHARGES TOTAL CHARGES , WHERE STATE L.\I/ REQUIRES that 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 com91eted application for germit. and do hereby certify that oIl information hereon is true and correct, and I further certify th~t 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 OCCUPAllCY will be mode 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 7Ql.055 will be used on this project. IlA/.IE(please print) JON.~'\~ \j'~~ \)e>.d.-?j'\ SIr,;/ATU~ \'t:\.N\. \J~ FOrnifFlCE USE ryillY\\ Sq. Ftg. llain Sq. Ftg. Access Sq. Ftg. Other Plan Ck. Comm/lnd _______.1:S:!flO. 65VBldo Ppr Fpp Plan CL Res . hI? :~n~/R1(i(l p(lr ~(I'" I ~~~c~--- <-- "U ------------, Demo I'Sidewa I K ELECTRICAL Residence of SQ. FT. I New circuits alts. or extensions 1 SERVICES I I 1 I I ITemporary Cons"truction l. IChange in existing I rpc; j dJ'.nrp Imultifamily, comm. or 1 TnAlJc:trit1l 10f ICO~1./IND. FEEDERS Install/alter/relocate I _____JCLic:trin- fpprlprc: Of amps./ amps.1 -I I 1 / Units Occy Lood Occy Group 9..L'-'€; A/C Paving I I I ~ '- ------------ _.,~ -~~...--....--..-_......_.. MECHAN I CAL. ~~ "'rw Jm.:.l I I I I I I I 1 I 1 furnace/burner to BTU's ,/ Floor furnace and vent 1 I 1 I 1 I I 1 I I I 1 Recessed wall ~n~rp kp~tpr ~nrl vpnt Appliance vent , ~.foi}ratp I Stationary evap. cooler . 1 Vent fan with ~ i n91 e dlJC::~ I Vent system apart from I hP.3t.ioC1 01'" A,r:o I Mechanical exhaust I t'tnnrl ,,"rl rlurt I Wood ~tove/heater .1 I -/ ,1-' I 1 I 1 I 1 I I ISSUANCE OF PFRllIT c. .. DATE \'\J h,<\\~ ,x Value x Value x Va 1 ue I~ t:)CJ TOTAL VALUATIOn~"~ Systems Development Charop 1'1. 5~1 ... .w.._ I I I I ITotal Comb. rermi t . I I I TOTAL ~~O. ~.s\ " J . , M COMBINATION APPLICATION/PERMIT (CAP) , I. Applicant to furnish A. Job Address B. legal Oescription I, example- Tax lot 100, lane County Map Refe 17 03 43 2. examp]e- lot 1, Block 3, 2nd Addition to ~pr'ngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceiling/or forced ~..' 2. example- waterheater/electrlcallor ~ ,E. Square footage or valuation, etc. I. example- 1250 sq. foot house, 500 sq. foot 2. example- if new project. check new - if ad~ cneck add, etc. F. Building penmit. information: . 1. example - construct single family house ,wit attached garcige . ~, '0 2. example - remodel existing garage into fami ~ J. examole - convert single family residence i re5taurant (change of use) _ 'r,: Value of work as defined in Section 303 (a) of )tructural Specialty Code H, OESIGN TEM1 ANO CONTRACTORS To avoid design or construction delays, Buildin, Division Staff must be able to contact appropr;. ,..... persons regarding design infonnation or job sitl \. corrections, etc. II. Abbreviated Plumbing, Mechanical, & Electrical Sche, A. Except where blank spaces 'occur in the descript- par"i.:ion of the Mechanical and Electrical Schedu' ( the applicant need fill-in only the No. Boxes a, to the appropriate item{s) to be installed " B. Full Plumbing, Mechanical, and Electrical Schedl ( are available at the Building Division ,1. To conserve space on the permit form the" set have been abbreviated 2. If the item{s) to be installed are not cover / the abbreviated schedules you should consult (e full schedules C. BUIlOING OIVISION STAFF WIll FILL OUT ALL FEES A CHARGES ON THE SCHEOUlES , O. As noted on the CAP, the label must be delivered electrical contractor for signature by his elect supervisor. The general contractor is .not autho to sign the electrical label. --- Applicant to sign and date c: Whenever possible, the initial application will be U~ a worksheet only. Where possible, Building Division will prepare a type written copy and return it to thl applicant at the time the actual permit is issued fOI (: 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. . PERMIT VALIDATION CITY OF SPRINGFIELD (" Date "... . (I City Hall Springfield, Oregan Department af Public Works OFFICIAL RECEIPT No. B 57 5 5 3 (I 19q/ It",:.-::J.q - (' Rec'd From '( ( \i 4 , co. O-iJ.S-T ! ''--'' III. V. FOR OFFICE USE ONLY Address Received For: ( (I !i -~ ;<:/. .IS.on ~ C/% . C,r7 C ~L. C-k c ?5" Ii - .- c ..J.<), :-1,~ ~, :d:-- 9/[) '76 r (tI- - - Amount ~' . -. . . PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: 1 1 A;d ; 111111'1 \, Pennit Cl erk '-'" ,- ,.'~I Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature ~ \ , date IO..;l?-~/ ~ ( ( ( ,. , I ! 1