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Home My WebLink AboutPermit Photos 1981-11-2 INSPECTION L1NE\ 726-3769(....- . CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT . INFORMATION LINE 726-3753 Lej:lal Description J, Heat Water Heater Range Value of Work: Sq. Ftg. Main Sq. Ftg. Accon. Sq. Ftg. Other _New_Add_Alter_Rep. I_FenCe,_Demo_Change/UI. _Othe:" Building Permit Info: Describe Wark (i.e., Build Single Family Residence With Attached Garaae) tr fl: 4) ~ " ~ Job Address t/D2 M A/A) Sr ENERGY SOURCES: I Owner '~ (1) 1:t.JJ:E.Lp /I I Address J,)../..I) N. R'!::!:J phone I SPED;_D R. Q_7.!f71 I Construction Lender I Address Phone I DESIGN TEAM (name) I Primary I Structural I Electrical I Mechanical CONTRACTORS (name) c;",n..rnl 71./-1-'/,;2 'tit ~d~'~ ~~-~~~~~ (lies. no.) (expires) (Ph~O.) (address) (addren) (lies. no.) ,...;~ "0__' PlumbinR JA-C!-k IJ.uIJL.EI,) I#tVAE AJ Bel Dr;,,1=: Electrical Mechanical PLUMBING ELECTRICAL MECHANICAL I NO, I 14- I FEE I CHARGE NO, I fEE CHARGE NO, I fEE I CHARGE Additional bath Amps. furnace/burner to D,TU', Appliance vent separate Stationary evop. cooler Vent fan with dnple duct Vent system apart from heating or A.C. Mechanical exhaust hood and duct Each single fixture Relocated building (new fix. additional) S.F. Residence (I bath> ,t;',f)() .2I;.1Jt) Residence of s9' ft. New circuits, alterations or extensions SERVICES Duplex (I bath) each Temporary Construction Water service Sewer Wood stove/heater Storm Sewer FEEDERS Heat Pump Air handler to 10.000 CFM Air handler over 10.000 CFM Amps. ISSUANCE OF PERMIT TOTAL CHARGES ~ ..2JJ ,/}() TOTAL CHARGES TOTAL CHARGES I WHERE STATE LAW REQUIRES thai lhe Electrical work be done by the Electrical Contractor, Ih. el.ctrical portion 0' Ihis permit .hall not b. valid until a label has bMn signed by an Electrical Contractor and attached 10 the electrical panel. NAME (please print)-1_ I HA VE CAREFULLY EXAMINED the completed application for permit, and do hereby cerlify that all information hereon is true and correct, and I 'urther 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 Stata of Oregon pertaining to the work described herin, and that NO OCCUPANCY will be made of any struelure without the permission of the Building Division. I further certify that my registration with the Builder's Board is in full force and effect a s required by ORS 701.0SS, that if exempt the basis for exemption is noted heron, and that only subcontractors and employees who ore in compliance with ORS 701.0S5 will be used on this proiect. I \l1:m-~_DATE v//17;;/ V ~ Basis for Builder's Board exemption' ~ CUUi/e/eY / SIGNATURE Y FOR OFfiCE USE ONLY Ion~ Fire Zone Flood Plain Type/Canst Bedrooms <:torie~ Ilnits l'1ccy Load n~-y Group Sq. Fig. Main <;". Fig. Access Sq. Fig. Other . Value x Value x Value TOTAL VALUATION BUILDING PERMIT Charges and Surcharges Plan Ck. Camm/lnd 65%/ Bldq Per Fee Plan Ck. Res 30%/ BldQ Per Fee Systems Development Charae n.5%1 PLUMBING PERMIT Charges and Surcharges ~ Ii , /J1) f.n,. ',gO O.mo Total Comb. Permit hJ, gO ELECTRICAL PERMIT Charges and Surcharges Sidewalk Alc Pavinq MECHANICAL PERMIT Charges and Surcharges TOTAL ~.w.SD Curb Cut , I' \C<?MBINATION APPLICATION/PER. (CAP) i: Applicant to furnish A. Jab Address B, Legal Description , 1. example-lax lot 100, Lane County Map Reference 17 03 43 2. example. Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. examcle-heat/electrical ceiling/or forced air gas 2. example-water heater/electrical/or solar, . . ''I E. Square footage or valuation, etc. . 1. example-1250 sq, foot house, 500 sq, foot garage 2. example-if new project, check new-if addJtion, check add, etc, F. Building permit information: 1. example.construct single family house with an attached 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 (a) of the Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction delays, Bull?~ng Div\i.si~n' . I Staff must be able to contact appropriate persons regarding design information or job site corrections, etc. ",,' , I II. Abbreviated Plumbing, Mechanical & Electrical 'Schedules A. Except where blank spaces occur in the description portion of the Mechanical ond Electricol Schedules, the applicont 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 abbrevi. ated schedules you should consult the full schedules C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES III. Applicont to sign ond date Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Division Staff will prepare a typewritten 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 ore 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: \, ,\ . \ \ Additional Project Information: PLANS REVIEWED BY: nam.... "ignatur.o. r \ ..', .'r .PER~;T VALlDATIO~ ~. ~ .... .' -- .-, ... \. . .... . '...1 '. " '.1.' Permit Clery " \, ': \". .. ...late INSPECTION LlNE.\ 726-3769.",..} . CITY OF SPRINGflElO COMBINATION APPLICATION/PERMIT . INfORMATION LINE 726-3753 Job Addren I/OJ. MAlA) ,5r ENERGY SOURCES: Heat 'Nater Heater _ Range V.::Jluo of Work: Sq. fig. Main Sq. Ftg. Accen. Sq. fig. Olher _New'_Add_Alter_Rep. _Fence_Demo_Change/ Use __Olher 0- fr 1.; ~ "- ~ Legal Description Own,,-cl2.b.LWJ:LCrE L.. I:; /I Add".. ,&) J-I-/) IU, f '!:!J .SI2ED_{) R _Q_'L'I:!.7? Address Phone '''7 a.'l! Building Permit l;'lfo: Dcuribe Work (i.e., Build Single 7~ -7::;<. 7~ Family ResidMce- With Attached Garace) .: _I ),,},IJJNU}" ;lj, ~ ~-;:r:i:;:: J~ . ':~ I I ';:;;;z:s.1~~'t~ (address) :' (lies. no.) (expires) I '-~~o.) . r Phone Construction Lender DESIGN TEAM (name) Primary Structural Electrical Mechanical CONTRACTORS (nome) (address) (lies: no.). (expires) (?hone no,) General Plumbing ..J A- e k. IJu J.) L-1'~_'I') IJtH!iLE AJ · Be.u2.G,i=: Electricol Mechanical PLUMBING ElECTRICAL MECHANICAL' I NO, 14- I I I I FEE CHARGE NO. FEE CHARGE NO. FEE CHARGE sq. ft. New circuits, alterations or extensions furnace/burner to l\TU's Appliance vent separate Stationary evap. cooler Vent fan with single duct Vent system apart from heatil':g or A.C. Mechanical exhaust hood and duct Each single fixture Relocated building (new fix. additional) S.f. Residence (1 both) .'5",f)() .1o.bO Residence of SERVICES Duplex (l both) each Temporary Construction Additional both Amps. Water service Sewer Wood stove/heater Storm Sewer FEEDERS Heat Pump Air handler to IO,OOD CFM Air handler over' 10.000 CFM Amps. 1.,- TOTAL CHARGES ~.2/).1iO TOTAL CHARGES ISSUANCE OF PERMIT I TOTAL CHARGES WHERE STATE LAW REQUIRES thar the Electrical wark be done by the Ehlctrical Can'ractor, the electrical portion of this permit shall not be valid until a lobe I has. be.n signed by an Electrical Contractor and attached to the electrical panel. NAME (please print)--" 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 011 work performed shall be dona in accordance with the Ordinances of the City of Springfield and the Laws of the State of Or.gon pertaining to the work described herin, and that NO OCCUPANCY will be mode of any structure without the permission of the Building Division. I further certlfy that my registration with the Builder's Boord is in full force and effect as required by ORS 701.055. that if exempt the basis for exemption is noted heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. / \7).,,_ t Jti,.~ \t:Z1'I" V Basis for Builder's Boord exemption- 7~ CJl1i Ie/eo Y / SIGNATURE ~ DATE :l'I/P,ff1 i I FOR OFFICE USE ONLY Zone Fire Zone flood Plain Type/Con),t Sedrooms Storie. I 'nits "tcy Load Occy Group Sq. ftg. Main Sq. Fig. Accen Sq. ftg. Other x Value Value Value x TOTAL VALUATIOt' 8UILDING PERMIT Charges and Surcharges Plan Ck. Comm/lnd 65%/8Idr;l Per Fee Plan Ck. Res 30%/ Bldq Per Fee ____-tf(.Jj I f)-O Fence '.SI) Demo Systems Development Charoe (1.5%) PLUMBING PERMIT Charges and Surcharges Tolol Comb. Permit "tn. gO ELEOR!CAL PERMIT Charges and Surcharges. Sidewalk AJ C PaviM MECHANICAL PERMIT Charges and Surcharges TOTAL ~U>, SD Curb Cut II. Abbreviated Plumbing, Mechanical & Electrical'5chedules A. Except where blank spaces occur in the description pOI of the Mechonical ond Electrical Schedules, the applicc need fill-in only the No, Boxes adjacent to the apprap' item(s) to be installed B, Full Plumbi'ng, Mechanicol, and Electrical Schedules are available at the Building Division 1. To conserve space on the permit form the schedule! hove be,en abbreviated 2. If the item(s) to be installed are not covered an the ated schedules 'you should consult the full schedule C. BUilDING DIVISION STAFF Will Fill OUT All FEES A~ CHARGES ON THE SCHEDULES J- Ill. Applicant to sign and date Whenever pos~ible, the initial application will be used as a worksheet only. Where possible, Building Division 5taff will prepare a typewritten 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 ather fees and charges are due and payable when the permit is issued. 'COMBINATION APPLICATION/PERI (CAP) I. Applicant to furnish ,', A. Jab Address ~ B. legal Description 1. exomple-tax lot 100, lane County Map Reference' 2. example-lot 1. Black 3. 2nd Addition to Springfield C. Name, etc. of owner and construction lender D, Energy Sources 1. example.heat/electrical ceiling/or forced-air qas 2. example-water heater/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, chec odd, etc. F. Building permit information: 1. example-construct single family house with an attOI, 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 (a) of the Structural Speciolty Code H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Oivisil Staff must be able to contect appropriate persons regc design information or job site corrections, etc. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ,\ " .:;: Addilianal Project Informotian, PLANS REVIEWED BY, nom"" ...,ignatur.... -, '- CITY OF SPRINGFI ELD .. City Hall i Springfield, 'O,egan ----, Department of' Public Works --OF~ICIAl RECEIPT .' No~ B 575.6,01 Q3 Oale//-)...-X( 19 ( Rec'd F.rom TDM. ilJlf ,'red AI-' Address ,t.;1jo A.J. cl $p F 'D lJ,p I ,( ( II ( Received For: li.J JM/ 1~ -lil..lunt ,-r- V #tJ ~' $) ~.t?iJ ....L!?lJ $1 4/) JI7J \, ,\1 (~ '. CI (!,f (I ~ (] ( ~~.Ro (I Amount Received ( ~] Ud. (I "UTHOAIZI!:O SIGN"TUAI!: '''lll~DN'~U~N'Ull "~'N~Il~' . IlUGIlNIl, D~ .,,.0, ..,,,., ( (I ".,", Permit Clery , ~.:' , , -fate