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Home My WebLink AboutPermit Mechanical 1988-10-20 I " " .' .11NSPECTION LINE L?26- 37 69 Job Address 9~ Bu.c:.v , Legal Description /7-c::J "3-,r,<;...c7C), . a. INFORlIATION UNt 726-3753 Sq. Ftg. I.lain Sq. Ftg. Access. Sq. Ftg. Other Ilew Add A Iter Rep. -Fence Demo Change/Use Other- - CITY Uf SPRINGFIELD COMBINATION APPLICATION/PERMIT 'R/i..p.:.,3<ff'<!:> .J:<. ,; '~-" s.-......>- ")0<" EIIERGY SOURCES: /,;V"~~,.yA7"~""A-<," /"""-A-","" Heat Hater Heater Owner MjRW'A'--'f'D ~'""~~C"S Address -::?<#?~ 8-!l~D9' I//EW.?X7. Phone ----'"~/~~C~ DA>. ~;>? """''''';M I ..~er 5<;/~4ii' 7? U.l'f;P Address C;;/n .#.e\W.?T.N 7$/~P'h1:.7~Y Ul:.~1(jN TE:.JU~ (name) (address) flies. no.) Primarv 7?:&?/h(/~h/E~/"#-_~'/~ "'?/? ?0/$7' .<S~P,,".D / . / Range ValUE of I'lork: ~0~ DD BuifriinQ Permit Info: Descr,be Work(i.e., Familr ~esidence With Attached Garaael Build Single ~ o \.l ~ \l t::'//~o r/LL. ~p ..09,::",":7.--....... /<~ C/"/o ~ ; -- ~N ///Vn.cvEt:.nP~D ;Z?~~~~...rT' I (exoires) (ohane no.\ c:;5/? -:;:> <,/ r-=:: -0,:::: 5"::> . . Structura 1 Electrical Mechanical CONTRACTORS (name) (addrec;.<:;) _ _ (li(':~,. nQ. \ {p'J('lil""'~\ (I).~n~p" '1,11 )_ '"/) ~/71$ a"",SA'/"'-" ri<P'7~ .>'Y.5""S7':>/ General-;/A,,;; L.;N'-"" ~~<;7 :!" ~N.1i'~I6~~. .R'::> ~)(' ::;)::?~-~~~>y.c>:2_ ~..,..,....~ '5 Plumbina Electrical ~'echani ca 1 PLUI,IB I NG ELECTRICAL , MECHANICAL FEE CHARGE NO~ CE.L..cI!ARG.E Jlll.....1 Residence of furnace/burner to SQ. FT. BTU's I..EEL ..cI!ARG.E NO. Each single fixture Relocated building (new fix. additional) S.F. Residence (1 bath) Duplex (1 bath) each Additional bath New circuits alts. or extensions Floor fu rnace and vent SERVICES Recessed wall So~rp hp~tpr ~nrl vpnt I I riOU V10~ ., I I !Temporary Construction Appliance vent seoarate IChange in existing Stationary evap. res.i denr:p cooler Imultifamily, comm. or Vent fan wi th Tnrlustrial sinale duct 10f amps.1 I Vent system apart from I heating or A,C. I COMI,!. II ND. FEEDERS I I Mechanical exhaust hood and dUl".t. I Install/alter/relocate I I Wood stove/heater rli"trih. fpprlpr" IOf amps.1 I I I I ~I I OH I 1\ I ISSUANCE OF PFRlm ~later service Sewer Storm Sewer TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L\\~ REQUIRES that the Electrical work be done by an, Electrical Contractor, the electrical portion 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 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 Derformed 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 fW OCCUPAHCY 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 701.055 will be used on this project. t)~..:>~"....." SIGIJATURE Q' ad FO~ OFFICE USE-enLY Sq. Ftg. l1ain Sq. Ftg. Access Sq. Ftg. OtherJ5f~ rD; NAME(please print) j',- OATE 10 120/8~ Zone Tvpe/Const. Bedrooms Units Occy Load Occy Group x Value x Va 1 ue OA'? 'Tl< Value "=?9c~- ; TOTAL V ALUA TI ON Fi re Zone Flood Plain Stories BUILDING PERfllT Charges and Surcharges Plan Ck. Comm/lnd ____________~/Blda Per Fee Plan Ck. !fes .." 30%lBldo Per Fee Fence - l./~.- syste.ms Development Cha roe (1. 5~ " PLut~BING PERMIT Charges arid.....--4 Surcharges. DeRlo. ELECTRICAL PERIHT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges 'Sidewa lk "A/C Paving I Curb C";,t ' 'l., 5 ' 11'5"~<L.< t'~. F/L( ?3/S, =&> ITotal Comb, Permit I I TOTAL :? ~e;:,. .0-0.'4_. ..>~=. . . .. !~ -, -. COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I: I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100. Lane County Map Reference II UJ 43 2, example- Lot I. Block 3, 2nd Addition to Sprlngtield Estates C~ Name, etc.'of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinq/or forced air Qas 2. exa~le- waterheater/electrical/or solar E. Square footage or valuation, etc. - I. examole- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check-n€w - 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 Sect,ion'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 OIVISION 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. permit is issued. V. FOR OFFICE USE ONLY Permit Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt 'from regi~tration with the Builder's Board because: ~ " ~, Additional Project Information: PLANS REVIEWED BY: '.. . name LtPftilAE ?CC?t!P? signature ~~~~ ',r P' r date /O."2~-8'8 INFORlIATlON lIN< 726-3753 Sq. Ftg. 1,lain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep, -Fence Demo Change/Use Other- - Electrical Mechanical CONTRACTORS (name) {addrpc;.c;, l General1'A~ ~.A/~ ~A:/57: ~ h/ir ~4;S~7f Plumbino - fJtcs,. no.1 (,l'~\ ~hnnp 00.\_ -:1....a/7.1:5 ,-/"1 j .;. H/"'" /"l'P. "?",..>Y,,,,=> ;5>-S 7;>/ XP_hbX::::l::/'~:~l"!'"~>y.c>:L ~~ Electrical ~'echanical PLUIIBIrIG ELECTRICAL MECHANICAL NO. FEE CH~ -HQ. rrr rH~ NO_ 'OEL .cJlARlif. SQ _ FT. furnace/burner to BTU's Each single fixture Residence of Relocated building (new fix. additional) New circuits aIts. or extensions Floor furnace and vent S.F. Residence (l bathl Duplex (1 bath) each Additional bath SERVICES Recessed wall SOAr.P h~tPr ~nrl vpnt Storm Sewer Of amps. Appliance vent seoarate Statfonary evap. cooler Vent fan wi th sin91e du~t Vent system apart .from heatina or A.C. Mechanical exhaust hood itnd durt Wood stove/heater Sewer Temporary Construction Change in existing resj~ence multifamlly. corrm. or Industrial Water service CO~1./IND. FEEOERS Install/alter/relocate distrih. fppdpr~ Of amps. I I SSUANCF OF PFRllIT TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES WHERE STATE L,\I/ REQUIRES that the Electrical wcrk be done by an Electrical Contractor. the electrical portion of this permit shall not be val11 until the label has been signed by an Electrical Supervisor and returned to the Building 01vision 1 HAVE CAREFULLY EXAMINED the comnleted apn1ication 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 Ore~on pertaining to the wcrk 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 effec~ 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 ORS 701.055 will be used on this project. Zone Fire Zone Flood Plain hoe/Canst. Bedrooms Stories : ;' Units Occy Load Occy Group SIGIlATURE Q. ad FUr. OfFICE USE-efiLV Sq. Ftg. 11ain Sq. Ftg. Access Sq. Ftg. OtherJ<YL./ DATE /0 ;';o;8S llAf.IE(please print) J'._ ~~..:) ~""' x Va 1 ue ,x Value On,?"'" Value_-::rr.c~- TOTAL VALUATIOII BUILOING PER/liT Charges and Surcharges . Plan Ck. Conmllnd 65%/Blda ~pr ~pp Plan Ck. Res 30%/Bldo Per Fee Fence l/.n. - -Systems Development Charoe (1. 5~ ' PLUI1BING PERMIT Charges and.-"" Surcharges 0_ _ __________JSidewalk I A/C Paving __n_n____J Curb Cut Iff~<'-' t'~, F/L( Total Comb. Permit ELECTRICAL PERllIT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges ?3~, ""'&> TOTAL 3~.e:. .0-0..... ~C>. t i COMBINATION APPLICATION/PERMIT (CAP) /. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax lot 100, Lane County Map Reference II 03 43 2. exampJe- Lot 1. Block 3, 2nd Addition to ~prln9tield Estates C. Name. etc. of owner and construction lender D. Energy Sources , 1. example- heat/electrical ceilinQ/or forced air QB: 2. exam~le- waterheater/electrica(/or Solar E. Square footage or valuation. etc. 1. examp]e- /250 sq. foot house, 50D sq. foot garage 2. examp'le- if new project. check new - if addition. enecK add. etc. F. Building permit information: 1. examole - construct single family house with an a ttached garage 2. example - remodel existing garage into family roan 3. examJPle - 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 ANO 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 D. As noted on the CAP, the label must be delivered to thl 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 signa ture. 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: _ '-I. CITY OF SPRINGFIELD City Hall Sprlngftold, Oregon -,'. ',OffIce of Community,and;Economlc DeYelop~ent OFFICIAL RECEIPT " ~.':;t r [}',' 12629 " ',Date!/c7. -<'P. 199.8 '~ec'd From S r-~~......... 75 Cb~? :Address -:3 q~ ""&-rp"" '\Ne",=-, t./J(f. :-Received For: 1L.::z<'#~':::::>73"2/"/,uZ:>~7': ~ - 1. r . 'It-/hi,L/frV/Pw.> /":'~. , 'F/C.c ~n// T y~~ '3/8..0 - -- ~r;4-L "'3s~. dd>_ ~d"'# z 3'-=<(;; = Amount Received ?S & ... ~ .~ ll- ~_ ?.4~~: V ~"UTHORlZE~lURE~ ./ r .' '. _ SUSINESSFOIlMS.INC. tslDl:M2-I1U ,r lse;l Pennit Cl erk Pennit applicant exempt from registration with the Builder's Board because: Additional Project Infonnation: " PLANS REVIEWED BY: . , .,~ . name LtPfrJ#E ?LL?~ . signature ~~~~ -r/ . <.' . . date i /0-'20, ~