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Home My WebLink AboutPermit Building 1989-12-28 i . . \ INSPECTION LINE .\ .726-3769 '. Job Address 3825 International Court . CITY UF SPRINGfiELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat t~a ter Ilea ter Range Valu€ of Work: $5000 -, . INfUR1IATION LINE 726-3753 Sq, Ftq, I~ain ~q. Ft~, Access. .' Sq. Ftq, Other flew Add Alter Pep, -Fence Oemo Change/Use Other- - J Owner KMTR, Addrc>s B ~ 2 5 INC. International Ct. ..I', Ph 746160" Buil,,;nQ Penllit In~o: Descr;be I~orkl ;',e.. one ~ Famil V l1es idence Hith Attached Garaoe' Build Single ~ "tI '" \N "\J ~ Legal Description Construction Lender Install a 4.7 meter:satellite Earth stati~h. l1echanical CONTRACTORS {address' (lics'~no.' ~ ~-', :::'(1.\ 1,J"" ~~.t<, ~'Vt, ;'>ff.~,'~~, .!~: :\ li"~l ! 4H {lies. no:' (pxDirps\ t:I' '., (exnires) (chone no. j Address Ut~ lliN H.Ar~ {namel rhone I address 1 Primary Structura 1 Electrical {namel (ohane n('l.) Genera 1 Plumbino Electrical "lechanical PLUllB IrIG ELECTRICAL MECHAN I CAl NO, FfE CHARGE ~n '_FFF' CHAJ!liE. Nn. OFF nlAJ!liE. SQ. FT. furnace/burner to BTlI's Each single fixture Residence of Relocated building (new fix, additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each SERVICES Recessed wall Soacp hpatpr and vpnt amps, Appliance vent ~eD!I ra te Stationary evap. cooler Vent fan with sin~le duct Vent system apart from heatina or A.C. Mechanical exhaust hood and duct Sewer Temporary Construction Change in existing rpll i qr.nce mul t i fami 1y. COrml. or Tnrlllc:trial Additional bath Water service Storm Sewer Of CO~1,/IND, FEEDERS Install/alter/relocate d~c:trih. fppdprc;. Wood stove/heater Of amps. TOTAL CHARGES TOTAL CHARGES WHERE STATE L"~ REQUIRES that the Electrical work be done by an, shall not be valiJ until the label has been signed by an Electrical ISSUANCF nF PFRIIIT I TOTAL CHARGES Electrical Contractor. the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFULLY EXN1INED 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 110 OCCUPAIICY 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 ~' [us~~oject. I~AI'IE(pIease print) .(,<............"-'l:. ~O'--;,.E-'l'i SIGIlATURF. -<. ' ~~ / DATE 1",\ 1..'O(~~ Fon OFFICE USE miL Y '(" S!1. Ftg. fiain x Sq. Ftt]. Access x Sq. Ftg, Other x Fire Zone Flood Plain Type/Canst. Bedrooms Stories Units Dccy Load Occy Group Value Value Value Zone TOTAL VALUATION BUILDING PWlIT Charges and Surcharges , Plan Ck, Conm/lnd ___~:;cq___ ~/Rldo ~.r F.. Plan Ck. Res "2. S'3 30%/Bl do Per Fee ~,"2 9'5 Isyste~s Development CharQe (l,5~1 ' I ' PlU'1BING PERMIT Charges and Surcharges Fence 0_ ElECTR I CAl PERI~IT Charges and Surcharges _. f1ECHANICAl PERMIT Charges and 'SurcharQes Sidewalk A/C Paving .Curb Cut , . Total Comb. rermit ~5..::::>"3 TOTAL &5.86 . . 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 II 03 43 2, example- Lot 1. Block 3. 2nd Addition to sprfngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examele- heat/electrical ceilinq/or forced air qas 2. examyle- waterheater/electrical/or solar 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. example - construct Single family house with an attached garage 2. example. 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 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 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 Clerk . l PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWEO BY: na'me k?rMF k:.-r~~ Si9natur~~~ date /?. '22 -------- -= /. \ , " -' INSPECTION LINE 726-37(09 ~ CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT EIIERGY SOURCES: Heat l~ater Ileater . INFOR/IATlON LINt 726-3753 Sq, Ftg. Haln ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Pep. -Fence Demo Change/Use Other- - ~ ~ '" ~ "-l' I"R Job Address 3825 International Court Legal Oescription Owner KMTR, Address 8825 INC. International Ran~e Valu' of Hark: $5000 BUlhiinQ Pennit Info: Oeser.be Work( Le. I Build Single Phone 746160) Famll" nesidence IHth Attached Garanel Ct. Install a 4.7 meter.satellite Construction lender , " Earth station. Address DESIGN TEN1 (name) Phone {address \ l?;" tiechanical CONTRACTORS (address \ (lics'~ no.l L., ~t~\ ~'6 ) .{;~~~. t .~ 1t?;. :i l./"(, ~ .\ '!h (lice;,. no."' (p\(l)irpc:.\ (@xnires1 (nhone no. I Primary Structural Electrical (name} (flhn"p nn \ Genera 1 Plumbinll Electrical ~lechanical PLUllBI riG .' ELECTRICAL MECHANICAL NO, ' FEE CHARr.E JI{l Hf' ru~ NO. ':EL .cJJARGf.. 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 II bathl Duplex (1 bath) each Additional bath SERVICES Recessed wall Soace heater and vpnt Storm Sewer Of amps. Appliance vent I ~~oar:o'l.t,p Stationary evap. coolp.r Vent fan wi th ~tnolf~ duct Vent system apart from heatinq or A.~. Mechanical exhaust hood itnd duct Sewer Temporary Construction Change in existing re'ijl'jrpce multifamily, comm. or lncil..::.triitl PIa ter servi ce CO~1./IND, FEEDERS Install/alter/relocate d;~trih. fppd~r~ Wood stove/heater Of amps. ) TOTAL CHARGES TOTAL CHIIRGES WIIEnE STATE L,\\/ REQUIRES that the Electrical work be done by an shall not be valiJ until the label has been signed by an Electrical ISSUANCr. OF PFRrHT TOTAL CHARGES Electrical Contractor, the electrical portion of this pe~it Supervisor and returned to the Building Division I HAVE CAREFULLY EXMilNEO 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 Orel)on pertaining to the work described herein, and that UO OCCUPAnCY 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 ~l r- ~~~~~t. IWIE(pleas. print) .(,'-....."""- (:, ~OL-;>,.E.IL'I SIC,IlATURE -<. L ' , / DATE \\.\ 'L'b(f,~ FOP. OffiCE USE miL Y .... "- s~, Ft~, llain x Sq. Ft~. Access x Sq, Ftg. Other x Zone Fire Zone Flood Plain Type/Const, Bedrooms Units Occy Load Dcc.y Group Value Value Value TOTAL VALUATION ,/ 'I Stories PLU'IBING PERMIT Charges and Surcharges Plan Ck. Conm/lnd ___~~<:?___~/BldO P!'r F.. Plan Ck, Res ::2. S'3 30%lBldn Per Fee Fence ";>:293 Systems Developn~nt Charqe (1. 5~ ' BUILDING PERflIT Charges and Surcharges D~mo ELECTR I CAL PERfm Cha rges and Surcharges IIECIIANICAL PERMIT Cha rges and Surcharnes Sidewalk A/C Paving Total Comb, Permit "'5""3'.0'"3' Curb Cut TOTAL &5.86 . COMBINATION APPLICATION/PERMIT (CAP) , ./ 1. Applicant to furnish A, Job Address B. Legal Oescription 1. example~ Tax lot 100. lane County Map Reference II oj 43 ' 2, exam~le- Lot 1. Block 3, 2nd, Addition to sprlngtield Estates ' C. Name. etc.' of owne~ and construction lender O. Energy Sources. . 1. examele- h~at/electrical ceilinq/or forced air Q3 2. exa~le- waterheatertelectrlcal/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, check add, etc. F. Building pennit informatio'~: 1. examele - construct single family house with an attached garage .. . 2. examele - remodel existing garage into family roo 3. example - convert single family residence into restaurant (change of use) G. Value of work as defined in Section 303 (aJ of the Structural Specialty Code H. OEsIGN TEAll 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 adjacen 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 permi t form the schedule 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 DUT ALL FEES AND CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must be delivered to tl 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, " 111. V. FOR OFFICE USE ONLY c _TV OF SPRINGFIELD City Hall Springfield. Oregon Development Services OFFICIAL RECEIPT I ,~ J 15657 Oate ?~ -:::Z"'l 19 E5"7 Rec'dFrom ~~~ /~ Address ;z::?~......~X ~~,cCftC.~.:-; 1 / ~eceived FOr:~73~ fl7~'/~ -"'"747. ll.#-Hc-~",.:; ~ 'pP- ~ ,7~~ 7'"<.83 ~o_..:>c> -Z -, '5"3- 5f>5:'l5b' Ck#/f/S6~ .!!:!:.... 1~1- C~/n.~t:F )9"av-fl#~ .B 6. en=> 4~~~ if"AUTHORlZED SlG~"TURE '" Amount Received Ie- ...' Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: I I :'\Pe~mit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: . '~;a'me: ~1'rh€ k~--:T'';:;-~ Signatur~,"J 1~~ 'or . /' . date /?- '2~ 13 --:;.,