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Home My WebLink AboutPermit Building 1981-7-1 INSPECTION LINE 726-3769 Job Address "~~ d-O Legal Description . 'i'. ~, . INFORMATION LINE 726-3753 CITY OF SPRINGFIELD COMBINATION APPLlCAJlONJPERMIT l ENERGY SOURCES: I Sq. Ftg. Main Sq. fig. Accltll. Sq. fig. Othor _New_Add_Alrer_Rllp. ___Fence_Cema_C1'tange' Uso _Olher (_~;a.fl Heat Water Heater Ran_ge Value of Work: Address t:.'u> Y\ r-b. Orui...cXr))} \ L fSlo,L\ q ~l'hJ OJ ~R(t'Pho".Cj3~-2.~4 Owner Construction lender Addreu DESIGN TEAM (name) Primary Structural Electrical Mechanical CONTRACTORS (nom.) Phone Q. L UJ J -hi (){LNjJ), , (addr.ss) (phone no.) (lies. no.) (expires) (address) (lics. no.) (expir.s) (O)"an., no,) General 1fxn.r ffinb. Q A . ~ 0 D Plumbin~ Electrical Mechanical PLUMBING NO. ' Each single fixture Relocat.d building (new fix. additional) S.F. Resid.nc. (1 ba;h) Ouplu (1 bath) e-ach Additional both Water s.ryice Sewer Stor.m S.wer. ;(, I I I r I TOTAL CHARGES I ELECTRICAL MECHANICAL I cfJ, - o ..c.. ~ I I FEE . CHARGE ' FEE . CHARGE , CHARGE NO, WHERE STATE LAW REQUIRES that the Electrical work be done by the Elct'~cal Contractor, the electrical porlion of this permit .hall not b. walid until a label has been si9ned by an Electrical Contractor and a"ached to the electrical pan.l. NO, FEE I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon i. true and correct, and I furth.r 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 Stale of Oregan pertaining to the warle described herin, and that NO OCCUPANCY will bit made of any structure without the permission of tho BulldingOi...ision. I further atrtlfy that my registration with the Builder's Board is in full force and effect as required by oas 701.055, that if exempt the basis for exemption is noted heron, and that only subcontractors and employees who or. in compliance with ORS 701.0.55 will be used on this project. Basis for Builder's Board exemption- . NAME (pl.ase print) Zone Fire Zan. Flood Plain Type/ Canst Bedrooms clori.~ BUILDING PERMIT Charges and Surcharges ,1 PLUMBING PERMIT Charg.s and Surcharges "1\ ELECTRICAL PERMIT Charges and Surcharges h"V I MECHANICAL PERMIT Charg.s and Surcharges Residence of furnoce/burnor to llTU's Appliance ...enl separate Stationary eyap. coal.r Vent fan with single dud Vent system apart from . heating or A.C. Mechanical exhaust hood and duct .'tI:ft. New circuits. alterations or extension; SERVICES Temporary Construction Amps. Woad slo..../h.ater FEEDERS Heat Pump Air handler to 10.000 CFM Air handler o....r 10.000 CFM Amps. I i I I I TOTAL CHARGES ISSUANCE OF PERMIT TOTAL CHARGES C;IGNATURl: FOR OFFICE USE ONLY DATE I!nits "ccy load Occr Group Sq. Ftg. Main C;q. Ftg. Access Sq. Ftg. Other . . Valu. Value Value TOTAL VALUATION :16, cd plan CIe. CommJlnd , 65%/ Bldq Per Fee Plan (It. Res 30%1 BIdet Per Fee Systems De...elopment Charqe (1.5%) I~.ro , (rf) I () to ,L/{)I Fence Demo Talal Comb. Permit Sidewalle Alc Pa...ino Curb Cut 5 {"aU TOTAL ,- ,~ COMBINATION APPlICATlON/P.T (CAP) 'I. Applican!, ta furnish A. Jab Address B, Legal Description 1. example.tox lat 100, Lane County Map Reference 17 03 -43 2, example.Lpt 1. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D.. Energy Sources 1. example-heat/electrical ceiling/or forced air gas 2. example-woter heater/electrical/or solar E. Square footage or valuation, etc. 1. example-l 250 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 on ottached garage 2. ".example-remodel existing gurogt: 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 avoid design or construction delays, Building Division Stoff must be able to contact. appropriate persons regarding design.informotion or job site corrections, etc. . II. Abbreviated Plumbing, Mechanical & Electrical Sched~les A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicont need fill.in only the No. Boxes adjacent to the appropriate item(s) to be installed a, Full Plumbing, Mechonical, and Electrical Schedules ' nre 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. Appliccmt to sign and 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 octual permit is issued for his signa turf.. 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 VALIDATION '. .....,......_=~,~,..,..o-_~.~__ -,-.~_.,..,..,,_~_______,,-.____.___..~.._~____.__._..,...._.. Permit Clerk PROJECT CONDITIONS TO liE SATISFIED BEFORE OCCUPANCY: q t Additional Project Information: PLANS REVIEWED BY: nam~ ";gl1oturr'" -iatp INSPECTION LINE 726-.3769 . f "\; CITY Of SPRINGFIELD COMBINATION APPlICAflON/PERMIT . INFORMATION LINE 726-.3753 Job Addren Qf\clu.a~; fl p . Sq. Ftg. Main Sq. Ftg. Acr;llu. Sq. Fig. Oth.r _New_Add_Alter_Rep. ___Fence_Demo_Chonge/ Ule _O,h.r cfJ, "~~ '()O I ENERGY SOURCES: Heat I Water Heater Ranqe I Value af Work: Y-b OrwV' :1...IIL I Q - n or A li\ i/J dJ ii3':l.. 'J (1'l1"1 BUIlding PermIt Info: Oeltnbe Work (i.e.. Build Single DC'\1.1 0 A ~JU1.., Ph""....,,, r f-~ -\ 'TI Fa{(t()b'-:Q~J. 'ItQ~Q I ~ J '" ci L U) l...u rxu'ld.D , I - U. ' I - Owner fuV"\. ESl OIL\ Cj o -C- r)J ~~ legal Description Addre" Conltructian lender Addren Phone I DESIGN TEAM I Primary I Structural I Electrical I Mechanical I I General I Plumbina I Electrical I Mechanical I I NO.' I I I I I I I I I I I I I r- (nome) (address) (lies. no.) (expires) (phon" no.) CONTRACTORS ~KY4/.) mrib.: D.L o 0 ' (nome) (address) ~QD flies. no.) (exDir'es) (ahan,. no.) PLUM81NG I FEE i CHARGE i - ., ----I I I I ElECTRICAL MECHANICAL Residence of I I I I 'I NO, FEE I CHARGE NO, I I furnace/burnltr to IITU's 'I Appliance ....nt separate I Stationary evap. cooler Each lingle fixture RelocaTed building (new fix. additional) S.F. Residenr;e (I bolh) sQ:ft. New circuits. alterations or eXTensions SERVICES Additional balh Amps. Vent fan with sinqle duct Vent sYltem apart from . heatinq or A.C. Mechanical exhaust hood and duct DUDlu (1 bath) each Temporary ConstruCtion ., Water service Sewer Wood stove/heater Stor.m Sewer fEEDERS Heat Puma Air handler to 10.000 CFM Air handler over 10.000 CFM I I I I TOTAL CHARGES I I I I I I I TOTAL CHARGES ISSUANCE OF PERMIT I TOTAL CHARGES ',I- I Am\::JI. WHERE STATE lAW REQUIRES that the Electrical worle be done by the ElerYical Contractor, the .Iectrical portion of this permit shall not b. valid until a lab.1 has been signed by an Electrical Contractor and attached to the e'ectrical panel. I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon i. true and. correct, and I further 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 Stat. of Oregon pertaining to the work described herin, and that NO OCCUPANCY will b. mad. of any structure without the permission of the Building Division. I further certIfy that my re.gistration with ,he Builder'. Board is in full force and e-ff.ct as required by ORS 701.0.55, that if exempt the balis for exemption is noted heron, and that only subcontractors gnd employee. who are in compliance with ORS 701.0.5.5 will b. uMd on this project. Basi. for Builder's Boord exemption" NAME (please print) 1I:''-NATURli: "ATE ~ FOR OFFICE USE ONLY Zone Fire Ion. Flood Plain Type! Const. Bedroom. II:toril'-'- 'Jnits f"Iccy Load -.ccy Group c,. Ftg. Main <q. Ftg. Access Sq. ftg. Other "alue Volu. Volue TOTAL VALUATION x x BUilDING PERMIT Charges and Surchorgn f\' 6,' cd Plan Ck, Comm/lnd d 65~;'/ Blda Per Fee I Plan Ck. Res 30'%/ Bldq Per Fee I ~, ttJ F.n<< , (rf) D.mo I () ('(; Sld.walk ,Lf.() Alc Povina Systems Development Chorrte (1..5%1 PLUMBING PERMIT Charges and Surcharge, I Total. Comb. Permit elECTRICAL PERMIT Charge, and S...rcnargu MECHANICAL PERMIT Chorgu and Surcharges Curb C...t I I I I TOTAL 5/..oU I. Applica~ to furnish A, Job Address B. legal Description 1. exomole-tox lot 100, Lone County Mop Reference 17 03 43 2_ example-Lot 1. Block 3, 2nd Addition 10 Springfield Estotes C. Name, etC. of owner and construction lender O. Energy Sources 1. example-heat/electrical ceiling/or forced air gas 2. examole-water heater/electrical/or solar E. Square footage or valuation, etc. - 1. exomple-1250 sq, foot house, 500 sq, foot gOI' '-' 2. example-if new project, check new-if addition ~e( add, etc. F. Building permit information: 1. exam ole-construct single family house with or (0.. garoge 2. example-remodel existing gwrag& into family 1 3. example-convert single family residence into restaurant (change of use) G, Value oi work as defined in Section 303 (a) of Ihe Structural Specialty Code H, DESIGN TEAM AND CONTRACTORS ( To avoid design or construction delays, Building D Stoff must be able to contact appropriate persons design information or job site corrections, etc. --- COMBINA TlON APPLlCA TlON/P.IT \ (CAP) " II. Abbreviated Plumbing, Mechanical & Electrical Schedl A. Except where blank spaces occur in the description of the Mechanical and Electrical Schedules, the apF need fill-in only the No. Boxes adjacent to the app' item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedules _,__u Clre available at the' Building Division' , 1. To conserve space on the permit form the sched... have been abbreviated 2. If the item{s) to be. installed ore not covered on tl ated schedules you should consult the fuil sehedu C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES J CHARGES ON THE SCHEDULES III, "'pplicc,"t to sign and dale Whenever possible, the initial application will be used a worksheet only. Where possible, Building Division Staff prepare a typewritten eopy and return it to the appliean 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 0 and no plans will be processed until these fees are paid. other fees and charges are due and payable when the pi is issued. V, FOR OFFICE USE ONLY 1,'..\ . PERMIT VALIDATION CITY OF SPRINGFIELD " : ( City ,Hall Springfield, Oregon Department of Public Works OFFICIAL RECEIPT No. B 56 8 3 0 ( /7 _ / - 19 g / Dale ' I k ,~d ',om &~fj:,b(fa .. Address ?!~71, [j fH ~ (!),{J ,.f ;Pj (' ~'~.G=-'- - ~I c'~ '0' Received For: '! .-, ( ( ( ( e --rY\\-4- ~:.+:- -iLr ,;]C;..,SO ( ( \ 'S pt! ( \ {b', , '(IF ,toD I I , I ( , 0,00 ~ I ,LJ-O ( ( _ _,t:::._,_",',J,' ?v Amou~t Received --, . r A ,~rLLu ...UT-HOIltIZI:O SIGNATUIltI: ~"nTO"'TU"".UU. "",,,'''.5 . 'lUO"".' o. .T.O' I 515"" \. ( (to (J ~I PROJECT CONDITIONS TO liE SATISFIED BEFORE OCCUPAr..." (~ Additional Project Information: -, , I I' I ,I , I ~1 PLANS REVIEWED BY, nOm- ".ignatur- ~~.-< .- _..... 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