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Home My WebLink AboutPermit Building 1984-11-28COMBI NATI ON APPL ICATION/PERMIT 726-3 Legal Description Job Address l,later Heater EIIERGY SOURCES: Heat 0wner /tWY'.r-) Sq. Ftg. Access.--- Sq. Ftg. Other_ lewJddJlter_Rep. _Fe n c e_Demo_C han ge / U s e 0ther Sq. Ftc l'1a n Addres s Construction Lender ;8. t Farn iI dence trli A , ng e W $s p Address Phone name I ics . no.exDt res ohone no- ryimary h?fa*zU.+€ fl2.- Ar> . structura r t;;,48 - . 7-A.fu ;g -r/>a . bn*n - dB - ?#3la-?>ls -7r7 El ectri cal a Hechanical CONTRACTORS name exDt res ohone no. Genera I 7 Pl umbi nq g E l ectri ca l l'lechanical PLUIlB I NG ELECTR I CAL MECHAN ICAL FFF CHARGF NN FFF CHARGF NO FFF CHA PG F Each single fixture Residence of FTsQ furnace/burner to BTLI' S Relocated building (new fix. additional)a./New circuits alts. or extens'ions/ .?ttCz:fi h,Floor furnace and vent S. F. Residence ( I uattr )S ERV I CES Recessed wal I SDace heater and vent Duplex (l bath) each Additional bath Temporary Construction Apol iance vent sPna rate hlater service ge in existing dence C han res i Stationary evap. cool er Sewer T ndrrstri a l multifamily, com,n. or Vent fan with s inole duct Storm Sewer 0f s.Vent systern apart from heatino or A-C. COMH./IND. FEEDERS Mechanical exhaust hood and duct Instal I /al terlrel ocate di stri h. feeders l'Jood stove/heater amp s.0f ISSUANCF OF PFRI1IT TOTAL CHARGES TOTAL CHARGES /a.--TOTAL CHARGES HHERE STATE LAtl REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permitshall not be valil until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAIIINED the completed application for oermit, and do and all work performed shall be done in accordance with the Ordinances of the Dertaining to the work described herein, and that NC 0CCUPANCY will be s IGNAliAt'1E(p1ease print)Dara nWS''cl/t,re;1erTfT rEQb/e!Too Ci ty made di on hereb,y certify that all information hereon is trueand correct, and I further certify that anyof Soringfield and the Laws of the State of further certil"y that m.y registration vrith the Builder'sof any structure without the permi Board is in full force and effect ssion of t 0regon he Bui I Division. I as required by ORS ng 701 055, that if t the basis for exemption is noted hereon, and thatonly subcontractors and employees who are in comcliance with 0l1S 701 'll i s project F qfr u"v#F Ftg . l,la i 0c cy Load Sq. Ftg T,ype/Cons t Val ts Flood Plain Stories_ Occ.y Gro TOTAL VALUATIOII Fire Zo Bedrooms Acces s x Val ue Zone ./ Ftg.0ther x val ue- Pl an Ck . Cornm/ I nd 65%/B1dq Per Fee Svsterns Deve charqe (1.5c opmeltBUILDING PERI'IIT Charges and Surcharges Plan Ck. Res 30%/BIdq Per Fee FencePLUMBING PERMIT Charges and Surcharges Dgmo Sidewal kELECTRICAL PERIIIT Charges and Surcharges 3 --r/ Total Comb. PermitA/C Paving Curb CutI,IECHANICAL PERHIT Charges and Surc ha rges ,b?,tuTOTAL COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description1. example- Tax Lot 100, Lane County Map Reference 17 03 432. e1mp1e- Lot 1. Block 3,2nd Addition toSFiin-g-field EstatesC. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION E 1. 2. Squa 1. 2. example- heat/electrical ceilino/or forced air oas example- waterheater/electrical/or solar .re footage or valuation, etc. example- 1250 sq. foot house, 500 sq. foot garage example- if new project, check new - if addition, check add, etc. II F. Building permit information:1. example - construct singie family house with an attached garage 2. example - remodel exist'ing garage into fam.ily room3. example - convert single family residence into restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. 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 sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedu'les,the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be instal'ledB. Full Plumbing, Mechanical, and Electrical Schedules are avaiiable at the Building Divisioni. To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult thefull schedulesC. BUILDING DIVISION STAFF t.IILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be del.ivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical label. Applicant to sign and date l,lhenever possible, the initial appl icat.ion wi l I be used asa worksheet on1y. Where possible, Building D.ivision Staffwi'|1 prepare a type written copy and return it to theapplicant at the time the actual permit is.issued for his s i gna ture. Fees and Charges PIan check fees are due and payable at the time of theapplication, and no pians will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY III IV. V Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from registrat"ion with the Bu'ilder's Board because: Additional Project Information: PLANS REVIEWED BY: i gnaturename ate //->G,&l PECTION LINE -37 69 CITY OF SPRINGFIELD COHBI NATI ON APPL ICATION/PERMIT Job Address Legal Description EIIERGY SOURCES Hea l,later Heater Ran 9 n Sq.Fts Ftg . Access._ . OtherSq l,lew Add Al -FenEE Derno ter_Rep c hange/ Use -0ther W $s p 'WE'.,-)Owne r / tddress/l/fi /r/-;Lr*'. z,iw"n r-Quil(ino Permit Info: Describe l^lork(i.e., Build SingleFarnily llesidence liith Attached Garaqd) Constructi on Lender , Addres s Phone DESIGN TEAI,I name address exoi res ohone no. pr;^u"y V - .Z ,V.a ruDZ> Structura I ?e€!- El ectri ca l Hechani cal CONTRACTORS name address 'lics. no- )( pxn i rps nhonp no I (/ Pl umbi nq E l ectri ca I ttecha ni ca I PLUIIB I NG ELECTR I CAL MECHAN I CAL N0.FEE CHARGE NO FFF CHARGF NO FFF rHA PGF Each single fixture Residence of SQ FT furnace/burner to BTLI' 5 Relocated buildino (new fix. additional ) 'New circuits alts. o" ,*'Y)o)lcz,ca,h Floor furnace and vent S. F. Res'i dence(l bath)SERV I CES Recessed wal I SDace heatPr and vent Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent cFna ratF laiater servi ce Change in existing rps i dencc Stati onar.v evap. cool er Sewer muitifamily, comm. or Tndrrctrial Vent fan with si nol e drrct Storm Sewer 0f Vent systenn apart from heatinq or A.C. c0r'4r.1. / rND. FEEDERS Mechanical exhaust hnod and drrcl InstaI I /aI terlrel ocate dis,trih- feederc l'Jood stove/heater 0f amps. ISSUANCF OF PFRI1IT TOTAL CHARGES TOTAL CHARGES /a-n-TOTAL CHARGES WHERE STATE L1\W REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be vaii:l untii the Iabel has been signed by an Electricai Supervisor and returned to the Building Division I HAVE CAREFULLY EXAI1INED the completed application for oermit, and do hereb.v certify th at all information hereon is true ce with the 0rdinances of the City and that ll0 0CCUPAI'ICY wil l be made registration with the Builder's xemption is noted hereon, and that s project. and correct, and I further certi f_v that any and all work performed shall be done in accordanof Soringfield and the Laws of t he State of Ore qon Buil oertaining to the work described herein,of any structure without the permission of the Board is in full force and effect as required di ng 701 Division. I further certify that m.y by ORS 055, that if the basis for e only subcontractors and employees who are in comcliance with 0l?S 7n1.il on trAr.tE (pl ease plnilDou n W Sclz. tcti,'a e.4IlE s r6rn Zone Z U Const.Uni ts So . Ftq . l,la i Val ue Fire Zone Bedrooms 0ccy Load Sq. Ftg. Access Flood Plain Stories 0cc.y Group Sq. Ftg 4'r€-Va ToTAL VALUATI0N_ . 0ther BUILDING PERNIT Charges and Surcharges __=_E_*_Plan Ck. Corm/Ind 65'A/B1do Per Fee Svsterns Deve charqe (1.51 opmmt Plan Ck. Res 30%/Bldq Per Fee PLUI4BING PERMIT Charges and Surcha rges Fence Dgmo ELECTRICAL PERt,IIT Charges and Surcha rges --r/ 4 Sl dewa I k A/C Pavi ng Total Comb. Permit I4ECHANICAL PEP.MIT Charges and Su rc ha rqe s Curb Cut TOTAL %?,Jtz. =J2Vat4rya,7 /, CI ( rY oF SPRINGFIELD hea t/el cal cei I i or forced air wa ec ca so ar - Rec'd Address Received For: CltY Hall Sprlngficld, Oregon Dcperlmcnl ol Publlc Workr OFFICIAL RECEIPT No. B coMBrNATr0N AppLrCATIoN/pERMrT (CAp) I. Applicant to furnishA. Job AddressB. Legal Descriptionl. gglp-]g_- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot l. B'lock 3, Znd Addition toSpringfield Estatesq. Name, etc. of owner and construction IenderD. Energy Sources exampl e- exampl e- are foota 63905 19 (. ( (. ?eE. Squ ge or valuat on, 1. examp-le- 1?50 sq. foot house, 500 sq. foot garagrz. example- if new project, check-iEw _ it adaitioi.check add, etc.F. Building permit informat.ion:1. examp,le - construct single family house with anattached garage ?. examp]e - remodei existing garage .into family rooJ. exampte - convert single family residence into - restaurant (change of use)G. Value of work as defined in Section 303 (a) of the.. Structural Speciaity CodeH. DESIGN TEAM AND CON1RACTORS To avoid design or construction delays, BuildingDivision Staff must be able to contait appropriitepersons.regarding design information or job sitecorrections, etc. Abbreviated Plumbing, Mechanica), & Electrica.l SchedulesA. Lxcept where blank spaces occur in the descr.iptionportion of the Mechanical and Electrical Schedulei,the applicant need fill-in onty the No. Boxes iajui.nt_ to_the appropriate item(s) to te instal.ledB. Fut'l plumb.ing, Mechanicit, ana-ifeiirical Schedulesare available at the Bu.ilding Division1. To conserve space on the-permit form the scheduleshave been abbreviated2. ]f the item(s) to be installed are not covered onthe abbreviated schedules you shou.ld consu.lt theful I schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAp, the iabel must be de.livered to theelectrical contractor for signature by his e.lectricai - supervisor. The general contractor ii not authorizedto sign the electrical labelApplicant to sign and date Hhenever possible, the .initial application will be used asa.worksheet oniy. Hhere possible, Building Division Staiiwill.prepare a type wr.itten copy ind retur; it to theapplicant at the time the actuai permit is issued for his s i gna ture. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans wiil-be procesiea unt.il thesetees are paid. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY ( cta {, atDD II. III (2_ (r Amount Received Permit Clerk AUTHORIZED SIGNA ffitsf eusrruess FoaMs. lNc 1503112 8149 ) IV V PROJECT CONDITIONS TO BE SATISFiED BEFORE OCCUPAIICY: t applicant exempt from registration with the Builder's Board because:PeYmi Additional Project Information : PLANS REVIEWED BY: name i gnature ate ( ( ( ]