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Home My WebLink AboutPermit Building 1984-08-07I IiSPEC 726-37 . CTTYTF SPRTNGFTELi- COHBI IIATION APPL I CATION/PERI.IIT 7?6-3 Job Address Legal Description oq\o\ Ranqe l,Jater Heater EIIERGY SOURCES Hea t Owner Cer."H-SdB- Sq. Ftg. Access._ Sq. Ftg. 0ther -llewJdd-AlG;-l[ep. - _Fence_Demo Change/Use 0ther nSq. Ftq Addres \)S,\ Phonu,r,(rq\\\BuiIr.inq Permit Info: Desaribe l^lorkIFamily llesidence l,lith Attached Garaoe :e., Build Single E t rc^.exrc Oae Q\ucrr.I I Addre s s Phone L "0tcu LrI qtl name address exDt res ohone no. q Mechan i ca I El ectr i ca I Structura I Pri PI El ectri cal ? ftechanicat \J \ PLUI4B I NG ELECTRI CAL MECHAN ICAL FEE CHARGF NO FFF CHAAGF NO FFF CHARGF Each single fixture Residence of SQ. FT furnace/burner to BTU' s Relocated buildinq (new fix. additioial)New circuits alts.or extensions Floor furnace and vent S. F. Residence(l bath)SERVICES Recessed wal I Soace heater and vent Duplex (I bath) each Additional bath Temporary Constructi on Apol iance vent seDa ra te l.later servi ce Change in existing resi dence Stationary evap. coo l er Sewer multifamily, comm Industrial 0r Vent fan with sinqle duct Storm Sewer 0f amps.apart from ,. c. Vent system heatinq or A COMI.1./IND. FEEDERS Mechan'icai exhaust hood and duct Instal I /ai ter/rel ocatedist-rih- feeders l/ood stove/heater 0f ISSUANCE OF PFRtlIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAt,l REQUIRES that the Electrical work be done byshall not be vali,J until the label has been signed by an Electri an Electrica'l Contractor, the electrical portion of this pernit ca1 Supervisor and returned to the Building Division llAl'lE(please print)IGNATURE DATE any of Ci ty made L EXAM EDN the e tica foon r t andc0mpDerm l here certi ttha ab.y onti reonhe s ruetfy nda rrectco and rfue cert hatrth t ap !') and a oerfowork shrmed afy be nedo n cca wlordance th t Ordihe ncena ofs theofpr'ls fi e anddng Lthe oaws Stathe te rta n to kDCtherwo desc r herebed n0relron andg th at NC PAr.rcOCCU wl betSructaofnyuretwluthothesrmlsonpeofhetBudiv1DisonfucertrtherathtsttraonthVJIButhe sfyreqderBoardsfuforcendefafects ng 701 0 55 tha fredORS ba fS o+erequby t 0n noteds reonhe thaand tonsu bcontr ac to rs and awho re n aempoyeesc0mc nce thwl 70Rs 0 055 sedu on s toroj ec fzD Flood Plain- Stories \ 0ccy Group Sq. FtS TOTAL VALUAT x Other \t\ Va 'I ueBedrooms - 0ccy Load Sq. Ftg. Acce zo nC\\.R__rvp./ con' N:\}_u ni ts Fire Zo VaI FtQ. l,lain i, x Val Plan Ck. Corm,/Ind 65%/81do Per Fee \t- ($p trs\Svsteris Deve charqe (1.52 opmeot 4r.6()BUILDING PERI'IIT Charges and Surcha rges .q(2 @ PIan Ck. Res 30%/81do Per Fee I FencePLUiIBING PERMIT Charges and Surc ha rges Dgmo Sidewai kELECTRICP,L PERI1IT Charges and 5u rcha rges Total Comb. PermitA/C Paving Curb CutCharge Surc ha IIECHANICAL PERMIT s and rqes TOTAL rlil (16I I'- Construction Lender nr COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, ?nd Addition to SE'FTn-ETield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION 1. examp l e-?, exampl e- Square foota air gas E l. example- 1250 sq. foot house, 500 sq. foot garage ?. 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 room3. example - convert singie family residence into iEs-taurant (change of use)G. Value of work as defined in Section 303 (a) of the Structural 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 site corrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occulin the descriptionportion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Division1. To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be installed are. not qovered on the abbreviated schedules you should consult thefull schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical label. Applicant to sign and date Hhenever possible, the initial application will be used as a worksheet oniy. Where possible, Building Division Staffwill prepare a type written copy and return it to the applicant at the time the actual permit is issued for his s i g nature. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans will be processed until these fees are paid. Ail other fees and charges are due and payable when the permit is issued. FOR OFFICE USE ONLY j L't \ h-$6 & II III IV V Permit Clerk Permit applicant exempt from registration with the Builder's Board because: Additional Project Information :FE s.*rr \su € LEcrB\c(\\-\) oPK\\\ NSSr-(\c)rs \\Yr \\S\€.S \ur OQC\\L\CrI- ?E({\fr\ I PLANS REVIEWED BY: n Si gnature date \-ttt\ \ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Addre sr ol Description ro Fo Ro Work: Qoooo rng Phone Fence- Demo-Chonge/ Use Address & ched Go Sq. Ftg. Access. Sq. Ft9. Moin INSPECTION IINE 72fF3769 INFORMATION TINE 72837s3 -Other ........=-........=----- Sq. Ftg. CITY OF SPRINGTIETD COMBINATION APPITCAIIONi PERMIT ENERGY SOURCES: Heol - With Permit lnfo: Describe Work (i.e., Build Single Consfruction lender // /l ,4-tr "0(-cr w-s /VftAddress Phone (nome)(odd ress)(lics. no.)(expire s)(phone no.)DESIGN TEAM primory fa(D 6ett Zrzr///rAtfuLdl DenzrttrunT /6809 lfacfBon; /Ot/€. /aur^.e'.Otrf O4)?9'-65AQ !'rr uciurcl iiectri rol /viechonical !3!134ci iis-:ei-q]--- f !unL (oddresri (iics. no.)iexpires)!r:_ PiilM5iNG EI-[CTRICAt MECH/.NICAt NC FEF f,!a :FEi CHAF{:.I. iixture --BTLI'S {urnoce/burner lo A,pplionce vent Stolionary evop. cooler Vent fsn w'!th duc* FEE CHARGE HC"CHARGE Iiesidence oi aL r5;\\a? SERVTCES Nev circuits, olterotions or exlensions Temporcry Conslruction Amps. Reloqoted building {new {ix. odditionol) S.F. Residence --LL!g:!f- - Duplex (l bolh) eoch Additionol both Yent Jyslem oport from hecting or A.C. ilechonicol exhoust hcod ond ductWoier service Wood stovel/heoterSewer FEEDERSStorm Sewer Ampr. Heot Purnp Air hondler lo 10,000 cFM Air hondler over 't0,000 cFM Nrrs \L\FP\\oL) \Dco( \111-Qq2p15\ a \o.oD ISSUANCE OF PER,I$.IT TOTAI. CHARGESTO]AL CHARGES \\N WHERE STAIE tAW REQ|IIRES rhor rhe Electrical work be tione by the Elactriccl eonlrdctor, the electricul portion of this permit, shal! not bo vq{id unlil c label hos been :igned by on Eleclriso! Conttq€tar ond ottoched to the aleelricol poael. TOTAT CHARGES oo\ I HAVE CAREFULLY EXAMINED the comple?ed opplicction for permit, ond do trereby certify thot ol! informstion hereon is lrue ond correct, ond I further ceriify ihot ony ond oll work performed sholl be done in ocordonce with the Ordinorrces of the City of Springfield ond the Lows of the Sfote of Oregon pertoining to the work described herin, cnd thqt NO OCCUP,AN,CY will be mode of ony struclure without lhe permission of. lhe Building Division. I further ertlfy thot my reglsfrcrion with the Builder's Boqrd is in full force ond effect os required by ORS 701.055, thot if exempt the bo:is for exemption is note'f heron, ond thot only subcontroctors ond employees who ore in omplione wifh ORS 701.055 will be used on lhis proiect. Bosis for Builder,s Boord exemprio n.,l/rr 4eo,tnaT Faa 4atu*tc77c4r< qdea( Aofl'/'cfrE SIGNATURE q D^TE 2 -/ l'NAlv{E (pleqse print) FOR OFFICE UsE Plon Ck. Comm/lndBUII.DING PERMIT __iz3 oooo % -So. Ftg. A,ccess Flood PIoin Yolue Sysiems Development Zone Group-Sq. Ftg. Other Per Plqn €k. Res Per Const. Chorges ond Surcho rges x -Yolue x ---VqlueTOT/.[ YAtUATiOi.{ . nils -.=-Sq. Ftg. Moin Fire Zone - Bedrooms -_ occy Lood Totol Comb. Permit PTUMBING PERMIT N Demo Chorges ond Surchorges __\ag_C& Sidewolk PERMIT Chorges ond Surchorges TOTAT \3\ 2< MECHANICAL PERMIT Chorges ond S urcho rg e r Curb Cut co r\o_-\ J /v/aftau(/E Woler Heoler --.--_- owner rtlgZzv l-tsruarr ,(.4. Fanca A/C Povino coMBINATTON AppLtcATtON/pERA._ _.p) l. Applicont tg furnish A. Job Address B. Legol DescriptionI. exomple-lox lot.1 00, Lone County Mop Reference I7 03 432. exomple-Lot l. Block 3,2nd Addition ro Springfield Estores C. Nome, etc. of owner ond construction lender D. Energy Sources 1. exomple-heot/'electricol ceiling i 6l. forced oir gos2. exo m p le-wo terTeoteilelEctri co l . o r- solE?-- E. Squore footoge or voluotion, etc.I. exo e-l 250 sq. foot house,500 sq. foot goroge nE-w-if odd ition, check2. eE new project,check o , elc. F. Building permit informoiion: I. exomple-conslruct single fomily house with on otloched goroge 2. exompie-remodel existing goroge into fomitv room 3. Jiarnp=Ie-convert single fomily residence inio reiicuront (chcnge of use) G. Vqlue of work os defined in Section 303 {o) of the Strucrurol Speciolty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction deloys, Building Division Stoff must be oble to contocf oppropriote persons regording design informoiion or iob site correetions, etc. ll. ,A,bbrevioted Plumbing, Mechonicol & Electricol S.:l';edules A. Except where blonk spoces occur in the description poriion of the Mechonicol ond Electricol Schedules, the opplicont need fill-in only the No. Boxes odiocent to the oppropriote item(s) to be instolled B. Full Plumbing, Mechonicol, ond Electri*al Schedules ore ovoiloble ot the Building Divisior, 'I . To ionserve spoce on the permit fornr the schedules hove been obbreviored 2. lf the item(s) ro be instolled ore not cove'red on the obbrevi-' oted schedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL TILL OUT ALL FEES AND CHARGES ON THE SCHEDULES lll. Applicont to sign ond dqte Whenever possible, the initiol opplicotion will be used os o worksheet only. Where possible, Suilding Division StCIff will prepore o typewritten copy ond relurn i? to the oppliconl ot the time the octuol permit is issued for his signoture, lV. Fees ond Chorges Plon check fees ore due ond poyoble ot the time of the opplicction, ond no plons will be processed until lhese fees ore poid. All other fees ond chorges ore due ond poyoble when the permif is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Cm.qf,-\\"u\t\\ g tI)c-GN \crx-\ O\ T\DgAdditionol Proiect lnformotion: EIC(r,rrCat\ \s\\tTQ- Lr-) r SQLu-\c^L \6r f\ T r D e HNvs,rrs.ru r 2 c-- a-1i.1 t T PLANS REVIEWED BY signoturenom dote :MIT VALIDATION + ('7 a'{'uq prL 4'/' Permit Clerk \*\r,-* 726- ECTION LINE 37 69 COMBI TI APPL I CATI ERI.t I T . 7?6 Job Address SO EIIERGY SOURCES Hea l.later Heater Fto. l.lain_ Sq. Ftg. Access._ Sq. Fto. 0ther_ _l{ew_Add A'lter_Rep. _Fence_Demo Change/Use 0ther o\ lo Ys+ Oe l-ega1 Description Owner Value of l,lork Address Phone Buildin Farni ly q Pernrit Info: Describe l,lork( Residence l,lith Attached Garaqe 'e.; Build Single Construction Lender Addre s s Phone DES I GN TEAI4 name address I CS. nO exot res ohone no. Pri mary Structura I EI ectri cal Hechan i ca l ACTORS n ame addres s I i cs. no.exDt res ohone no. Genera I Pl umbi nq '/ (,e (-6 2y'7a&/EI I I o PLUI,{B I NG ELECTRICAL MECHAN I CAL FEE CHARGE NO-FFF CHAPGF NO FFF CHARGF Each single fixture Residence of SQ FT furnace/burner to BTU' S Relocated building (new fix. additional ) New ci rcui ts al ts or extensions Floor furnace and vent S. F. Residence(l bath)SERV I CES Recessed wal I Soace heater and vent Duplex (1 bath) each Additional bath Temporary Constructi on Apol iance vent seoa ra t-e talater servi ce C han res i ge in existing dence Stati onar,v evap cool er Sewer multifamily, comm. or I ndus t-ri a l Vent fan with sinole duct Storm Sewer 0f amps.Vent systern apart from heatinq or A.C. cOr.il'1./IND. FEEDERS Mechanical exhaust hood and duct Instal I /al ter/rel ocate distrib- feeders l'lood stove/heater 0f amps .? o'e ./ro4a /tl,u) -st)1J /J-o4 ISSUANCE OF PFRIIIT TOTAL CHARGES TOTAL CHARGES o*Y TOTAL CHARGES WHERE STATE LAl,l REQUIRES that tlre Electrical work be done by an Electrical Contractor, the electr shall not be vali:l until the label has been signed by an Electrical Supervisor and returned to the Bu ical portion of this permit ilding Division completed apnlication for oermit, a hereb.v certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the 0rdinances of the City of Springfield and the Laws of the State of Oreqon oertaining to the work described herein, and that NC OCCUPAI{CY will be made of any siructure without the permission of the Building Division. I further certify that m.y registration v,ith the Builder's Board is in full force and effect as recluired by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees r.rho are in comoliance with 0l?S 701.055 wilI be used on this Droject. IlAl.lE(please print)E S IGiJATURE TE o\ Zone Const.its Ftg Ftg Ftg . l'lain . Acce X Val ue Fire Zone Bedrooms Load lq x Val ue Flood Plain S 0c c.y Group Sq.x Val Ip ToTAL VALUATI0N_ tori es . 0ther BUILDING PERI'IIT Charges and Surcharges Plan Ck. Corm/Ind 55%/Bldo Pcr Fee teris ve 5'/" opment 1 PIan Ck. Res 30%/81dq Per Fee PLUI4BING PERHIT Charges and Surcha rges Fence Demo ELECTRICAL PERI1IT Charges and S u.rcharges 1s od 6o Sidewal k A/C Paving Curb Cut Total Cornb. Permit 14ECHANICAL PERMIT Charges and Surc harges $oToTAL /J-,/s 6: COMBINATION APPLICATION/PERMIT ( CAP) Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot 1. Block 3, Znd Addition to Springfield Estates C. Name, etc. of owner and construction lenderD. Energy Sources 1. exampl e-2. exampl e- E. Square footag hea t/cal ceiIin or forced air gas wa e or solar e or valuation, e 1. example- 1250 sq. foot house, 500 sq. foot garage ?. 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 room3. example - convert single family residence into restaurant (change of use)G. Value of work as defined in Section 303 (a) of the Structural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Bui!din9 Division Staff must be able to contact appropriate persons regarding design information or job site corrections, etc.II. Abbreviated Piumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedules are avai lable at the Building Division1, To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult thefull schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractor for signature by his electrical supervisor. The general contractoris not authorizedto sign the electrical label.III. Applicant to sign and date lrlhenever possibie, the initial application will be, used as a worksheet on1y. l,lhere possibie, Building Division Staffwill prepare a type written copy and return it to the applicant at the time the actuai permit'is issued for his s i gna ture.IV. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans wi1 I be processed untiI 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 N* bzqbZ t1",/*,/ Perm'it Cl erk oA/ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from registration with the Builder's Board because Additional Project Information PLANS REVIEWED BY: name S1 g nature date I iISPECT I OI,I L iNE 726-37 69 COHB I CAT I ON RJ{IT 726-3753 Job Address Legal Description \\ct5zs 3q oq\o\ EIIERGY SOURCES: Hea t l,later Heater Ranqe ou'n'" \\c-\cN \:rlgtrne\)a. co. Val ue of l.lork:?.SCY)- Sq. Ft9. I'lain_ Sq. Ftg. Access._ Use Sq. Fta. 0ther Address2-raaa Ct\\c!^otr\\)E\ Phons{s*c<r\\\tI Descri be Fami I n k .e., Build Single Eug.gr.:e OQc- Q\um I , Construction Lender rl Addre s s Phone ) "0tcI 0)I IJL5IGN It.AI.l name addres s 'I ics. no.exo t rFs ohone no. _9r,x-e\)E. Oa€ Q\qorPri ma q structural \p.1.f.fe \\. \a.lfr Sr \-fq-F-(tcb\ \rr- t3ri EI ectri ca l l'lechani ca l name address 'I ics- nn exD l res (ohonp no- 2SCnesrno\)'tr\\\r$t e \)c\F.\\F. L\t5qql\Gen I Plumbinq \l.N? Itectranical \l N. PLUIlB I NG ELECTR I CAL HECHAN I CAL N0.FFF NHARGF NO FFF rHAPN F NO FFF CHA RCF Each single fixture Residence of SQ. FT furnace/burner to BTU, s Relocated buildinq (new fix. additioial)New circuits alts or extensions Floor furnace and vent S, F. Residence(l bath)SERV I CES Recessed wal i Soacp hcatpr and vpnf Duplex (I uath) each Additional bath Temporary Constructi on Apol iance vent sepa rate l.later service Change in existing res i dence Stationary evap coo I er Sewer multifamily, comm Industrial or Vent fan with sinole duct Storm Sewer 0f amps.Vent system apart from heatino or A.C. COMI'I./IND. FEEDERS Mechanical exhaust hood and duct Insta l I /a1 ter/rel ocate di qfri h fppdprs l'lood stove/heater 0f s. ISSUANCE OF PFRI{IT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L,1tl REQUIRES that the Electrical woshall not be vaiiC until the label has been signed rk be by an done by an Electrical Contractor, the electrical portion of this pernit Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed apolication for oermit, and do herecomect, and I further certify that any and all work oerformed shall be Ci ty madeof of Boa b.y certify that all information hereon is true and done in accordance with the Ordinances of theSoringfield and the Laws of the State of 0reoon oerta.inin g t0 the work described herein, and that NC 0CCUPAI,|CY wilI be reqistration vlith the Builder'sssion of the Building Divi sion. I further certify thatany structure without the permi rd is in full force and effect as required by ORS 701.055, that if basi s ion is noted hereon, and thatonly subcontractors and employees who are in comoliance with 0l?S 701.055 used on h i s oroject fzDl{AllE(please print)S IGNA' zonC\\.L -ryoe/cors$)_units - so. Fts. r,tai Fire Zone - Bedrooms 1 Occy Load So. Ftn Flood Plain- Stories \ Occy Group Sq V TOTAL Access x Va'l Ftg . 0ther lue Val ue Plan Ck. Conm,iInd 657"/8lrlo Ppr Fpp \t- (Hn.rrru\svsteris Deve Charqe (1.51 opment 4I.50BUILDING PERI.IIT Charges and Surcharges co qb PIan Ck. Res 30%/Bldq Per Fee , FencePLUHBING PERHIT Charges and Surcha rges Dgmo Sldewa l kELECTRICAL PERIIIT Charges and ! l rcha rges A/C Pavi ng Tota l Cor,nb. Permi t Curb Cut rlil (16I l'- IlECHAN I CAL PEP.HIT Charges and Surc ha rges TOTAL \CTORS El ectri ca I COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot l. Block 3, 2nd Addition to SETin'sTielO EstatesC. l{ame, etc. of owner and construction lender0. Energy Sources1. example- heat,/electrical ceilino/oZ. example- waterheater/ejectrical/or Square fbotage or valuation,-etc. -l. example- 1250 sq. foot house, 5002. Exaffile- JT-i'ew project, check-new check add, etc.F. Building permit information:1. example - construct single family house with anattached garage ?. example - remodei existing garage into fami ly room3. example - convert single family residence inlorestaurant (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, BuildingDivision Staff must be able to contact appropr.iitepersons regarding design.information or job sitecoffecti ons , etc . Abbreviated Plumbing, Mechanical, & Electrica't SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fiil-in only the No. Boxes adjaientt0 the appropriate item(s) to be installedB. Fu'll Plumbing, Mechanical, and Electrical Schedulesare availab'le at the Building Div.ision1. 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 shouid consult theful l schedulesC. BUILDING DIVISION STAFF l.lILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES0. As noted on the CAP, the label must be de'livered to theelectrical contractor for signature by his electricaisupervisor. The general contractor is not authorizedto sign the eiectrical labei.Applicant to sign and date lJhenever possible, the initial application will be used asa-worksheet only. Where possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual perm.it is issued for hissignature. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans wil) be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY II. III. IV V r forced air qas solar sq. foot garage - if addition, E PERMIT VALIDATION Permit Clerk \4 *(, + A6 Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REViEWED BY: oate\-3\-BqS1gnature PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: INSPECIION TINE 7263769 CIIY OF 9PRINGFIETD COA{BINAIION APPTICAITON / PENA{IT INFORMAIION TINE 7263753 Addre:r Descripfion Owner ENERGY SOURCES: Heot --.................'==-_EASq. ftg. ,Accesr Sq. Ftg. O -Alter-Rep.- -New Woter Heoler 5q. ftg. Moin -Fence-Demo- Chonge/ Use _nrLa,& Vol ooooo Addre ss Phone Gqro Building Permit lnfo: Describe Work (i.e., Build Single dtr /</<Yrtr& Addre rr Phone .0sot\.\$.-s (nome)(odd res:)(phone no.)DESIGN TEAM (lics. no.) f3ettPrim 1 i-'.!!rsl Liectri;cl l-qechonical coi.rTRAcI.f Is L I F It_ no m Fi)(otid nc.)(expires)(plr:r^ r c.)I I "F!-_L ,\/,4 'r!e:'ri:,:! I IL-- I I ! i L, 7 retircnicol ? Pi.U/Y'IJING EI.::CTRICAt MECHANiCAL FEF CHARGE NG.FE Re:irience o'I fr Reloroted buiiding (new {ix. ociditionol) S.F. Residence (l both) bolh) eoch Additicnol both I I FEE CHARGE hro. Eosh sinqle fixlure furnoce/burner to --BTU'S cr)\ i--Applionce veni sepc rqle Nerv circuits, olteiotions Or ex?cnStOnS SERVICES Stotionory evop. cooler Vent fqn w'ith sinqle ductTemporory Conslruction Amps Yent syslenr oport from heoting or A.C. Woler service Mechonicoi exhousl hcod ond ducf Sewer Wood stove / heoter Storm Sewer FEEDERS Amps. Heqt Pum Air hondler to I CF,!{ Air hondler over I 0,000 cFA RFrrr Nr\F.9tss\ott) I \lrrr-r tur.\r\\Dco TOTAL CHARGES \o.oD ISSUANCE OF PERrrtlT TOTAT CHARGESTOTAL CHARGES I HAVE CAREFUttY EXAMINED the completed opplicotion for permit, ond do hereby certify thot ol! informotion hereon is lrue ond correct, ond I further certify thot ony ond oll work performed sholl be done in ocordonce with the Ordinonces of the City of Springfield ond the Lows of the Stote oi Oregon pertoining lo the work described herin, cnd thor NO OCCUPAN,CY will be mode of ony slructure without the permission of the Building Division. lfurther ertlfy thot my registration with the Builder's Boord is in full fore ond effeci os required by ORS 701.055, lhoi if exempt the bosis for.exempiion is nobd heron, ond thot only subcontroctors ond empioyees who ore in omplione w ith ORS 70I Flood Ploin-E- Stories I Occy Group-Sq. Frg. Other -./l-NA,lvlE (pleose print)DATE Systems Development q" J ?{;. Bosis for Builder's Boord exemption:llr tqeouna/t tsaz 4atr.ttezz'cttl< fiatg.tt So Ftg. Access Sa Ftg. Moin x Volue 7r)6s9Ll Per .055 will be u*d on this proiect. Plon Ck. Comm/lnd Plon Ck. Res Per30% \ FOR OfFICE U5E SIGNATURE Zone TTpe/ Const, BUITDING PERMIT Chorges ond Surchorges x Volue a -Volue TOTAT YAI.UATIOi.I . Fire Zone - Eedrooms - occy Lood < L.!, <..1, Totol Comb. Permit PTUMBING PERMIT Chorger ond Surcho rges Fe\' Demo EI.ECTRICAL PERMIT SidewolkChorges ond Surchorges MECHANICAT PERMIT Chorges ond Surchorges Curb Cut TOTAT \3\ 2( i WHERE SIATE tAW REQUIRES ,hot ,he Electricol work be tione by tha Electricsl eontrqclor, the cleclricol .portion of this pe;mit' rhal! not ba volid until c lobel hor been signod by on Electrico! Contrsctor snd ottoched to the electricol palel. )( \r-et o -r' \-r ,cl oo tal0(q.r I -5911 i A/C Pavina COMBINAIION APPLICATION/PERM,vTCAP) l. Applicont t9 furnish A. Job A,ddress B. Legol Description l. exomple-tox lot .l00, Lone County Mop Reference IZ 03 43 2. exomple-Lot I. Block 3, 2nd Addition to Springfield Esrores C. Nome, etc. of owner ond construction lender D. Energy Sources 1. exomple-heot/electricol ceiling,/or forced oir gos 2.exo;;E-woterTEEGiEEctrk-tricol,'o.-sqE,.: E. Squore footoge or voluotion, etc.l. exomple-1250 sq. foot house, 500 sq. foot goroge 2. exomFlE-iT nEw proiect, check new-if oddition, check odd, etc. F. Building permit informotion: 'I . exomple-conslrucl single fomily house wilh on otloched goroge 2. exompie-remodel existing goroge into fomity room 3. cianol-e-convert single fomily residence into lls-tarrront (chonge of use) G. Volue of work os defined in Seciion 303 (o) of the Structurol Specio lty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or conslruclion deloys, Building Division Stoff must be oble to contoci oppropriote persons regording design informotion or iob site corrections, etc. ll. Abbrevioted Piumbing, Mechonicol & Electricol Schedules A. Except where blonk spcces occur in the description poriion of the Mechonicol ond Electricol Schedules, the opplicunl need fill-in only the No. Boxes odiocent to the oppropriole item(s) to be instolled B. Full Plumbing, Mechonicol, ond Electricol Schedules ore ovoiloble ot the Building Divisior. 'I . To conserve spoce on the permit fornr the schedules hove been oL;brevioted 2. lf the item(s) :,: be instolled ore not covered on the obbrevi- ' oted schedules you should consult the full schedules C. BUITDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES lll. Applicont to sign ond dote Whenever possible, lhe iniliol opplicotion will be used os o worksheet only. Where possible, Suiiding Division Sroff will prepore o typewrirten copy ond return it to the opplicont ot the rime the octuol permit is issued for his signolure. lV. Fees ond Chorges Plon check fees ore due ond poyoble ot the time of lhe opplicolion, ond no plons will be processed until lhese fees ore poid. All other fees ond chorges ore due ond poyoble when the permit is issued. V. FOR OFFICE USE ONLY -"JERMIT VATIDATION + (/1aaX.x." 0 4'/' PP Permit Clerk o PROJECT CONDITIONS TO 8E SATISFIED BEFORE OCCUPANCY: CCf>tS)rr \f\\t= r r-\c ()S rcx\ c:\ T\D€Additional Proiect lnformotion: C?fflr \Ca,\ \ \t\\EB - \ x\ r :Qflrt"\ta\'\e{ n :[ i Dtr HNtzsrtu.t-u r 2G^a-1i=1 PLANS REVIEWED BY: no signoture dote \ -\, --