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Home My WebLink AboutPermit Building 1984-12-21I 7 CITY OF SPRINGFIELD COHBI NATI ON APPL I CATION/PERMIT /11"h*nt/cJob Address / {6 Lesal Descri ptlon //- Q7.<9-V-, O??OO Range EIIERGY SOURCES: rt"ut 4EC7 ,frtl , liater Heater "rr0wner n I tw,t Value of l.lork:6 i 2 ,o-t-o Sq. Ftg. Access.-- Sq. Ftg. 0ther_ l,lewx Add Al ter P.eo. J e nie-Derno-C ha-n g e / U s e 0ther . l.la ..e., Bui1d SingleAddress 7-a 4A t o r7a."-.$' A/ "l vnoneft{/U n t ra In scr l,li th Attached € 44 /,<_- ( r4fo^ f 7 /n) Construction Lender /L< )^'L-c/S / Addres s Phone bo v) G. O Oo DES I GN TEAI,'I name addre s s no exoi res phone no v?f-?)??3 )-2/1/3",S.L"*24- Structura l Pri El ectri ca l Mechani cal CONTRACTORS address'l ics. no^exni rps )(nhonp no- ) a {a IPI (General O E l ectri cal ,rCa#t {9v;-za ,llay{tt1 7v I -r/ (:-/l'lecha ni ca I I PTUIIB I NG ELECTR I CAL I MECHAN I CAL C HARGFFFF NN FFF CHAPT]F THAPGFNOFFE Each single fixture Residence of FTSQ / furnace/burner to BTU, s laoc. Relocated buildino (new fix. additionaI) New ci rcui ts al ts. "2"5)tilbx e lsq Floor furnace and vent S. F. Residence(l tatn)S ERV I CES Recessed wal I Snace hpater and vPnt Duplex (1 bath) each Additional bath Temporary Constructi on Apol iance vent seoa ra te tlater service ge in existing dence Chan res i Stati onar.v evap. cool er Sewer multifami 1y, Industrial comn. or Vent fan with sinole drrct Storm Sewer .amps.0f Vent systenn apart from heatinq or A.C, c0Mr.1./rND. FEEDERS Mechanical exhaust hood and duct Instal I /al ter/re1 ocate d'i stri b. feeders l'lood stove/heater .amps0f Zra- 2r"//€,,,2? i.Sr{*eH7r"FF"fi{-- TOTAL CHARGES TOTAL CHARGES /s*I0TAL CHARGEi )(//ty. /A -' I HAVE CAREFULLY EXAI''IINED the completed appfication for oermit, and do hereb.y certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accoidance with the 0rdinances of the Cityof Springfield and the Laws of the State of 0regon oertaining to the work described herein, and that NC 0CCUPAI,ICY will be madLof any structure without the permission of the Building Division. I further certify that rn.y registration vlith 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 thatonly subcontractors and employees who are in comcliance with 0l?S 701.055 will be used on this oroject. J.llAtlE(please print)I GNATURErt/* t4 zone_1Qfr1Q__Itoe/const.t-N un:t a lue Val ueFire Zone Bedrooms 0ther Value xLoad F]ood Plain Stories 0cc.y qsS ,Qryot Croup -I>-? _ -t_e4 T0TAL VALUATI0N lZ'-t /) o. Ftq. l,lain q. Ftg. Acce Plan Ck. Conrn/Ind 65%/B1do Per Fee 6 &3?. oo Systerns Devel oomert Charse (t.sq) '/8e.nBUILDING PER}IIT Charges and Surcha rges __6a.=___ ?Plan Ck. Res 30%/Bldq Per Fee FencePLUi4BING PERMIT Charges and Surcha rges D6mo Sidewal kELECTRICP.L PERIlIT Charges and Surcha rges ta=__.@ A/C Paving Tota'l Cornb. Permi t tg, la Curb CutHECHANICAL PERHIT Charges and Surc harges b TOTAL z6g. t/o WHERE STATE LAII REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be vali'l until the label has been signed by an Electrical Supervisor and returned to the Building Division ur,t Bu \ il 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 SpTin-qTietd EstatesC. Name, etc. of owner and construction lenderD. Energy Sources1. example- heat/electricai ceil ing/o2. exampTe- waterheateEETeETil ca'j7or Square footage or vatuation, EEc.- r forced air qas E sol ar l. example- 1250 sq. foot house, 500 sq. foot garage2. exainpje- JT 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 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 Schedules, the applicant need fill-in only the No. Boxes adjacent II. to the appropriate item(s Fui l Plumbing, Mechanical ) to be installed , and Electrical Schedules III. 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 covered on the abbreviated schedules you should consult theful l 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 theeiectrical contractor for signature by his electricalsupervisor. The generai contractor is not authorizedto sign the electrical Iabel Applicant to sign and date Hhenever 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 permit is issued for hissignature. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no p)ans will be processed until thesefees are paid. Al l other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY IV V PERMIT VALIDATION +wil .d&a It l \ ( Permit Cler PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Perm'it applicant exempt from registration with the Builder's Board because: Additional Project Information PLANS REVIEWED BY: name S1 gnatu date //- INSPECTION LII,IE 726-37 69 COHBI IF SPRINGF APPL I CATI ERMIT Job Address / {O /4 oho*/a EIIERGY SOURCES: ueat tCttcr El. Ran l,later HeaterLesal Descript:on //- e).49 "J/'0wner n lpJ 1 Va I ue .of l,lork :# i 2 ,c-o"o Sq. Ftg. Access._ Sq. Fto. Other_ l,lew x Add Al ter Peo . _Fence_Demo_C han ge/ U se 0ther Sq. Ftq. liai ,e., Build SingieAddress L-" 6d t q r-7e*-4' U a vnoneyy(/1lt rlino Permit Info: Descri be l,,lork(1y Residence l,lith Attached Garaqe Bu iI Fami ( aaz,<__ (raqo^ f 7 /n) Construction Lender /L<\P'/s/3a bo v) s-a (h Addre s s Phone DES I GN TEAI,I name addre s s tcs. no.exo i res ohone no. 3 3-?,/v?f-?J?lSJ"*P4-?3 , Structura l Pri ma El ectri cal Mechani cal NA:TLE t aq noCONTRACTORSadd res s exD I res ohone no. Or4"4/ C-"*t7- 4 :-7ia {zL'*r{Uq,?pi'- /7 //Genera I IPI umbi nq El ectri ca I l*-< {9v;-za ,U,n1y'-ht1 7vL-r/(-v/I'lechani ca l I P'TUI,IBING ELECTR I CAL I MECHANICAL FEE CHARGE NN FFF NHARGF NO FFF CHARGF /aoO, Each single fixture Res idence of FTSQ / furnace/burner to BTU. s Relocated building (new fix. addit'iona1) New ci rcui ts al ts "2"5fff#axe /sq Floor furnace and vent SERV I CES Recessed wal'l SnaaF heatFr and vpnt S,F. Residence ( I uatn) Duplex (l bath) each Additional bath Temporary Construct ion Apol iance vent s eDarate [.later service ge in existing dence Chan res i Stationary evap cool er multifamily, cornm. or I ndus tri a I Vent fan with sinole ductSewer 0f amps.Vent systern apart from heatino or A.C.Storm Sewer c0Mr.r./IND. FEEDERS Mechanical exhaust hood and duct- Instal I /al ter/rel ocate distrib. feeders l'lood stove/heater 2-0f amps 4r-bx, ffi T0TAL CHARGES ,Wry. /A t'TOTAL CHARGES TOTAL CHARGES /s* WHERE STATE LAI,I REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pernit shall not be vali'J until the label has been signed by an Electrical Supervisor and returned to the Building Division of any structure without the permission of the Building Division. i further certify that m.y reqistration yrith 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 er,'rployees who are in comcliance with 0l?S 701.055 will be used on this project. J"l.lAt'lE ( p1 ease pri nt I GNATUREn/* t4 oermi t rformed Ct'ty made an rtce hat at n tforma on nhereo s truecatnaeCAREFULLHAVEEXAI'1I theNED reb.y fypl')comp thefwlht0rdnancesnIrkahasacecordanctheedonbendcoffectndafucerrthertithatandawoDCfyanytw1IbefnathaandNCOCCUPAI,ICYeadthendofLawshettaofteDe rta nl to het dwork crles here ibedSrtong0regonngSp E Fire Zone Bedrooms 0ccy Load Sq. Ftg. Access x Value_ Bb Ftg. l4ain Group x x Const E-Z -, <:t) T0TAL VALUATIONlZ'zt V Val ueUni ts Flood Plain Stories 0ther Value zone C.*L? 6 e3?. oo tems Deverqe ( 1.57 Svs Cha opment /€e.*Plan Ck. Conm/Ind 65%/B1dq Per Fee BUILDING PERIIIT Charges and Surcharges __6a-& ?.Plan Ck, Res 3)%/Bldq Per Fee FencePLUI4BING PERMIT Charges and Surcha rges D6mo Si dewa I kELECTRICP,L PERIIIT Charges and Surcha rges ___/€,=__.@ A/C Paving Total Comb. Permit 88. la Curb Cut 268. roI,IECHAIIICAL PERMIT Charges and Surc harges TOTAL___/e,_=__ coMBrNATr0N AppLrCATroN/PERMrT (CAp) I. Applicant to furnishA. Job AddressB. Legal Description l. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, 2nd Addit.ion toSpringfield EstatesC. Name, etc. of owner and construction IenderD. Energy Sources PERMIT VALIDATION 1. example- heat/electrical ceilino/ot, exampte- waterheater/electrical/or Square footage or valuationlGtE'- r forced air gas L+l&t il E 5sE- 1. example- 13!9. sq. foot house, 500 sq. foot garageZ. example- if new project, check new - if addition,EIEEI-I-dd, etc.F. Bui lding permit information:1. example - construct single family house w.ith anattached garage ?. examp]e - remodel existing garage into fam.ily room3. example - convert single family residence intorestaurant (change of use)G. Value of work ai defined in Section 303 (a) of the . Structural Specialty CodeH. DESIGN TEAM AND CON1RACTORS To avoid design or construction delays, Build.ingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc. Abbreviated Plumbing, Mechan.ical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechan.ical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjacentt0 the appropriate item(s) to be instailedB. Full Plumbing, Mechan.ical, and Electrical Schedulesare available at the Build.ing Division1. To conserve space on the permit form the schedu.leshave been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful l 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 electricalsupervisor. The general contractor ii not author.izedto sign the electrical labelApplicant to sign and date Whenever possibie, the initial app)ication w.ill be used asa.worksheet on1y. t^lhere possib'le, Building Division Stafiwill prepare a type written copy and returi it to theapplicant at the time the actuai permit is issued for his s i gna tu re. Fees and Charges P'lan check fees are due and payable at the time of theappl ication, and no plans will be processed until thesetees are paid. All other fees and charges are due andpayable tvhen the permit is issued. FOR OFFICE USE ONLY ltr\ II III. IV. ( V Permit Cler 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 date tSignatu