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Home My WebLink AboutPermit Building 1980-10-13PECTION LINE -37 69 CITY OF SPRINGFIELD COHBI NATI ON APPLICATION/PERMIT 7 -3753 Job Address 3l 81 Ore ON TT Legal Description 'Lt )ttb ^ (o EIIERGY SOURCE Hea l.Jater Heater Ranqe Sq. Fto. l'1ain Sq. Ftg. Access. /?? Sq. Fto. 0ther_ _llew_Add_Al terrffl- _Fence_Demo Change/Use 0ther t $qVal ue of l,lork:/ /6y.*Owne r GaA.1 ,,r1. d 6rtce ft' ens',,qN Address 3'18 q Qlei on s-\Phone-1qt-6 16l Builciin Farni I y g Permit Info: Describe Work(i'e., Build Single Residence Hith Attached Garaqe) ( \o -rfinr t Construction Lender (# Addres s Phone DES I GN TEAI.I name address l ics. no ( exoi res phone no. Pri ma r_v Structura I El ectri ca I llechani ca I COIITRACiORS name (address )(Iics- no.exDl res ohone no- i 2l El ectri cai "echan i ca I PLUI1BI IIG ELECTR I CAL MECHAN I CAL 1 FEE C HA RGF FFF I CHANCT nrr)FFF l.HAAGF Each single fixture Residence of 5Q FT furnace/burner to BTLI' s Relocated building (new fix. additional)I New ci rcui ts al ts or extensions lo.o Floor furnace and vent lS.F. Pesidence I (1 bath)SERVICES Recessed wal I Snacp hpatpr and vcnt Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent seoa ra te l.later servi ce Change in existing resi dence Stationary evap cool er Sewer multifamily, comm. or Indrrstrial Vent fan with sinole duct Storm Sewer 0f amps.Vent systern apart from heatinq or A.C. COMT!./IND. FEEDERS Mechanical exhaust hood and duct Instal I /al terlrel ocate distrib. feeders [,Jood stove/heater 0f s. ISSUANCF OF PFRIlI] TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAll REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be valil until the label has been signed by an Electrical Supervisor and returned to the Building Division I HA E CARE FU L L xAt,!I t\ED t he comp e app c a t n fo r Derm t an d do he reby ce rt 'I fy t ha t a I 'I n forma t 'I n hereo n i s true the CityI be made a nd c0 rrec L an d I fu rth e r ce rt I fy t ha t any a nd a I I t^Jo r k oe rfo rme d ha I 'l be don 1 n accordanc e 1 t h the 0 rd I n an ces f of Soringfield and the Laws of the State of Orelon pertaininq to the work described herein, and that of any structure without the permission of the Building Division. I further certify that my registra Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption only subcontractors and employees who are in compliance with 0l?S 701.055 will be used on this Droject 0cc UPAI.I CY w'l I t 'I o n t{'l t h the ul I de r S j s no ted hereon and t ha t I,lAt'lE(please print S I Gi,IATURT ;; -RJ----, y o e r Kn s t .fuk/.,-_yni t s So Ftg Ftg Ftg l'la i n x Val Fi re Zone Bedrooms Load 5q AccessJQQ--x / ? vatue Flood Pl ain Stories Occ.y Group q 0ther x Val ToTAL vALUATron /%a. to BUILDING PERI'1IT ___/f,-__Clrarqes and Su rc ha rges 6a Plan Ck. Comm/Ind 65%/B1dq Per Fee terxs VC 5% opment 1 I .s?,Plan Ck. Res 30%/81dq Per Fee PLUI4EING PERMIT Charges and Surcha rges Fence D6mo dz€ql4fr?6<,?6 ELECTRICP.L PERIlIT .D Charges and Surcha rges /4, a Sidewaik A/C Paving Total Cornb. Permit I,IECHANICAL PERMIT Charges and Surc ha rge s Curb Cut TOTAL 3o:# Q- /4* COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, Znd Addition to Springfieid EstatesC. Name, etc. of owner and construction 'lender D. Energy Sources PERMIT VALI DATION 5q 883 1. 2.E. Squa 1. 2. example- heat/electrical cei l ing/o exarno I e- waterheater/el ectri ca I /or"re f99l3gs or valuation, etc. r forced air gas &,t 3 lqSosol ar )gleq!]!: i250 sq. foot house, 500 sq. foot garage example- if new project, check new - if addition, check add. etc. iI F. Buiiding perr,rit information:1. exanple - construct singie family house with an attacneo garage2. exarnole - remodel existing garage into family room3. q{..1p!" - convert single iamily-residence iniorestiuFant (change of-use)G. Value of work as defined in Section 303 (a) of theStructural Specia lty CodeH. DESI6N TEAI.,| AND CONTRACTORS To avoid design or construction delays, BuildingDivisjon Staff must be able to contact appropr.iate persons regarding design information or job sitecorrections, etc. Abbrevialed Plumbing, Mechanical, & Electrical SchedulesA. Sxcept vrhere blank sDaces occur in the description:3rtion of tne liechanical and Electrical Schedu.res,the applicant need fill-in oniy the No. Boxes adjacent:c the aoprooriate r'tem(s) to be installedB. Full Plumbing, Mechanical, and Electricai 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 covered onthe abbreviated schedules you should consult theful I schedulesC. BUILDING DIVISION STAFF I.IILL FILL OUI ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the iabel must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorized iII to sign the electricaI Iabel Appiicant to sign and date lJhenever possibie, the initial application wiII be. used asa worksheet only. Where possibie, Building Division Staffwill preoare a type written copy and return it to theapplicant at the time the actua'l perm.it is issued for his s i gna tu re.IV. Fees and Charges Plan check fees are due and payab'le at the time of theapplication, and no plans will be processed until thesefees are paid. Al l other fees and charges are due andpayable ythen the permit is issued. V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from r.egistration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: name S1 gnature date /o-Db=a Job Address 3 181 Or-€ Legal Description 5'r xr!' ^ ('cN 5'1 Ranqe EiIERGY S0URCES:- l.,later Heater Hea t rL 1 Val ue of ilork/ /6y.* Sq. Ftq. Access. ..' = ? Sq. Ftq. Other_- _ilerv_Add_Ai terrff _Fence_Demo_C ha nge/ U s e 0ther Sq. Ftq. liai n Owne r C: oR.i '-..:. e\ 6r-Nce }\' enr:,',3,ni Phone -iqi.6, 11;Address jl E q Cr€<r o\\ S*I Builciinq Pernrit Info: Describe l,Jork(FaniIv Residence l.Jith Attached Garaoe e., Build Singie ( \o rn-r Construction Lender (# u $q Address Phone DEsIGN IEAII name addres s lics. no exo i res ohone no- cr? Pri rna rv i::-.-::-- I ienera I - r.traultrralt. 'L9lrnirlunL li0 --::i:l I I I Resicience:: in =:I furnace/ burner to BTU. s I i Vo.n New c.i rcur rs ai is or extensions Fl oor furnace and vent I SERV ICES Recessed wal I Soacp heatpr and vpnt i I ' iDuoiex (l bath) eacn I .S.i. -lesrcence t i l bath) Temporary Construct j on Apoi iance vent seDa rd teAdditional bathI I I in existing ri e encp Chan rps i Stationary evao cool erl.later servi ce multifamiiy, comm. or Jndrrctrial Vent fan with sinole ductI I Sewer !Stcrn Seirer arnp s.0f Vent systerx apart from heatinq or A.C. i,lechan i cal exhaust hnod .rnd drrct i c0t4t!./IND. FEEDERS Instal I /al ter/rel ocate di qtri h- feeriprs l'Jood stove/heater 0f am0s. I I I ISSUAI]CF OF PFRI1ITI TOTAL CHARGESTOTAL CIiARGES TOTAL CHARGES e>b/o. l,iiltiE SiATE 11"'J REQUII?ES that the Electrical work be done shail ncr:e valij until the label has been signed by an Elec bytri an Electrical Contractor, the electrical portion of this oernit cal Surlervisor and returned to the tsuilding Division I HAVE CAREFULLY EXAIIINED the comoleted apnlication for oermit, and do hereb.y certify that all inforrnation hereon is true and correct. and I further certif-v that any and ail work oerformed shall be done in accordance vrith the Ordinances of the Cityof Soringfield and the Laws of the State of 0regon oertaining to the work described herein, and that ll0 0CCUPAI{CY rvill be madeof any sir-ucture without the permission of the Building Division. I further certify that my registration r.rith the Builder's Boaro js in full force and effect as requireci by ORS 701.055, that if exempt the bas.is for exemption is noted hereon, and that onl_v subcontractors and ernnloyees r.rho are in comcl iance with 0l?S 701.055 wilI be used on this l-rroject. I'lAl.lE(please orint S i GNAT 1 DAT /. Plan Ck. Conrn/Ind 65lL/B1do Per Fee .5?, teixss qer opment 1.57. 6a Plan Ck. Res 30%/81dq Per Fee ar-Fence , D6mo (&-a<741p,r.\"?6oo1()BSidewalk\) l\fConb. terryS1/ /a,'D 7o . '/a \/ A/C Paving Curb Cut 6p763oTOTAL - INSPECTION LII.iE 7?6-37 69 Type/nst..fa&/-r--!n its Bed rooms ry Load TI 6-3753 Fto. l'la in Val ue rts. accessJftZ =-x / ? value /y67.s Value TOTAL VALUATIOII / I;iTY OF SPRiNGFiELD COI1BI |'IATI ON APPLI CAT ION/PERMIT .,:-.:..-: 3::a:::a :.ti iCing ,:--x f rx. rcdiEional) I I Zone Fire Zone Flood Plain BUILDII.IG PERI.IIT lharges anC lurcharges UI4BING PERMiT rges and 'ha rges qICP.L PERI|IT s and 9es AL PERMIT ind S (n !q 5qStories 0cc Group . Ftg .0ther aS lQ-, nhnnp no :'r'-:'li i i':3 COMBINATION APPLICATION/PEP.MIT (CAP) I. Appl icant to furnishA. iob AddressB. Legai Descriptjon1. example- Tax Lot 100, Lane County Map Refer - .L/ uJ 4J 2. examole- Lot l. Block 3, Znd Addition toS!FTng;ield EstaresC. llarne, etc. of owner and construction lenderD. Energy Sources electrical c ili or forcedr sofaF-eater ectr ca E Squa valuat on, etc CITY /^..._-Lc \3 PERMIT VALI DATION OF SPRINGFIELD Ciry Holl Springfield, Oregon Deportmenl of Public Works OFFICIAL RECEIPT 0. B 54883 )e 6 { f f r r { ( D Rec'd From r9 1. examoie- 1259 sq. foot house, 500 sg. foot r2. efqole- lT-i-erv project, cnect new - if addcnE< aco. e:c-:_--..,! ---i..,, - :::Cn::tiOn::- :r:::le - ::is::,ic: singie family house witt .- :i.-:ie - :e.:cc?j existing garage into famili- !l;=i - :c,.rve!.i single iaiily"resioence ir:est:,j.3n: ::I3nce of use)G. ;a i'ue or- rvork :s cef ined in Section 303 (a) of tj:l'uctura i Specjal ty Codei{. DESIG;i TEAI.? AIiD CCiIiRACTORSio avcid ossicn cr ccnstruct.ion deiays, Buildinqlivision S:aii- r':usi be able to contait'upp.oo.iiiersons re_oaro.ing oesign information or job siteccrrectjons, ecc.;SbrevjaEei Piurbinq. i,lechanicai, & Electrical Schedl- l:<c=:::.;nere 5lini sDaces ociur.in ihe rescrit:.i,:::::Jfi ;; ::: ::3a:ra!:jcal and Electricai Scne:...;:,:::e :l:iictna ne?c fill-in onty the llo. Boxes ac.:t :i: a::rc:: iate :tem(s) to be .installec a. :":!I P'i u;cinc, il::nan.ica i , anO Electri cal Schecu,:re availabie at the guiiding Division:- l; ccns?rve s.ace on the permit form the scheitaye ieen rooreviated2- .: :,re t;enls) to oe installed are not covereihe abbrevia:ed scnedules you should ccnsultfui'l scheou'iesC. siJILDiI,iG OIVISIO|I STAFF l.JILL FILL OUT ALL FEES AN CHARGES O;i iHE SCHEDULESD. As noted on rhe CAp, the jabei must be del.iveredeiecirical contractor for signature by his electrsupervisor. fhe generai contractor ii not authorto sign the electrical IabelApplicant to sign and date lrlhenever oossible, the initial application wi.ll be usra.worksneer only. !{here poss.ible, Bui lding Division Iwill.preoare a type written copy and return it to theappiicanc ai the time the actuai permit is .issued forsignacure. Fees and Charges +- Plan cneck fees are due and payable at the time of theapplication, 3nc no plans wiil be processed unti.l thesefees are paid. All other fees and charges are due andpayab.le r.rnen the permit is jssued. FCR CFTICE USE OIILY 'LANS REV r EWEDdlfi I*f.1 Addres -, Received For: J ( I BY (: 6 (Ytrtll Amount Received --{AUTHORIZED SIGNATURE 3HEIIOX.IUiNEUL! FR'{TER5 EUC€NE OR 9"OI Permi t Cl erk PROJECT CONDITIONS IO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from r.egistration with the Bujlder,s Board because: Additional project Information : name s ''l gna tu re da te 10-B-E ( ( ( \ t ( (