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Home My WebLink AboutPermit Building 1980-02-28tiL COHBI i]ATI ON APPLICATION/PERMIT 7?6-3 Job Address /r n M./ Lega1 Description E IIERGY Hea t l'later Heater Ranqe . Ftq . l.la i n_ Sq. Ftg. Access._ Sq . Ftg. Other__ _l{ew_Ad d-A1 te r_Re p . _Fence_Demo_C han ge/ U se -other- lcA DolA ri S Va l ue of l,lork:L,ry-fiOwnerE2rrSI Addres s /i 7 )rora _v,Phone nq Re Descr I,lork e., Bu Single Fani I s i dence Iii At G Constructi on Lender + Q,\ef # { Addre s s Phone name add res s I CS. nO exDt res phone no Prima Structura I Electricai l{echani ca l n ame add res s lics. no-)(pxni rps ohone no- ) Foot nd 11€,Lral 'I umbi 'I i PLUIIB I NG ELECTR I CAL I'lECHAN ICAL NO FEE CHARGF NN FFF CHARG F NO FFF CHA RGF Each single fixture Residence of SQ. FT. furnace/burner to BTU' S -X Relocated buildinq (new fix. additionaj )lo o6 New ci rcui ts al tsor extensions Floor furnace and vent S. F. Residence(1 batn)\t SERV I C ES to co Recessed wa l I Soace heater and vpnt Duplex (1 bath) each Additional bath Temporary Construction Apol iance vent separate Change in existing res i dence Stati onar.v evap, cool er Sewer multifamily, comm. or Industrial Vent fan with sinole duct Storm Sewer 0f Vent systern apart from heatinq or A.C. c0l,1l'1./IND. FEEDERS Mechanical exhaust hood and duct I nsta l I /al ter/rel ocate di stri b. feeders l'lood stove/heater 0f amp s. ISSUANCF OF PFRIlIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L1IIshall not be valil I REQUIRES that the Electrical rvo unti l the label has been signed rk be done by an Electrical Contractor, the electrical portion of this permitby an Electrical Supervisor and returned to the Building Division i L E XAII i lr ED the comp e ted a p l-) ,] 1 cat i on I I rvork rn oerta ilding oRS 701 for Derm I t an d do he reb.y rt 'l t ha t a I l 'I nf,rma t ,1 on her'e0 n i s true the City be made I der' s and that and correct, and I further ce rt 1 f-v t ha t any a nd a DE rfo rme d s ha 'I I be don e 1 n ac cordan C t h the 0 rd .l n an ces o ffSori anyrdi ysu ngfield and the Laws of the S ta te 0 f 0 rego I n 'I n s to th e wor k descri bed he re 'l n and tha L t,tc OCCUPAI,I CY W'I I Ifst ruct ure wl t ho ut t he pe rm 'I s s 'I on of t he Bu 1 'l s 1 0n I fu rther c xempt t 5 wilI e rt 1 fy t h a t 1 t t i 1 t h the B ulBoas'I f I I fo nd f fec m.y re q s ra o nnUrceaetasrequIredby055that'l f he ba s 'I s for exemDt 'I n I s n ote d he reo0nIbc0ntLLndIwho nra0rsaer,'l D oyee S a re I n c0 D I I nc WI th 0 DC 7 0 1 05 be u sed 0 n th 'i s proj L W.E, /. Itl r //rA /t4llAi.lE(please print)3 S I Gi{ATURE 44*2. 2* ,l Zone e/Const its Ftg. l4ain ValueFire Zone Bedrooms Load Ftg. Access X Val up Flood Plain Stories Occ.y Group Sq. Ftg. 0ther Value TOTAL VALUATION BUILDING PERMIT Charges anC Su rc ha rges -ZQ.w--- P I an Ck. Corffn/ i nd 65"1/Bldo Per Fee Systems Deve Charqe (1.5q o pmen t Plan Ck. Res 30%/Bldo Per Fee PLU!'4BING PERMIT Charges and Surcha rges _l o Fen ce Dgmo ELECTRICP,L PERilIT Charges and Surc ha rges _,r_,f,o Sidewalk A/C Paving Tota'l Comb. I'ermi t MECHANICAL PERI"IIT Charges and Su rc ha rge s Curb Cut TOTAL +l ,bo N RACTORS l.later service COMBINATION APPLICATION/PERMIT (CAP) Applicant to furnishA. Job AddressB. Lega'l Descriptionl. example- Tax Lot 100, Lane County Map Reference 17 03 43 2. ' example- Lot 1. Block 3, ?nd Addition to Spiingfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources 1. example- heat,/eiectrical ceiling/o2, example- waterheater/electrical/or E. Square footage or valuatjon, etc. l. example- 1250 sq. foot house, 500 2. example- if new project, check new check add, etc. r forced air gas r.laf- sq. foot garage - if addition, F. Building permit information:l. example - construct single family house with an attached garage 2. example - remodel existing garage 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 Staff must be able to contact appropriate persons regarding design information or job site corrections, etc. II. Abbreviated Plumbing, Mechanical, & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fil'l-in only the No. Boxes adiacent to the appropriate item(s) to be installed B. Ful l Plumbing, Mechanical, and Electrical Schedules are avai lable at the Building Division l. 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 scheduies you should consult the ful I schedulesC. BUILDING DIVISION STAFF I^JILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered to the electrical contractor for signature by his electrical supervisor. The general contractoris not authorized to sign the electrical label.III. Applicant to sign and date Whenever possible, the initial application wil I be used as a worksheet on1y. Where possible, Building Division SLaff will prepare a type written copy and return it to the applicant at the time the actua) permit is issued for his signature.IV, Fees and Charges Plan check fees are due and payable at the time of the appiication, 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 Perm'it Cl erk PROJECT CONDiTIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit appljcant exempt from registration with the Builder's Board because: PLANS REVIEWED BY name SI g nature date Add'itional Project Information: IiiSPECTION LIIiE 725-37 69 CI-i\ r-rr- SPRiiIGFIELD COI!BI iiATI ON APPLI CAIION/PERMIT ll 7 //r 7t llv l-egal Description Job Address EiIERG' Ilater Heater Ran qel(. io S E,er0wn 7us Val ue of l.lork:L,c{Y) ss._ r ller-nep. - _C hange/ Use llerv A.d -Fence-0ther l.1a iSo. Ftq Sq. Ftq So. Ftg Acce 0thedA Demo lli th Attach Ga ra n F 1 S ng eAddressPhoneo/,)rr.rir. 3y,/ Constructi on Lender + Q-,\qr # { Address Phone lcA oolA name addres s lics. no.. exDt re5 phone no. Pri ma Structura I Electrical l'lechanical n aire address I i cs. no.(exoires)I ne.L P Foa n& lectrical l'recha n i 'I PLUIIBI IIG ELECTRICAL MECHAN ICAL FFF CHARGE NO FFF CHARGF NO FFF C HARGF Each single fixture Residence of FTsQ furnace/burner to BTLI' s ix Re I oca ted bu'i 'l d i nq (new fix. additional )lo o6 New c i rcui ts al tsor extensions Floor furnace and vent S.F. Residence(l bath)-!SERV I C ES lo co Recessed vral I Space heater and vent Duplex (l bath) each Additional bath Temporary Construction sepa rate Apol iance vent l,later servi ce i n exi sti nge e nce Chang resid Stationary evap cool er Sewer mul tifami ly, comrn Industrial 0r Vent fan with sinole duct I sto., s"*."0f .anps.art fromp C Vent systen a heatinq or A. COMI'1./IND, FEEDERS itlechan'i ca I exhauii iood and duct Insta l l /al ter/rel ocatedistrib. feeders ['Jood stove/heater 0f -amp s. ISSUANCF OF PFRI,lIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES llAi.lE(p1ease print) S IGiJATURE " 2#s' IW,E It/ r //rA tl 4s ,e I,JHERE STATE L1u REQUIRES that the Electrishall not be valil until the label has been s cal rvork be done by an Electrical Conigned by an Electrical Suoervisor and tractor, the electrical portion of this oermitreturned to the Building Division and ofS ofa Boa r on 1y 0reoo he Bu fy 0i?s xempt 5 r,ri I HAVE EX I ItE theD e ted II ac ot nac0mp for 'I0erm t danpi)r 'I+he0 reb.y t tha Ia I fo trma In1fy on reonhe 'I s trucorretaindrtfuhrecer1ttthaandlaIfyanytv0DErkrmerfoIdIShanIedonbeacncordactth0rdhena'I ESnc of the ciIrfi tyedltandn9Lhewsaf0ethSteLdofn0etr'Ia 'In n to th e descriworkI hebed Ire n thaand t CI UPAIICOCC 1 I beI madetSruUctretIuhotthe,lrmDC ss 0n1 f0 t i d 'ID .I Is 0nn9 fu enrth ec Iirt ttha re 1 fS It n0 tl,/ I hr'ty .q th Be 'IU deI r s ny d j ,]s n Uft II fo rc ae dn fe tfec a s lureq red 7 10 505 fORSthatjby L ba 'IS foS rhe oni s'i n dexemDtte nhereo a nd th a tSntu bco ar toc ars emDnd 1 s areho I0yee n I ai tvtc0mc hL C7n7 5 I be sU de n ,]th S tecPro.j D Ftt-: Ftg Ftg Uni ts Value TOTAL VALUATI X x Va lue Zone .Tyoe/ Cons t l''la i n Acces s 0therFlood Plain tories Val ue Load Sq Group Sq Fire Zone Bedrooms_ 0ccy Plan Ck. ConnnTlna - 65"j/Bldo Per Fee Syster';ls DevETocmEnt Charqe ( 1.5q) BUILDIiIG PERTlIT Charges anC Surcharges Plan Ck. Res- ] :]7$1ds Per Fee Fe ncePLUI4BING PERMIT Charges and Su rc ha rge s l Dgmo SidewalkELECTRICAL PERIIIT Charges and Surcha rges co_l A/C Paving Total Cornb. Permit Curb Cut IlECHANICAL PERMIT Charges and Su rc ha rge s TOTAL +l bo N n GN ILAI.I nhonc nn I COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description l. example- Tax Lot 100, Lane County Map Refer 17 03 43 2. ' example- Lot 1. Block 3, ?nd Addition to SlFTnlFietd Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceiling/or forced 2. examole- waterhEater/electrical/or solar E. Square footage or valuation, etc.l. ellqole-_ 1250 sq. foot house, 500 sq. foot 2. examoTe- if new project, check-new - if adc Eleck-add, etc.F. Building permit information:l. example - construct single family house wit ;ttaclEd garage 2. example - remodel existing garage into fami 3. examole - convert single family residence i EsTiIFant (change of-use)G. Value of work as defined in Section 303 (a) of Structural Specialty Code .H. OESIGN TEAI4 AND COI1TRACTORS To avoid design or construction delays, Buildin Division Staff must be able to contact appropri, persons regarding design information or iob sit, corrections, etc. II. Abbreviated Plurnbing, Hechanicai, & Electrical Scher A. Except vrhere blank spaces occur in the descript portion of the Mechanical and Electrical Schedu the applicant need fill-in only the No. Boxes at to the appropriate item(s) to be installed B. Ful I Plumbing, Mechanical, and Electrical Schedt are available at the Building Division l. To conserve space on the permit form the sci have been abbreviated2. If the item(s) to be installed are not cover the abbreviated schedules you should consuit ful I schedul es C. BUILDING DIVISION STAFF I^IILL FILL OUT ALL FEES I CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must be delivered electrical contractor for signature by his eiect supervisor. The general contractor is not autho to sign the electrical label. III. Appiicant to sign and date Hhenever possible, the initial application will be u a worksheet on'ly. t,lhere possible, Building Division will preoare a type written copy and return it to th applicant at the time the actual permit is issueci fo PERMIT VALIDATION OF SPRINGF!ELD Ciry Holl Springfield, Oregon Deporlment of Public Works OFFICIAT RECEIPT No. B 5?922 CITY o 0 0 {l I (, ( ( ( ( ( ( {.er' Rec'd F frtl -8,1 .Ut.[,1. ,",, EZ Received For: I I I I ( ( ( ( (e oo ( e (ta\€ Amount Received n AUTBORIZEO SIGNATURE PiTNTEIS ZUG€tE OR 07'ol !a!tr'' si gna ture. (IV. Fees and Charges Plan check fees are due and payable at the time of t'p application, and no pians vrill be processed until these' fees are paid. All other fees and charges are due and payable vrhen the permit is issued. V. FOR OFFICE USE ONLY ( Perm'it Cl erk .(e( PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: permi t appl .icant exempt f rom regi stration w j th the Bui I der' s Board because: Addjtional Proiect Information: PLANS REVIEWED BY dates i gnaturename