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Home My WebLink AboutPermit Building 1987-07-28I ll SPECT r 7?6 376e LINE CITY OF SPRINGFIELD COMBI NATI ON APPL ICATION/PERMIT 726-3753 Job Address 3 EIIERGY SOURCES Hea t liater Heater Range Ftg !q. Ftg. Access._ Sq. Ftg. 0ther_ -l,lewlddJl ter-ReP. Fence -Otner r_Demo_C ha nge/ Use cc o (^ RJ l--T.- l-ega1 Description Value of rrrfrf(, lr0Owne r a_'N.z Addres s a(o rna;--..-)enoneJ !Builciin Fami l y g Pernit Info: Describe t^lork(i.e., Build Single Residence l,lith Attached Garaqe) 4 a3q 3 I Eonstruction Lenae/r /0) Addre s s Phone name address 'I ics . no.exDl res ohone no. Primary Structura I El ectri cal l''lec ha n i ca l n ame address (lics. no.exot res ohone no.tt41;* Pl umbi nq {t /U q})C. \o C) El ectri cal l.lechani cai PLUIlBI NG ELECTR I CAL MECHAN I CAL N0.FEE CHARGE TJO FFF C HA RGF NO FFF rHA RGF Each single fixture Res i dence of sQ FT furnace/burner to BTU' s Relocated building (new fix. additional ) New circuits alts or extensions Fl oor furnace and vent S. F. Residence ( l bath)SERV I CES Recessed wai I Soace heater and vpnt Duplex (l bath) each Additional bath Temporary Construction Apol iance vent seoarate talater servi ce Change i n exi sti ng rp< i dpnce Stati onary evap. coo l er Sewer multifamily, comm. or I ndus tri a l Vent fan with sinole duct Storm Sewer 0f s.Vent systern apart from heatino or A-C- c0t4t1./IND. FEEDERS Mechan i cal exhaust hood and duct Instal I /al ter/rel ocate d'i stri b. feeders [.lood stove/heater 0f .amp s. x,l-l ISSUANCF OF PFRIlIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES I,JHERE STATE L,ltl REQUIRES that tlre Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAI'IINED the completed application for oermit, and do herebv certif,y 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 Ordinances of the Cityof Spningfield and the Laws of the State of 0reqon oertaining to the work described herein, and that NC 0CCUPAI'ICY will be madeof any structure without the permission of the Building Division. I further certify that rny registration vr.ith the Builder's Board is in full force and effect as rectuired 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 wilI be used on this oro,ject. I,lAl'lE(p1 ease pri nt) l 6<-" hrfr,f S IGNATURE rEF 2r-57 FOII OFFICE USE OiiI Zone oelConst. Units So. Ftg. t,lain x Value Fire Zon Bedrooms Load Ftg Acces 0ther x Val ue Flood Plain S -Occ.y Gro up Sq. FtS x Value ToTAL VALUATT0N_ to ri es BUILDING PERI.lIT Charges andSurcharges "). 56"Y J.8 Plan Ck. Comm/Ind 65"/"/B1do Ppr Fce Svs Cha terns Deve rqe ( 1.57 opment Plan Ck. Res 30%/Bldq Per Fee PLUI4BING PERMIT Charges and Surcha rges Fence Dgmo ELECTRICP.L PERt|IT Charges and Surcharges SidewaIk A/C Pavi ng Curb Cut Total Cornb. Permit 14ECHANICAL PERMIT Charges and Surc harges TOTAL 5q,3a n_ COMBINATION APPLI CATION/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 Springfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources 1. example- heat/electrical ceiling/or forced air gas2. Examtfe- wa te rhEa teiTETec ti] cETo r so-T;;--E. Square footage or valuation, etc.-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 singie family residence into restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI.I 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.II. Abbreviated Plumbing, Mechanical, & Electrical Schedu'lesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules, the applicant need fill-in oniy the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedules are avai iable 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 the ful I schedul esC. BUILDING DIVISION STAFF I"IILL 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 e.iectricalsupervisor. The general contractor is not authorizedto sign the electrical label.III. Appiicant to sign and date Hhenever possible, the initial application will be used asa worksheet only. Where possible, Bui)ding Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for hissignature.IV. Fees and Charges Plan check fees are due and payable at the time of theapplication; and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued. V. FOR OFFICE USE ONLY PERMIT VALIDATION E bxuqb"1 >?-84 Perm'it Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit appf icant exempt from registration with the Builder's Board because: Addit'ional Project Information : PLANS REVIEWED BY: name signature date u_- G00D 0,E B0Y'S RO0FING C0.vIPANY 12A- 5982 4489 MAIN STREET SPRINGFIELD, OREGON SZ/NA PROPOSAL ond CONTRACT Date .riAy 11 MIMIIE @ SP;IINOTICLD AEEAC*.rcffi- 19 1,7 PROPOSAL SUBMITTED TO RAT,PI{ Si'TilID HOME PHONE BUSINESS OR WORK PHONE 746-"39j STREET 240 1',tA1I{ ST.. JOB NAME ROOF REI,TOVAL & R]1I'LACNI/MNT CITY, STATE zrP cooE SPT1IIYGPItrLD, oRtr 9?477 JoBLocAroN /W CO;il'iER 0F 3rd.& ?t. "A" , SPFD, ORE. I propose to R11ld0\ri:-,CLl]AIil LTP AND HAUL.AYIAY ALL OLD ROOFII,IG i,IATERIAL, AItl) OTHER I?lii,:IS N0't; 0I.l Tj{E R00F, !,IHICH YOU Y/A}IT l?Iid0VEjr. INSTALT, A BUILD-UP'HOT'' ROOF, USING O,{IEN:J-CORNINC T.,IATtrRIAL, I IIILL I}ISTALI,l ONE (1) >fr ].b. FIBERsLASS BASE SI{EET TO TH.i] SHEATHING; TIJO (2) ".:.1 1b" FIBERGLASS PJ,Y-SHEETS, ]]ACH MOPI'ND O}'I 1'{ITTI HCT ASPHA]XT; OI'IL (1) 7? lb. fIBNRSLASS CITT'S.qEET, ALSO I,TCPPED ON I,IITH HOT'ASPHAJ,T; INSTALL I\iF;,] R]DSE CAP IfiTIAI., OI: T,P OT'T}iTi T,'IPI,\,IALLS AND AIOI'I} T}IE EJ-Iii Oli THI HTG}AT:B BUILDII,I? ROO]T AI:]I II{STAI,L SI]{ ((-) I]']]:i ATTIC V]Iiil' C]i T]ACI{ BUILDII{}. tiOTi; : Ti'lIS ICOF CD:ii)LiES't'JITli THI tlr{IirCRN BUILDII{l C0D-1, Seetioyl }?0'), Ai'lii :l,.OUi,D TAST FOR T.!EI']TY (20) TO TyJIII{?Y-FIVE (25) ]EAP.S. TliE L;\ECR TlILl, CAP"nl'' ,t. FI'.rll l5) lnAn I',TRITTEI\: iilJ1RAliTY. 1.! '.I -if,l . .4,1i., Fnn::i:t: nfQUIP.iJD F0:i Tlii,,l JCB '',ILL Bl:- 0IlLAItEn By TltI-S C0.i1'AllY }IOTE: T}tE FJTY]TII'ITS i,iILL BF--TO l.il?It/:. (ti:,000.00) upoi{ c0t[,.IEI.IcEl/n]t'TT, t/3 upoN coi/ipl,ETlo]i AND THII EALAi'icl iluE AIii' PAYIiBLtr I.IITHI}' TI{]]]TY (3C) DAYS AFTER. CO:,IPI,ETIO].I DATE WE PROPOSE hereby to lurnish material and labor - complele in accordance with above specilications,lor the sum of: -qrx-Tli0usAi,[D&N0/00- : qTr-r l.Il)rnr. . A?41rf.- -Gsii "dii 60 Ni iIEf rO hird H U p'o'N' r Fi L'c Ei F i rUF'd [ii ii c. All material rs guaranteed to be as specilied. All work to be completed in a workmanlik6 manner according to standard practices. Any alteration or deviation lrom above specilications involving extra costs will be executed only upon writlen orders, and will become an exlra charge over and above lhe estimate. All agrsements contingent upon slrikes, accidents or delays beyond our control. Owi€rlo€afrylirc{o;radoando$prfleo$ssryfl'rlurance. Our workers are fully covered by Workmen's Compensation lnsurance. P.lmonl lo b. m.do es lollows: Authorized --+- ( ( -'t-,Signalure n') dollars / ^^\-. .-l t) NOTE: This proposal m8y bs wilhdrawn by us il not accBpted wilhin - days. ACCEPTANCE OF PROPOSAL Thoaboveprices,speciticationsandcondi- lions are salis,actory and are hereby accepted. You aro authorized lo do the work as specilied. Dale of Acceptance: Signature L Signature Paymeni will be made as outlined