HomeMy WebLinkAboutPermit Building 1985-03-01" RESILcNTIAL..
22s North rro r,r*""APPLicATr0N
/PERMrr
Springfield, Aregon 97422
Building Diuision
7 26-37 53
-'.ece'-ct r
SP'?INGFtELD
DR!\|ALL i!'ISPZC?I1N: Tc be naCeafter aLL dtVuaLL is ,Jn olace,
but prtor to cng taping,
l4ASO!lR!: Steel Location, bond
beons, grouting or uertieals in
accoz,riorce,'/Lth U, ts, C. Section
,iCADSTC',ry: After installatlon is
r*i ^L^)tvtttu uc neu.
CURB E APPRCACH .a.PP)N: After fornsee evecteC but ptior to pc-.n1:tq
conc"ete.
SfDSilLLK 8 DRI;,ffiiAl: ?or eLL ccn-
crete pauing uixhtn st?eet right-
of-txy, tc be male afler aL! ezcc-
uatinq eanoleze l, fotn ,,:ork ,tr sub-
base material in place.
e!"*t*iil 3*,-.^J*
&^,-^.; a--t*--tf-
I Lr-.rb /ya*J C^-ll.A^.^,t
t"/o
/o.oo
,to
is.oa
.to O
&G oa
/c.
Your CiQ Desigra.ted Job lhnber is:8= oeqf
t-8
I.t ie the respottsibility of -tle petmit hotder-to see- tha+--al! inspections ee nad,e at ahe u?ope? tln€, thrrt e-ch -ii?es1 is rea;ait-e:.1on.-tp stl".ee., arud, zhac the cet,trit eail. ia. iocateri at-.9\Z ftcnl'of tl,,e ?-ro?e"tA.'9uiairq )iuiczo= aorrct:ed prin shc.Ll renain on tke itiai"lg- s:iie et eLL t.tnes.
PR)clDUPr l1R rllsP4nroll R1QUE;T:CALL 726-3769 (tecorCet) state youz, City desiyated job ntnnbez,, job aiiress, type of inscec;icnrequestbWeaiyfo.t,inspection'ciiL.tiii-oraaersraneard,pLnnenulber,Pequestsleceited,befcne7:c0ci
,tLL be nade the sdte dcy, reouests'n'cd." "it* ?:00 ott r,till be nace the nest wrkinT dag,
el.l:'F rrtqDia-r.rr.
ezeatlaticn, cut
(tllqsRsLtts PLuEflc, zLEc?Prc;L a
i!EC4t.;!iC;L: io be narie belbie cnywrk is ccuered..
FCCTi:tG_tr l?U;tDAT:Cil: ?o be tm,Ce
-
c;:er t"encnes c?e ezcqLated arui
fcrms c,te ereczei, bux pricr io
pouz,ing ccnc:eta.
To be tmie after
pr.tor to set up of
INSULA.TIAN/VAPOR ]ARRITR IIISPIC?ICN :to be nade after all insulaticn ed.
required oqot bavie?s @e in olacehtt befone oty iaih, Wpsun bcazi cr
rnLZ eoueting is applied, end beforeay insul,ation is concealed.
I U J:ILi
DreLcnee
;heae '-r-scectiors )zaue beer,
UilDIRFLCaR ?LU:.3 tltG I :|tCtt. lticAl :Io be naie pricr to r.nsxcllatdoi oi
f1.ooz, ineuiction or Cecking.
POST AilD ?gA?l: lo be r,ade piot to
insxallatzon of fl,oor inauiatic-n or
: .'lo uctk to ae
I
alr
noie arC zoarcued.
EIPIPLAC1: Pt-tor lo plccirq fcc.t-ngr.cteriai,s arti befcre iro.ri,r.a inscei-
tior-.
PR-4"|,!MC: l4ztst be recuested cfterqprou,zl cf rnqh Vlwr,bin4, electti-cal 1 neeba.nieal. )l! mn.t'-a
bracing i chiicys," "i..'ririJ s"
cotnplececi. llo .;crk is to be con-
cei|.ed until this insoeeiicn ia.a
been nod.e anC aporcv'e\.
!!NCE: llhen eomplate -- Proviie
gates o? nooable aectians thtough
Dtrn
PT)l^r artlrrDt.!.
FI;IAL ."IEC.|A:IICAL
ALL proiect eonditions, such as the inscallaxicn cf street i"ees, :c-:!ec'Jon cf tierequired Landsccpirg, etc.' rrust be satisf;JeC before the AUILDiliG lIllAL ecn be reqttestei.
ilNAL BUILDINC: Tne Final Euildirq lnsoection rast be recuested clter the ?inal ?Lwnbinqlleccrieal, ani lled,aricel lns>eet--ons leuc been nade ard'atorcuzi.
2/.iob Locaticn:
Aeseseore jlao #
5ubd,!.uiszcn:
Ztl - ?z
Desct+be llot k:
IU-AL i.
Date of Applica
lad ,(
-;1^(i
Vaiue
L
&; &^-r.J -*#"1ticn 0---v-
C*zer':
.1d&ess:
w'b9.
PVone:
r u!.
L
ceneral
Pltnbin4
)!eclwniccl
a:rt.aT lo7nil
^D
Sanilot 1 se"tet ccp?ed =t prcperfu Lire
Septic totk pt::-ced a,d filled uith gratei
Pinal - i.lhen abcue itens ue ccnoletei
o:C uhen Tenclitiot is eatalete br s:z-;:-ttne noueC a:i tret:-)ses clbanei uc.
!.!cbi tcn2s
tsLocking otd. Set-up
Plunbing connecticns -- sal)er od, uc=er
Electical Ccnnection - Blcekit4, set-u,
and pluntbing cottneetions nr;st be cpptc,--ec
befor e request'Jng electrical insp ec:ior:
.4eeessa,.! tsuif,irnq
Pital - .!,ftar :crekes, ekirting, decT;,
etc. @e ccnpleled.
?zr'e 1 oi 2
?IIIAL ZLIC!?ICAL
*ALL !'lAllHcLEs AIID cLEA.ltcurs:lusr BE.lccESJrELZ, .4Dius?:!i:it ?o Ji:titz !.,? lto:,s? ?c cry
&7
l-t
Constptctic-n Lervier
T
lat Sq. Ftg.
1 cf Lct Cateraga
! of Stozles
?otal leiEht
lopogrqhg
:!3:t
PermLt fssu.oce
Meciuniccl Permit
SO LAR :Ess REQ.-
CtoJi:
f n4 dn?
_ Ir.terior
_ Cormer
_ Panhnrtile
_ Cul-<ie-sac
q<L-CO G+
Sigr"ed:
Mecha:nicol Permit
-ta lan.uAn Date
f HAW CA-RSFULLY IXLUINED thz completeC eppltcation foz, pernit, ai da
hereby cettify that aLL infotnation herecn is tmte anC ccrrecx, atr,C f
furthet: certiiy that ary ard aLL aork cerforned shall be done in accoz,-
danee w[th the Ordintnces of the Ciiy of Soi"ngfield, ani ;ha Laas of the
State of 0regcn per'b.zining to tke aork CescribeC herein, enC tilcc ll0 1CCU-
P/.!lCy LvLIL be ra.d.e of enA st"uctitle aithout permissiot of the Euiiding Dt-
oision. f futther =ertifE titct otlg ccntlecicts ad etplcyees ai"a cte in
ecepliance aith CRS 701.055 ttill be used on this aroject
JOB NO $b
Lot ?eces -
ieat
AecessD.iiouse
toxe+,
-- lees --
:('/a
!a!.4L i,t LaE
ani 7 <-
Reeel.pt #:
Building Volue & Permit
This perr,rt is granted on the e*p"ess eond.ition tlat the said-cona.trtc;ion
s?wLL', in ail r"espects, eonfcrrn xo the 3r*Lrnnce edopted iliy the City ci
Sptit",gfield, tnclluirng- ;he ioning Ct'dinanee, tegulctittg th.e ccnstr*eticn
*ra "Z'n oi butldings,- and nag be susperrieC or reuckei at o1! t.:ine titn !1-c-
1.at:.an cf any prcuisicns af saiC 0rd.ir'ances.
?uilding Pentnt
lotal lhangea
F5i
Reaid.mtial (i bath)
Seaer
Plumbing Permit
No pe?ecn shall constotct, instaL!, alter or eTunge c/-A nea ct etisti-t'.g
ptulnbina cr drainage syste-n in ahole oz' in pott, unless such person is the
iegal pbssessor of , ualid plmber's License, esce?t tl".at a perso1 naV Qo-ptinttlig aork to propertg uhich is ouned, Leased or aperated by the appli-
cdnt.
Plunbrng Petrit
1
ONau/Ezted Circaits
Sezlsice
lo. o o
oo
6 "oo
Electricol Permit
l{here State Lan requines that the eleetz'ical uork be done by an Electt'leal
Cont"dctor, the elictrtcal portion of thia permit shaLl not be ualiC until
the Label ias been signed by the Electz"tcal Conttactar.
Stcr.e
-'i;f U.1Dat
STUIS
Ezi'anst HooC
Vent ?at
'r/cotisio:se
-- :.tL;iAL:.,::L: - --
Petmit
raoaf Att^rtitfr ittd. a Ql",oo
l,lobila ilcne
Beitcons:
Stcteoe
|,tain-f.nntc
?en=e
Eleexz,iccl Label
?.cee'-l= !a" RESIIJENTIAL"
z.s ltorth stlr streeAP?LicAT
r0II /PERl4r!
SpmngfieLd, )regcn 97477
Eu1-LCLna DLtl-3LOn
726-3? 5"3
SPFlINGFIELD
B,P, 9-
tl?o
olr
2e
?r 5.7o
Daie: :"e/2-83
PLunbina
'az Sru ;r.Job iocaticn:
Aosesso,'e :!aDt \1 O3BSZI ;;;;OZlm
Bo**-zer:2
Ph!::226- 22Q..lC&ess.'
ci:y: .).2F, ?,aR zi.o: 2>'/ >?
Deseibe Hork:
//tfarrr-o / e--, a D €c, /tu,rl ar-
2/fFq €q,> Ptv4wz- /.YjcJt27€
Ar: k4*ce- J;Ye* rtS.t .F/P/D*,
? lsdr.veDt .
v
Vaiue fb,no
t-t )lqs
Date of App
t ) )-' t-' ^-
Licaticn 2-72j€ 3
General
Sani'-u1 seset eqned .t Wc?.!4- Li.e
Septic tank pliryed. ad. filLei lrith gratei
lindl - t'lhen abc"-e itens ee ccnaleyed
a.d xhen lencl)tion is eor=Le:e bt stt-,i:-
tuye eoueC arl =rat-.ses cleaned t=.
rcn2s
Pltnbing ccnnec-.lcns -- sare? el aater
Electr.Jcal Ccnneczion - Blcckin4, aet-r.
anC pilnbr!.ng ecnneeticns r;st be qptctec
be;'ore reques ting electrieal insi ee!'Jo;z
Accesec,'g Suililr4
Fittal - ,r,fter lcrckes, ekirting, iecZs,
etc. @e ccnele'.2C.
tsLocking ad Se;-'"tg
?:'-:a 1 oi 2
l,!eehct:iczL
f2d1f od ac^o'l' ana
It ia lhe responsibili:y of tl,e penri! holder to see ihat aLZ inspeetiotls @e nad,e at )he proper lrhte, thet "247 aiirc-ss is rea;ab1-ejrq tiu street, anC iiut the peyntt cail ie Lccaled at the fra$ of tl,e property.tSuilditq h;ti:iot- coVrw-ed plbn shcll yenain cn the tsuil<inng Site Zt aLL'tiines.-
?!?ociDuel?cR. ilspi7rcil.!iC!ESr.f4\ZZ*3769(yecpriey) state youz' City d,esigrtted iob nwtber, iob aiiress, type-9f ins?e,elicnre-quiiia-Zi u-iTtii aLLL ce "ecc! jor tns@crffifficturs oi a;ners r,aae Lra pnoi" tttnber.- -.?eque";s rcbei,;'ed b'efcre- 7:0C ;.i'-iZL be Fade :he sc.e Ccg, ?eouesxs ncie afta 7:00 an viLL be tade the ne.ct..nrking dag.
Eiig i.YSPttl:rl,t.' To be r,cie af'-er
*cauani,6; priar tc de! up of
fotns.
U\ID'PSL;.? ?IU:.!i I:IG. ZLJC:?T,1.L 1
n!5Ci!;.;!iC;L: To. ce ncde belote cny
wrK Ls ccrele|.
FCOT:iG 1 ?0U;tDA!:C:t: lo be na.ie
;F ; t "-"c;A- at -at c qs at e d ard.
forns cre erectai, aut p!-:cr to
pout4.r,g ccnc?eie.
;:;SULA!:'N /VAPCF 3.A.RRT|? i:ls?lc!rcil :
?o be naie after aLL insulaticn cd.
reauired uqor borie?s &e in olaeehft beJ'ore oty la.th, Wpsltn bcotC cr
unLL couering is coplied, ctd. before
d.A ;-nsulation is concealed.
tr
fA4 DRIYA.LL |JSPZCT|C:I: Tc be raCe
I Al tf:ar aLL ctyuall ,l.s ..Ln olace,
-
but prion to c:ny taping.
llr
il
u
a
I,l
I
U!19':RG2'U:!D ?'L'!.EI:;G, SIWP,'J.tT!3.
D?A.I;:AGE: io be r.z=e pr)at to ;'iL-Ifraii,:cies.
ullDEPlaCCP ?Lit!.9 t:lc ), !4!Ci!.n tI CAL :
@oi
f,oor inaukxian or Ceckrng.
POST AitD 3AAr,!: lo be ncCe ?!':o" to
insxa L Lcz'.cn o f i-Lcot,inauiaiicn or
decking,
EA!q-::4::-ic- ilz zll ijl LEil-ffiied-
until ;'nese '):^sce-c'-ict:s 'a.:ue leer
naie a"d. qprc:te!,
F!Pi?LACZ: -*)or ;.o plce:-,q fceingnccar.-als ard beiore ir*irg inspec-
!iov:.
FP-r-'lillC: lAtst be recuesteC cfler
aporov;L c1' rcugh plurbing, electr:-
cal 7 nechenica!. AL! rcoflrq
bracing 3 chinmcys, etc. nrtst be
. comole'-ed. llo ';crk is to be con-
. cec-Leci uiril ihis irsoecicn i"a.s
'been nede uti apato"-ed.
PT|IAL PLU:/3r:IC
PI;IAL :.!EC:!A:IICAL
=7tr^t:t:aaof,-.?
i4ASC!|i?!: Steel Location, bond
beans, gtouling oruetticcls in
accoriotce ,,nth U.ts.C. Section
2415.
'TCADS!31/7:
r-i .. -)
After instaLlation,)s
cup.B n .reppcAcl! .4?:2N: Ai.tet fotns7,eZ;*t;IAt@A to pa"u-:ng
coflcrete.
SDS'#.LX 4 DRf',TnA!: 7or aLL ecn-
7t"r; ?cu6G;ffi str.eet right-
oi'-';cg, tc be ncCe after aL! e*cc-
uatino cattolete I fom wrk ,? sub-
base rcter)al in pl-zce.
?l,IC9: 'lhen conolete -- Prouiie
@ii or notsable' secxians through
Dil?
ALL pro;ect eonii:ions, suci cs the i.nstallacian cf stz.eec:raes, :c-Vle-"icn cf z're
requineci Laniscccitcg, ctc, , rast be saxisiied before the tslJiiDfi:C ?!!"AL :cn 'ce reges;ed,.
PlilAL ilfLDi:l?: Tne Final Bu:.Uirg lnsoection ntst bo- requesced..i:er the ?!r-zL ?l-u.nbir-7
Eleettieal, otC ,'.leci"aniccl inscecttcns lara been nad,e atti ctctcued,.
'ALL !.lAiftiCLZS AilD CLZ;.itCtJ:S ilus? 38.1C!ES3:?!.I, ADJUS?::!::T !0 3t:.:'"t3,t!:t0::5? ?1 Cry
Conslrrclic-n_!gfrs!_
you? Citg' Destgra.ted. Job Nunber ,r, I 3 aG Vf,
tr
G)
SubCivisicn:
Sl.oe .
JOB NO SOLAR-JCESS REQ..
Crotc
?:ge 2
L-CO G*
,ecl20i2s:
Reeeipt #:
Sig:zei:
Electricol Permit
Were State La't tequiz,es tfu.t the electi.eal uork be done by an lTectrtcal
Contractor, the electr"tcal portion of this permit slwll not be uali-C. until
the Label has been signed bg the Electrtcal Cont actaz,.
Mechq nicol Permit
Pet*it issuance
Mecianiccl Pern|t
-f i!ouse
Lot ?eces -ee .\1. . '5.
iZ cf 1.ct Cc.retage
! oi Stor|es
_ Intet)or
_ Cormer
_ Pc.nhanuile
Cul-de-sacTcgogqT'4
-- Fzes --
Building Vqlue & Permit
This gennt is granted ott the eqress condition tl@t the said-constrtccion
slalL', in ail tZsoeeis, eonfcrn'to the \rdirwnce e.do.oteC 5:y the ci:1 of
Spt'ingfield, ::nclding ;he ioning Ctdinar.ce, reg.alctirtg th.e ccr.st:--tct')cn
anC use oi bu:-L,Lings, and ncy be ;ucaeruieC or reuckei at c'n! tine tpcn u't,c-
l.a.ticn af oty prcu.Jsions of sa"-C Cz:dir,cnces.
TaLue
f.zo
?TC .r
.,.o
AO
s.r.c. 1.5 c
aAfraf .rt?t.d
12-
Zuilding ?e"t?.,;
State
Plumbing Permit
Ilo perecn shall ca.stt"tct, instal!, altet ot change anA rea cz, e:isting
plutnbitq cr drainage systen in aiole or in part, unless such person is
Legal possessor of a ualid pLrtnber's License, e.cept tllat a petson nay
plvbing xork to prope"b! uhich is ortned, Leased or operated bg the app
cdflt.
Pl'anbing Penit
CARGEI:::I
-ri:;u.ae9
SesiizztiaL (1 bcth)
Seue"
tie
do
Li-
I:T)I ,,,.0..- ! ,\ Ja:
Pes. Sa. fle.
il -:zt / Ezt end. C itcui t s
lerocray Selice
?ttrtce ?TU'S
bhanst 1coC
Tent ?a,
7co<istoie
-- ::tc?.cAC::.:::!! --
t
2-/>-QS6A--
f HAW CARIFULU,X.Lt'lf.ilED t!"a conrpleted copLicaiion for permit, crti da
hereby eertify ila.t aLL ilfomatton h.erecn ls true ar-C. ecrreet, ar"7 i
furlket' celtifi lhat ang dr.d aLL uork >erfozned slalL be done in acecr-
dance vith the ?rd.inences of the City ol Sprtngiield, ani. ;he Lat;s of the
Sr.ate of Aregcn pefi:aining to the uork Ces*ibeC hereir., sd. :hr.t ]i0 CCC!-
Pl,llCI DiLi be ra.de of cnA scz,ttct,ry2 aith.out pernisaiol of the 3uiiCir.g D:--uision. I furiher :ertif'-i th.at o:tly ccntnactcr.s a;d e:,alcyees ah-o ee in
ccepliance u:.th CRS 70L.055 aiLL be used cn thia ptcject
Mobile ilone
4
Date
Sectzn)tu 1a:osi'"
Storzqe
i4alntacnce
Curbcu!
ETecvrical LcieL
-^raf .t.^tt\ta ^rr--I-!4.1J ^r-VCtil UUC.C=a(J.SiEned
?o'.al Changed
i?i:4
?o)cl. Acyces
State Swehztae
leaee
CIIY OF SPRINGFIETD
COMBINAIION APPTICAIION /PERA,IIT
INSPECII,-iN I,INE
7?63769 INFORMATION IINE
726-3753
Job Addres:+n
[ego I Description
ENERGY SOURCES:
Heot
Woler Heoter
Volue of &-New-Add-Aher-Rep.-.-Fence -Demo-Cho
ng"/ Ure
Sq. Ftg. Moin
Sq. Ftg. Access.
Sq. Ftg. Other
Address Pho ne Sin g le
Fom I Residence With
Bvilding Permit lnfo: Describe Work (i.e., Bui
Con Le
PhoneAddress
DESIGN TEAM (nome)(oddress)( lics.(expires)(phone
Pri
o nicol
I ru t3 't-oo i-73- g I
e
(o c-z--
Plum
Electricq I
Mechqnicol
PTTJMBING ETECTRICAT MECHANICAL
NO.7EE CHA.RGE NO.FEE Ne.FEE CHARGE
Eqch si fixture
Residence of
fr.
furnoce/burner lo
5
Relocored building
(new fix. oddirionol)
New circuits, olterqlions
or exlensions
Applionce vent
le
S.F. Residence
(l bolh)SERVICES
Sfotionory evop.
cooler
eo ch Tem Consiruction
Vent {on with
duct
Additionqi both
Vent system oport from
or A.C.
Woler rervice
Mechonicol exhqust
hood o
Sewer
Slorm Sewer FEEDERS Heot
Air hondler to
Air hondler over
'|CF/r4
ISSUANCE OF PERI*IT
TOTAT CHARGES TOTAT CHARGES TOTAI. CHARGES
WHERE STATE tAW REQUIRES thol the Electrical work be done by lhe Electrical Conlrqclo., the eleclricol portion of rhis permit sholl not be v.tlid untit a
label hor bmn signed by on Elactricol Controclor ond oltoched to the eleclricol ponel.
I HAVE CAREFULTY EXAMINED the completed opplicotion for permit, ond do hereby certify thot oll informotion hereon is true ond correct, ond I further
certify thot ony ond oll work p€rformed sholl be done in occordonce with the Ordinonces of the City of Springfield ond the Lsws of the Stote of Oregon
Bosis for Builder's Boord
NAME (pleose prinl)SIGNATURE DATE
3*Y -{ /
heron, ond thot only subco ndo reo NG oRsrhniroclo rs whoemployees complio
structure without the permislion of the Building Division. lfurtherof ony
required ORS 701.055, thot if exempt tha bosis for exemption is noted
will be used on this proiect,
pertoining to the work described herin, ond rhot NO OCCUPANCY will be mode
certlfy lhot my registrolion with the Euilder's Boord is in full force ond e+fect os I
rOR OFfICE UsE
Fire Zone-Bedrooms Occy Lood
-Sq
x Vo lue
x Vo lue
x
-Volue
FloodPloinslorie3-occyGroup-Sq.Ftg.o1her
Type/ Const.
-Units
Ftg, A,ccess
Zone Ftg, Moin
TOTAT YATUATION
s DevelopmentPlon Ck. Comm/lndBUITDING PERMIT
Chorges ond
Surchorges Plon Ck. Res
Demo Tolol Com
PTUMBING PERMIT
Chorges ond
Svrchorges
Sidewolk
PERMIT
Chorges ond
Surchorges
c
Curb Cut
MECHANICAT PERA{IT
Chorges ond
Surchorges TOTAT /5.bo
tn
COMBINATION APPLICATION/PE
l. .Appliconf. lo furnish
A. Job Address
r (cAP)
B. Legol Description
't . exomple-tox lot 100, Lone County Mop Reference 17 03 43
2. exomFie-Lot l. Block 3, 2nd Addition to Springfield Estotes
C. Nome, etc. of owner ond construction lender
D.. Energy Sources
l. exomple-heot/electricol ceiling,/or forced oir gos
2. exo mFIe-wo te TTEEGiTEIE-cI ri co I /or@-
E. Squore footoge or voluotion, etc.
'I . exomple-1250 sq. foot house,500 sq. foot goroge
2. ex"mFlE-iT new proiect, check-new-if oddition, check
odd, etc.
F. Building permit informotion:
1. exomple-construct single fomily house with on ottoched
goro9e
2. exomple-remodel existing goroge into fomily room
3. @-convert single fomily residence inlo
resiouronl (chonge of use)
G. Volue of work os defined in Section 303 (cr) of the
Struclurol Speciolty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction deloys, Building Division
Stoff must be oble to contoct oppropriote persons regording
ciesign informotion or iob site corrections, etc.
ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedules
A. Except where blonk spoces occur in the description portion
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. Fuil Plumbing, Mechonicol, ond Electricol Schedules
ore ovoiloble ot the Building Division
'l . To conserve spoce on lhe permit form the schedules :
hove been obbrevioted
2. if the item(s) to be instolled ore not covered on the obbrevi-
. oted schedules you should consult the full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
lll. Appliconl to sign ond dote
Whenever possible, the initiol opplicotion will be used os o
worksheet only. Where possible, Building Division Sroff will
prepore o lypewritten copy ond return it to the opplicont ot
the time the ocluol permit is issued for his signolure.
lV. Fees ond Chorges
Plon check fees ore due ond poyoble ot the time of the opplicotion,
ond no plons will be processed until these fees ore poid. All
other fees ond chorges ore due ond poyoble when the permit
is issued.
V. FOR OFFICE USE ONLY
V PERMiT VALIDAITON
Permit Clerk
PROJECT CONDITIONS TO BE SAIISFIED BEFORE OCCUPANCY,
,Additional Proiect lnformotion:
nome signoture dote
PLANS REVIEWED BY:
INSPECTINN tINE
72U37 69
CIIY OF SPRINGFIETD
COMEINAIION APPTICAIION/PERMTI
INFORMATION !INE
7263753
ENERGY SOURCES:
Hcot
-
5q. Ftg. Moin
Job Sq. Ftg. Accesr.
Woter Heoter Sq. Frg, Olher
-
-New-Add-Alter-ReP.
Legol Dercription
Volue of oc)-Demo-Chongt/
Ute
Owner
Addresr Phone
Building Permit lnfo: Dercribe Work (i.e., Build Single
Fomily Residence With Attoched C:fgg").
,I
i 1 I
Addresr Phone
OESIGN TEAM (nome)(oddres:)(lics. no.)(ex (phone no.)
Prim
rol
Electrico I
CONTRACIORS
(I l3Lt o -(:'LCe i-23- { I /-t 7
Plu
Electrico I
Mechonicol
PTUMBING ETECTRICAT MECHANICAL
NO. i 7EE CHARGE NO,I FEE CHARGE NO.FEE CHARGE
Eoch ringle fixture
Residence of
fr.
{urnoce/burner lo
-_BTU'S
Relocoted building
(new Iix- odditionol)
New circuiis, olterotions
or exlensions
Applionce venf
5eporo re
S.F. Residence
(l both)SERVICES
Stotionory evop.
cooler
Duplex (l both) cqch Temporory Consrruclion
Vent fon with
single duct
Additionoi both Ampr.
Venl lyitem oporl from
heoting or A.C.
Wqler terYice
Mechonicol exhoust
hood ond duct
Sewer Wood siove/heoler 5()c)
Storm Sewer FEEDERS Heol Pump
Ampr.
Air hondler to
I0,000 cFM
Air hondler over
r0.000 crM
ISSUANCE OF PERMII a)
TOTAL CHARGES TOTAT CHARGES TOTAI. CHARGES /5,od
WHERE STAIE tAW REQUIRES rhot thc Elcctricql
lobel hos bxn rigned by on €lectricol Controctor
work be done by the Ete<tricol Controclo.. thc clcclricol portion of this permit sholl not be volid until o
ond ottoched to the electricol ponel.
HA'VE CARETUTT Y EXAMI N ED the completed opplicotion for Perm t,ond do hereby certify thot o tl tn formqtion hereon t3 lrue o nd co a rect,nd further
rertify lhot ony ond oll work performed sholl be done n occordo nce with the Ordinonces of rhe City of Springfield ond lhe Lows of lhe Stote of Oregon
pertoi n ng to the work de scribed herin, ond thot NO OCCU PANCY will be mo de of ony
required
structure withoui the permis:io n of the Building Division.further
cerllly tho t registtorion rh lhe Builde r'5 Eoord s tn fu I force ond effect o ORS 70 .055,thot if exe m Pt lhe bo 5t 5 for exemption t:notedmy
ho ln rh o RS will be u*d on ,his proiect.he ron,nd thot nly rubconlroclors ond ore
Eoris for Euilder's Boord a
c 3-Y -{ t
NA,|'{E (pleose prinr)ATURE DATE
FOR OFFICE USE L
Zone
-TypelConst. -Unirs
----Sq. Ftg' Moin a
---=-Voluex Volue
1-Volue
TOTAT VATUATION
Fire Zone-Bedrooms occy Lood Sq' Ftg' Acce:s
Flood Ploin Group-Sq. Ftg. Other-
BUILDING PERMIT
Chorges ond
Surchorges
Plqn Ck. Comm/lnd
6596i Blds Per Fee
Sy5tems Developmeni
Chorqe (1.5?t )
Plon Ck. Res
3O%/Bldg Per Fee
PLUMEING PERMIT
Chorge: ond
Surchorges
Fence
Demo Totol Comb. Permit
ETECTRICAI- PERMII
Chorger ond
Surchorger
Sidewolk
A/C Pqvino
MECHANICAT PERMIT
Chorger ond
Surchorges
Curb Cut
TOTAI./s bo
Mechonicol
(oddress)(lics. no.)(expire:) (phone no.)
employees complionce
/5, OC)--- in7l--
coMBTNAI|ON AppUcATtON/pr tT (cAp)
, Appliconf. to furnish
A. Job Address
B. Legol Descriprionl. exomple-tox lot .l 00, -Lone .Counly Mop Reference l7 .o3 /32. exomple-Lor l. Block 3, 2nd Addition ro Springfield EstC. Nome, etc. of owner ond construction lender (.
D. Energy Sources
lectricol ceili
2 ler ecl col
or forced oir oos/. +,'or solor
E. Sguore foologe or vol uotion, etc.I. exomple-.1,250 rq. foot house, 500 sg. foot goroge2. ex.ompie-if new proiect, checkiEi-ii oddition, ciheckodd, etc.
F. Building permit informorion:l. exomple-construct single fomily house with on oltochegoroge
2. exomple-remodel existing goroge into fomily room3. exo;pG-convert single fIr;ily iesidence into
restouront (chonge of use)
G. Volue of work os defined in Section 303 (o) of theStructurol Specioity Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or consrruction deloys, Building DivisionSloff must be oble to contoct oppropriote p.rrJn, regordidesign informotion or [ob site iorrections, etc.
ll. Abbreviored Plumbing, Mechonicor & Erectricor schedules
A. Except where blonk spoces occur in the description portict
of fhe Mechonicol ond Electricol Schedules, the oppiicont
need fill-in only the No. Boxes odiocent to the oppropriotr
item(s) to be insrolled
B. Full Plumbing, Mechonicol, ond Elecrricol Schedules
ore ovoiloble ot the Building Divisionl. To conserve spoce on the permit form the schedules
hove been obbrevioted
2. tf the item(s) to be instolled ore not covered on the obl. oted schedules you should consult the full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
lll. Applicont to sign ond dore
Whenever possible. the initiol opplicotion will be used os oworksheet only. Where possible, 'Building Division Sroff willprepare o. typewn.tten copy ond return it to lhe opplicont otthe time the octuol permit is issued for his signotuie.
lV. Fees ond Chorges
CITY OF SPRINGFIELD
Ciry Holl
Springfield, Oregon
Deportment ol Public Works
OFFICIAT RECEIPT
PERMIT VALIDATION
No.B 55964,
I9
Rec'd F
dress
R eceived For
(
/t
Amount Received
BY
ZEO SIGNATURE
5HE!rON.tutx!u!L "irNyEiS EUGEnt Oi graot !6rrr.6
V
Plon check fees ore due ond poyoble ot the time of the opplirond no plons will be processed until these fees ore poid. alt f_other fees ond chorges ore due ond poyoble when ihe permit
is issued.
FOR OFFICE USE ONLY Permit Clerk
PROJECT CONDTTIONS TO BE SAIISFIED BEFORE OCCUPANCY:
,Additionol Proiect lnformqtion:
nome signoture dole
PLANS REVIEWED BY:
(
I
(
(
(