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Home My WebLink AboutPermit Building 1985-03-19I NSPECT I O 726-37 69 COHB I I CAT RMIT 7 Job Address Legal Description I i-l Hea Ranqe EIIERGY SOURCES l,later Heater o*n"" WoBrz- ( x*ttt d k*x !-afuf-of llork: 7)*.oa .l'lain_ Sq. Ftg. Access._ Sq. Ftg. Other_ _t{ewJdd_A1 ter_Pep. _Fence Demo Change/ Use 0ther Address Phone Builciir Fami I y ng Perm i t I nfo : Descri be l,lork ( Residence llith Attached Garaqd .e., Build Single 2/&%vr € Construction Lender Addres s Phone s $ N DESIGN TEAI.I name address I ics . no.exD l res ghone no. Pri ma ry Structura l Hechani cal n ame addres s 'lics- no-'l pxnl rPs ohone no. umbi El ectrical Ittechani cal PLUIIBI NG ELECTR I CAL MECHAN I CAL N0.FEE CHARGE NO FFF .HAAGF I'10 FFF CHARGF (Each single fixture /a*Res'i dence of FTSQ furnace/burner to BTU' S Relocated building (new fix. additional ) New ci rcui ts al ts. or extensions Floor furnace and vent F. Residence bath )SERV I CES Recessed wal I SDace heater and vpnt Ouplex (l bath) each Additional bath Temporary Construct i on Apol iance vent sPDa ra t-e [.later servi ce Change in existing res i dencp Stationary evap. cool er Sewer multifamily, conrn. or Indrrstrial Vent fan with sinole duct Storm Sewer 0f Vent syster,n apart from heatino or A.C. COMI.I./IND. FEEDERS Mechanicai exhaust hood and duct Instal I /al ter/rel ocate di stri b^ fppders l'Jood stove/heater 0f amp s" ISSUANCT OF PFRI.IIT /o.QTOTAL CHARGES TOTAL CHARGES IOTAL CHARGES I.IHERE STATE L..1tl REQUIRES that tlre 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 I HAVE CAREFULLY EXAI1INED the completed apnlication for oermit, and do hereb.v certify that all information hereon is true and correct, and I further certify that any and all work oerformed shall be done in accordance with the 0rdinances of the Cityof Springfield and the Laws of the State of 0regon oertaining to the work described herein, and that N0 0CCUPAI,ICY will be madeof any structure without the permission of the Building Division. I further certify that my registration vrith 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 ernployees who are in comcliance with 0l?S 7n1.055 wil'l be used on this project. r,rAr.,rE(prease r,,,r,Zl rtln lZl! /E n c/ <r S IGNA Fire Zone Bedrooms 0ccy Load Sq. Ftg. Acces Value Val ue Value TOTAL VALUATI xFlood Plain Stori ES Uni t s So. Ftg. t'lai FtgGroup Zone___TyDe/ Const 0ther Plan Ck. Conrn/Ind 651"lB1do Ppr Fpp s 0 1 57BUILDING PERMIT Charges and Su rcha rges ___z_a_./2 Plan Ck. Res 30%/81dq Per Fee Fence DSmo PLUI,IBING PERMIT Charges and Surcha rges 4D( Sidewal k A/C Paving Tota'l Cornb. Permit ELECTRICAL PERIIIT Charges and Surcha rges Curb Cut 3752I{ECHANICAL PERMIT Charges and Surcharges TOTAL El ectni cal COMBINATION APPLICATiON/PERMIT (CAP) I. Applicant to furnish A. Job AddressB. Legal Description I. example- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lenderD. Energy Sources PERI.4IT VALI DATION 1. example-2. exampl e- E. Square footag hea t/'I al wa e or e or valuat on, etc F 1. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check new - if addition, check add, etc. Bui lding permit information : I examp I e a ttac hed - construct single family house with an ga rage 2. example - remodel existing garage into family room3, example - convert single family residence into restaurant (change of use)G. Value of work as defined in Section 303 (a) of the Structural Specialty CodeH. DESIGN TEANI AND CONTRACTORS To avoid design or construction delays, Building D'ivision Staff must be able to contact appropriate persons regarding design information or job site corrections, etc. Abbreviated Plumbing, Mechanicai, & Electrica'l SchedulesA. 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 instailedB. Full Plumbing, Mechanical, and Electrical Schedu'les 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 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 deljvered to theelectrical contractor for signature by his electricalsupervisor. The generai contractor is not authorizedto sign the electrical label Applicant to sign and date }Jhenever possibie, the initial application wil l be used as a worksheet only. t,lhere possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actuai permit is issued for his s ignature. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans will be processed until these fees are paid. All other fees and charges are due andpayable when the permit is issued. II III IV V. FOR OFFICE USE ONLY Permi t Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY name i gnature dat " VZf€ il SPECT I 6-3769 LiIiE CoHBI iIATI Crl :.PPL ICAIIoNZFERHII 726-31 Lega I Descr.i pti on Job Address Ranqe llater Heater E!IERGY SOURCES Hea t 0wner lgl-uq-pf l{ork: _/Jc?, oo Access...- 0ther l{ew Add I ter--IeD. - Cha nge/ Use Sq. Ftq Sq. Ftg .Ftq Address Phone Builcii Fami I y nq Pennit Info: Res'i dence l,li th Descri t Attacher l^lo rk .e., Bui ld Single 2/&Zvr &D 5t*? Addre s s Phone lw \ $ \ 0\ DESIGN TEAI,name a06 reS S tcs. no.cxn'res (phone no. ) Pri mary Structura l El ectri ca I llechani ca I address I i cs. no.(PXnr rpq (ohonp nn PLUIIB I NG MECHANICAL FEE CHARGF N0.FFF rHA PCF NO FFF CHAPGF (Each single fixture /e*Residence cf SQ. FT furnace/burner to BTU' S Relocated buildino (new fix. additional)New circuits alts or extensions Floor furnace and vent S.F. Residence ( l batn)SERV ICES Recessed wal I Duplex (1 bath) each Additional bath Temporar-v Constructi on Apol iance vent sepa ra te [.later servi ce Chance in existing res -j ::nce Stationary evao cooler Sewer mul ti--::i iy, conrn. or indus:r: al Vent fan with si nol e duct Storm Sewer 0f amps.Vent systern apart from heatinq or A.C. COT,IH,,' ::I]. FEEDERS Mechanical exhaust hood and ductInstal I ..al ter/re l ocate di str'':. 'reders l'Jood stove/heater 0f ISSUANCE OF PFRI1JT TOTAL CHARGES /o.a TOTAL CIli::iiS TOTAL CHARGES I/HERE STATE '.11.,l REQUIRES that the Electrical worr :e ocne by an E1shall not be vali'l until the Iabel has been signed by:n liectricil su ectrical Contractor, the electrical portion of this permitpervisor and returned to the Building Divis.ion a/ - // c4 r--l l{Al.lE(please print r r/h rirr s fy Ci ty made ngfi e struc 0reg .he Bt the permi and effect f exemp .055 wi EXAM NE c at iorctleted t9erm r and docomp rtce th at a rmatfoap r)hereby hereoon n s trueandrrecc0tandcertifu rther t tha an d a herfyany lerfo sharmed donbe e accon rd an WIce tth he nances0rdi 0 f theofSorianddethofLawsstheota te nt nonfDe r:3 tht0 wo krg cr'ldes herebed n thand NC w1OCCUPAI'ICY beoftureanywlthoulonsf0LulconslfucertherrtthatsfytratvnontthBuiheder smyregrdBoasnfuforcesared0Rsrequi55thatbybasforstionthetthaandnotedShereon texemponsubcovntractorsandemPawhorerioyeesance0esth7oc0mDbeusedthntecproj Flood Plain Stories_ 0cc.y Grouo Sq. Ftg Fi F . 0ther Fire Zone Bedrooms_ 0c cy Load_ lueZone_Type/ Cons t. lue ToTAL VALUATI0N_ Val ue ts So. Ftg. l,la i n x Va Ftg. Access Pl an C k. :lilr/ I nd 65%/8ldq t:. Fee rqe (1.52Svs CIa terns Deve opmentBUILDING PERNIT Charges and Surcha rges ./2 Plan Ck. ies 30%/B.ldo :?r Fee FencePLUI4BING PERMIT Charges and Surcha rges EO ee( Dgmo SidewalkELECTRICAL PERIIIT Charges and Surcha rges A/C Paving Total Comb. Permit Curb CutI,IECHANICAL PERMIT Charges and Surc harges TOTAL 3752 ELECTR ICAL Snace hpetor:nd rroni Uni ___<_a_ L .ITY OF SPRINGFIELD \ Clty Hall v Spilngfield, Orcgon Dcpartmenl ol Public Workr OFFICIAL RECEIPT No.B For ( COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 43 ?. elqmple- Lot l. Block 3, 2nd Addition toSliTffiield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources 1. example- heat/electrical ceilinq/or forced air q2. exampTe- wa terhEJIETTElETiJcaTor so-TaF-E. Square footage or valuationl eEil- 1. example- 1250 sq. foot house, 500 sq. foot garag?. example- if new project, check-new - if addition check add, etc.F. Building permit information:1. example - construct single family house with anattached garage ?. exampie - remodel existing garage into family ro3. example - convert single family residence intorestaurant (change of use)G. Value of work as defined.in Section 303 (a) of the. Structural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid des'ign or construction delays, Building0ivision Staff must be able to contact appropr.iitepers0ns regarding design informatjon or job sitecorrections, etc.II. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descript.ionportion of the Mechanical and Electrical Schedules,the app)icant need fill-in only the No. Boxes adjaiert0 the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electr.ica'l Schedulesare available at the Building Div.ision1. To conserve space on the permit form the schedulr have been abbreviated2. If the item(s) to be installed are not covered orthe abbreviated schedules you should consuit thefui I schedulesC. BUILDING DIVISION STAFF HILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES0. As noted on the CAP, the label must be detivered to theelectricai contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical label.Applicant to sign and date Hhenever possibie, 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 hissi gnature. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no pians will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY ( ( 64404 Rec'd From Address ( P-7 /6.@ (. B 2&-e( ( ( ( (. /z* Amount Received Permit Clerk fuEr ^,,",rr"c FoEMa ,N. rsotr?.2-nltq )- III. IV. v PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit appl'icant exempt from reg'istration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: datenamesignature CTION LINE 769 COHBI NATION APPL ICATIONIPERMIT R}IA 72 Job Address /{ /L/ { Legal Description llater Heater Ranqe EIIERGY SOURCES: Hea t Owner of a4 Sq. Ftq. Access.--- So. Ftg. Other_ _l'lew_Ad d_A 1 te r_Re p . _Fen c e_Demo_C ha nge/ U se 0ther . Ft9.in Addres s 3r l,lork ng e Constructi on Lender Addres s Phone \ Y name a Pri ma Structura l El ectri cal Mechani cal 7 lFtz *,] PI '--2-2,-t - 12 a'f,s8<- -> PLUI{BI NG ELECTR I CAL MECHAN ICAL Each single fixture Residence of FTSQ furnace/burner to BTU' s Re oca buted di ng ona New circuits altsor extensions Floor furnace and vent . Residence SERV I CES Recessed wa l I Duplex (1 bath) each Additional bath Temporary Constructi on Apol iance vent l^later servi ce Change in existing Stati onar-v evap. Sewer mult'i family, comrn or Vent fan th Storm 0f Vent systern apart from A COMI'I./IND. FEEDERS exhau stnca Instal I /al ter/rel ocate l'lood stove/heater 0f ISSUANCE OF PFRI,IIT TOTAL CHARGES TOTAL CHARGES )0 TOTAL CHARGES WHERE STATE LAl,l REQUIRES that the Electrical workshall nor be valid until the label has been signed by be done by an Electri ' an Electrical Contractor, the electrical portion of this permit ca1 Supervisor and returned to the Building Division tlAllE(please print r IGNA'7 and of of Boa onl oermi t rfo rmed Ci ty made0reg the B exempt 055 wi l etedchetED c at 0nompap doand here certi ttha al-)t no hereon ts rueb.y fytcorrecandfurrthecerttahatandaworkfynyshabenedon ncaccorda wle t hpe the 0rd nances theofrfidndaSpngLawsthetheofteStaofonrtanttoethkworrdescbednhereindngathaNCwlOCCUPANCYDEbestrucretutwlhoutthermlss0nfanyudnpeDs0ncertfurtherithasstrf,a o v,ln ht Buthe der sfyregm.yrdsnfuforcendaecteff,ca red 0 RS 7requ 0 505 tha t f ba fo rtheby ex on s n0 ted hereon tha tandempt ibcontracsuvandtorswhoareempoyeesancetwlh011s701ubecomDonsedths ectproj ts Sq. Ftg. l4ain_ x Value x lte qcFtg. Acce Con s t.Zone Fire Zone Bedrooms 0ccy Load Value Flood Plain Stories TOTAL VALUATION-- Group Sq. Ftg. 0ther x Val Pl an Ck. Comn,/ Ind 65%/B1do Per Fee Svstems Deve' Charqe (1.5q'opmmtBUILDING PERMIT Charges and Surcharges 3- /_4A N Fee Plan Ck. Res 30%/Bldo Per FencePLUI4BING PERMIT Charges and Surcha rges Demo SidewalkELECTRICP,L PERI|IT Charges and Surcharges 0 A/C Paving Total Comb. Permit Curb CutI,IECHANICAL PERMIT Charges and Surcharges /s{OFlo7t\L/5rry n (new fix. additi r) COMBINATION APPLICATION/PERMIT ( CAP)PERMIT VALIDATION I Appl icant to furnish A. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot 1. Block 3, 2nd Addition to SEiin-ETi ei d Estates C. Name, etc. of owner and construction lenderD. Energy Sources M bqa?-r W a 27 1. exampi e-2, example- E. Square footag heat/eiectrical ceiIi forced air gas wa ea e EC r ca or solar or valuati 0n, e II 1. example- 1250 sq. foot house, 500 sq. foot garage 2. 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 single family residence into restaurant (change of use)G. Value of work as defined in Section 303 (a) of the Structural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction de)ays, Building Division Staff must be able to contact appropriate persons regarding design information or job site corrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occulin the descriptionportion of the Mechanicai and Electrical Schedules, B the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedFull Plumbing, Mechanical, and Electrical Scheduies are available at the Building Division1. To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be instal'led are not covered on the abbreviated schedules you should consult theful l schedul esC. BUILDING DIVISION STAFF IlIiLL 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 contractolis.not authorized III to sign the electrical label Appiicant to sign and date }Jhenever possible, the initial application will be used asa worksheet only. Hhere possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actuai permit is jssued for his signature.IV. Fees and Charges PIan check fees are due and payable at the time of theapplication, and no plans will be processed until these fees are paid. All other fees and charges are due andpayable when the perm'it is issued. V. FOR OFFICE USE ONLY Permi t Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from reg'istration with the Bujlder's Board because: Additional Project Information: PLANS REVIEWED BY: name S'I gnature date .. P quired ln spec t? .-1s .. IT IS THE RESPONSIB]LITY OF TIIE PER}4IT HOLDER TO SEE THAT ALL INSPECTIONS ARE MADE AT TI{E PROPER TII.{E,THAT EACII ADDRESS IS READABLE FRO}T T}JE STREET, AND THAT T}IE PER},TIT CARD IS LOCATED AT TIIE FRONT OF THEPROPERTY. BUILDING DIVISION APPP.OVED PLANS MUST BE ON JOB SITE AT ALL TI}IES. PROCEDURE FOR REQUESTING IIISPECTIONS: Ca11 726-3769 (recorder) state you CIIY DESIGNATED JOB NIIMBER,job address, type of inspection requested and vrhen yorr will be ready for the inspection. Contractorsor orrners name and phone number. Requests received before 7:00 am,will be nade the same day, requestsreceived after 7:00-am ',rill be nade fhe fo1lowing work day. Your City Designated Job Number Is:84o946uJob Address Ovrner a Contractor:L SITE INSPECTI0N: To be made after excavation, but prior to setup cf fcrns. IjNDERSLAB PLIJ}.IBING, ELECTRICAL & IIECHANICAL: Tc be nade befcre ;nyl"ork-il-covered. CONCRETE SLAB INSPECTION: To be nade after all inslab building service equipnent, conduit, piping, accessories and other ancillary equipment items are in place but before any concrete is poured, FOOTINGS & FOUNDATICNS: To be made after trenches are excavated and forms are erected, all steel in place, but prior to pouring concrete LJI,IDERGROUND: Plumbing, Electrical, Gas, Sanitary Sewer, Storm Sewer, Water and Drainage Iines. To be made prior to covering or filling trenches. LJNDERFLOOR:, Plumbing, Electrical, Mechanical, To be rnade prior to installation of floor insulation, decking or floor sheathing. C,U Phone:7/6-7bq/ 7A-( - ROb?.Phone: ATTIC DRAFT STOPS G CURTAIN WALLS FIREPI-ACE: Prior to placing facing rnaterials and before frarning i inspection, INSULP.TION E VAPOR BARRIER: To be nade after all insulation and required vapor barriers are in place but before any lath or gypsurn board interior waI1 covering is applied. FRAMING: To be made after the roof, ElTEning, fire blocking and bracing are in place and all pipes, chimneys and vents are conplete and the rough electrical, plumbing and heating wires, pipes and ducts are approved. FIRE & SEPARATIoN WALL: Located u ccnstructeC according to plans, 4l! 4N!/!R GYPqUM B0ARD rNSpECrroN To be made after all lathing and g)?sum board, interior and exterior, is in place but before any plast is applied or before gypsum boardjoints and fasteners are taped and finished. hrooDSToVES: After installation is Ei;l,piet;a SIDEWALK & DRIVEWAY Required for all concrete paving within street right-of-way, to be made after all excavating conplete G form work & sub-base material in p1ace, CURB AND APPROACH APRON: After foms @pouring concrete. PARKING LoT: After gravel is in place but prior to placing asphalt or concrete. In accordance wi the Building Code a special be enployed by the Owner/ ng construction of the A copy of the special shall be furnished to the on. on 306 inspector shall ntractor duri fcllowing work ing reports ding Divisi tr K STRUCTURAL C0NCRETE: In excess of 3000 P.S.I. (306 a.1) ETRUCTURAL IIIELDS: Preforned on the job. (2722 f) HIGH STRENGTH BOLTING: During all - Eol t-Es6lfi;E;-ana tigt t ing operations (306 a.5) SPRAYED ON FIREPROOFING@ (u. B. c. SPECIAL GRADING EXCAVATION ,AND a.11 E-effi:ter GLU-LAM B.EAI-{S: lnspection Certificate, by an approved agency, furnished to the City's Building Division before beams are placed. (2501-U.B.C. STDS. 2s-10,11) . x In addition to the inspections specified hereon, the Building Official :nay make or require other inspections of any construction work to ascertain conpliance with the Building, City or Zoning Codes During 2s) POST & BEAM: lnstalG;lon To be made pricr to of floor insulation, tr decking or floor shdating, FLOCR INSULATION G VAPOR BARRIERS To be made prior to installetion of decking or flcor sheating. MASONRY: Steel location, bond beams Eioutl-ng or verticals in accordance with U.B,C. Secticn 2415. ROOF SI{EATHING A}lD NAILING: Prior to installing any roofing. Ro uGH P LUMB r N c, (flcr n r m l--)E, MECIIANCIAL: No h;Ftr=I-o- be covered untiL these inspections have been made and approved. FINAL PLUMBING FINAL ELECTRICAL FINAL I{ECHANICAL FINAL FIRE DEPARTME}IT CITYTS SITE PLAN RE\IIEW BOARD INSPECTION: Must be requested 2 days in advance of the date you suchas1andscaping,parking1otstripingetc.must be completed before requesting this inspection. fU FINAL BUILDING: Must be requesteC after the final Plumbing, Electrical, l,,lechanical and Fire lA Scpartrnentlnspections are nade and approved. No occupanc!-of the preni-ses can be made until a Certificate of Occupancy has been issued by the Building Divisicn and posted on the prernises ,n*'7 .,1 27. 1rA)'SI tr *ALL IIINHOLES AND CLEANoUTS I,UST BE ACCESSIBLE, ADJUSTN{ENT TO BE I{ADE AT No CoST TO THE CITY L NE CITY OF SPRINGFIELD COMBI NATION APPLICATION/PERMIT Job Address EIIERGY SOURCES: Hea llater Heater Ran Sq. Fto. l.lain_ Sq. Ftg. Access._ Sq. Ftq 0ther llew Add Al ter_Rep. -Fe nce_Demo Change/Use -0t her P 7I r-esa1 Description n 6 3 3S ?tl 14? O O ,Value of l,lork: Owne Addre ft,.Phone t Des Farn i Ga :e., Build Single "5ntrt r\ .ffGloFrs\, construct\in \noer \ Phone \: name address I ics. no.exDt res Pri mary Structura I E l ectri cal Hechani cai na!]re addres s I ics- no.exDl res ohone no. Genera I Plumbinq , hani PI-UHBIIIG ELECTR I CAL I,,1ECHAN I CAL FFF CHARGE NN FFF . HA ACF NO FFF CHARGF Each single fixture furnace/burner to BTU' s Relocated buiiding (new fix. additional) New circuits alts. or extens i ons Floor furnace and vent S . F. P.es i dence ( l bath)SERV i CES Recessed wal I Snace heater and vent Duplex (1 bath) each Additional bath I Temporary Construction l0,o.,Apol iance vent seDarate [,later servi ce Change in existing rec i dpncp Stati onar-v evap. cool er Sewer multjfami1y, comrn. or Industrial Vent fan with sinole duct Storm Sewer 0f (Vent system heatinq or A apart from ,. c. COMH./IND. FEEDERS Mechani ca l exhaust hood and duct- I n sta I I /a I ter/ re1 ocate di<trih fpcders !'lood stove/heater 0f i ISSUANCE OF PFRI.IIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L1\ll REQUIRES that the Electrical work be done by an Electrical Contractor, the e shall not be vali,l until the label has been signed by an Electrical Supervisor and returned to t 'lectrical portion of this permit he Bui1ding Division completed apnlication for oermjt,certify that all information hereon s true and correct a nd I fu rthe r ce rt 'I fy t ha t any and all te of 0regon n of the BuiI work oerfo rmed sh a I I be do ne 'I n a cc orda nce wt th t he 0rd 'I n ances of t he C I ty of Spri anyrdi ysu ng f '|e 'I d and the Laws f the S ta DE r ta 'I n 'I n s to the wor k de sc r 1 bed h ere 'I and th at NC OCCUPAI'ICY wl I I be mad e s tructure without the permi.in full force and effect SS ,l d 'I ng Di I S 'I on I fu r ther c ert I fy th at my reg I s tra ti on v,l th t he Bu I I de r s Boa s as req u 'I red by ORS 701 0s5 tha t 'I f exempt the ba s 'I s for exemp t 'I on I noted he reon and tha t o n I bc ontractors I 0yee s who qe I f [oo n comp 'I 1 a.oce wl th 0us 7t)1 055 wl I I o n th 'I proj CC t I I /ao t'lAl'tE(please pri S IGNAT TE .\-/ t- Zone T'YPe/ Cons t Uni ts Ftt: Ftg Ftg l4ain x Val Fire Zone Bedrooms Flood Plain Stories Load Sq.Access x other x Val ue Occ,y Group Sq Val TOTAL VALUATION BUILDING PERI{IT Charges and Surcharges Plan Ck. Conrn/Ind 65"1/81rlo Ppr Fee terns opmeo 57 Plan Ck. Res 30%/Bldq Per Fee PLUI.IBING PERMIT Charges and Surcha rges Fence D6mo I :GS ELECTRICAL PERI|IT Charges and Surcha rges OO Sidewal k A/C Paving Total Comb. Permit I,IECHANICAL PERMIT Charges and Surc harges Curb Cut TOTAL \ti.t."o Addres s Residence of s0. FT. U s .r20I COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description1. example- Tax Lot 100, Lane County 17 03 432. example- Lot 1. Block 3, 2nd AdditSpringfield EstatesC. Name, etc. of owner and construction ID. Energy Sources 1. example- heat/qleqtlllqL ceiIing/o2. examile- waterhearEiTETeEtrJciTorE. Square footage or valuation,GTE- PERMIT VALIDATION Map Reference ion to ender r forced alr gas CO,:glsr. 1. example- 1?-50 sq. foot house, 500 sq. foot garage2. example- if new project, checklEw - if additio;, check add, etc.F. Building permit .information: 1. example - construct single family house with anattached garage ?. examp]e - remodel existing garage into fami ly room3. example - convert single family residence iniorestaurant (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 construct.ion delays, BuildingDivision Staff must be able to contatt appropriitepersons regarding design information or job sitecorrections, etc.II. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blink spaces ociu. in the description--portion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjaient - to the appropriate .item(s) to be installedB. Full Plumbing, Mechanical, and E)ectrical Schedulesare avaiiable 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 thefull schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES0. As noted on the CAp, the label must be deljvered to theelectrical contractor for signature by his electricalsupervisor. The general contractor ii not authorizedto sign the electricai labelIII. Applicant to sign and date Hhenever possible, the.in.i tial application wil.l be used asa.worksheet only. Where possibie, Bu.ilding Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued io" frlssignature.IV. Fees and Charges Plan check fees are due and payable at the t.ime of theapplication, and no plans wiji'be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued. V. FOR OFFICE USE ONLY \q ,T \y Permi t Cl er PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: name S1 g na tu re date \ t- '.{-- )u-) a FIRE DAI4AGE REPORT OR ELECTRICAL HAZARD sb/-0 716 Building Department Sori ngfi el d Fi re Oepartnent Structural Damage to Bui'ld'ing DATE: 12-18-BL TO: FR0r'1: SUBJECT: Address or locat'ion of buildinq 315 N 9th Street spfd. Itlamg of o'r/ner rahrn,t- p. T,ogpn Attorwrenrs Type of building Offlees Es t'imated va I ue of bu'i 'ldi ng Estimated I oss to bui lding Date of fire I2-18-Bl (Dwel 1ing, Store, l.larehouse, etc. ) s s Location or damage in building Wal1s Floors, tnterlor (Rcof , h/a'l i, Exterior, Interior, etc. ) Structural weakness as a result of the fire Errrnod f'!oanr. {n{sts and studs (Burned raf ters, Beams , "loi sts, etc. ) Addi ti onal oe rti nent i nforma t,'on Bu:med electrical rrlrelng El ectri ca'l l{azard (l,Jirjnq, 0Utlets, etc. ) S i qneo D