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Home My WebLink AboutPermit Building 1980-12-16ii\-Teg- -'- coMBIIIATIoN APPLICATIoN/PERMIT INFORI,IATJON LINL 7?6-3753 l-egal Description Job Address llater Heater Ranqe -- EIIERGY SOURCES: Heat Tc^x ao* 4Ao I Sq. Fto. l'1ain_ 5q. Ftg. Access.=- Sq. Fto. 0ther-- Use Owner F,rhnrr/ (thgc.ltt t I I on Value of l,lork:30o,o9 Address loq.q At, 6U .=hool Phoae 729 -Quil!ing Permit Info: Describe Vlork( FarniIy Residence tlith Attached Garase .e., Build Single b7g3 <m,huln0 d ,4!d -/nuk Constructi on Lender rtklt Lafu .furt) Address Phone m o 9J (, -0 DESIGN TEAI{name (address ICS. nO.exoi res ohone no. l.lechan ica l Electrica.l Strr:ctura I Pri ma 5 P] Gen PLUIlB I XG FEE C HARGE NN ELECTR I CAL FFF C HARGF ilO. MECHAN I CAL ectri ca l chani ca I FEF CHA R{]F Each sing)e fixture Res idence of SQ. FT furnace/burner to BTU' s Relocated buildino (new fix. additiorial ) New ci rcui ts al tsor extensions Floor furrrace and vent 5 . F. Res i dence(l bath)SERV I CES Recessed wal I Soace heater and vpnt Duplex (l bath) each Addi t ional bath Temporary Constructi on Apol iance vent separate l,later service Change in existing res i dence Stationary evap coo I er Sewer I ndus tri a I multifamily, comrn. or Vent fan with sinole duct Storm Sewer 0f S.Vent systerx apart from heatinq or A.C. COI.II.I. /IND. FEEDERS Mechanical exhaust hood and ductInstal I /al ter/rel ocatedistrib. feeders l'lood stove/heater 0f s. TOTAL CHARGES O TOTAL CHARGES o o ISSUANCF OF PFRIlIT TOTAL CHARGES STAI^JH ,TE L.1I,JEER RESI hat tREQU tlr e I I kv/0r donbe e E Ian c Ictr 1 Con tractor th e e eI rct I ca I 0n'I ofp0rt th SI '|thaslIpermVA1IunIbetnoIttheIIabehas'I sbeen I ned na E e ct by ri,Icasby 'I sor andSuperv rnedretu 0t Bthe Iut d 1 n Di 1 'IIs 0n llAtlE(please print) DArE/2-/6- gO]GiJ requi be I HAVE CAREFULLY E the compl cation for oermit, and do heap!')reb.y certify that all inforrna tion hereon is trueand correct, and I further cer tify that any and a ll work performed shall be done in accordance with the 0rdinances of the City 0CCUPAI'ICY wili be made of Springfield and the Laws of the State of Ore qon oertaining to the work de scribed herein, and that N0of any s Board i s tructure wi thout the permission of the Building Division. I further that m.y reqistration vrith the Builder,scerti fyin full force and effect as red by ORS 701.055, that if exempt the basi s for exemption is noted hereon, and thatonly subcontractors and emn loyees who are in comciiance with 0l?S 701.0 on this oroject Zone x x ,%w- 0c cy Load Flood Plain VC\s to ri es (o Sq lueGroup 'R 1 so e/const. V N uni l'la i nFire Zone_$lfBe Val ue Val ue TOTAL VALUATION ts So Ftg Ftg Ftg . Access . 0ther Pl an ck. CoffiTino- 65%/81dg Per Fee 0pmentems rqe VE 5l BUILDING PERI,IIT Charges and Surcharges -<J-oo .20 Plan Ck Res 0%/B1dq Per Fee FencePLUI4BING PERMIT Charges and Surc ha rge s Dgmo Sidewal k ELECTRICP.L PERI|IT Charges and Surcha rges A/C Pavi ng Total Cornb. Perm.i t I ?3 Curb Cut I,IECHANICAL PERI.IIT Charges and Surc harqes TOTAL 6tc%. fbh. /r,+ . t-v t)/t,vtn RAC IORS narne aridrpcc l aq nn (n ectri ca PERMIT VALIDATION Permi t Cl erk COMBINATION APPLICATION/PERMIT (CAP) I. Applicant 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 Spiingfield Estates C. Name, etc. of owner and construction Iender D. Energy Sources or forced air gas r solar 1. example- 1250 sq. foot house, 500 sq. foot garage 2. exampie- if new project, check new - if addition' cirec[--add, etc.F. Building perrnit information: 1. example- - construct single farnily house with an attached garage ?. example - remodel existing garage into family room 3. example - convert single family residence into iesifuiant (change of use) G. Value of work as defined in Section 303 (a) of the _Structural 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 infoi-mation or iob site corrections, etc. Abbreviatecj Plumbing, I'lechanjcal, & Electrical Schedules A. Except vrhere b.lank spaces occurin the description portion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate item(s) to be installed B. Fuil Plumbing, Mechanical, and Electrical Schedules are available at the Building Division 1. To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be instal"ted are not covered on the abbreviated schedules you should consuit the ful I scheduiesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCI.iEDULTS D. As noted on the CAP, the label must be delivered to the electrical contractor for signature by his electrical supervisor. The general contractor is not authorized to sign the electrical label. Applicant to sign and date I'lhenever possible, the initial application will be used as a worksheet only. l,Jhere possible, Building Division Staff will prepare a type written copy and return it to the applicant at the time the actual permit is issued for his s i gna ture. Fees and Charges Plan check fees are due and payable at the time of the application, 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. FOR OFFICE USE ONLY 1. example- heat/electrical ceil ing/2. example- waterheater/electrical/o E. Square footage or valuation, etc. II. III. IV. t, PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAITCY: Perm-it applicant exempt from registration wjth the Builder's Board because: Additional Proiect Information: PLANS REVIEI^IED BY: dates i gnaturename N "TW,AL, IIISPECTIOiI LIIiE t'26-37 69 CITY t)F SPRINGFIELD COI1BI iIATi ON APPL ICATION/ PERMIT INFORIIATIOi{ LINt 7?6-3753 Ttl Lega1 Description Job Address .. Tay Lo* 4Rc t Sq. Fto. 0ther_ _r.l ew__,Ad d] t IEFIEEI- _Fence_Demo_C han gel Use .Lother-- U] Farni I .e., Built[,lo rk s ng Re Hea ing 5q tg. l.lain_EIIERGY SOURCES: l.later Heater Ranqe Val ue of l,lork:5oc,c9 5q. Ftg. Access._ Phone7h Owner Addres s b7g3 (r'rilrut,OblD H ,b.1 /ruk Construction Lender /tr11 Addres s Phone c0c 9J W _O DtSIGN TEAI{name add res s exnires ohone no. Ni l'lechan ica I E I ectri ca i Structura I Pri ma PLUIlB I IIG FFF CHARGF ELECTR I CAL il0 MECHAN I CAL al Each single fixture Residence of SO. FT furnace/burner to 8TU, s Relocated building (new fix. additional ) Floor furnace and vent S. F, Res idence (1 bath)SERV i CES Recessed wai I Soace heaLer and vent Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent seDarate [.later service Change i n exi sti ng res i dence Stationary evap coo I er Sewer multifamily, cornm. or I ndus tri a I Vent fan with sinole duct Storm Sewer amp s.UI Vent system apart from heatino or A-C. COI,II1./IND. FEEDERS Mechanica l exhaust hood and duct I ns ta I I /a I ter/ re I ocate di stri b- feeders I'Jood stove/heater .amp90f TOTAL CHARGES O TOTAL CHARGES o o ISSUANCE OF PFRI1IT IOTAL CHARGES HHERE STATE L,1l,l REQUIRES that the Electrical work be done byshall not be valil until the label has been signed by an Eiectri EI Su ectrical Contractor, the ejectrical portion of this permitpervisor and returned to the Building Division an cal I HAVE CAREFULLY EXAI{INED the compieted application for oermit, and do hereb.y certi ing Division. I further certify that m.y registration with the Builder,s llAl'lE (pl ease pri nt )/e-/6- goSI ' Oregon the Bui and be $ fy that all i hereon is truecorrect,and al] work oerformed shall be done in ac cordance with the 0rdinances of the Cityof Springfiel oertaining to the work described he and I further certif-v that any d and the Laws of the State of rein, and that t'l0 OCCUPAI,ICY wili be made ssion of 1dof any structure without the permi Board is in full force and effect as required by ORS 701.055, that if the basis for exemotion is noted hereon, and that onl_v subcontractors and ernployees who are in comciiance with 0l?S 701.05 on this Droject Flood Plain )rrrJC\stories ra 1tl. Occ-v Group ,B 3 Sq. Ftg Ftg Ftg SoT x x on-'Ei,A.o9- cyLoao t() Sq l4a iconst. V i\ units ue Val ue al ueZone r Val TOTAL VALUATI n/ c! 0c . Access . Other Fi re Zone_yvla_Bedrooms Plan Ck. Conun/Ind 651/81do Pcr Fee Svsteris Develocment Charqe f1.52) 'BUILDING PERI'IIT Charges and Su rcharges .eo\r_-oo PIan Ck. Res 30%/81dq Per Fee FencePLUI4BING PERMIT Charges and Surcha rges Dgmo Sidewal kELECTRICAL PERIlIT Charges and Surcha rges A/C Paving Total Comb. Permit I.\,e3 Curb CutHECHAHICAL PERI.IIT Charges and Surc ha rges TOTAL 6tc%. El ectri ca i Nn rrg aHApGF New circuits aits. or extensions on COMBINATION APPLICATION/PERMIT (CAP ) Applicant to furnish A. Job AddressB. Legal Description 1. examole- Tax Lot 100, Lane County Map Reference T7-0-s 432. example- Lot 1. Block 3, 2nd Addition to SIiTfrgflield EstatesC. Name, etc. of owner and construction IenderD. Energy Sources1. examoie- heat/electrical cei I inq/or forced Bir n,.2. exa;Dl?'- waterh-eateF/ETEETFIZIj T .F-- aITYE. SquaiE-T6oGge or valuation,=E- / \, t r 1. examole- 1250 sq. foot house, 500 st toc,2. effpTe- TF-new project, check-iEw - - check add, etc. OF SP RINGFIELD HollCirY PERMIT VALIDATION fl (. ( SPringtield "'tll'":l;l Oregon Public Worlts RECEIPT No' B 55 4oB rF. Bui lding perr,rit information i a1. exaqole - construct single fan:i1y hor (w' a ltached garage 2. examole - remodel existing garage int3. ExamolE - convert single iamily-resid, ,..iEliilrant (change of-use) ( G. Value of work as defined in Section 303 (a ( Structural Specialty CodeH. DESIGN TEAI4 AND CONTRACTORS To avoid design or construction delays, But Division Staff must be able to contact appr persons regarding design information or job corrections, etc.II. Abbreviatecj Plumbing, I'lechaniccrl, & Electrical !A. lxceot r/here blank spaces occur in the descr oortion of the Mechan.ical and Electrical Sch, the applicant need fill-in to the apDropriate item(s) Full Plumbing, Mechanical, are available at the Building Division1. To conserve space on the permit form the s have been abbreviated?. If the item(s) to be installed are not cov the abbreviated schedules you should consufulI schedulesC. BUILDIIIG OIVISiON STAFF WILL FILL OUT ALL FEES CHARGES Oi'I THE SCHEDULESD. As noted on the CAP, the label must be deliverer electrical contractor for signature by his elect supervisor. The general contractor is not autho to sign the electrica1 Iabel (no (,, only the No. Boxe: t).to be installed ( and Electrical Sch o9 ry D 'l (( 6a ( III. Applicant to sign anci date I'lhenever possible, the initial application w'i ll be us a worksheet only. l.Jhere possible, Building 0ivisionwill prepare a type vrritten copy and return it to the applicant at the time the actual permit is issued for s i gna ture.IV. Fees and Charges Plan check fees are due and payable at the time of the appiication, and no plans r.ril1 be processed until these fees are paid. AII other fees and charges are due and payable vrhen the permit is issued. V. FOR OFFICE USE O|,ILY PROJECT CONDITIONS TO BE SATISFiED BEFORE OCCfi"RIICY: 6 ( (. ( gtaor ttttl-6 P Permit applicant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: datenameatureS1gn ( rf ( 3N€Lloi lUiisuLL I