The URL can be used to link to this page

Home My WebLink AboutPermit Demolition 1980-07-16INSPECTION LINE 7?6-37 69 COMB I APPLiCATIC|N RMIT SOURCES Hea t l.later Heater Ra 7?6-3753 Job Address 1300 North 2gth Street Ftg n_ 5q. Ftg. Access.=--- Sq. Fto. 0ther__ llew Add Alter Peo. _fen-ce,perno Change/Use 0ther @OO Or!O t-egat Description Tax LOt 900 It'lap Reference 17 03 25 44 0wner M'ilt Rubert/l4cKenz'ie F]ying Service Address 90600 Greenh.il I Road Phone ng Re rnrit In scr e d Single Farni I s Euqene, 0R 97402 688-0971 Demolish Residence and accessor.y build'inq Construct.ion Lender Address Phone name address I i cs. no.phone no Pri Structura I El ectri cal l'lec ha n i ca I name address lics. no.) (exoires ohone nn Genera l I ld Fire rth PI 1 nical PLUIlB I NG ELECTR I CAL I'4ECHAN ICAL FFF CHARGE NO FFF rHA RGF NO FFF C HARGF Each single fixture Res'idence of furnace/burner to BTLI' S Relocated building (new fix. additional ) New ci rcui ts al tsor extens.ions Floor furnace and vent S . F. Res i dence(l barh)SERV I C ES Recessed wal l Soace heater and vent Duplex (1 bath) each Additional bath Temporary Constructi on Apol iance vent sepa rate I,later servi ce C han res i ge in existing dence Stationary evap. cool er Sewer multifamily, comm. or I ndustri a I Vent fan with sinole duct Storm Sewer 0f s Vent systen apart from heatinq or A.C. 1 SEWER CAP 10.0 l COMI.1./IND. FEEDERS Mechanical exhaust hood and ductInstal I /a1 ter/re1 ocate d.i stri b. feeders I,lood stove/heater 0f ISSUANCF OF PFRI1JT TOTAL CHARGES NO FEE TOTAL CHARGES TOTAL CHARGES WHERE STATE Llll,l REQUIRES that the Electr.icat work beshall not be vali.j until the label has been signed by an do EI ne by an E'lectricaj Contractor, the electrical portion of th.is Dermitectrical Supervisor and returned to the Bu.ilding Div.ision E I ID t he comp ap i)c at 1 0 n for t an d do he re b.y ce rt th a t a I I 'I n forma t 'I on he reon 'I tandcorrec t an d fu rthe r t 'I f-v t ha s ru ecertanyanda'I I w0 r k pe s ha I I be do ne 1 n cc0 rd an ce W'I th t he 0rd i na nce s of the C 1 tyfSori any ard i ng fi e I d an d th e La ws of the S ta of 0reqon oe rta 'I n ,l n g to th wor k desc r 'l bed h ere .l n d th t NC OCCU PANC W'I I I beofstruLLwlthtthe'I I of an a madeure0upermss0ntheBuIIdIngDI'I s 'l I fu r ther c ert 'I fy th a t rn.y reg 'I s t ra ti on t,1 th the Bu 'I I deBo1nfruIIforceandffect,]red by ORS 701 55 r sASrequ0thLIIexemptthebaS'I s for t I 0n 'I S noted he reon and tha ton1ysubcontractorsandempIoyeeswh0are'I n c0mD 'I i an wl th 0us 7 0 05 5 'i 'I 1 be sed th 'I tun l,lAl"lE(please pri nt)I GIIATURE DATE 7-16-80 Zone e/Const Uni ts Ftg Ftg Ftg l4ain Val ueFire Zone Bedrooms cy Load !q Acces 0the r s x al ue Flood Plain Stories 0cc.y Group Sq X Val TOTAL VALUATION BUILDING PERI.IIT Charges and Su rcha rges Plan Ck. Comm/Ind 65%/Bldq Per Fee Systems Deve Charqe ( 1.5c o pmen t Plan Ck. Res 30%/B1dq Per Fee sewer cap N() FEE PLUI4BING PERMIT Charges and Surcha rges Fence Dgmo NO FEE ELECTRICAL PERIiIT Charges and S u rc ha rges Sidewal k A/C Pavi ng Total Comb. Permit IlECHANICAL PERMIT Charges and Surc harge s Curb Cut TOTAL NO FEE -\-:l-. Val ue of llork: RACTORS SO. FT { FNP NTFTT J COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description1. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. BIock 3, 2nd Addit'ion toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources 1. 2. Squa 1. ?. example- heat/electrical ceil ing/ examol e- waterheater/el ectri ca I /ore footage or valuation, etc. or forced qir gas r sol ar E example- 1250 sq. foot house, 500 sq. foot garage example- if new project, check new - if addition, check add, etc. II 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 the Structural Specialty CodeH. DESI6N TEAM AND CONTRACTORS To avoid design or construction delays, Bui lding 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 occur in the descriptionportion of the Mechanical and Electricai Schedules, the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be'installedB. Full Plumbing, Mechanical, and Electrical Schedules are ava.i lable 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 delivered to theelectrical contractor for signature by his e.lectrical supervisor. The genera) contractoListo sign the electrical label. Applicant to sign and date not authorized III IV Whenever possible, the initial appl ication wil I be used as a worksheet only. l^Jhere possible, Building Division Staffwill prepare a type written copy and return it to the applicant at the time the actual permit is issued for his s i gna tu re. 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. V. FOR OFFICE USE ONLY PERMIT VALIDATIOI'I Permi t Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAITCY: Permit applicant exempt from registratjon with the Bu'ilder's Board because: Additional Project Information : PLANS RTVIEWED BY: name Si g na tu re date CIlrY C)lt-' SPItIlifCl.rIELD sPRINGFIELD, OREGON 97 477 December 17, 1980 346 [\4AIN STREET 726-3753 PUBLIC WORKS CERTIFIED LETTER Mr. Harry Ruberg c/o McKenzie Flying Service 90600 Greenhill Road Eugene, 0regon 97402 RE: Demolition of Existing Building Dear Mr. Ruberg: In response to a comp'laint, it was brought to our attention that buildingslocated at 1300 North 28th Street, county Assessor's Map L7-03-zs-44, TaiLot #1000, are in the process of being demolished and aie currently ireat-ing a dangerous situation. The above records show the property to be underyour ownership. In this regard, please be advised that it is unlawful to enlarge, construct,repair or demolish any building or structure without first obtiin'inq a sena-rate permit.for each building or structure from the Building 0fficiil (Set-tion.301 (a) 0regon State Stiuctura'l Specialty Code and Fj16 ana Life iafetyCode). Because of the imminently dangerous conditions caused by the partial demoli-tion of the existing structures, we urgent'ly request at this time that allnecessary permits be obtained and the ionsummation of the demolition be com-pleted immediately. Your failure to 99mply with this notice will cause this office to refer thematter to the Office of the city Attorney for approprtate regit-action. If you have anv questions,-please direct all inquiries to the springfieldBuilding Division at 726-37bS. - Si ncerely, David J. puent Building Inspector cc: Joseph J. Leahy,Assistant Ci ty"Attorney 1001.3 DP/1s t\L\(\ .p,}-: Job Address 1300 North 2gth Street R APPL I ION RMIT EIIERGY SOURCES Hea t llater Heater Ranqe L c0r{B r i TI l-esal Descri pti on TaX LOt 900 Sq. Ftq. l.lai n !q. Ftg. Access Sq. Ftq. Other -llel Add Al ter Pep. _fen-ce_AOemo Change/Use -other-- @o O Ol! Ol{ap Reference 17 03 25 44 Va lue of llork: Owner Milt Rubert/McKenzie Flying Service Address 90600 Greenh.il I Road Phone Bu I ng Re Pe si rnn t I n fo e ng etde Eugene, 0R 97402 688-097 1 Demolish Residence and accessory buildinq Construction Lender Addres s Phone name addres s lics. no.exni res )ohone no. Pri ma Struc tura I Electrical l4echanical S name address I ies, no. ) (exoi res )ohone no - ) Generar City of Sprinqfield Fire Department 4th & North A Streets So fl d. 726-3737 Pl umbi nq El ectrical l.lechani cal PLUIlB I NG EL ECTR I CAL MECHAN I CAL FEF CHARGF NN FFF C HA RGF NN FFF 1.I{A RGF Each si ng1 e fi xture Residence of sQ FT furnace/burner to BTLI s Relocated buildinq (new f ix. addit'i onal) New ci rcui ts al ts or extensions Fl oor furnace and vent S . F, Fles i dence(l bath)S ERV I CES Recessed wai I Soace heater and vpnt Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent s epa rate l.later service Change i n exi sti ng res'i dence Stati onar_v evao cool er Sewer multifamily, comrn. or Industrial Vent fan with sinole duct Storm Se,rrer 0f Vent systenr apart from heatinq or A.C. 1 SEWER CAP 10.0 l COI,lI,l./IND. FEEDERS Mechanical exhaust hood and duct Instal I /al terlrel ocate di stri l-r- fppders Iiood stove/heater 0f s. ISSUAIICF OF PFRIlIT TOTAL CHARGES NO FEE TOTAL CHARGES TOTAL CHARGES WHERE STATE LltJ REQUIRES that tlre Electr.ical work be doneshall not be valil until the label has been signed by an E)ec by an Electrical Contractor, the electrical portion of this pernittrical Supervisor and returned to the Building Division E CARE t c 0mp I e ted ap l-)I 'I Ld ti 0n fo r DE t a nd do here b-y c e rt 'I fy th a t a 'I n forma t 'I o n hereo n 'l t rueand correct, and I further certi fy t ha f any and a 'I I wo rk perfo rmed s ha 'l I be do ne 1 n a cc 0 rd an ce v/t th L he 0rd i an ces o f t he t',l tyofSringfield and the Laws of the Sta te of 0reSronf the Buil pe rt a 1 n 'I ng to the WO r k de sc r 1 bed here I n an d tha t ilc 0c CUP AI,ICY wl I I be madeof any s Board i s t ruc t WI th 0u t t he p erm l s s 'l 0n di n9 Di s 'I on I fu rt her cert i fy th a t m.y reg 'I s L ra +1 on u,1 t h the Bui 1 d e r S'I n fu I I fo rce and e ffec t a s requ 'I red by ORS 7 0 05 cJ tha t 'I f exem0 t t he ba S 1 s fo r t 'I on 'I s n oted hereo n a nd tha t I u bco0nvs ntr a c to rs a nd ernp I 0yee s who a re comc I I a nce tvl th OPS 7nL 0 55 1 I I be u s e d n th 'I ec t ( r,lAilE(ptease print) lYlJ I t Ruberq sTGitATURE TE 7- 16-80 FF Zone Tyoe/Const. Un its . Ftg. l'!ain Val ue Fi re Zone Bedrooms Load 5q Ftg. Access X Val Flood Plain Stories Occ.y Gro up S q. Ftg.0ther x Val ue TOTAL VALUATION BUILDING PERI'IIT Charges and Su rc ha rges Plan Ck. Comm/ind 65%/B1dq Per Fee S vs tems Cha rqe Deve (1.52 opment Plan Ck. Res 30%/81dq Per Fee sewer cap Nt) FEE PLUI4BING PERMIT Charges and Su rcha rges Fence Dgmo O FEE ELECTRICAL PERI:IT Charges and Surcharges Sidewalk A/C Paving Total Cornb. Permit I,IECHANI CAL PERI',IIT Charges and Surc ha rge s Curb Cut TOTAL NO FEE \-) v COMBINATION APPLICATION/PERMiT (CAP) I. Applicant to furnishA. Job AddressB. Lega l Description 1. glulplg: Tax Lot 100, Lane County Map Reference .1/ 03 432. example- Lot 1. Block 3, Znd Addition toSpr'ingTield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources 1. exarnole- heat/electricaj cei I ino/or forced ai- E. 3;r.*%;nwaterhElte/e-lEEt,riGri. - Ctf V l. examole- 1250 sq. foot house, ( s,2. exampie- if new'project, cheik' check add, etc.F. Building perrnit .information: 1. example - construct single fami lotr;ItaaIEd sarage2. exarnole - remodel existing garag3. axarnplE - convert single iafrity"r iEiT?u7ant (change of"use) (G. Value of work as defined in Section 3Structural Specialty CodeH. DESIGN TEAi,l A|ID CONTRACTORS To avoid design or construction delays fuiDivision Staff must be able to contactpers0ns regarding design information orcorrections, etc. Abbreviated Plumbing, Mechan.ical, & ElectritA. Except vrhere blank spaces occur in the o oF SP RTNGF IELD Holl PERMIT VALIDATION CirY Soringtield ""tlI'":l;l t-'t-";H; 5 riCIil1 i ,TURE ( (II.(s. ,iV ed III IV portion of the I'lechan.i cal and Electricalthe applicant need fill-in only the No. I - to the appropriate item(s) to be installe (B. Full Plumbing, Mechanical, and Electrical are available at the Building DivisionI. To conserve space on the permit form t have been abbreviated (- ?. If the item(s) to be installed are not the abbreviated schedules you should ccfulI scheduiesC. BUILDIIIG DIVISION-STAFF I.IILL FILL OUT ALL Ft i,NI CHAR,GES ON THE SCHEDULES0. As noted on the CAP, the label must be delivelectrical contractor for signature by his e ,,.supervisor. The general contractor is not aL irito sign the electrical labelApplicant to sign and date Hhenever possible, the initjaj application will be a.worksheet only. t^Jhere possible, Building Divisi ,$-t; will'prepare a type written copy and return it to rapplicant at the time thdactual permit .is issued I s i gna ture. Fees and Charges ( Plan check fees are due and payable at the time of t - application, and no plans wi I1 be processed until th (l ( fees are paid. A1l other fees and charges are due ar )payable when the permit is issued. ( FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE O 97aor t6t11-a V -1 L FcupRttcv t SHELroil-luitEuLl OtQt Permit appf icant exempt from registrat'ion with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: da tes i gnaturename ( i (r ( INsPECTION UNE 72&3759 CITY OT SPRINGTIETD COMBINAIION APPTICAIION/PERMII .-TNFORMATION TINE 7283753 LesorDescriprio. / 7- 03-25- 44 TX+/OOO a,Job ,nu Ru bai. .@,'.8 -PhoneAddresr /58 !, N, ai Building Permit lnfo: Describe Work (i.e., Build Single Fomily Residence With Attoched Gorogel- Volue of Work: ',/)rr"rt o/La/ t -4nnnzo -o?7/ .n , ,6iil*h;n, ( Construclion Lender m o D e .\.l D U Address Phone (nome)(lics. no.)(expires)(phone no.)DESIGN TEAM Primory Mechonicol CONTRACTORS (nome)(oddress)(lics. no.)(expire s)lpisrere.) nic"tzL- 6,56.s 7{68t O0'r ml , \ru.P(, zlqfuee*)lor'{- E le ctri co I Plum Mechonico I ETECTRICAT MECHAN!CALPLUMBING NO.rEE CHARGE NO.FEE CHARGENOFEECHARGE furnoce/burner to -BTU'S Eoch sinqle fixture Residence of --sq. ft. New circuils, olteroiions or extensions Applionce vent sepqrole Relocoted building (new fix. odditionol) S.F. Residence (l bolh)SERVICES Stotionory evop. cooler Duolex (l bolh) eoch Temporory Conslruciion Vent fon with single duct Amps. Veni syslem oport from heotinq or A.C.Addilionol bolh l'{echonicol exhqust hood ond ductWoler:ervice Wood stove/heoterSewer Heot PumpStorm Sewer FEEDERS Ampr. Air honciler to 10,000 cFM Air hondler over r0,000 cFM ISSUANCE OF PERMIT _\_J _ TOTAT CHARGES o-TOTAt. CHARGES o WHERE STATE tAW REQUIRES rhot the Elertricol work be done by the Eleclricol Conttoctor, the electricol porlion of lhis permit shcll not bc volid until c lsbel hos bmn signed by on Electricol Controctor ond ottoched lo lhe eleclriccl ponel. oTOTAT CHARGES I HAVE CAREFULTY EXAMINED lhe completed opplicotion for permit, ond do hereby certify lhot oll informotion hereon is true ond correct, ond I further certify thot ony ond oll work performed sholl be done in sccordonce with the Ordinonces of the City of Springfield qnd the Lows of the Stote of Oregon pertoining lo the work described herin, ond ihot NO OCCUPANCY will be mode of ony structure without the permission of the Building Division. I further cerllfy thot my registrotion with the Builder's Boord is in full force ond effect os required by ORS 70I.055, lhot if exempt the bosis for exemption is noted heron, ond thot only subontroctors ond employees who ore in omplione with ORS 701.055 will be used on this proiect. SIGNATURE DATENAME (pleose print) Bosis for Builder's Boord exemplion: FOR OFFICE USE ONtY .Type/Const. - Units --Sq. Ftg. Moin x Volue x - Volue Zone Flooci Ploin Itg. Access TOTAT YATUATION L-d.- Fire Zone '- Bedrooms / occy lood Group-Sq. Ftg. Other-x -Yolue Syslems Development Chqrqe (1.5%) BUITDING PERMIT Chorges ond Surchorges Plon Ck. Commf lndoPer Fee Plon Ck. Res Per Fee 9 t ao /t Totol Comb. Permit PI,UMBING PERMIT ____e___Fence Demo Chorges ond Surchorges Chorges ond Surchorges ETECTRICAT PERMIT o Sidewolk C Povi MECHANICAT PER/rlIT Chorges ond Surchorges Curb CutO IOTAI. $r oo/, ENERGY SOURCES: Woier Heoler 5q. Ftg. Moin ---- Sq. Ftg. A€cbsr. Sq. Frg. Other -New-Add -Alter---ReP'- - -F.nr" y'D"*o-Chonge/ Use -Other (odd ress) Struciuro I Electricsl COMBINATION APPLICATIoN//PERMIT (LAP) l. Appliconr. to furnish A. Job Address B. legol DescriptionI. exomple-tox_lot.l 00,_Lo-ne.County Mop Reference lZ 03 432. exomple-Lor l. Block 3,2nd Addiiion ro springfierd EstotesC. Nome, etc. of owner ond construction lenderD. Energy Sources 9I9JI{ : - h eo t. "=!S:t.isokgl! ng,' o r f o rce d o i r s o s exo mple-woter heoter electrico l,'oi solEi-2 E. Squore footoge o. "olrotionlu-f,]l. exomple-.PI9 .C.foot house, .500 sq. foor goroge2. exomple-if new proiect, check nEi-ii oddirion, check odd, etc. F. Building permit informotion:I. exomple-construct single f66;1, house with on ofioched goroge 2. exomple-remcdel existing goroge into fomily room 3. @-convert single fcmiiy residence into restouront (chonge of use) G, Vqlue of work os defined in Section 303 (o) of the Structurol Speciolty Code H. DESIGN TEAM AND CONTRACTORS To ovoicj design or conslruction deloys, Building Division Stoff must be obie ,o contoct oppropriote pu.ron, regordingdesigninformotionoriobsitecorrections,etc. ll. Abbrevioted PIumbing, Mechonicol & Electricol Schedules A. Except where blonk spoces occur in the desc:,iption portion of the Mechonicoi ond Electricol Scheduies, the oppiicont need fill-in only the No. Boxes odiocent to the oppropriote item(s) to be insrolied B. Full Plumbing, Mechonicol, ond Electricol Schedules ore ovoiloble ot the Building Division I. To conserve spoce on the permit form the schedules : hove been obbrevioted 2. lf the item(s) to be instolled ore not covered on the obbrevi- oted schedules you should consult rhe full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL TEES AND CHARGES ON THE SCHEDULES lll. Applicont to sign ond dote Whenever possible, the initiol opplicotion will be used qs o worksheet only. Where possible, Building Division Stoff will prepctre o typewritien copy ond return it to the opplicont ot the time the octuol permit is issued for his signoture. lV. Fees ond Chorges Plon check fees ore due ond poyoble qt 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 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project lnformotion r --7 nome signoture dote PLANS REVIEWED BY3 PERMIT VATIDATION Permit Clerk n/ -z')pztzt*Prl ,/ro0 ./n INSPECIION tINE 72&3769 CIIY OF SPRINGFIETD COMEINATION APPTICAIION/PERMIT' INFORI^ATION TINE 72G3r53 ENERGY SOURCESI m o D ,1 .-l D +/alegol De:cription Build SingleBuilding Permit lnfo: o?7/ 4 GoPhone Phone (lics(oddress)(nome) Ro wilh atto<h Dercribe Work (i.e Volue of Work: Woler Heoter lleot Owner Addrers Address DESIGN TEAM Primo 5q. Flg. Moin Sq. Ftg. Accer. Sq. Frg. Other -New-Add -Alter-ReP. --F. n". -y'D " ^o-Cho n ge / U se -Other - S Mechonicql ress)CO C.beeo E le ctri co I n 6 \cu.,8 zL^l.a 56.s 7t68t O0gt<- 6 Mechonicol AAECHANICALETECTR !CALPIUMBING CHARGENO. i FEEFEECHARGECHARGENO.No. I i FEE furnoce/burner to ---BTU'; Residence of tr.Eoch rinEle fixture Applionce vent sepqrqle New <ircuils, qlterolion: or exlensions Relocoted building (new fix. odditionol) Stotionory evop. coolerSERVICES S-F. Reridence (l both) Vent {qn with singie ductTemoorory ConslruclionDuolex (l both) eoch Vent syslem oport from heotinq or A.C.Amps-Additionol bcth Mechonicol exhqusl hood ond ductWoler rervice Wood slove/ heoierSewer Heol PumpFEEDERSSlorm Air hondler to 10,000 cFMAmpr. Air hqndler over 10,0c0 cFM ISSUANCE OF PERA4IT -o- WHERE STATE tAW REQUIRES thor the Eleclricol work be done by the Electricol Conlraclor, the elcctricol portion oi this permit shqll not ba valid unril o lcbcl hot bmn :igncd by on Elc<?ri<ol Contractor and altoched to lhe electricol ponel. I HAVE CAREFULIY EXAMIN€D the completed opplicotion for permil, ond do hereby certify lhot oll informotion hereon is lrue ond correcl, ond I further c€rrify fhot ony ond oll work performed sholl be done in occordonce with the Ordinonces of the City of Springfield ond lhe Lows of the Stote of Oregon pertoining ro rirc work described herin. ond thoi NO OCCUPANCY will be mode of ony struclure withoul the permission of the Building Division. I further errlfy th-ot my regirtrorion with the Builder'r Boord ir in full force ond glfect os rsquired by ORS 701.055, thol if exempt lha bosis for exemption ic noted heron, ond rhot only rubcontroctors ond employees who ore in omplione wirh ORS 701.055 will be used on lhis proiect. Bo:is for Buildcr'r Boord exemption: TOTAL CHARGESIOTAI- CHARGES ATURE DATE o O -o- NAME (pleose prinl) TOTAT CHARGES FOR OfFICE USE ONIY 1---Volue x -Yolue 1-Vqlge TOTAL VATUATION, cZone Flg. Acce:sFire Zone - Bedrooms - occY lood Flood Ploin Iype/Const. ._ Units --Sq. Ftg. Main Group-Sq. Ftg. Other--- Systems Development Chorse (!BUILDING PERMIT Chorger ond Surchorges PIon Ck. Comm/lndoPer Fee Plqn Ck. Res Per Fee Fence Totol Comb. Permit# t oo /t PI.UMBING PERMIT Chorger ond Surchorges ____Q___ Demo Sidewolk A/ C Povino ETECIRICAI PERMII oChorges ond Surchorger Curb Cut MECHANICAT PERMIT Chorges ond S urcho rge: O TOTAT oo4/ E le rtri <o I ( raav Additionol Proiect lnformorion: PLANS REVIEWED BY: nome signolure dote COMBINATION APPLICATIONiPERMIT (LAP) l. Applicont,to furnish A. Job Address B. Legol DescriptionI. exomple-tox lot 100, tone Counly Mop Reference I7 03 43 _ 2. eiEmFlE-Lor l. Block 3, 2nd Addirion to Springfield EstoresC. Nome, etc. of owner ond construction lenderD. Energy Sources E. k PERMIT VATIDATION OF SPRINGFIELD /- CitY Holl Springfield, Oregon D"p;;;;t or Publil works ( OFFICIAT RECEIPT No. B 55322,. CITY F. Building permil informotion:l. exomple-construct single forni;, house wilh on tgoroge 2. exomole-remodel exisling goroge into fomily rc3. exompE-converr s;,-lgle fiJily rlsidence intores?ouront (chonge of use) G. Volue of work os defined in Section 303 (q) of theStructurol Speciolty Code H. DESIGN TEAM AND CONIRACTORS To ovoid design or construction deloys, Building DivStoff must be-oble to.o.,ro.t opplop.iotu persons r€design informction or iob site corrections, etc. ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedul,A. Except where blonk spoces occur in the desc:,iption pof the Mechonicoi ond Electricol Scheduies, rhl appiineed fill-in only the No. Boxes odiocent to the opproitem(s) to be insrolled B. Full Plumbing, Mechonicol, ond Electricol Schedulesore ovoiloble ot rhe Building Divisionl. To conserve spoce on the perrnit form the scheduk hove been obbrevioted 2. lt the item(s) to be instolled ore not covered on fht. oted schedules you should consult the full schedulrC. EUILDING DIVISION STAFF WILL FILL OUT ALL FEES AI CHARGES ON THE SCHEDULES lll. Appliconr ro sign ond dore Whenever possible, the initiol opplicolion will be used osworksheet only. Where possible, 'Building Division Stoff $prepore o typewrilten copy ond return it to the opplicontthe time the octuol permit is issued for his signotuie. lV- Fees ond Chorges Plon check fees ore due qnd poyoble ot the time of the opond no plons will be processed until these fees ore poid, Iother fees ond chorges ore due ond poyoble ,"hen ihe pe,is issued. V. FOR OFFICE USE ONLY t<t ( Dote e<(,O,t9 c)l-1 F d rt ( ob, il ( {.. (t { o ( ( Amount Received AUTHOFIZEO SIGNATUR€ SHELTON.TURNBU!! 'iIftIERg EU6IIE OR 97'OI BY PROJECT CONDITTONS TO BE SATISFTED BEFORE OCCUPAN +- ( ( I t