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Home My WebLink AboutPermit Building 1980-07-18g"t 74 3sam COMBI I,IATI ON APPL I CATI ON/PERMIT N 7 Job Address 4dn l-ega1 Description Hea Ranqe EIIERGY SOURCES l.later Heater Owner Val ue of l,lork Sq. Ftg. Access.-- Sq. Ftg. 0ther _llew_Add Alfer-neil- _Fence_Demo_Chan gelUse -other__._- tq. lla n_ Addres s Phone Builcinq Pernrit Info: Describe tlori(J.E., Bui1d-STFamily Residence llith Attached Garaqd) ?v6 -Zez 1 _Lrfu a.J *-ua;**^.4,y1."rA Construction Lender 1:,I --t Vo . 4r* t dr^--f '-L,.,-o\h , Addre s s Phone tiv *c 4e#,- DESIGN TEAI.I name address exDr res phone no.' Pri mary Structura l 2So3P-o-$6 o LL El ectri cal l,lechani cal nam\addres s res )ohone no. Genera I Pl umbi nq han i PLUIlB I NG ELECTR I CAL L MECHAN I CAL o 2u FEE CHARGF NN FFF CHARGF NO FFF CHARGF Each single fixture Residence of sQ. FT./o furnace/burner to loo,ooo BTLI '.s 6 6o,oo Relocated building (new fix. additional)New ci rcui ts al tsor extens ions FIoor furnace and vent S . F. Res i dence ( I bath)SERV I CES Recessed wal l Space heater and vent Duplex (1 bath) each Additional bath Temporary Constructi on Apol iance vent se pa ra te l,later servi ce Change in existing res i dence Stati onar.v evap cool er Sewer Industrial multifamily, comm. or I Vent fan with si nol e duct j 2y.oo Storm Sewer .amps.0f Vent systern apart from heatino or A.C. c0tlt't./IND. FEEDERS Mechanical exhaust hood and duct Instal I /al ter/rei ocate di stri b. feeders l'lood stove/heater 0f amps rssuANcE oF pFRr,rrr io, oo TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES 4Yo 9*,oo a- )L WHERE STATE LII,J REQUIRES that the Electrical work be done by an Electrical Contractor, the electricalshal'l not be valii until the label'has been signed by an Electrical Supervisor and returned to the Buildin tiAtlE(please print)D/..|E?^ttr-YolEesTGNATURE 2-€g* portion of this permit g Division 7 and of of Boa onl fy any rd I ted II ac ontiheDINEt rm'lrcomp t a dond here Icert f ttha Ia I n'I rmafo 'It onl-)ap DC b.y 'Ireon ts ruev a Ind futc0rrec cerrther 'It hat t a nd Ia Ia work foper rmed 'Iha beI nedo n,1 cca rda enc thwl t ihe0rd an esnc tof Cihe tyrlIIeadnd ny oftheLawsoftheSttae nSpnga1 Irt to the WO kr sde rc be'I d nI a thnd a t,t0nngDCheret UPOCC I,ICA II beI emad0reg struc tu tthou het 'I ss 0n1 th Irepermeu3 I 1d n Di 'Is on fu herrt tcer i ath t 1 s 'lItrat v/1on tth he 'Iu deI r sfym.y reg 'I n'I5 Ifu forceI nda f tfec as Iu r ed ORS 07 051 5 tha t het b S1 I r Ireqbyas0ext 0n s'i hnoted ereon dan hat texempemp s bcu trac0n antors d I whsvernD a0 Ire n 'II nca wle ht 0t?s 7oL 0 55 I I'I0yeec0mD be su oned lth s p ro,j G-e- P. FOI? CFFICE USE Oi{LY ,_, fi -oo ror^L vALUATIoN- Zone Type/ Cons t. Fire Zone Bed ro oms Flood Plain Stories ltc Up Ftg l'la i n Ftg. 0ther x Val I Load Ftg. Access.Val ue Group Uni ts Plan Ck. Comm/Ind 65%/81do Per Fee q1 1A Svstems Deve' Charqe ( 1.5%' o pmen tBUILDING PERNIT Charges and Su rc harges Plan Ck. Res 3}%/Bldq Per Fee rQc,64O7+ FencePLUI4BING PERMIT Charges and Su rcha rges Demo SidewalkELECTRICAL PERIlIT Charges and Surc ha rges A/C Paving Total Cornb. Permit Curb Cutl,lECHANICAL PERMIT Charges and Surc ha rges TOTAL ; COMBINATION APPLICATION/PERMIT (CAP) I. App'licant to furnish A. Job Address B. Legal Description 1. exampie- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, Znd Addition to Springfield Estates C, Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceil ingl 2, example- waterheater/electrical/o E. Square footage or valuation, etc. or forced air gas r sol ar 1 exampl e-1250 sqif new foot house, 500 sq foot garage )exampl e- check add project, check new - if addition, , etcF. Bui lding permit information:1. exampie - construct s'ingle family house with an attached garage 2. example - remodel existing garage into family room 3. example - convert single family residence into' restaurant (change of use)G. Value of work as defined in Section 303 (a) of the Structural SH. DESIGN TEAI'I pecial ty Code AND CONTRACTORS II, To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or iob site corrections, etc. Abbrevjated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fill-in oniy the No. Boxes adjacent to the appropriate item(s) to be installedB. Fuil Plumbing, Mechanical, and Electrical Schedules 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 fui I schedulesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the labei must be delivered to the electrical contractor for signature by his electrical supervisor. The general contractor is not authorizedto sign the electrical label. Applicant to sign and date Hhenever possible, the initial appiication will be used as a worksheet only. Where 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 signature. Fees and Charges P'lan 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. III IV V. FOR OFFICE USE ONLY PERMIT VALIDATION Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit applicant exempt from registratjon w'ith the Builder's Board because: Add'iti onal Project Informat'ion : PLANS REVIEWED BY: name s i gnature da te INSPECTION LINE 726-37 69 -ur'-rffi COMBI IIATI ON APPL I CATION/PERMIT 726-37 Job Address QV Z ,y- 2a4*EIIERGY SOURCES: Hea t l^later Heater Ran Sq. Ftq. l'1a n_ 5q. Ftg. Access.---- Sq. Ftq. lther 6C7/2_ _!{ew____rR46-ql ter' P.ep . _Fence_Demo Change/Use 0ther \ to, N N w Legal Description fr4*, oF TL. p, @- i'?p lMhr7 / 7a3t- 3€-/ /Val ue of l,lork?tua.<60wnerLD Address 5*,*og Phone Bui I cil Farni I y nq Pernit Info: Describe I,Jork(' Res'idence llith Attached Garaqe .e., Build Single Zzur.r-5>32,n Dfu;.t*ag Construction Lender Ua*rt<.tt PAz *7 Addre s s Phone DESIGN TEAI4 name addre s s 'I ics. no.exD t res ohone no. 3Pri ma ry )4 Structura I El ectri cal l'lec han i ca I CONTRACTORS n ame ( address'(lics. no.)exD l res ohone no. €enerut- Pl umbi Eiectrical Ittechanical PLUI,tB I NG ELECTR I CAL MECHAN I CAL FFF CHARGE NO FFF C HARGF Nr)FFF CHARGF Each s'ing1e fixture Residence of SQ FT furnace/burner to BTLI' s Relocated building (new fix. additional ) New ci rcu i ts al tsor extensions Fl oor furnace and vent S. F. Res i dence(l bath)S ERV I CES Recessed wal i Snacp heafpr and vpnf Duplex (1 bath) each Additional bath Temporary Construction Apol i ance vent seDa rate l,la ter serv i ce Change in existing res i dence Stati onar.v evap cool er Sewer mu l ti fami 1 y,comm. or Tndrrstria I Vent fan with sinole duct 1fl'Storm Sewer /a7aa lF uo,4 0f s.Vent systern apart from heatino or A.C. c0r,1r.1./rND. FEEDERS Mechanical exhaust hood and duct- Instal I /al terlrelocate distrih. feeders lJood stove/heater 0f amp s. ISSUANCE OF PFRI1IT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE L,tl,l REQUIRES that tlte Electrical work be done by an Electrical Contractor, the electrical portion of this permitshall not be valil until'the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed apnlication and correct, and I further certif-v that any and all worof Soringfield and the Laws of the State of 0reqon oertof any structure without the permission of the Building Board is in full force and effect as required by ORS 70 only subcontractors and enployees who are in comcliance for oermit, and do hereb.y certify that all information hereon is true k performed shall be done in accordance wjth the Ordinances of the City aining to the work described herein, and that NC 0CCUPAI,ICY will be madeDivision. I further certify, that my registration vlith the Builder's 1.055, that if exempt the basis for exemption is noted hereon, and that wi th 0llS 70i.055 vri'l I be used on thi s nroject. llAl'tE(p)ease print)J" f" u.\ B , St.- zr,-L ."^S I GIIAT L s. SLr*-- _,-..,-.- DA 7/ t,f/ t-0 : USE OilLY Fire Zone Bedrooms Occy Load Ftg. Access x Val ue Fl ood Pl a.in Stori es 0c }ther 6C.7tZ Daac.y Group Sq. FtS Val ue TOTAL VALUATION BUILDING PERMIT Charges and Surc harges Plan Ck. Comm/Ind 65%/Bldq Per Fee Svsteris Develooment Charqe (1.5c)' Plan Ck. Res 30%/81do Per Fee PLUI4BING PERMIT Charges and Su rc ha rges -oq) 7 o> Fence Demo ffAs' <ltc<t<Re Du.E /// . Y' ELECTRICAL PERIiIT Charges and Surcha rges Sidewal k A/C Pavi ng Tota'l Comb. Permit 224'* NECHANICAL PERMIT Charges and Surc harge s Curb Cut TOTAL v=?.ao Zone__-_-______Tyoe/Const._ Units So. Ftq. l,lain x Value il/.*'e /zz.* COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 43?. example- Lot 1. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources I I i. exampl e- he2, exampie- waE. Square footage atleiectrical ceiling/or forced air gas t e rh-e a fE 17 elE c t r fEIlTo ror valuation, etc. sol ar l. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check-new - .if addition, check add, etc.F. Bui lding permit information:1. example - construct single family house with an attached gardge 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 theStructural Speciaity CodeH. DESIGN TEAM 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, & Electr.ical SchedulesA. Except vrhere blank spaces occur in the descriptionportion of the Mechanical and Electrica) Schedules, the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Eiectrical Schedules 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 onthe abbreviated schedules you should consult theful I schedulesC. BUILDING DIVISION STAFF l^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 electricalsupervisor. The genera) contractor is not authorizedto sign the electrical label.III. Applicant to sign and date l.Jhenever possib)e, 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 h.issignature.IV. Fees and Charges Plan check fees are due and payable at the t'ime of theapplication, and no pians will be processed until thesefees are paid. All other fees and charges are due andpayabie when the permit is issued. V. FOR OFFICE USE ONLY PERMIT VALI DATION * ?',r't : iRi{, :-'','tt{t; Perm'it Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAITCY: Permit applicant exempt from registrat'ion with the Builder's Board because: Additional Project Informat'ion : PLANS REVIEWED BY: name s'i gna tu re date IIISPECTION LIIIE 726-37 69 - ' CI ir 0F :IRI|IGFIELD COI1BI iIATI ON APPL I CAIION/PERI'IIT ON 726-3753 Job Address 2V Z ryo 28ru EIIERGY SOURCES Hea t Ran Ftg l.1a n !q. Ftg. Access._ Sq. Ftq. Other 4.t -//2 J.rewJddJttet$t- _Fenc e_Demo_C ha n gel U s e 0ther \Jr) \, ,,1 N ir, l-egal Descri Otion 'S:On, aF f L. S,czl.:!)<a>, f j;-:,_:,rt '//?V / 7'a::" *;:;)" / / Va l ue of l.lork:?Po' qoowner {opc,.D . ..:.,_i-ru,; t,.: -.--^ll' .7^-': t J4lr--Phone - .:!- .- -,Bu i I tile Fani I y q n Perntit info: Describe L^lork( esidence fJith Attached Garacle .e., Build Single ?",r,,r,*-5 ro,p: r^ ]t*t u* c. €,f-;.=r'1p., Construction Lender a----.,-'?',af / -f ';1':;' ..- -€'q 1-i:>7 Addre s s Phone DES I GN TEAI,I name addres s lics. no.exDr res ohone no. Pri ma ',,L'il' ": ..:i Structura I E l ectri ca I l'lec ha n i ca I CONTRACT(]RS n ame addres s 'l i cs. no.exo i res )(ohone no. r''-:it;-Z) E l ectrical l'lechanical PLUIlB I I]G ELECTR I CAL 14ECHAN I CAL FEE CHARGE FTF l^HAAT:F N0.FFF CHARGF Each si ngl e fi xture Residence of SQ FT furnace/burner to BTL!' s Relocated building (new fix. addi t iona I ) New circuits alts or extensions FIoor furnace and vent S.F. Pesidence(l bath)SERV I CES Recessed wal I Sneap hpaiPr and vonl Duplex (l bath) each Addi tional bath Temporary Constructi on Apol iance vent s eDa ra te l,later service Chan rpsi ge in existing dpncp Stati onar-v evap. cool er Sewer multifami1y, cornm. or Industrial Vent fan with sinole duct 4C..storm sewer'J'].n cr tc,0f amps.Vent systern apart from heatinq or A.C. c0r,1r.1./lND. FEEDERS Mechanical exhaust hood and drrct Instal I /al terlrel ocate di stri b. feeders lrlood stove/heater 0f _amps. ISSUAIICF OF PFRIlIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES I'IHERE STATE L1l'l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permitshall not be valil until'the label has been signed by an Electrjcal Supervisor and returned to the Building Division I HAVE CAP,EFULLY EXAIl IIIED the completed apn)ication for oermit, and do hereb.v certify that all information hereon js trueand correct, and I furth er certi f_v that any aws of the State of and all work performed shall be done in accordance vrith the 0rdinances of the City Oreqon oertaining to the work described herein, and that ll0 0CCUPAIICY rvill be made the Building Division. i further certify, that m,y reqistration yrith the Builder's of Soringfield and the Lof any structure without the permission of Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemotion is noted hereon, and thatonly subcontractors and ennioyees who are in comcliance w.i th 0l?S 701.055 vrilI be used on this rrro.ject l,lAtlE(please print)+ J" f, ', B, SL..i !,r r-L c'*S i GiIA Ls.DA.T 7/wn FON OFFICT USE Oi,]LY Zone Tyoe/Const Fire Zone Bedrooms its So Ftg Ftg Ftg llain xr value- r Value0ccy Load Sq Acces s Flood Plain 0c c.y Group Sq oth", 6 2. 7.r2 GlZ,.i. * u^1r"--L42o-- TOTAL VALUATION Stories BUILDING PERI,IIT Clrarges anC Surcharges Pl an Ck. Comm/ Ind 65i{/Bldo Ppr Fpe i.'r :.,*!}Svsterns Deve Charqe (1.52 I opmen t ) Plan Ck. Res 30,i/Bldq Per Fee PLUt4BiNG PERMIT Charges and Surc ha rge s a - Fence D6mo r<A^;:cl-{ ;,; E4_ii I t'/ . :''*'> ELECTRICAL PERIiIT Charges and Su rcha rges Sidewalk A/C Paving Curb Cut /'72 6:-Total Cornb. Permit ?: d <]5 TlECHANICAL PERI"lIT Charges and Surc ha rges TOTAL -€4-4 2 < .>u' l,Jater Heater P lrrmhi no coMBINATI0N AppLICATI0N/pERtltT (cAp) I. Applicant to furnishA. Job AddressB. Legal Description1. example- Tax Lot 100, Lane County tiapI7-0'ITr (2. examole- Lot 1. Block 3, Znd AdditionSliln-gfieid EstatesC. Name, etc. of owner and construction lenderD. Energy Sources ( I. examo]e- heat,/electricgl ceiling/or forz. exarnple- waterheater/electrical/or soL-E. Square footage or valuationl-eTEl-- l. examole- 1250 sq. foot house, 50! sq. I t g2. example.-- lT-new project, cheik-i-ew - it check add, etc.F. Building permit information:l. examoie - construct single family house {thr.TGiF d gardse 2, examole - remodel existing garage into3. examole - convert single family resider restaurant (change of use) (' , G. Value of work as defined in Section 303 (a) Structural Specialty CodeH. DESIGN TEAI| AI{D CONTRACTORS To avoid design or construction delays, Bui rhqDivision Staff must be able to contact appr \- persons regarding design information or job corrections, etc.. Abbreviated Plumbing, Mechanical, & Electrical 6oA. Except vrhere blank spaces occur in the desc \.' portion of the Mechanical and Electr.ical Scthe appiicant need fill-in only the No. Boxto the appropriate item(s) to be .installed fB. Full Plumbing, Mechanical, and Electrical S, r! are available at the Building Div.isionl. To conserve space on the permit form thr have been abbreviated t?. If the item(s) to be installed are not t L the abbreviated schedules you should corful I schedulesC. BUILDI|,IG 0lVISi0N STAFF WILL FILL OUT ALL FI /ai CHARGES ON THE SCHEOULES \ D. As noted on the CAP, the label must be delirelectrical contractor for signature by h.is rsupervisor. The generai contractor is not ; totto sign the electrical iabel \. Applicant to sign and date Whenever possible, the initial application willa.worksheet only. Where possible, Bui 1din9 0ivi tnwill prepare a type wrjtten copy and return it t U"applicant at the time the actual permit is issuesignature., Fees and Charges Plan check feei-are due and payable at the time 6application, and no plans vriil be processed unti,fees are paid. Al l other fees and charges are dIE anopayable when the permit is issued. FOR OFFICE USE O|.ILY PERMIT VALI DATION CITY OF SPRINGFIETD Ciry Holl Springfield, Oregon Deportment of Public Works OFFICIAL RECEIPT .*. t No. B 5337t fi4r9 R f r ( ( ( ( ( ( Received For: II 2 III Amounl Received Ov, SHEfTON,TUFN E AUTAORIZEO SIGNAAURE ut! PRrrrERs €UGENE Oi 97aor IV ( V Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permi t appl i cant exempt from reg i strat'ion wi th the Bu'i I der' s Board because : Additional Project Information: name da tesignature PLANS REVIEWED BY: ( l,i)r 725- EC TiOiI LIIiE 69 P r'l(i uti LJ / PERr'l I T TICiI LI COI,IB I IiAT I ON AP L 1CA /lD-sl5J ffi sNib Job Address 9L2 N. 23ih St. r-eeal Descrrption flap p1 7 033611 Lo t ;i{s 800 Owner (name/address/phone)7 46- 8331 Buildino permit info.: describe work (i.e sing.le fam. res. with detached qaraqe) build SprinqField Community Chapel Inc.build gymnasium 942 N. 2ALh St. Construction Lender (name/address/phone) nOng DESiGN TEAII name addres s exDl res ohone no. Pri mary Ed Zi=bart c/o 241 t{. 28LlLSt. None 7 46- 8331 Structural y _Bu-_rlrling I yster'1s535-B trli1l St. . f uo.444-7 433 ElectricaI Yechan'i cal n arne addres s ll ics no PXnl res chonp no - Genera l SorinqField Communit y Chapql lnc.7 46-8331 prumuinq Contract Plumbinq 2B-18 [1. Znd. Spfd, ilZC-llr, 0/SC/aO T4G-D?_zo PLUil8 I NG MECI]AN ICAL ELECTR I CAL F':Ci]ARGE NO I FFF l^HAPIlF iln FIF I^HAPGF Each si ngl e fi xture furnace/burner to BTLI' s Residence of SQ FT Relocated buildinq (new fix. additional ) Fl oor furnace and vent New c i rcui ts al ts or extensions S. F. Pesidence(l bath) Recessed wal l Soace heater and vent SERVICES Duplex (1 bath) each Additional batn Apol iance vent seDa ra te Temporary Constructi on l,later servi ce Stati onar_v evao coo I er Change i n exi sti ng res i dence Sewer Vent fan with si nol e duct multifam'i 1y, comm or Industria l Storm Seler Vent systern apart frorn heatino or A.C.0f amps. ivlechani cal exhaust hood and duct c0141.1./IND. FEEDERS !/lood stove/heater Insta I I /a l ter/rel ocate d i stri b,. feeders 0f ampS. New ci rcui ts, al tsor axtens i ons ISSI]A[{CE OF PERIlIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES I,IHERE STAiE LAI.] REQU sha'l I not be val id unti I IRES that the Electrical work be done by an Eleccrical Contractor, the electricai portion of this permitthe label has been sioned by an Electrical Supervisor and returned to the Building Division. i HAVE CARtFiILLY EXAt'llNED the compieted application for permit, and doand correct, and I further certify that any and ail work pei.formed shall beof Sprinqfield and the Laws of the state of Oregon pertaining to the work deof any structure without the permission of the Bu.ildinq Divjijon. hereby certify that all inforrnatjon hereon is truedone in accordance wjth the Ordinances of the Cityscribed herein, and that N0 0CCUPANCY will be made l,lAl'lE (please print) Steve Pflaf f S IGNATURE TE /=Dvur\eb z tEB,\Fr rU^ UTITLL IJJL JIILI lones Flood llain BLIrns Tme Consr. So Fro Value Occy Load Occ C rou Stories Units lueFt BUILDlIIG PERI'lIT Charges and Surcharges P'l an Ck. Comm/ ind 651i./81C'o Per Fpc Storm Sewer Connec Plan Ck. Res 30111/Bl dq Per Fee 0ther PLUI,lBING PERi'JIT Charges and Surcha rges Fence 0the r Sprinkler System 0ther ELECTRICAL PERIlIT Cha rges and Surcharges Demo A/C Pav i ng >UL IlECI]ANICAL PERMIT Charges and Surcharqes Curb Cut Sidewalk TOTAL rces: lue of work: $1 70 000 ji t _other : TORS Electrical Jave I s El-ectrrc 4015 Flain St. . Snf d !!Cn-qS a/ln/An 7 L6-aGL.n ilechanical Cbq ED Total Comb. Perm'i t t... , j tl< ].L i i a'.r!L' COiliBINATIOI{ APPLICATION/PERI'IIT (CAP) I. Applicant to furnish A. iob Address 8. Legal Description l. example- Tax Lot 100, Lane County l,lap Reference]7TTT:2, examole- Lot 1. Block 3, 2nd Addition to SprT!'Fieta Estates C, Name, et-c. of owner and construct'ion lenderD. Energy Sources l. exancl e-2. Exans I e-e- E. SquaFE-T6-ota heat/electrical ceiIi or forced air qas or soiar II III PERMIT VALIDATION :ITY OF SPRINGFIELD City Holl Springfield, Oregon Deportment of public Works OFFICIAL RECE!PT l e or val uation, l. exanole- 125! sq. foot house, 500 sq. foot garage 2. examiler J-f new project, check-i-ew - if addition, cIEit<--a-cd, etc.F. Building perrnit information: l. example - construct single family house with an att3cned garage 2. examcle - remodel existing garage into famiiy room 3. exaircE - convert singie family residence into ilesiaurant (change of use)G. Value of work as defined in Section 303 (a) of the Structural Speciaity Code H. DESiGII TIAI.I ANO CONTRACTORS To avoid design or construction delays, Buiiding Division Staff must be able to contact appropriate persons regarding design jnformation or iob site corrections, etc. Abbreviaied Piunbing, Mechanical, & Electrical SchedulesA. Exceot',rhere blank spaces occulin the description por!ion of the l'lechanjcal and Electricai Schedules, the appl jcant need fil l-in only the I\0. Boxes adjacent to the appropriate itenr(s) to be instal ledB. Full Plunbing, Ilechanical, and Electrical Schedules are ava.ilable at the Building Division 1. To conserve space on the permit formTthe schedules have been abbreviated 2. If the item(s) to be installed are not covered on the abbreviated scnedules you should consult the fulI scheduIesC. EUILDII.iG DIVISION STAFF I.JILL FILL OUT ALL FEES AND CI]ARGES OiI THE SCHEDULESD. As noted on the CAP, the label must be delivered to electrical contractor for signature b"v his e.lectrical suoervisor. The general contractoLis not authorized to sign the electrical label. Apolicant to sign and date lJhenever possible, the initial application wil l be used as a worksneet only. Hhere possible, Building Division Staff will preoare a type written copy and ret.urn it to the cunl Received appiicant at the time the actual permit is issued for his -signaiure.IV. Fees ano Charges Plan check fees are due and payable at the time of the application, and no plans r'ii11 be processed until these fees are pa'id. All other fees and charges are due and payable vrhen the permit is issued. V. FOR OFFiCE USE OIILY wa t_1 0. B 51000 w d ( s SHELION,TURNBUL! PRINTERS EUGERE OR 974Ot Perm'i t Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI'ICY: PLANS REVIE JED BY: da tes'ignaturename I I (r ( ( ( Add'it'ional Project Informatjon : ,' *- ' INSPECTION LINE 726-37 69 CITY OF SPRIIIGFiELD COMBI NATION APPL I CATION/PERMIT I NFORI,IATI ON L I NE 726-3753 Job Address 942 N. 26th St. r-esal Description nap #17A23611 Lot #s 80CI 9680. 97UU. 9800 heater €a EC .none--fence demol ition changeffise other$170rooo nbte a r accsy Iue of work ater Sources 1ec . Owner ( name/addres s/phone )7 46-8331 build3uilding permit info.: describe work (i.e sinqle farn. res. with detached qarage) Sprinqfield Community Chapel Inc.build gymnasj.um 942 N. 2Bth 5t. Construction Lender (name/address/phone) nOng $ DES I GN TEAI.I name exoi res phone no. Primary Ed Zi*bart c/o 942 N. 28th St. None 7 46-8331 484-7 433 El ectri cal Structural Kifb y .Bu-r.Isling I ystems335-B f4il], St-. Eue. Mec han i ca I ral rln Cha 7 46-8331c n S 6 field Communit el Ine. 0- I PLUMB I NG MEC HAN I CAL ELECTR I CAL N0.FEE CHARGE NO FFF NHARGF NO FFF II]A PGF Each single fixtureI/z -d l furnace/burner to BTU' s Residence of 5t,FT Relocated building (new fix. additional ) Floor furnace and vent S . F. Res i dence ( I bath) Recessed wal I Soace heatpr and vPnt SERV I C ES Duplex (l bath) each Additional bath Apol i ance vent sPDarate Temporary Constructi on [^]ater service Stationarli evap cool er Chan rtrq 1 ge in existing dp ncpN("*""@7to ,14 -L3 a- Vent fan with sinole duct --1-6,Indust-rial multifamily, cornm. or Storm Sewer Vent systern apart from heatinq or A.C.z -amps.of za ?5.ir sb' i,lechanical exhaust hood and duct COMI.I./IND. FEEDERS I,Jood stove/heater Insta1 1 /aI ter/re l ocate distrib. feedersflrbr ?)r.p.f lf 0f New c i rcu i ts, al ts nr pxtpnsion< t*ISSUANCE OF PERIlIT&=TOTAL CHARGES TOTAL CHARGES y-n TOTAL CHARGES &* _i^IHERE STATE LAl,{ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrica.l portion of this permitshall not be valid untii the label has been siqned by an Electrical Supervisor and returned to the Buildini; Division. I HAVE CAREFI,LLY EXAMINED the completed application for permit, and correct, and I.further certify that any and all work performed sof Sprinofield and the Laws of the State of 0regon pertaining to theof any structure without the permission of the Buildinq Diviiion. and do hereby certify that all information hereon is truehall be done in accordance with the Ordinances of the C.ity work described herein, and that N0 OCCUPANCY will be made S IGNATURE D^rE lo* /0-UNAI'IE (please print)Steve Pfaflf IUA UT i ILtr U)L UIIL I 2.""' E<4R-l <ffi.L nrin.- Bdrms -* rype constltt({FAt,,ru 4*_occv Load occy Gtoup-al'?- stories:z units sq Fts. ffixngu Value nEle @r- Plan Ck. Comm/Ind 65%/Bldo Per Fee 6\a -)c- Storm Sewer Connec Fee Pl an Ck. Res 30%/B1 dq Per 0t her Fence 0ther Sprinkler System 0t her Demo Total Comb, Permit €{t, 6o e __7_?_o_,-f,_o___ BUILDING PERI'IIT Charges and Surc harqes PLUI4BING PERMIT Charges and Surcha rges ELECTRICA,L PERt|IT Charges and Surcharges A/C Paving sDc t.sz 56"2 : tz ?s#2.oo Curb CutI,IECHANICAL PERMIT Charges and Surcharges 7{t.%Sidewal k TOTAL t l0_ tb Jzz3 N New circuits alts. or extensions 7t/z,lz COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description l. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Btock 3, 2nd Addition toSpringfieid EstatesC. Name, etc. of owner and construction IenderD. Energy Sourcesi. exampl e-?, exampl e- Square foota hea t/d air qas water E ge or II 1. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - if addition, check add, etc.F. Bui lding permi t information:1. example - construct single family house with an attached garage2. Sxamp-13- - remodel existing garage into famiiy roonr3. 9IAIS], - convert single family residence intorestaurant (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 construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or job sitecorrections, etc. Abbreviated Plumbing, l,lechanica1, & Eiectrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical 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 available at the Building Division1. To conserve space on the perm'it formTthe schedules have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful I schedu.lesC. 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 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 hissignature. Fees and Charges Plan check fees are due and payable at the time of theappiication, and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY III IV PERMIT VALIDATION Permi t Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: h f,:en,r 7c.rat foa. Dze ;Pa.-//affi >rtrev h Frre v ry,,a,f,rr.s 4>PF/<d? E< P.rg V€v.ot- ?' 42'rOo Addi ti onal Project Informat'ion : PLANS REVIEWED BY: name @/P V<€g sig na tu re da te -n t l0_tb 3zz3 RI'lI TcoilB I 726-37 L NE ,TI N APPLI JobAddress 942 N. Zgth St. Lesal Description $ao #12089611 Lot #s 800 5Cr So 1 ,l 'I deta ter h eaterBJ.€C.none- $1 7o 000 a work e., build I accsy. 'I ue of work ra ng perm urces:ec. - ergyatE fent6 dE-mol itioi- change/u-se _other 0wner ( name/address/phone )7 46- 8331 Sprinefield Community ChapeI Inc.build gymnasium 942 N. 28th St. Construction Lender (name/address/phone) nOng $ nameDESiN TEAI4 address exDIres phone no Primary Ed Ziebart c/o 942 N. 28th Et, None 7 46-8331 El ectri ca l Structural Kifb v Buildino S Hechani ca l Inc 746-8331SrJ. n field Communit Cha e1 prumuinq Contract Plumbi.nq 2O3B N. 2nd. Spfd. #ZO-1lq A/SO/AO 746-0220 t PLUI,IB I NG MECHAN I CAL ELECTR I CAL N0.FrF CHARGF [0 FFF CHARGF N0_FFF r!]APAF I Each single fixture/z -,%=furnace/burner to BTU' s Residence of SQ. FT Relocated building (new fix. additional ) FIoor furnace and vent New circuits alts. or extensions S.F. Residence ( I bath) Recessed wal I Soace heatpr and vpnt SERV ICES Duplex (l bath) each Additional bath Apol iance vent seDa ra te Temporary Constructi on I.,ater service Stationary evap. coo l er Cha res nge in existing i dence7ftaTtot.r."'<4,w *l a Vent fan with sinole duct -C1-t6*mu)tifamily, corm, or Indrrstrial Storm Sewer Vent systern apart from heatino or A.C.1 ampsof zG .r*sb" Mechanical exhaust hood and duct COMI.I./IND. FEEDERS l,lood stove/heater I nsta I I /a I ter/ rel ocate distrib. feeders ?frb+r funP.f ltr 0f New ci rcui ts , al ts nr cxtpncions ISSUANCE 0F PERrlrT ,* TOTAL CHARGES qTJ&TOTAL CHARGES 3q.n TOTAL CHARGES 5a'st _WHERE STATE LAl,{ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permitshall not be valid until the label has been siqned by an Electrical Supervisor and returned to the Building Division. I HAVE CAREFULL and correct, and i of Springfield and of any structure wi NAIIE (please print) Y EXAMINED the completed applicationfurther certify that any and all work the Laws of the State of 0regon perta thout the permission of the Building Steve Pfaff for permit, and do hereby certify that all information hereon is trueperformed shall be done in accordance with the 0rdinances of the Cityiningr to the work described herein, and that N0 0CCUPANCY will be madi Division. S IGNATURE DArE /o - /6-)f ruh UTTIUL U)L UIILI 2.""' EZ,4R'| iFil*'u lt"ln-- Bdrms - rwe const@-61 {n sq Fts. t4W-vlr. /H&.-0ccy-Load = occy Group ,l'Z- stories:?- unirs sq Fts. fi*lXiai vrro-- lia$;-EoACCII.IMAFonPIan Ck. Corrn/Ind 65%/B1da Ppr Fpp Storm Sewer Connec 0the rPlan Ck. Res 30%/BIdq Per Fee Fence 0ther Sprinkler System 0ther Demo Total Comb. Permit SGz:rz f,o €d (tc) / .&, 6,2 2'.6$, a-., BUILDING PERI'IIT Charges and Su rc ha rges ELECTRICP,L PERIIIT Charges and Surcha rges A/C Paving soc l.s,'eq|-,25fu.* Curb Cut7{ /.%Sidewal k *.,TOTAL 8I,IECHANICAL PERMIT Charges and Surcharges PLUI,IBING PERl'lIT Charges and Surcha rges 7t/z,lz :;q i# For: COMBINATION APPLICATION/PERMIT (CAP) Applicant to furnishA. Job Address8. Legal Descriotiont. ii* O[eO, Tax Lot 100, Lane County ilap Reference " : i#i,$;.f;'rl;.fll'u 3' znd Addition to i: iilinr'13;.llro*nu" and construction Iender I exampl e- examo I e- re toota hea t,/e I trica ceili2watertere rced air E. Squa I e or vaiuati or so ar I exampl e- ex amp I e- check add 1250 s oo, 2 JF-new q. foot house,500 sq. foot 9ait ra ge etc project, check new - if:add ion,F. Bui I ding permit informa tion:I example - a ttac hed -construct single family house with an9arage2.examp'l e - examole - res ta uran remodel existi3.convert si ngle ng fa garage into fami.ly roommrty residence intoG. Valu e of work t (change of use) Structural S as defin ed in Section 303 (a) of rhe H. pec i a)ty Code CONTRACTORSDES I GN TEAI.I AND To avoid desion Division Stafi r or construction del ays,Bui)ding persons regardi must be able to con tact a ppropriateng desi gn information or job siteII. Abb corrections,etc A reviated piumOi n9, Mechani cal, & Electrical ScExcept where b 'lank spaces hedu I es portion of the Mechan i ca I occur in the descri ption the appl ica nt need fiil-in and Eiectrical Sc hedu I es ,to the appropriate item(s)umbing, Mectranical.ilable at the Buiti only the No. B oxes adjacentB. Fult pl to be install ed are ava .and-Electrical Schedu.lesrng DivisionToconserve oilliililo,ne-permit formTtne schedu.reshave been a 2 If the item s) to be installed areted schedules you shoulthe abbrevi not covered on ful I schedul es d consult theC. BUIL DING DIVISI 3lr:Jff[r*,,1 FrLL ouT ALL FEES ANDCHARGES ON THE D.As noted on the CAP, the labe I must be deliverede l ectri ca l contractor for sl gn ature by his elect to the supervi sor.The general cont rical to sign the e lectrical la bel. ractor is not aut hor i zedII I. Appl icant to si I I n and datelJheneve r possib e, the initial a pplication willa worksheet on 1y l^lhere possibl e, Building Divi be used aswill prepare a typ e written copy tme the actual and return it sion Staff appl icdnt at s i gna ture. the t to thepermit is iss ued for his IV Fees and Charoes liii,iilti,i"*0.ff si:,t,!, fi,83,;":l.ll:0,,1ffi, i,,f;::.fees are paid. AI I irther r.., ira-.ii'.iir".r. due andPayable when the permit is issued. FOR OFFICE USE OTJLY ' :V PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: z€R Yretqli-I Additional project Info rmati on : da te -zE€3R Si gnature'name PERMIT VALIDATION Y OF SPRINGFIELD Ciry Holl Springlield, Oregon Deportment ol Public Works OFFICIAL RECEIPT B s1807, l9 b 1 rnl Received AUTHORIZEO SIGNATURE SHELTOT,YURNBULL IRIilTERS ' EU6ENE OX 97'OI Permi t Clerk ( ( ( ( t, ( ( ( PI-ANS REVIEWED BY: L COMBI I ERI"lIT 726-3 a)'\s * 0p Job Address 'o rgy Sources ma n accsy ter heater new a ter 1ue of work: ./2 fence demol ition change-/use other Legal Description 0wner (name/address/phone) {,%frOO,gGl .b Building permit {nfo.: describe work (i.e., Uuild sinqle fam. res. with detached qaraqe) I Construction Lender (name/address/phone) hame address exo l res phone no Pri ma I gyelarfr,<B S2*- Eo.ra-/y€ 6a?BZ.T Structural El ectri cal I'lechani cal CONTRACTORS name add res s t aq nn PYNl TPq ohone no- )bVZ, Pl umbi El ectri ca I Z3 PLUI.IB I NG lDMECHAN ICAL \--a) ELECTRI CAL FEE CHARGE NO FFF CHA RG F NN FFF CHARGF Each single fixture furnace/burner to BTU' s Residence of SQ FT Relocated building (new fix. additiona l ) Floor furnace and vent New ci rcui ts al ts or extensions S. F. Res i dence(l bath) Recessed wal I SDace heater and vent SERV I CES Duplex () bath) each Additional bath Apol i ance vent sFoa ra tF Temporary Construction hlater service Stationary evap. cool er Chan res i ge in existing dence Sewer Vent fan with s'inol e duct multifamily, comm. or Tndrrqtria l Storm Sewer Vent systern apart from heatinq or A.C.0f Mechanical exhaust hood and duct COMI'I./IND. FEEDERS lrJood stove/heater Insta'l I /a1 ter/re l ocate d i stri b. feeders 0f .amp s. New ci rcui ts, al ts nr cvtpn< inn< ISSUANCE OF PERIlIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES I^IHERE STATE LAI/ REQUshall not be val id until IRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permitthe label has been sioned by an Electrical Supervisor and returned to the Building Division. I HA E CAR EFl.I LL EXAM I I\L D the comp I e ted app I 1 ca t 1 on for permi t and do herebyhall be done in ce rt fy t hat a I 1 'I n fo rma t 'I on hereon is true ces of the City CY wi l I be made a nd correc t an d I fu rt her cert 'I fy tha t any and a I I wo r k per f ormed s AC co rd ance th the 0rd i n an o f Sp rt nqfield and the Laws of the structure without the permi tl I ease pri nt )'\_il7!tto, S ta te of 0re go n perta 1 'I n9 to the wo rk de crt bed he re I a nd hat NO OCCUP,AN o f a ny s S I o n of th Bu 'I I d i n g Di s I n x NAI'IE (p 4k ln., {S I G NATURX DATE //-c , FOR OFFICE USE ONLY Zones Flood Plain _ Bdrrns Type Const Sq Ftg Sq Ftg Value ValueOccy Load Stories UnitsOccy BUILDING PERI'lIT Charges and Surcharges Plan Ck. Comm/Ind 65%/B1dq Per Fee ,{(.*Storm Sewer Connec Plan Ck. Res 30%/81dq Per Fee 0ther PLUI4BING PERMIT Charges and Surcharges Fence 0ther Sprinkier System -- r-5/<,0the r ELECTRICAL PERNIT Charges and Surcharges D€fior / ??o :.88 Total Comb. Permit A/C Paving SDC I4ECHANICAL PERMIT Charges and Surc ha rges Curb Cut TOTAL / zl,ea Sidewalk Generat A,U,<t tooot> lt COMBINATION APPLICATION/PERMIT (CAP) L Applicant to furnishA. Job AddressB. Legal Description 1. example- Tax'Lot 100, Lane County l,lap Reference 17 03 432. example- Lot 1. Block 3, 2nd Addition to Springfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources 1. L. Squa exampl e- examp I e- re foota hea t/ca I or forced air gas WA or solar E ge or vaiuation, e II. 1. example- 1250 sq. foot house, 500 sq. foot garage 2. qxqnp'l e- if new project, check new - if add'ition, EI6EI- add, etc.F. Building permit information:1. example - construct singie 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. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or job site corrections, etc, Abbreviated Plumbing, Mechanical, & Electrica'l SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical 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 available at the Bui)ding 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 schedul esC. BUILDING DIVISION STAFF l,llLL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be deljvered to theelectricai contractor for signature by his electrical supervisor. The general contractor is not authorizedto sign the electrical label. Applicant to sign and date Whenever possibie, the init'ial appl ication will be used as a worksheet oniy. I^lhere possible, Building Division Staffwi)l prepare a type written copy and return it to the applicant at the time the actual permit is issued for his III. signature.IV. Fees and Charges Plan check fees are due and application, and no plans wi p 'I ayable at the t'ime of theI be processed until these fees are paid. All other fees and charges are due and payable vlhen the permit is issued. V. FOR OFFICE USE ONLY PERMIT VALIDATION Permi t Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Additional Project Information : PLANS REVIEWED BY: name s'l g nature date iNSPECTIOII LINE 776-37 69 CiTY OF SPRIIIGFiELD COMBI NATI ON APPL ICATION/PERI'IIT INFORI,IATION LINE 726-3753 Job Address e->84 n Legal Description 739. ter ma n new _a alue of work: / accsy ter heater ergy Sources at demol i tion r/u-se _other fence change 0wner (name/addres s/phone )1 ng permit fnfo.: describe work (i.e., build fam. res. with detached qaraqe) Bui I di sinqle /)furo./<L€B ,%fg-*, Construction Lender (name/address/phone) DESIGN TEAI{tame address I ics. no.exoi res 10ne no - Prima | .gY-1os<<n Sr. {o4€tva 6a?t;r-,T Structura l 7 El ectri cal Hechanica l CONTRACTORS name a ddres s ( exni rps )lics. no.)ohone no.' eenerat € o4k ,4]>va. !1 umbi nq El ectri ca I llecha ni ca l PLUI,IB I NG MECHAN I CAL ELECTR I CAL N0.FFF CHARGE NO FFF CHAPGF NO FFF CI]AANF Each single fixture furnace/burner to BTLI' s Residence of SQ. FT Relocated bui )ding (new fix. additional ) FIoor furnace and vent New ci rcui ts al ts. or extensions S. F. Res i dence ( l bath) Recessed wal I Soace heat-er and vent SERV I CES Duplex (l bath) each Additionai bath Apol iance vent seDa rate l,later servi ce Stati onar.v evap. coo I er ge in existing dence Chan res i Sewer Vent fan with sinole duct multifamily, comm 0r Industrial Storm Sewer Vent systern apart from heatinq or A.C.0f amps. Mechan'ical exhaust hood and duct COMI.I./IND. FEEDERS l,Jood stove/heater I ns ta I I /a I ter/ rel ocatedist-rib. feeders UI amp s. New circuits, alts or pvipnsinn< ISSUANCE OF PERI,iIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LA|.l REQUIRES that the Etectrshall not be valid until the label has been ical work be done by an Electrical Contractor, the electrical portion of this permit sioned by an Electrjcal Supervisor and returned to the Bujlding Division. 1 HAVE CAREFLILL and correct, and Iof Springfield andof any structure wi NAl"lE (please print) the Laws of the State of 0regon pertaining to the work described h ty de x Y EXAttINED the compieted appl.ication for permit, and do hereby certi fy that all information hereon is truefurther certify that any and all work pe rformed shall be done in a ccordance with the 0rdinances of the Cierein, and that N0 0CCUPANCY will be mathout the permission of the Buildin g Division //-o2-SIGNATURX DATE FOR OFF.ICE USE ONLY VaLue Value Zones 0ccy Load Occy Group Units 9q FtgStories Plan Ck. Comm/lnd 657ilBldq Per Fee ,{(- 8-Storm S-ewer ConnecBUiLDING PERI'lIT Charges - and Surcha rges Plan Ck. Res 30%/81dq Per Fee 0ther Fence Other -PLUI4BING PERMiT Charges and Surcha rges Sprinkler System 72.*0the r / ??-Demo'.?. 88 Total Comb. PermitELECTRICA,L PERIlIT Charges and Surcha rges A,/C Pavi ng SDC Curb CutI1ECHANICAL PERMIT Charges and Surc harges Sidewalk TOTAL / z7,ea' Temporary Construction ,V # L<t/t4 7X/ Flood Plain _ Bdrms Type Const. Sq Ftg. COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 1/ UJ {J2 3#$#r""i!trli.?13'o 3' 2nd Addjti^^ ' clTyC. Name, etc. of owner and construction le ("0. Energy Sources 1. exampl e- heat2. example- wate ec 0rr /electrical cei /or OF SPRINGFIELD CitY Holl PERMIT VALIDATION . Oregon Public Works RECEIPT ( r e Soringfield DePortment of OFFICIALE. SquaiET6-otage or valuat on, e f 51"958ri. examole- 1250 sq. foot house, 500 sq2. "*rrT". JFTew project, cheik-new -EEEk-Edd, etc.F. Bui lding perrni t information:l. examDle - construct single family hor;TtaEfA garase2. exarirple - remodel existing garage int3. examole - convert s'ingle family residiElTiuFant (change of"use)G. Value of work as defined in Section 303 (i Structural Specialty CodeH. DESiGiJ TEAI,I AND CONTRACTORS To avoid design or construction delays, BuDivision Staff must be able to contact app persons regarding design information or jol corrections, etc. t{0. c1 B ( D R 1, 6 { II III. IV portion of the Mechanical a the appl icant need fill-into the appropriate item(s)Full Plumbing, Mechanical, are available at the Building Division1. To conserve space on the permit form the F,have been abbreviated2. If the item(s) to be installed are not cr the abbreviated schedu'les you should consfui] schedules (C. BUILDING DIVISION STAFF I.JILL FILL OUT ALL FEE \' CHARGES ON THE SCHEOULESD. As noted on the CAp, tne label mriit be deliverelectrical contractor for signature by h'is ele flcsupervisor. The general contractor is not aut \ to sign the electrical label. Appiicant to sign and date l{henever possible, the initial application will be lda trorksheet oniy. Where possible, Building Divisic \ wiII prepare a type written copy and return it to t .rapplicant at the time the actual permit is issued f si gnature. iFees and Charges \ Plan check fees are due and payable at the time of 1application, and no plans will be processed until th fees are paid. AII other fees and charges are due a ,payable vrhen the permit is issued. i V. FOR OFFICE USE ONLY v Abbreviated Plumbing, Mechanical, & ElectricalA. Except r.rhere blank spaces occur in the desc nd Electrical Sc oniy the No. Boxtto be installed and Electrical Sc (i For IR ) I --rl 5IGNATU RE eTao! 6Atrr_a ( Permi t Cl erk PROJECT CONDiTIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Additional Project Information : PLANS REVIEWED BY: da tenames'l gna tu re ( ( ( f'() INSPECTION Li . 7?6-37 69 m COI1BI i{ATI ON APPL I CATION/PERMIT InmRr{AfoN frNE 726-3753 Job Address qq| ,,/. 7gE St IIE fr l-ega l Description Ranqe EIIERGY SOURCES: HeatEn, ELEL l.later Heater Value of l,lork Sq. Fto. l'la in_ sq. Ftg. Acceill- Sq. Ftq. 0ther__ _l'leur-__rAdd_Al ter_Pep . _Fence_Demo Change/Use 0ther 0wner gpgtN6F/E/.D ao*rr.uttry c,urrEl -gAlc .e., Build Singlenq Pernrit Info: Describe l^lork(' Residence liith Attached Garaqe Builei Farni I yPhoneAddress qyL ,\/. 2gg sL 1YO- sral ME(jl. (p.nor,t,,r,ru) trllgj sttile22\ PEPatT E9s0EoConstructi on Lender Io-tL-7q \\$ sb (r\l Address Phone lics. no-exDr res ohone no-DES I GN TEAI.I name addre s s Primary Structura l El ectri ca I Mec han i ca I add res s lics- no-exD I res ohone no- )CONTRACTORS n ame nPI Genera I El ectrical l''lechani ca l ELE CTR I CAL MECHAN I CALPLUI.lB I NG FEE CHARGF NO FFF CHARGF N0^FFF CHARGF Each single fixture 5 furnace/burner to J90-y0O2- BTLr s b sba Relocated building (new fix. additional ) New circuits aits or extensions Floor furnace and vent S. F. Residence(l bath)SERV ICES Recessed wal i Snace heatpr and vcnt Duplex (l bath) each Additional bath Temporary Construct ion Apol iance vent seoa rate l,Jater serv ice ge in existing dence C han res i Stati onar.v evap coo I er Sewer mu1 ti fami ly, J ndrrstri a I cornm. 0r Vent fan with sinole duct Storm Sewer 0f Vent system apart fron heatinq or A.C. c0Mr-1./IND. FEEDERS Mechanical exhaust hood and duct Instal I /al ter/rel ocatedistrih. fecdprs lJood stove/heater 0f s. ISSUANCE OF PFRI{IT IAA TOTAL CHARGESTOTAL CHARGES TOTAL CHARGES 10,b WHERE STATE LllN REQUIRES that the Electrical work be done shall not be valil until the label has been signed by an Elect by ri, an Electrical Contractor, the electrical portion of this permit ca1 Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed application for oermit, and do hereb.y certify that all information hereon is true and correct, and I further certif-v that any and all work performed 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 NC 0CCUPAIICY will be madeof any structure without the permission of the Building Division, I further certify that my reqistration r.rith 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 thatonly subcontractors and ernnloyees who are in comoliance with 0l?S 701.055 will be used on this Droject. om v2l *80I,lAl'1E(please pri nt)SS LiR I Gi.IA I 'l Val ue TOTAL VALUATION xFlood Plain S tori es 0c Ftg 0ther Zon 0c tc Val / Con st. c.y Grou al ue Zone Fire Fto. l4ain x cy Load Sg. Ftg. Access Plan Ck. Cornm/lnd 65%/81do Per Fee S vs terns Cha rqe DeVe (1. 5Z 0pmentBUILDING PERMIT Charges and Su rc harges PIan Ck. Res 30%/81dq Per Fee {c Pr,,N ?7,7L &r :flor{PLUI4BING PERMIT Charges and Surcha rges Dgrno Sidewal kELECTRICAL PERIIIT Charges and Surcharges A/C Paving _U Total Comb. Permit Curb CutIlECHANICAL PERMIT Charges and Surc ha rges loa a TOTAL , {/,6o Residence of sQ. FT. €b,tb a*.*, COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legai Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 43 ?. example- Lot 1. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION 1. exampl e- hea2. example- wat Square footage o t,/electrical ceilin or forced air ea ec tr ca or so ar E r valuat on, etc1. example- 1250 sq. foot house, qOq sq. foot garage2. example- if new project, check new - if addition,iIEiI-Eod, 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 theStructural Specialty CodeH. DESIGN TEAI.I AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriatepersons regarding design information or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except v/here blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the appiicant need fill-in only 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 thefull schedulesC. BUILDING DIVISION STAFF WILL 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 electr.icalsupervisor. The general contractor is not authorizedto sign the electrical label Applicant to sign and date Hhenever possible, the initial application will be used asa worksheet only. Where possible, Building D.ivision Staffwili prepare a type written copy and return it to theapplicant 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 theapplication, and no p)ans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY 1Al-80 # SqcB+ II III IV. V 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 Si g nature date I 7 CTI 769 RMITCOMBIOI'I APPLICATION25- ONN oil Lru 7?6-3753 Job Address g l-egal Descri ption Hea t tF:L. EIIERGY SOURCES l.later Heater Ranqe : 5q. Ftg. Access.--_ Eer Tep. -Sq Chan Ftg. Other l,ler.r Add Al 9elUse . Ftg.n Value of llork Owner €. r 'i ng elnI(t I 1F n l^lo r Ga ralr'i thPhoneAddrdssE- t,a/ Construction Lender \\tq (.r{ }J }J uc Ilr-lo- Address Phone r res name Pri ma Structura I El ectri ca l l.lechani cal RS Pl umb ri cal MECHAN I CALELE CTRI CALPLUIIB I NG it 3o€c furnace/burner tot(t.1,.EtO BTU'sResidence of FTSQEach single fixture Floor furnace and ventNe!,J circuits alts or extensions Relocated building (new fix. additional) Recessed wal l Soace heater and ventSERV I C ESS. F. Residence(1 bath) Duplex (l bath) each Apol iance vent seoa rateTemporary ConstructionAdditional bath Stati onar"v evap coo l erge in existing dence C han resil.later serv ice Vent fan with sinole ductmultifamily, comm' or I ndu stri a ISewer Vent systern apart from heatino or A.C..amp s.0fStorm Mechanical exhaust hood and ductc0r.1r'1./IND. FEEDERS l'lood stove/heaterInstal I /al ter/rel ocatedistrib. feeders 0f amp s. ISSUANCF 0F pFRHIT lo,rn TOTAL CHARGES 1U,trTOTAL CHARGESTOTAL CHARGES WHERE STATE LAI,I REQU shalI not be valiI unti l IRES that the Electrical work the label has been signed bY be done by an Electri an Electrical Contractor, the electrical portion of this permit cal Sufrervisor and returned to the Building Division DA1E 7-21 -8aI,lAl''lE ( p I ease pri nt ) 0reg the Bhe permi effect ng 70 f on h s rUt etcertthaahedonorrnatereonINEthedLcofornermLanaFULLEXAIlDreb.y fycomp!')p acc ncorda e tth 0rdhe na enc cofthenedonndaal^rO kr rfoDC srmed ha tyberrdanfucrtherLerftthaandacot-V o here n thand t OCCUNC PAI,IC wl be maderc ny ofnfidthandofwsStathete art n +to WOhe rk d bee0neLaeofSngDrlsDE t Lra 0n th1.r'l Buthe der sssonfoUdiDr'on fu cerrther ti th atv m.y regructuretwltht0utaofnyfor t 0n ns heoted nreo a nd th tarcndafulnrdtha+f het sba s exemrJasORS1055foaBoexemptredrequby n tarvhorenwlance0th7DC0505!Jl be sedu o th s ecUtrbcontoSonr5andprojvernDoyeesc0mD SS LL R Ftg Ftg Ftg Uni tsTyoe/ Const Stori es TOTAL VALUATIOII So xBedrooms x Zo np Val ue_0c 0c cy Load Sq c.y Grou l'lain x Value_ Flood Plain Fire Zone Val ueAccess 0ther Svs cfa tens Deve' rqe (1.57'opmentPlan Ck. Comm/ind 65:l/Bldq Per Fee Plan Ck. Res 30%/Bldq Per Fee q7,7 6 /3'-,,',#eb{P,rJdSenee Demo '7;r--;*\ Sidewalk s6,16 tal*? d/,,2. . A/C Pavi ng IJ Total Comb. fermit Curb Cut ,d2O #!,ca TOTAL BUILDING PERMIT Clrarges anC Su rc ha rges PLUI4BING PERMIT Charges and iurcha rges .ECTRICAL PERI:IT arges and 'cha rges iANICAL PERI"IIT ges and larqe s {/,1 d I I I 'I1I 1 \ COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Descriptr'on1. example- Tax Lot 100, Lane County tlap ReferenceI7-T3-?32. gxamplq: Lot 1. Block 3, Znd Addition tosprrngfie)d Estates 9. Name, etc. of owner and construction IenderD. Energy Sources I exanole- heat/eJectricai ceilino/oexaTo I e- rva terEEa reiTElEciFfEEt-ibruare fgef6gp or valuation,-eTF- examo]e- 1250 sq. foot house,500examoie- if new project, check-iEwcneck add, etc. r forced ai2soE. sq ar 2 sq. foot ga it ra ge if add 'ion , F. Bu ilding permit information 1 examp I e - construct s.ingie famity house with ana ttached garage 2 exanole - examoie - iEitauran remodei existing gara ge into famiiy room3.convert si ngle fami l y residence into G. Value of work t (chang as defi e of use) Structural Specia I ned in Section 303 (a) of the H ty Code OESIGN TEAI.I AND CONTRACTORS To avoid desiqn Divi s ion Stafi or construction delays, Buildi ngmust be able to contatt a ppropri atepersons regardi ng design informat.ion or job sitecorrections -IL Abbreviated plum etc. A. Except r.rhere b'ing, Mechanical, & Electri cal Schedulesblank spaces occur in the descriptionportion of th e lt4echanical and Elec trical Schedulesthe appl icant need fill-in onl y the No. Boxes adj acentto the aporo priate item(s) to be installedB. Full Piumb.i ng, Mechanical, and Electrical Schedulesare avai lab le at the Building D 'lvrston1. To cons erve space on the permit form the scheduleshave been abbreviatedaL.If the item(s) tothe abbreviated s, be installed are not covered onchedules you shouid consuit theful l schedules III C. BUILDING DIVISION STAFF I,IILL FILL OUT ALL FEES ANDCHARGES ON THE SCHEDULESD. As noted on the CAp, the labe.l must be delivered to theelectrical contractor for signaturu Oy f,rir.i.iiri.ui - supervisor. The general conlractor ii not authorized- to sign the electrical labetAppifcant to sign and date Hhenever possible, the init.ial application will be used asa._worksheet onjy. rilhere possibte, guilding Division Staiiwr rr.prepare a type wriflen copy ancj return it to theapplicant at the time the actuai permii-is issued for hiss i gna ture. Fees and Charqes Plan.check feis are due and payable at the time of theapplication. and no p)ans rviil-be proceiied until theserees are paid. Al I other fees and charqes are due andpayab)e yihen the permit .is issued. FOR OFFICE USE ONLY IV V PERMIT VALIDATION 't -8{ SD 5qc3+ Permit Clerk # PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from registration with the Builder's Board because: Add'itional Project Informatjon PLANS REVIEWED BY: name S'I g na tu re da te Daw'o Azffirz ELECTRICAL CONTRACTOR 47331 McKENZIE HIGHWAY VIDA, OREGON 97488 PHONE 822-3420 11-tO-77 Forest PriceCity of Springfield Bui-1ding Inspeetor This ls to inform you that Davers Electric, State license # 20-95 Accepts all responsibility for the electrleal work on the addition at 942 N. 28th Street, Springfield, Ore. A11 work installed according to NEC. Rough-in was inspeeted by Springfield City fnspeetor, Ar1o. Davers Electric Da Gadomski, Owner REMODELING RESIDENTIAL COMMERCIAL /'> U" .'z.t.,-,:\./ r,-r.->?t,,....{.,:\"-/ ...r-svw' ,' ';J r ir / 'Vr-4'.r.\< r''d. ......rr,-{Y I ,) fhis Certifcate isued pursuant to the requireilteilts of Sectioil 306 of the Unifonn Building Cade certifying t/tat at t/rc time of issuance tltis structure ruar in compliance with the aaiout ordinances of the City regulating building construction 0r ure. For tlte following: Occ. Group- !:l-Type Construction VN 6i;e Tens III Use Zone R-I Owner of iui fId. Gos abernac e ."r, 942 North 28th Street BuilcJing ACd 942 N rh dg. Permit No 4250 15--V Dqte Building Officiol POST IN A CONSPICUOUS PLACE t-"r^/':),"/\'lww w.gt/(, ICITY CF SPRINGTIELD, OREGONtublic Works .ir{ 1{-?z{'r*r, 5r w i 4, ri ,,o 1,' /'L BUILDING DEPARTI,IEM PI^I- 11 Inspector t s Memo lfv JOB ADDRE SS 7), 3g /J.,",L DArE 5- I 7- 7/ TO /57d dn lnra:^h^- AA /1 u4) Phone 747 -422L INSPECTOR 4ut