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Home My WebLink AboutPermit Building 1984-02-08Job Address 32 e t.ega1 Descri ption ?- JWner g ti 1) \ \ \ \ 0 Sq. Ft9. l'lain_ Sq. Ftg. Access._ Sq. Ftg. 0ther-- _l.lew_AddJ l ter_P.ep . _Fence_Demo_Chan ge/ U se 0ther b'-//zo '. EIIERGY SOURCES Hea l,Jater Heater Ran Address 5 )q o Val l.lork Pe si tI Descri be d l,,lo rk :e., Build Single Fami I ,C c\\lo?1 \so,,\\s,r 1 \(\ Exrt\rsc* B.LrI r n\r\(: Addre ss Phone T a Pri ma c,oJ c V,-l-^c i,,.-,'ao d C a*.^^.\ Structura l Electrical y'lAatrt Mechan i ca I CONTRACTORS name addres s (licc. no'exD l res ohone no- ) Genera I Pl umbi El ectri ca i l.lechani cal PLUIIB I NG ELECTRI CAL MECHANICAL \\ \ FEF CHARGF NN FFF CHARGF N0.FFF (.HARGF Each single fixture Residence of sQ FT furnace/burner to BTU' s Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S. F, Res idence ( I bath)SERVICES Recessed wal I Snarp hpatpr end venf Duplex (l bath) each Additional bath Temporary Constructi on Apo'l iance vent seoa rate [.later servi ce Change i n exi sti ng rpc i dpncp Stationary evap coo I er Sewer multifamily, conrn. or Industrial Vent fan with sinole duct- Storm Sewer 0f Vent systern apart from heatinq or A.C. I trLUUnfirlE \1.-\qcf)cor.il.r./rND. FEEDERS Mechanical exhaust hood and drrct ({ng^,1r-,!Lrur}I nsta I I /a I ter/ rel ocate dictrih fpcdprc l'lood stove/heater 0f S. ISSUANCE OF PFRI1IT TOTAL CHARGES \5.<r(>TOTAL CHARGES TOTAL CHARGES WHERE ST shall not be ATE Lr\N REQUIRES that tlte Electrical work be done by an Electrical Contractor, the electrical portion of this perriitvali'l until the label has been signed by an Electrical Supervisor and returned to the Building Division and I HAVE CAREFULLY EXAMINED the completed application for pe perfo rmit, and do hereb.y certify that all information hereon is truecomect, and I further certi fy that any State of and al I work rmed shall be done in accordance with the 0rd'inances of the Ci ty deof Springfield and the Laws of the 0regon oertaining to the work descrjbed herein, and that N0 0CCUPAI'ICY will be ma he Building Division. I further certify that my registration vrith the Builder'sof any s Board is tructure without the permission of tin full fo rce and effect as required by ORS 701.055, tha and ernployees who are in comcliance with 0l1S. h)o,./( # --7a7- l/ ZO t if exempt the basis for exemption is noted hereon, and thatonly subcontractors 701.055 wilI be used on this ect. l.lAl.lE(p lease print)/4 *-sr;rt D ZFctL S IG|IATU DAT Ea : ';. T voelConst.\.i - \ t;q,Wunits S q Ftg. Ftg. Ftg. n x Va I '| '| Fire Zone * Bed rooms - Load Sq c.oriTa-f--sqFlood Plain -_ Stories.1 .0cc.y 0ther Y,VA TOTAL VALUATIONrA BUILOING PERTIIT Charges and Surc ha rges b_g(l Plan Ck. Comm/Ind 65%/81C'o Ppr Fpp 2.-A-t.l aB tazug Svsterns Deve charqe (t.sz opment q,^'0^@ Plan Ck. Res 31%/Bldq Per Fee PLUI4BING PERMIT Charges and Surcha rges \f-, <ic> -:4:_____,b Fence Dgmo ELECTRICAL PERIIIT Charges and Surcha rges SidewaI k A/C Paving Tota'l Comb. Permi t IlECHANICAL PERHIT Charges and Surc ha rges Curb Cut TOTAL U?u'4qI \, '. CCI1B I ilA r Construction Lender COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference 17 03 432. exampie- Lot l. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construction IenderD. Energy Sources l. example- heat/electrical ceilinq/or forced air oasz, examDle- waterheater/electrrcal/or soTarE. squaFe-T6-tage or vaiuation;-eE- l. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check-new - if addition, check add, etc.F. Building permit information:1. example - construct single fami)y house with anattached garage ?. example - remodel existing garage into family room3. example - convert single family residence inlorestaurant (change of use)G. Value of lvork as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Build.ingDivision Staff must be able to contact appropriite, persons regarding design information or job site' corrections, etc.II. Abbreviated Plumbing, Mechanica'1, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Scheduies,the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be installedB. Full PIumbing, Mechanical, and Electrical Schedulesare available at the Building Division1. To conserve space on the perm.it form the schedules have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful l 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 theelectri'cal contractor for signature by his electricalsupervisor. The general contractor is.not authorizedto sign the electricai labelIII. Applicant to sign and date l,lhenever possibie, the initial application wilI be used asa_lrorksheet only. I,lhere possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for hissi gnature. IV. Fees and Charges P'lan check fees are due and payable at the time of theapplication, and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information : I ,l PLANS REVI EI,IED BY : n S1 g na tu re\aate 2-2I SL PERMIT VALIDATION Permi t Cl erk \ .\)pt\L\C-Y Fr) \5 c.\](v r-..c'} vlxl nF s\qYE$ *AtiIrHE:S$" 63:: LiHHLLHY $]' I'Etif, li I UAi.{0F Y Af iir I 1' l: il1,,1 -0hll,tEft-. i'tAJtlR ITEFLIE g?$*656i1 ?:t37O HtlY 9? S0LlTl'l JLli'lCl'I UN L: Il'Y r LlRES0N - I NF'ti* HfiT}A I R ULll'lliE.ItC L fiL 5300 tru I Ltr I i.{fi [r.I tJ I S I Lli.{ _r(]t{.I, $ 4 ij (1?"- -.Lti.[i,t,l...-' L. Ll l' [iL o I l,i I r'L,J;/ .LLrLrtsJUL..8,+(i",f:7 i S:;OS*4 -"if, I t-t I t\-' TILIIG ZTINE: I,ii'I $ ruft IEfi FLotltrF't-ftIr.,t I'rFEI'ftl,l t][C 6RF' S: ur.,tI1's$ti frEEt' t:0]'{sT 1'YF'E Ul.r SF ft / - Utrll-Uti-.16691: -Et'{[:fttiY*HESTI- ',J- H:0* ITAHGE- a1 A/A4J'lal i rrl:F-4 cl^'LlJJfi Cir:JLrr'- t-! i Art,afl 1 ,.1r/\,.1tr.t\.r..:Jc] if,J.-rvi l't i ,-.. '-1.-1 lt / .1 f: A r-i cI t t r r'- ,: L1 -. li .-.r L! i'- -C0l'lTFlfrf,T0ftS- GHNL*T]I,JI{EF: IOI{1'F{4f, T'UI;: F HOI'lE-- F Lti$-- ELHCl'- r,rEuH- ttE$tiN-$ItAh,rcH 1 1 t-| REr]T CAl' * ilo 1 *0*':--tiu I LIr I FIG l-'Fatil.i I T {i {i:- 0{}5- tjt_utlB I t.tG *+3*O,]L*IlLf{l',| IHHfl.i FEE ii+4.'OT'J.'EiY5 tIEU CHARGE 9Cl . (iif, 15,OO L1J + UU 3C,9.0C) L C' r ci?li t1 fi i] ::{. tr4 0.60 UTULJ i:i[:L.t--HIN].Ht-U.l IN$r]HCTI:t]l{$ + ftEAUIRE:t.1E:t,il'$- -----E.Xr., Irrrr'rE---AIT Irtrl'ti- fiot-.09s--FTEnUIREHE:t'tT FCIt.tlr FUR $F'ftil.ltil-HH ti\'$]'El.t '3OI*O99-REfiUIREIIENT (S4yOO0.Ofi) REfiUIREIT $EFfiFtE LlO3-O99-F:EtlUIftEl'18.t't1' F'E:tt14IT f,fiF{ $E IS$UEIr,/tt. FUEI.!1' {io4*$,}t-"F t}fiT I HG ,) o5* o*3--FOUNITAT I 0l.l *0Cr*Ot I -'UNI'E:RFLCI0R F'L.LIi'it{ r*l O 7 -- L\ U *-- F Fl 6rl't I NS,:Jo$-014-$FECIAL SFRIHI{L.ER SYtiTEll ilO9-0*4--Fl:F{&L- FIRE I|EF l' O1 0*019-F Il'lAL. truIL[|Il.{G {i1.1-O9g--ttEttuIREtlENl $4000 $0t'!Ir Fil$TErr 3-3S-$4 ttIoS()4 s503fi4 {} O L * 0rJ:l, -- F ti Ul"l It Frl' I 0i'i i:i*?--+04--$t-A$ {i i}.1-. i}fi 3 -- F t}ut{ I'A 1' :t il t,t {}{}4*O'r !'-.F:' I NAL. tttJ I LIr I i.lti (:i0ri--,] t 4*sF E:f, J. AL iiilC.i*01. ?*f:' I NAL. SU I LIr I Nfi $l:'R I l.lltLEFi r t-H.t 1' }.']:F:E TiF,FI T i.JIiLIiF:$ 840tI? Uli $40t39 fiti s50I13 0li I'fi0R r 11.,!$ULA f I0N S50?13 N0 A[rF'Utr.*ttENl.'lI$ SHEtal 85S304 0li s503{i4 0li fti} ft$ n$ tlLr {E'l.*l ii9 1'uti IIISPECTION LINE 726-37 69 CITY OF SPRINGFIELD COMBI I{ATI ON APPL I CATION/PERMIT Job Address 20<) d\&EIIERGY SOURCES Hea t tlater Heater Ra Sq. Ftg. l.la n_ Sq. Ftg. Access.-- Sq. Ftg. Other_ _t{ewJddJl ter_Rep. _Fence_Demo Change,/Use 0ther loa \ \ \ \ \ Legal Description O Val l,lork 0wner VY#0 tr,7 -//zo Addres s '7 )q o n Fami l n 'o : Descri be l,lork ( th Attached Garaqe ..e., Build Singie /\)C c\tJoPt \ssis\(\'r \er /G,trt\rrr c, Bs r Lf-rir \c,- Addres s Phone name Pr <-,oJ c V-.,-i.^L Structura I oa d C -o-^..- El ectr i ca I A./rt Hechani ca I I tn ectr i PLUt{BI NG EL ECTRI CAL MECHANICAL N\FFF CHARGE NO FFF NO FFF CHARGF Each single fixture Residence of sQ FT furnace/burner to BTU, s Relocated buildinq (new fix. additional)New circuits alts.or extensions Floor furnace and vent S. F. Residence(l uatn)SERV I CES Recessed wal I Soace heater and vpnt Duplex (1 bath) each Additional bath Temporary Constructi on Apol iance vent sepa rate l.!ater service Chan res i ge in existing dence Stationary evap cool er Sewer multifamily, corm. or Industrial Vent fan with sinqle duct Storm Sewer 0f s.Vent systern apart from heatino or A.C. I RLmnfirts \5.-\59p COMH./IND. FEEDERS Mechanical exhaust hood and duct(stmrtmrrr\I nsta I I /a I ter/re1 ocatedistrib. feeders ['lood stove/heaterI0f-amps ISSUANCE OF NPBI111 TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES -IJHERE STATE LAU REQUIRES that the Electricalshall not be vali.l until the label has been sign work be done by an Electrical Contra ed by an Electrical Supervisor and re ctor,.the electrical portion of this pernrj tturned to the Building Division NED the comp a pl')I 'I c at n 0erm 1 t an d he reby ce rt 'I fy t ha t a I I 'I n forma t 'I o n hereo 1 trand correct, Spri ng fi e I any struct a nd I fu rthe r cert 'I fy t ha t any and al I, of 0regonof the Buil rk rformed ha I .I n s ue of d and t he L wo pe s be done 'I n acco rd an ce wl th the 0rd 'I nance s of the t'1 tyawsofthestafooertaining to the work described he re I n d t ha t NO 0c CUPAI'ICY w1 'I I beofuret{l tho ut the pe rmi 1 d ,l an made Board is in full S s on ng Di v'r s '|0n I further ct if exempt t 701.055 wi'l I ert 'I ty th at my reg 'I 5 tra ti on tr1 th t he Bu 1 I deforce and effect as required by ORS 701.055, tha he bas r 5 nly subcontractors and employees who are I n comc l i ance wi th 0l?S 'I s f o r exemp ti on s not ed hereon and f ha t lrOor-,k # 7 be u s ed 0n th '|s roj ec t'l 7 // zo I'lAl'lE ( pl ease pri nt )/4 fr-s:r,DE L SI DAIE 2 Zone ns i ts So . Ftg . Ftg . Ftg n IFire Zone - Bedrooms - occy Load !qFlood Plain - Slsris5 x Val ue Group 0ther Val TOTAL VALUATI BUILDING PERI{IT Charges and Surcha rges Plan Ck. Conrn/Ind- 65%/8ldq Per Fee r;)-<,.1 .) 2:a'7<l tB itlg Systems Deve' Charqe (1.51.opment PLUi4BING PERMIT Charges and Surcha rges @>____\i. @ Fence D6no ELECTRICAL PERIIIT Charges and Surcha rges SidewaIk A/C Pavins Total Comb. Permit I,IECHANICAL PERMIT Charges and Surc ha rges Curb Cut TOTAL H ztq+ L-- >Y/ Construction Lender GN I LAT.1 nhonp nn RACTORS ( name Iirc nn an PERMIT VALIDATION Permit Clerk B ( COMBINATION APPLI CATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Lega l Descriptionl. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, 2nd Addition to SEiTn-E-fi el d EstatesC. Name, etc. of owner and construction lender0, Energy Sources example- 1250 sq. foot house, 500 sq. foot garage example- if new project, check new - if addition, check add, etc.F. Building permit information: 1. example - construct single family house with an attached garage 2. example - remodel existing garage into family 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 Specialty CodeH. DESIGN TEAM AND CONTRACTORS persons regarding design information or iob site corrections, etc. Abbreviated Plumbing, Mechanical, & Eiectrical Schedules A. Except where blank spaces occur in the description ion of the Mechanical and Electrica'l Schedu'les, applicant need fill-in only the No. Boxes adjacent appropriate item(s) to be installed umbing, Mechanical, and Electrical Schedules are availabie at the Building Division 1. To conserve space on the permit fonn the schedules have been abbreviated2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the ful l schedules C. BUILDING DIVISION STAFF ltJILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. 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 electiical label Appl icant to sign and date Whenever possib'le, the initial application wil'l be used as a worksheet only. Where possible, Building Division Staff will prepare a tJpe written copy and return it to the applicant at the time the actual permit is issued for his s i gnature. 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. Al l other fees and charges are due and payable when the permit is issued. II III. IV. exampl e- hea t/el ectri ca!_!!_ll.! ngl Ex amETe- wa te rh e-aTEil efec t rJ c aVo re footage or valuation, etc. or forced:ir gasr soTar port the , V. FOR OFFICE USE ONLY 1. 2.E. Squa t. ?. To avoid design Division Staff or construction delays, Building must be abie to contact appropriate to theB. Full Pl PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAITCY: permit applicant exempt from registrat'ion with the Builder's Board because: Additional Proiect Information: PLANS REVIEI^IED BY: s'ignature aate 2 - 2_\- \q81 I