The URL can be used to link to this page

Home My WebLink AboutPermit Building 1981-04-01INf D€CnOtr. UNE 72{ .3769. - CITY OF SPRINGf IEtD COMEINAIION APPUCAIIONi PERIAII .- - INFORMATION tINE 726.3753 t- ,", orr,.,, I bz I N 34t^-.5t, Legol Dercription Woler Heoter Heoi 5q. Ftg. Olher -New, -Add-Alter-Rep. --Fence--Demo-Chqnge/ Usa - -Othe. __---_ 5q. Ftg. Accerr. Sq. Ftg. Moin Volue of Work: PhoneAddreenLIf\NI ;Euilding Permil lnfo: Oescribe Work (i.e., Build Single Fomilv Reridence With Aroched Gproge) Construction Lender o J o N$o Add re rs Phone (nome)(oddress)(lics. no.)(expires)(phone no.)DESIGN TEAM Primory rol Mechonicol CONTRACTORS (nome)(oddress)(lics. no.)(expi re s)(phone no.) t &,thrt 0J/Electrico I Mechonicol PLUA^BING ETECTRiCAI. No. i i rEE CHARGE NO.I FEE CHARGE NO FEE CHARGE I Eoch sinqle iixiure I Residence of -sq- ft. furnoce/burner to -=.--BTU': Relocoted building (new fix. ociditionol) New circuits, ollerotions Applionce vent se porgte 5.t. Residence (t both)SERVICES Slolionory evoo. cooler Duolex (l both) eoch Temporory Conslruction Vent fon with single duct Additionol both Amps. Vent sysiem oport from heotin.-o or A.C. Woler reryice Mechqoicol exhoust hood ond duct Sewer Wood stove/heoter Slorm Sewer FEEDE RS Heot Pump Amps. Air hondler to 10,000 cFA4 Air hondler over '10,000 crM ISSUANCE OF PERMIT TOTAT CHARGES TOTAT CHARGES WHERE SIAIE tAY, REQUIR€S rhqt rhe Electricsl work be done by the Electricsl Conlioctor, rhc electricol portion of rhis permir shall not be volid unrit olqbel hos beon :igned by on Electricol Controctor ond qttached to the electricol panel. TOTAI. CHARGES I HAVE CAREFUTLY EXAMINED lhe completed opplicolion for permit, ond do hereby certify lhot oil informqiion hereon is true ond correct, ond I furthercertify thot ony ond qll work performed sholl be done in occordqnce with the OrCinonces of lhe City of Springfield ond the Lows of the Slote of Oregon Pertoining to fhe work described herin. ond rhat NO OCCUPANCY will be mode of ony siructure without the permission of rhe Building Division. I furiie.certlfy thot my regiitrolion with the Builder's Boord is in full fore onci e,Ffect os required by ORS 701.055, thot if exempt the bosis for exempiion is'notedheron, ond ihot only subcontrociors ond employees who qre in complione wiih ORS 701.055 will be used on ihis proiect. rLoc 4 OATE TY /'q Bosis for Builder's Boqrd exemotion: FOR OFFICE USE SIGNATURENArr\E (pleose print)fqrr * (. A FloodPloin-5torier-occyGroup-Sq.Ftg.other- x Volue x Yo lse x -Volue TOTAT YATUATION Orrw Iood So-Flg. Access n its Ftg. MoinZone -Typ"/Cortt. Fire Zone-Bedrooms Syslems Development Chqroe ( I .5ol")I BUITDING PERMTT Chorges ond Surchorges zSco PIon Ck. Comm/lnd 300./0/ Bld, D Per fee Per Fee Plon Ck. Res TAyY\PtxSh ,ZDPTUAABING PERMIT €horges ond 5 urchorges _J5_c_Q_ Demo Totoi Comb. Permit ETECTRICAT PER',lII Chorges ond Surchorges lo o A c Sidewolk MECHANICAL PERMIT Chorge: ond Surchorges Curb Cut TOIAI.5t Lo tt-' t3z l-I ;71 0, { Electrico I MECHANICAL or exiensions COMBINATION APPLICATION,/PERMIT aP) l. Applicont to furnish A. Job Address B. Legol DescriptionI. exomple-tox lot I00, Lone County Mop Reference iZ 03 432. exompie-Lot I. Block 3, 2nd Addition ro Springfield Esrotes C. Nome, etc. of owner ond construction lender D. Energy Sources , E. Squore foologe or voluotion, etc.l. exomple-1 250 sq. foot house. 5C0 sq. foot goroge2. exomp-lE-i?-new proiecr, check nEi-ii oddirion, cieck odd, etc. F. Building permit informotion: I, exomple-construct single fomily house with on ottoched goroge 2. excmple-remodel existing goroge into fomily room3. exornpi-e-convert single fomily residence into restolEnt (chonge of use) G. Volue of work os defined in Secrion 303 (o) of the Structurol Speciolry Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construciion Celoys, Building Division Stoff must be oble to contoct oppropriote persons regor"Cing design informction or iob site correclions, etc. Abbrevioted Plumbing, Mechonicol & Electricol Schedules A. Except where blonk spoces occur in the description portion of the Mechonicol ond Electricol Schedules, the oppiicont need fill-in oniy ihe No. Boxes odiocent to the oppropriote item(s) to be instollecj B. Fuil Plumbing, Mechonicoi, ond Electricol Scheciules ore ovoiloble ot the Building Division I. To conserve spoce on the permit form the schedules : hove been cbbrevioted 2. lf rhe item(s) to be instqlleo' ore not covered on the obbrevi- oted scheduies you should consult the fuil schedules C. BUILDING DIV|SION STAFF WILL FILL OUT ALL FEES AND CI1ARGES ON THE SCHEDULES Applicont to sign ond dote Whenever possible, the initiol opplicotion will be used os o worksheet oniy. Where possible, Builciing Division Stoff will prepore o iypewritten copy ond rerurn it to the opplicont ot the rime the octuol permit is issued ior his signotuie. Fees ond Chorges Plon check fees ore due ond poyoble ot the time of the opplicolion, ond no oions will be processed until these fees ore poid. All other fees ond chorges ore due ond poyoble when the permit is issued. FOR OFFICE USE ONLY e x o m p I e- h e " t,"e-.lg!l r,Ss! l qi I i n g./o r f o rc eo' o i r g o s exo m o ie-wo te r Feo GiTe lEEico l,/oi sdE?- -.i- tv PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additionol Proiect lnformotion: nqme signoture dote{ PLANS REVIEWED BY: PERMIT VATIDATICi(. Permit Clerk lNS9ECTIO-- UNE 72L,3769 CIIY OF SPRINGFIETD COMBINAIION APPTICAIION IPERMII . - INFONHAIIOI{ IINE 7263753 loztJob lDercription )az )-a,-- Sq. Frg. Olher -New,-Add -Alter-ReP. - -Fence--Demo-Chonge/ Use --Oth.. - ES: Volue of Work: Woter Heoler Heoi 5q. Ftg. Accerr. Sq. Ftg. Moin Building Permil lnfo: Describe Work (i.e., Build Single Fomilv Re:idence With Afioched Gproge)raa,"s'!ft In^.-.t-_-r Pho ne (Conrfrucrion Lender J --O N$c Addrerr Phone (nome)(oddress)(lics. no.)(expirer) (phone no.)DESIGN TEAM Primory Strucruro I Electrico I Mechonicol CONTRACTORS (nomel (9d!re11)(lics. no.)(expires)(phone no.) I &u,frn 0 JrElectricol Mechonicol MECHANICALEI.ECTRICAI.PI.UA^BING CHARGECHARGENO.FEE CHARGE NO.FEENo. I i FEE Residence of ft. Iurnoce/burner lo -BTU'T Eoch rinqle iixture Applionce vent seporo re Relocored buiiding (new {ix. oo'ditionol} New circuiis, olterotions or exiensions Stotionory evop. cooler S.F. Rerideace (l both)SERVICES Vent fon with sinqle ductTemporory ConrlruclionDuolex (l both) eoch A.mps. Vent sysrem oport from heoting or A.C.Additionol both Mechonicol exhgusl hood ond ductWoler rervice Wood slova/ heolerSewcr Heot PumpStorm Sewqr FEEDERS A-P.. A,ir hondler to 'r0,000 cFM Air hondler over t0,000 cFM ISSUANCE OF PER}AII IOTAT CHARGESTOTAL CHARGES WHERE 5IAIE tAW REaUIRES thot rhe Electricql work be done by the Eleclri<ol Conltodor, the alectricol portioo of thir permit rholl not bo volid until o lcbal hqs been rigned by on Eleclricol ConltoGro? ond cttoched to lhe electricol pcnel. TOTAT CHARGES I HAVE C,AREFUttY EXAMINED the compleied opplicotion for permil, ond do hereby erlify thot oil informoiion hereon is lrue ond correcl, ond I further certify ihot ony ond oil work performed shoil be done in occordonca with the OrCinonces of rhe City of Springfield ond the Lows of the Slota of Oregon pertoining to the work dercribed herin, ond thqi NO OCCUPANCY will be mode of ony srruclure withoul the permission of the Building Division. I further certify thot my regirtyotion with the Euilder's Boord is in full fore ond effect os requireci by ORS 70t.055, thot if exempt the bosis for exempiion ir'noted heron, ond' thot only sub<ontroctorr ond employees who ore in complione wiih ORS 701,055 will be used on ihis proiect. NAlvrE (prcorc o,r^,, ??1t * c' Arzclc I STGNATURE /'qDATE Bosir for Buildar's Boord exemption: FOR OffICE USE ONI.Y FloodPloin5lorie3-occyGroup-Sq.Ftg.other- x --Volue x Volua x -Volue So-Fig. Moin Fire TOTAT YATUATION Bedroomc lood -59. Flg, Access Zone -Type/Const. Systems Development Chorqe ( 1 .5?/.)2500 Per Fee30e6 6s9Ll Pet Fee Plon Ck. Comm/lnd Plon Ck. Res TAnnPtxSb ZDcoLFence Demo Totol Comb. Permit BUILDING PERMIT Chorge: ond Surchorger PTUMBING PERMIT Chorges ond Surchorges ETECIRICAI PER]r{lI Chorger ond 5 urchorger Sidewolk_o IlECHANICAT PERATIT Chorger ond Surchorger Curb Cut IOTAT 5{ LC \ owner vlf 0t..1 rnal o ., I t)tc. (nO A/C Povino CoMBTNATION AppLtcATtONipERMtT .-Ap) l. Appliconf. to furnish A. Job Address B. Legol DescriptionI. exomple-tox lot.l 00, Lone County Mop Reference I7 03 432. ex"Eiie-Lot l. Block 3,2nd Addition ro SpringJ:-r , F . C. N"*]"t.]of owner ond construction lender /.. C I D. Energy Sources \ 'l . exomple-heot,lelectricol ceilinqz'or forced oir ol. exo mole-woter heqter., electricol,,'or solor e. sqrE6Jose or,rotrotioilil]-l. exomple-Elg .q. foot house, 5C0 sg. fooi gorc2. e-iE mETe-iT-iiw p ro i ect, .he.k E-*-ii od d irion,AZ=rc. F. Building permit informotion:I. exomple-construct single fomily house with on , goroge 2. exompie-remodel existing goroge inlo fomily rc3. "rg-_gG-convert single fomily residence into restouront (chonge of use) G. Volue of work os defined in Section 303 (o) of the Structurol Speciolry Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construciion Celoys, Building DirSloff must be oble to contoct oppropriote ou.rJ.,, ,,design informction or iob site corrections, etc. Il. ,Abbrevioted Plumbing, Mechonicol & Electricol Schedul A. Except where blonk spoces occur in the description 1of the Mechonicol ond Electricol Schedules, the oppi need fill-in oniy ihe No. Boxes odiocent ro the oppr< item(s) to be instolle<j 8. Fuil Plumbing, Mechonicoi, ond Eleciricol Schecjules crre ovoiloble ot rhe Building Divisionl. To conserve spoce on the permit form the schedul hcye been cbbrevioted' 2. lf the item(s) to be instolled ore nor covered on th oted scheduies you should consult rhe fuil schedul C. BUILDING DIVISION STAFF WILL FILt OUT ALL FEES A CH,ARGES ON THE SCHEDULES lll. Agplicont to sign ond dote Whenever possible, rhe initiol onplicorion will be used or worksheet oniy. Where possible, Builciing Division Stoff \ prepore o iypewrihen copy ond rerurn it to the oppliconi the rime the octuol permit is issued for his signotuie. PERMIT VALIDATIO-N. i TY OF SPRINGFI EtD CirY Holl Springfield, Oregon Deportment of Public Works OIFICIAT RECEIPT No. B 562C2 o ( ( !, { ( ( ( ( ( ( ( (n ( ,rO t ( a ( ( Rec' Amounl Received I ( ( (lV. Fees ond Chorges Plon check fees ore due ond poyoble ot the time of the o {c,ond no plons will be processed until these fees ore poid. ( other fees ond chorges ore due ond poyoble -hen ihe puL-,,,ir issued. V. FOR OFFICE USE ONLY AUTHORIZEO SIGNATURE 5BELTON-TURXBULL PRIRTEAs ' EUGENE OI '7'OI 5A!rr.8 Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additionol Proiect lnformotion: nome signoture dote a PLANS REVIEWED BY: ./ For: