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Home My WebLink AboutPermit Building 1981-06-16Addrc:r f\ INFORA{AIION TINE lz&*TtStINSPECIION tINE ,783769 CIIY OF SPRINGTIETD COMEINAIICN APPI.ICAIION / PERMII Sq. trg. Moin Sq. f tg. Accas. Sq. Ftg. Othcr -New-Add -Alrer-ReP.-,-Fence-Demo-Chongc/ Use -Other Voluc of Work: Euilding Permit lnfo: Attoched GoFomi Dercribe Work (i.c., Suild Singlc Worer Heorer Heqt PhoneAddrerr S,[ftS tConrtrucrio^ l'"^).r tL 4 \, BJ PhoneAddrcrr (oddrerr)(lic:. no.)(expirer)(phone no.)DESIGN TEAM (nome) ?timotl Mcchonicol (nomc)(oddre:s)- (lics. no.) (expireri (phone no.)CONTRACTORS Plumbing L ,YTECHANICALPIUMBING E CHARGECHARGENO. I ETECTRICAT T:E NO.ROEF Mechonicql Elecrricol furnscc/burner !oReridenca of .-'(.Eoch ringle fixturc Applionce vent iepqrote New circuils. olterorion! or extenrionr Relocored building (new fix. oddirionol) Stolionory ovop coolerSERV ICES 5.F, Reridence (l both) Vent fon with sinqie CuctTemporory ConslruclionDuolcr (l bolh) co<h Vent system oporl from heotinq or A.C.Ampr.Aciditionol both Meqhonicol exhou:l hood ond ductWot.r t"rvi(? Wood rtove/heoterI I Scwcr Heqt PumpFEED ERSSlo(m Scwcr A-Pt.CFMI Air hondler ro Air hondler over 10,000 cFM lSSu{NCE OFnPER,IAII WHETE SIAIE tAw REOUIRES rhcr rhG Elccricol work br donc by thc Elerlricol Contrscro?, thc rlectricol porliol of lhir pcrmil :holl not bc valid unril o lobal hor brn rigncd by on Etrctricol Controclor ond ottothed to thc cloctricsl ponel. I }IAVE CAREtUttY EXAAfINED the complctcd opplicotion for pcrmil, ond do hereby cerrify lhot oll informotion hereon ir truc ond correcl, ond I further ccrtify thot ony ond oll work pcrformed sholl bs done in ocordoncc wilh th. Orciinoncer of rhe City of Springfield ond rhe Lows of the Stote of Oregon pertoining io tha work dercriixd herin, ond thot NO OCCUPANCY will be mode of ony slruclure withoul the pcrmision of rhc Euilding Divirion. I further c"rtlfy thot my rGgitnotion with the Euilde/r Boord ir in full forcc ond effect or required by ORS 70L055, thot if exempt ,he boris for exempiion ir notod heron, ond thot only rubonrroclorr ond employeer who ore in omplionce with ORS 701.055 will be uscd on lhit proicct TOTAT CHARGES SIGNATURE Bo:ir for Euildcr'r Eoord exempiionr NAA{E (plaorc prinr) TOTAT CHARGES TOTAI CHARGES ONTYFOR OFTICE U l'loin Accerr o lhsrFlood Ploin Fire Zons- Zonq Sq. Ftg 5q. Frg Sq. Fts Lood - Group- x ----Yoluc a Yo lua 5 -Volue TOTAI VAIUATION Typc / Conrr. -----'o.-Units Scdroomr N-I/ o.., Sy5remi Development Chorqe ( I .5?'o) Plon Ck. Comm/lnd 65%/Bldq Per Fee BUITDING PERMIT Chorga: ond Surchorger 5 Plon Ct<. Ret 30%/ Bldq Per Fec Fenre Totol Comb. PermitDemo Chorgcr ond S urcho rgcr PTUMBING PERMII Sidewolk A/C Povinq I Chorgcr ond Surchorger PERMIT ) Lurb Lul MECHANICAI PERA{IT Chorgrr ond S urcho rgcr TOTAI Slco ta r$ )ATE az*,/z-8( OO t= oo ) oc) COMBINATION APPLICATION,'PERMIT i-AP) l. Applicoru. to furnish A. Job Address B. Legol Description I. exomole-tox lot I00, Lone County Mop Reference 17 03 43 2. ;G;E-Lot l. Block 3, 2nd Addition ro Springfield Estores C. Nome, elc. of owner ond construction lender D. Energy Sources l. exomole-heotr'electricol ceiling/or forced oir gos 2. eE--J]E-*o te r IE6Gr. EIEiii[o I z'or solor E. Squore footoge qr voluotion, etc. I. exomole-1250 sq. foot house, 500 sq. foot goroge 2. ex#;E-iTllei^/ proieo, checki-ew-ii oddition, c-heck odd, etc. F. Building permit informotion: I. exomple-construct single fomily house with on ottoched goro9e 2. exomole-remodel existing goroge into fomily room 3. a;omEE-convert single fomiiy residence inio restouront (chenge of use) G. Volue of work os defindd in Seciion 303 (o) of the Structurol Speciolty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construclion deloys, Building Division Stoff must be oble to contoct oppropriote persons regording design informction or iob site corrections, etc. ll. Ab6ievioted Plumbing, Mechonicol & Electricol Schedules A. Except where blcnk spoces occur in the description porlion of the Mechonicol onci Electricol Scheiules, the opplicont need fill-in only the No. Boxes odiocent to the oppropriole ilem(s) to be instolled B. Full Plumbing, Mechonicol, ond Electricol Schedules ore ovoiloble ot the Building Division I. To conserve spoce on the permit form the schedules .r hove been obbrevioted 2. lf the item(s) to be instolled ore not covered on the obbrevi- . ored schedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES lll. Applicont to sign ond dote Whenever possible, the iniiiol opplicotion will be used os o worksheet only. Where possible, Building Division Stoff will prepore o typewritten cop), 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 ooyoble ot the time of the opplicolion, 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: ,RMIT VAr-IDATION Permit Clerk I Additionol Proiect lnformotion: PLANS REVIEWED BY: dotesignoturenome 4 BJ no.)(axpirer)no,)(oddrcsr)(nome)OESIGN TEAM TNSPECIION tINE- ,2e3r69 CIIY OF SPNINGFIEID COMEINAIICN APPI,ICAIION / PERMIT INFORMATION TINE 77&'77s3 Addrc:r [egol Dc:rriotion n Voluc of Work: Addrerr FomiPhone Heo t Attoched Gor Sq. frg. Orhlr -New-Add -Alrcr-f,cP'---Fence-Demo-Chon9./ Urt -Other Sq. frg. Moin Sq. Ftg. Accrrr. Wol"r H"olet Euilding Permil lnfo: Darctibc Work (i.o., Suild Single S.,C}-C 142_\nof h, \,t)f\q,\\\t\co^ll.uction ,.^).r\ l) --t T-PhoncAddrcn EIearicoI ETECTRICAT T=Z I CHARGE Raridence of lc firturc NO ffEoch FEg I CHARGE furnoce/ burner to Applionce vent sepoaq le New circvits, olterolion! oa ext?nliont Relo<orcd bvilding (ne* fix. odditionol) Slolionory evop coo IerSERV ICESI S.F. Rer,dencr (l both) Vent fon with :inqle ductTemporory ConslruclionDuolcx {l both) coch Venl sy5t.m oporl from heoring or A.C.Ampr.Aciditionol borh Mechonicol exhourl hood ond dvctWotar rcrvicr Wood :love/ heoterScwcr Heot PumprEED ER5Sbr.m Se-or Ampr. Air hondler to CFM Air hqndler over 10,000 cFM IOTAT CHARGESrOTAT CHARGEs Syslcm5 DevcloPment Chorqe (1.59'o)EUItDING PERMIT Chorgar ond Surchorger Plon Ck. Comm/lnd B Per Fee 30161 8 Per Fae Plqn Ck. Rer Tolol Comb. Permit PIUT^BING PERMII Chorger ond Surchorger Demo ELECTRICAL PERMII Chorger ond Surchorgar Sidewolk C Povi o TOTAT r'{ECHANICAL PERMII Curb CutChorgrr ond Surchorgar nicol mc)lic.R Mc<honicol PIUMBING A{ECHANICAL NO. tsstlANcE oFjPERA.\lT TOTAI CHARGES WHERE SIAIE fAW REOUTRES rhqi thc Elcctricol work br donr by tha Elcrtricol Contrs lcbtl hot bon rigard by on Etccrriccl conrroctor and oroched to lha chctricol pcncl cro?, lh. clectricol portiorr of thir pcrmit :holl not br volid unril o f HAVE CAREfU[ty ExAAiINED thc completcd opplicotion €ot permit, ond do hcraby <errify lhot. oll_ informotion hereon i: lruc qnd correcl, ond I further certify thot ony ond oll *orl frformci sholl bo donc in ocrordoncc with tha Ordinonces of rhe Ciry of Springfield ond lhe Lows of the stolc of Oregon p"rroining to rirc wort dercriixd hcrin, ond rhot No occupANcY will be moda of ony rfrucrure withou, tha pcrmirrion of rhc Building Divirion. I further trrify rh-ot my ,"git;otion wirh rhc Bvilde/r Boord ir in full fora ond gffect os required by oRS 7ol'055, thol if exempt the boris {or exemption ir notcd haro., ond rhot only rubonrroctors ond cmployeer who ora in complionce wirh ORS 701'055 will bs urcd on this P'oi'(t' Borir for Bcildat/r Boord exemplion; 1^. , -L ,/-./- - . . /SIGNATURE ss12 az*/z-3( NA.r\{E (ploorc print) FOR OFTICE U ONI.Y Zonr Fire Zono-Lood flood ploin <roriar-Occy Group-Sg. Fig. Other So Flg. Moin x ------Volvex ----Yoluc Ftg. Accetr x -Yolvc - TOTAI VATUATION - 5loo -.u w)D FEE !( c95co oo Additionol Proiect lnformotion: signoture dotenome PLANS REVTEWED BY: COMBINATION APPLICATION, PERMIT {LAP) l. Applicoru. to furnish A. Job Adcirers B. legol Description l. exomole-tox lot 100, Lone County Mop Reference 2. eGFiE-Lot l. Elock 3,2nd Addition to Springfielc C. Nome, etc. of owner ond construction lender D. EnergY Sources l. exomole-heolr'electricol ceiling,/or forced oir gos 2. eE-T-*o t e r IEEJEiJIETT-i ccr I z'or solor E. Squore footoge or voluotion, etc. l. exomole-1250 sq. foot house, 500 sq. foot goroge 2.eTo---iiE-iT-newproiect,checkiE-w-if oddition.chet odd, etc. F. Euilding permil informolion: l. exomole-<onstruct single fomily house wilh on ofto' 9oro9e2. exomole-remodel exis?ing goroge into fomily room 3. ex#Ej-e-converl single fomiiy residence inlo EiEiEnt (chonge of use) G. Volue of work os Ccfineid in Section 303 (o) of the Structurol Speciolty Code H. DESIGN TEAM AND CONIRACTORS To ovoid design or construction cieloys, Building Divisic Stoff mus, be oble lo contoct oppropriote Persons rego design informolion or job site corrections, etc. It. Ab6revioted Plumbing, Mechonicol & Electricol Schedules A. Exceor where blcnk spoces occur in the description porl of the Mechonicol oncj Electricol Scheiules, the opplicor need fill-in only the No. Boxes odiccenr lo the cppropri ilem(s) to be insrolled B. Full Plumbing, Mechonicol, ond Electricol Schedules ore ovoiloble ot the Building Division 'l . To conserve spoce on the permit form the schedules hove been obbrevioted 2. tf the item(s) to be inslolled ore not covered on the o . oted schecjules .7ou should consul, the full schedules C. BUILDING DTVISION STAFF WILL FILI OUT ALL FEES AND CHARGES ON THE SCHEDULES lll. Applicont to sign ond dote Whenever possible, rhe iniriol opplicotion will be used os o workshee, only. Where possible, Building Division Stoif will prepore o typewritten copy ond return it to the opplicont ol the time the octuol permit is issued for his signotur€. lV. Fees ond Chorges l- Plon check fees ore due ond coyoble ot the time of the opplicotion, ond no plons will be processed unlil lhese fees ore poid. All other fees ond chorges ore due ond poyoble when the permit is irsued. V. FOR OTFTCE UsE ONLY PROJECT CCNDIIIONS TO BE SATISFIED BEFORE OCCUPANCY: . cRMIT VALIDATION oF SPRINGFIELD ( CitY Holl Springfield, Oregon Oepo.iment ol Public Works (. OFFICIAL RECEIPT l{0. B 56734 CITY le (t Received For: (l il(. ( ( (l rl ,'l Amounl Received BY( (: q THORIZEO SIGNAIURE 3HELION.TURNAULL FiINIERS ' EUGENE Oi 97'OI gE!II'A Permit Clerk ( ( ( I