HomeMy WebLinkAboutPermit Building 1985-09-12a^----d ^wh"o4i.r^pdafij{,v St-,. Cai I -,
INSPECTION LINE
726-37 69
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COMBI NATI ON APPLICATION/PERMIT 726-37
Job Address 3 EIIERGY SOURCES: ,Heat E/..1r,.Sq. Ftq. Access.727
l,later Heater €
Ran USe
Val of l,Jork:%a,o
Bu rml t I nfo S c i ng e
s 'I de nc l.l 1 h At ta c Ga ra
u0
htl
.0
l-ega1 Description
o
Owner So.inorl
Address
Constructiof Lende(/Me.*tt<.. s6tj
Addres s Phone /.*
name address exDt res ohone no.
Pri ma
Structura I
El ectri cal
Mechani cal
ACTORS n ame address 'lics- no-)exot res ohone no.
Genera I
Pl umbi nq
E I ectri ca l
Itlechan ica l
PLUt.lBI NG ELECTR I CAL MEC HAN I CAL
N0.FEE CHARGF NN FFF CHARGF NO FFF CHARGF
Each single fixture Residence of
SQ FT
furnace/burner to
BTU' S
Relocated building
(new fix. additional )
New ci rcu'i ts al ts
or extensions
Floor furnace
and vent
S. F. Res i dence(l bath)SERV I CES I "F.-,$f*f**lanrr v.nr
Duplex (l bath) each I
-
Dn&rr*-t>tEt &1.fr
Additional bath Temporary Constructi on Apol iance vent
seoa rate
l^Jater servi ce Chang
resid
e in existing
ence
Stationary evap
cool er
Sewer multifamily, comm. or
I ndrr st-ri a I /Vent fan with
s inol e drrct 7.oo9'Storm Sewer /5.o I /2s0f amps Vent system apart from
heatinq or A.C.79.'
c0Mt1./IND. FEEDERS Mechan ical exhaust
hood and duct
InstaI I /aI terlrel ocate
distrib. feeders l,lood stove/heater
0f amps,
ISSIJANCF OF PFRI,IIT
TOTAL CHARGES /u.oo TOTAL CHARGES -?Qa<)t TOTAL CHARGES 1?{o
WHERE STATE LAtl REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed apnlication for oermit, and do hereb.y certify that all information hereon is true
and correct, and I further certify 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 pertaining to the work described herein, and that NC 0CCUPANCY will be madeof any structure without the permission of the Building Division. I further certify that rny registration 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 that
only subcontractors and ernployees who are in comcliance with 0l?S 701.055 wi'll be used on this project,
tlAtlE(please print)Cltorl* s S IGNATURE
FOP. OFFICE USE OI{
Zone const. 9t1/ uni ts . Ftg
. Ftg
. Ftg
. l'lain x Val ue
Fire Zo Bedrooms Load .Ac I ue#
'"-ffi%'nFlood Plain Stories Group 0ther x Val
ToTAL VALUATI0N_
BUILDING PERNIT
Charges and
Surcharges ---{z 1r2
.4
P l an Ck. Conrn/ Ind
65%/Bldo Ppr Fpe ',27 ,o Svsterns Deve
Charqe (1.57 opment / y?""./
Plan Ck. Res
30%/B1dq Per Fee
PLUI,IBING PERMIT
Charges and
Surcha rges
___/{._l:__
.6,0
Fence
Domo
ELECTRICAL PERI,IIT
Charges and
Surcharges
___"_f,:_&
Sidewal k
lo?.72A/C Paving
Curb Cut
Tota'l Comb. Permi t
I,IECHANICAL PERMIT
Charges and
Surc harges
f,o.rl TOTAL z?3 ./a
oo
-
,,
------\-- Y\
coilBrNATr0N AppLrcATroN/PERMrT (CAp)
I. APPlicant to furnishA. Job AddressB. Legal Descriptionl. examp'le- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot 1. Block 3, 2nd Addition to
SEiTnsfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources
PERMIT VALIDATION
1.
2.L. 5qua
exampl e-
exampl e-
re foota
hea t/d air gas
wa ter
ge or
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 family house with an
attached garage
2. example - remodel existing garage into family room3. example - convert singie family residence intoEiTiuFant (change of-use)G. Value of work as defined in Section 303 (a) of theStructurai Specialty CodeH. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriite
persons regarding design information or job sitecorrections, etc.
Abbrev'iated Plumbing, Mechanical, & Electrical 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 PIumbing, Mechanical, and Eiectrical Schedulesare available at the Building Divisionl. 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 I schedulesC. 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 generai contractor is not authorized
bcq >tr
II.
III to sign the electrical label
Applicant to sign and date
IV.
l,Jhenever possible, the initial application will be used asa worksheet oniy. 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.
Fees and Charges
Plan 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.
FOR OFFICE USE ONLYV 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 s'l gnatu date ?-3€S
7
g q31 Stl/uft{y
I
PUBLIC I,JATER UTILiTY EASEI4ENT
Kll0l,.l ALL MEll BY THESE PRESENTS, that the undersig ned, l.lillamalane Park and Recre-
ation District, for a good and va'l uable consideration, the receipt whereof ls hereby
acknor'rlCdgedl does hereby grant unto the City of Springfield, a municlpal corpora-tion, acting by and through its SPRINGFiELD UTILITY B0ARD, and unto {ts successors
and assigns, the right to enter upon the lands of the undersigned situated in theCity of Springfield, State of Oregon, and more particu'larly described as follows:
Beginning at the most easterly corner of Lot 2, glock 29, of the Plat of Emerald
Heights Addition to Springfield, recorCed in vo'lume 4 of Plats, page 14, Records of
Lane County,Oregon; thence North 47059'l.lest 397.59 feet to a point; thence North
4?oIB'45" Hest 279.27 feet to a point on the easterly right-of-way line of Summit
Boulevard; thence l{orth 13032'10" Hest 100.0 feet a'long the easterly right-of-way of
Summit Boulevard to a point, said point beinq the True Point of Beginning; thencellorth 73032'10" llest 50.0 feet to a point; thence North 86025'35" East 75.0 feet toa point; thence South 13032'10" East 50.0 feet to a point; thence South 86025'35"
lJest 75.0 feet to the True Point of Beginning, being a portion of Block 33, of the
PIat of Emerald Heights Addition to Springfield, containing 0.09 acres more or Iess,in Lane County, 0regon.
To have and to hold the above easement to the said Grantee, its successors and as-
signs forever. And to construct, operate, maintain and replace therein facil ities
including a water pump station, power and contro'l lines, water pipelfnes, to remove
and replace fences, lawns, and trees to the extent necessary to construct, maintain,
and protect said facilities. Said Grantee, its successors and assigns, shall submit
cc,nstruction plans for a'll major improvements fn the easement area to the Hil-
lanalane Park and Recreation District, its successors and assigns, for its review
ancj approval, which will not be unreasonably withheld, prior to beginning the work.
tio part of any building containing sanitary facilities or any permanent structurevrill be placed upon this easement, other than asphaltic pavement, curbs, sidewalks,
and Criveway aprons without the expressed consent of the Springfield Utility Board.
The l.lillamalane Park and Recreation District shall be notified of all work and re-
pairs that wil'l impact the park property prior to such work or repairs if at all
pract'ica1. In the case of emergency repairs, notfce will be given as soon after the
repairs as practical. Restoration of the easement area disturbed by SUB installa-
tions will be SUB's responsibility and is to result in a condition equa'l to that
existing prior to the vrork.
The undersigned covenants that they are the owner of the above described property
and that such property is free and clear of encumbrances and liens of whatsoever
character except,easements of record.
IN I.IITNESS }IHEREOF, thE
J u^JE , l9-g 5-.
STATE OF OREGON )
undersf qned has set their hand and seal tni, &fr day of
L{) ss.
c0uNTY 0F LANE )
BE IT REI.IEI,IBERED that on the
undersigned, a Nota_ry Pub'lic
t"li thin iameO OLUieu
I tV day of ,ruLY , lg-lfIl , before me, theffi anA-for the SEE oT-0Legon, perEnE'lly appeared theR. (Loz*
known to me to be ident'ical personE descr bed herein, and who executed within in-
strurnent and acknowledged to me that they executed the same freely and voluntarily.
III t.lITIIESS HHEREOF,last above written.
I have hereunto set my hand and notarial seal the day and year
otary Publ c regon
l4y commission exp ires: A-a3'YG
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PECTiON LINE
-3769
gA*r.,a-{ J{ iS*cr:l \i.l- {iv :D- dale':
m
COHBI NATI ON APPL I CATION/PERMIT 7?6-3753
Job Address 3 EIIERGY SOURCES: ,Heat E/ c.fr, .sq
Fto. l'lain_
Ftg. Access. T?7
I'later Heater //e4 €Sq. Ftq. 0ther
)(J{ew_Add_Ai Ier--Pep. -
_Fence_Demo Change/Use
0ther
Rang
Val of llork
n ng e
F il 'I den ce !li th A
/o
q
0
htl
{
l-egal Description
Owner
Address tt
Constructi Lend
Addres s Phone /.ou
DE5 I GN TEAI{name address exDl res
Primar
Structura l
Ei ectri cal
Mechani ca l
CONTRACTORS name a ddrps s I ics. no.pxni res )nhonp no
Genera l
PI uqbj nq
Electrical
Itlechanical
PLUI.IB I NG ELECTR I CAL MECHAN I CAL
N0.FEF CHARGF NN FFF CHARG F NO FFF aua pAF
Each single fixture Residence of
SQ. FT.
furnace/burner to
BTU' s
Relocated building
(new fix. additional)
New circuits alts
or extensions
Fioor furnace
and vent
S. F. Residence
( l bath)SERV I CES I ;#ffi*#**]and venr 6.oo
Duplex (l bath) each I
-
DF&o -/D/Ft &t.f,6
Additional bath Temporary Constructi on Apol iance vent
sepa rate
blater servi ce Change in existing
reci dpnep
Stationary evap
cool er
Sewer multifamily, comrn. or
Industrial /Vent fan with
sinole duct 7.oofr'Storm Sewer /5.e I or / 2{ ^*pt.
Vent systern
heatinq or A
apart from
.c.
COMH./IND. FEEDERS
Mechani cal exhaust
hood and duct
I n sta I I /a I ter/ re1 ocate
di stri h fecdcr<l'Jood stove/heater
0f s,
ISSUANCF OF PFRI{IT
TOTAL CHARGES /foo TOTAL CHARGES /f,e TOTAL CHARGES /7.{o
WHERE STATE L.ll,l REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pernit
shall not be valiC until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed application for oerm'it, and do hereb.y certify that all information hereon is true
and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the Cityof Springfield and the Laws of the State of 0regon pertaining to the work described herein, and that NC 0CCUPAI'ICY will be madeof any structure without the permission of the Building Division. I further certify that my registration 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 that
only subcontractors and employees who are in comcliance with 0l?S 701.055 will be used on this rrroject,
tlAllE(please print IGNATURE DATE r/aft(
F
Zone t 9-/l! units Ftg . t,la i
Fire Zone Bed rooms Load . Fto. Access 72? x Val
-
u"ffi
'""27?e'nFlood Plain S tori es 0cc.y Grou Ftg 0ther VaI
TOTAL VALUATION-
BUILDING PERI'IIT
Charges and
Surcharges ---52 Ao
2.4
Plan Ck. Conrn/Ind
65%/81do Per Fce ',32 eo Svstems Deve
charqe (1.52 opment / y?""./
Plan Ck. Res
30%/B1dq Per Fee
PLUI4BING PERMIT
Charges and
Surcha rges
___/{._t:__
.6,0
Fence
D0mo
ELECTRICAL PERI1IT
Charges and
Surcharges &
Sidewal k
/o?.72A/C Paving Tota'l Comb. Permit
I,IECHANICAL PERHIT
Charges and
Surcharges ---,lV=8---,rl Curb Cut
TOTAL z?3 ./a
cro
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnishA. Job AddressB. Legai Description
l. example- Tax Lot 100, Lane County Map Reference
17 03 432. example- Lot l. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction IenderD. Energy Sources
1. example- heat/electrical ceiling/or forced air qas2, exarlrp I e- wa terhea tEF/GlEETFiEilTor soTe;--E. Square tootage or valuation, etc.
l. 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 garage2. example - remodel existing garage into family room3. example - 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, BuildingDivision Staff must be able to contact appropriate
persons regarding design informat.ion or job sitecorrections, etc.II. Abbreviated Plumbing, Mechanical, & Electrical 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 Schedulesare available at the Building Divisionl. 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^lILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be del.ivered to theelectrical contractor for signature by his electr.icalsupervisor. The general contractor is not authorizedto sign the electrical iabelIII. Appiicant to sign and date
Whenever possibie, the .init.ial 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 hissi gnature.IV, Fees and Charges
PIan 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
PERMiT VALIDATION
bb5 >t
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI,ICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name s i gnatu date ?-7€S
(
7