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Home My WebLink AboutPermit Building 1981-04-17INSPECIION I,INE 7?b3769 CITY OT SPRINGTIETD COMSINAIION APPIICAIION / PERIAIT INFORT'ATION tlNE 7283753 Job ol S JIr\xodo Phone Owner Address Sq. Frg. Othar -New.-Add --Alter--Rep. -- -Fence--Demo-Chonge/ Urc Building Permit lnfo: Dercribe Work (i.e., Euild Single Fomily Reridence With Attoched Goroge) Volue of Work: LA -Other\ Sq. Frg. Moin C12 LI Sq. Ftg. Accerr. CC 1,t tA.14 x 6(o Y.\ o r Il tYl nfv d-[- uction lender Address Phone I ffi P Dtss lD (nome)(oddres:)(lics. no.)(expires)(phone no.)DESIGN TEAM Primory Slruciuro I Ele ctri co I Mechonicol CONTRACTORS (noma)(qdCress)(lics. no.)(expirer)(phone no.) Plumbing Electricql Mechonicol PTUMBING ETECTR ICAL MECHANICAT No. I I FEE CHARGE NO.FEE CHARGE NO.FEE CHARGE Eoch rinqle fixture Residence oI f|. furnqce/ burner lo ----BTU'TRelocoted building (new fix. odditionol) New circuits, olterotions or exlension5 Applionce vent sePo rqre S.F. Reridence (l both)SERVICES Stotionory evop. cooler Duolex (l both) eo<h Temporory Conilrucrion Vent Ion with sing le duct Additionol both Ampr. Vent syslem oport from heotinq or A.C. Woler rervice Mechonicol exhourt hood ond dua Sewer Wood stove/ heotcr Storm Sewer FEEDERS Heot Pump Ampr. Air hondler to r0,000 cFM Air hondler over 10,000 crM ISSUANCE OF PERMII TOTAL CHARGES TOTAI CHARGES WHERE SfATE IAW REQUIRES thot tha Elcclricql work be donc by the Eleclricol Conltoctor, thc alactricol portion of this permit rholl not ba valid unril o lobcl hos b*n signcd by on Electricol Controclo? ond sttoched to lhc electricol panel. TOTAT CHARGES I HAVE CAREFULTY EXAMINED lhe completed opplicotion for permit, ond do hereby cerlify rhot oll informotion hereon is trua ond correct, ond I furthcr cerfify ihol ony ond oll work performed sholl be done in ocordonce with the Ordinoncer of the City of Springfield ond the Lowr of the Stote of Oregon pertoining to the work de:<ribed herin. ond lhot NO OCCUPANCY will be mqde of ony structure without lhe permission of the Building Division. lfurther cerllfy rhot my regirtolion with rhe Builder's Bocrd is in full lore ond effect os required by ORS 701,055, thot if exampt lhe bosis for exemption is'noted heron, ond thot only subcontrqclors ond employees who ore in complione wiih ORS 701.055 will be used on this prolecr. ,o,4zz4--rr- Borir for Euilder'r Eoord exemption: NAr\lE (pleose print) FOR OTFICE USE ONI.Y o Fire Zone-Bedroom: occy Lood Sq, Ftg. Acce:: x Yolue x -Volue x -Volue TOTAT VATUATION, Ftg, other Sq. Ftg. /r{oin Flood Ploin Zone -fype/ Conrt. -Units lorie!-Occy Group-Sq. Systems Development Chqrqe ( I .59'o)SeccBUII,DING PERMIT Chorges ond Surchorges Plon Ck. Comm/lnd Plon Ck. Res I Fee OCn PI,U,\1BING PERMIT Chorges ond Surchorges Demo C5.,_._c_1 Totol Comb. Permir Chorges ond Svrchorger PERMIT SidewolkC)e ,'{ECHANICAI. PERMIT Chorger onl Surchorger Curb Cut TOTAI.4Lt 4C €NERGY SOURCESI Heot - Wotlr Heotet _- tr tn Ax, Fencehh aa 7 COMBINATION APPLICATION, -iMIT (CAP) l. Applicoru. to furnish A- Job Address B. Legol Description I. exomple-tox lot 100, Lone County Mop Reference l7 03 43 2. exompie-Lot l. Block 3, 2nd Addition ro Springfield Estores C. Nome, erc. of owner ond construclion lender D.. Energy Sources exomple. exomole. l"rsefurcs: r solo r -heot,/'electricol ceil i ior IV a -woter oter..eciricolr'o E. Squore footoge or voluotion, etc.l. exomple-1250 sq. {oot house,500 sq. foot goroge 2. eIEmFle-iTTIw proiecr, check-new-ii oddition, cieck odd, etc. F. Building permit informorion: l. exqmple-construct single fomily house with on ottoched goroge 2. exomple-remodel existing goroge into fomily room 3. exqrnpia-convert single fomily residence into relTElTdnt (chonge of use) G. Volue of work os defined in Secrion 303 (o) of the Structurol Speciolty Code H. DESIGN TEA}VIAND CONTRACTORS To ovoid design or construction deloys, Building Division Stoff must be oble to contoct oppropriote persons regor.ding design informction or iob site corrections, etc. Abbrevioted Plumbing, Mechonicol & Electricol Scheduies A. Exceot where blonk spoces occur in the description oortion of the Mechonicol ond Electricol Schedules, the opplicont need fill-in only the No. Boxes odiocent to the oppropriote item(s) to be instolled 8. Full Plumbing, Mechonicoi, ond Electricol Schecjules ore ovoiloble ot the Building Division l. To conserve spoce on the permit form the schedules : hove been obbrevioted 2. lf the item(s) to be instolled ore not covered on the obbrevi- oted schedules you should consult the fuil schedules C. sUIIDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES Applicont to sign ond dote Whenever possible, the initiol opplicotion will be used os o worksheet oniy. Where possible, Builciing Division Sroff will prepore o typewritten copy ond return it to ihe opplicont ot the time the octuol permit is issued for his signotuie. Fees ond Chorges Plon check fees ore due ond poyoble ot the time of the opplicoiion, ond no plons will be processed until these fees ore poid. All other fees ond chorges ore due ond poyoble when lhe permit is issued. FOR OFFICE USE ONLY PERMIT VALIDATION Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additionol Proiect lnformotion: nome signoture dote PLANS REVIEWED BY: INSPECTION tINE 72#3769 CITY OT SPRINGf IETD COMEINAIION APPTICAIION/PERMIT INFOR'TAIION TtNE 726375t L I I I itu,cLro -)Job ol Dcrcription €NERGY SOURCES: Hcol - Wolar Hcalcr -- Sq. Ftg. Moin 5q. Ftg. Accarr. Sq. Ft9. Other -New -Add--Altcr-ReP.-- -Fence--Demo-Chonge/ U rc --Othcr Volue of Work: L1 C CC 4 $$ t -r\-l D'\) S^f) : Owner €ta ZE iAddre rr ) Phonc Addrerr Phonc I DESIGN TEAM (nomc)(oddress)(licr. no.)(expi re r)(phonc no,) P?ino.y Strucivro I T Electricol l'{echonicol CONTRACTORS (nomc)(oddress)(licr. no.)(expircr)(phone no.) Plumbi Ele<tricol ilechonicol PtUMEING ETECTRICAT MECHANICAL No. I I FEE CHARGE NO. I I rEE CHARGE NO. r I FEE CHARGE Eoch rinqlc iixturc Residencc o! -rq. ft, furnoce/burnar lo -BTU'I Relocoted building (ncw fix. odditionol) New circuits. ollerotionr or exien5ions Applionce vent 5epo ro ta S.F. Reridence (l both)SERVICES Stoiionory evop. cooler Duolex (l both) coch Temporory Conslruclion Vent fqn with :inqle duct Additionol both Ampr. Yent systcm oport from heotinq or A.C. Woler leryicc Mechonicol Grhourt hood ond duct Scwcr Wood stove/ heoler Slorm Scwcr FEEDERS Heot Pumo Ampr. Air hondler to 10,000 cFM .A,ir hondlar over r0,000 cFM ISSUANCE OF PER'{IT TOTAT CHARGES TOTAT CHARGES TOTAT CHARGES WHERE SIAIE fAW nEOUIRES rhot rhc Elcctricol work be dono by thc Elacltitsl Cotrltoclot, thc rlecricol podion ol thir pcrmit rholl nor bc valid uaril o lobcl hor brn rigncd by on Elcctricol Controclor ond oltochrd to tha electricol pcnal. I HAVE CAREFUIIY EXAMINED rhe completed opplicotion for permit, ond do hercby cerlify thot oll informotion hereon is lrue ond correcl. ond I furrhcr cartify thot ony ond oll work pe#ormed sholl be done in orordonce with rhe Ordinoncss o{ thc City of Soringfield ond tha Lows of the Stofe of Oregon pcrtoining to the work de;cribed herin, ond rhot NO OCCUPANCY will be moda of ony tiructure withou, lhe pcrmi:sion of the Building Division. I further cerrtfy rh;r my rcAistrotion with thc Builda/: Eoord ir in full fcro ond effact os required by ORS 7O1.O55, thol if cxempt the bosir for crcmption ir'notcd hcron, ond thor only subcontrostorr ond employecs who ore in complione wiih ORS 701'055 will be uscd on lhis proiect. Boris for Euildcr's Boord exrmption: NA-i!{E (pleore print))aSL.,',)".-./1 - f'D. ,o)o SIGNATUR DA' FOR OFFICE UsE ONIY x Voluc x -_Voluc Fire Zonc-Ecdroom: occy Lood Sq. Ftg- Accars flood Ploin Storiet-Occy Group-Sq. Ftg. Othcr-r -Volua IOTAL VAI.UAIION BUITDING PERMIT Plon Ck. Comm/lnd Chorger ond Surchorges Per Fee Plon Ck. Rer 300.!"1 Per Fac Systems Developmenl Choroo {l-57"1 3,?co Pt UrltBlNG PERIAIT COChorger ond Surchorger fance Demo Tolol Comb. Parmit Chorger ond Surchorger _La Sidewolk A/C Povino ,I\ECHANICAT PER}AIT Chorgcr onl Surchorgar Curb Cul TOTAI.ALt 4c 8uilding Permit lnfo: Dercribe Work (i.e., Euild Singlc Fomilv Ratidanra Wirh Axached Gorooe) 0t b *{ _; COMBINATION APPLICATION:-ERMIT (CAP) l. Appliconf ro furnish A. Job Address B. tegol Description l. exomple-lox lot 100, Lone County Mop Referenc2. eIE-iiE-Lor t. Btock 3, 2nd Addiiio" ro Sp.insiiu C. Nome, etc. of owner ond construction lender D. Energy Sourcesl. exomple-heot.'electricol ceilinqz'or forced oir oos Z. exomole-woler heoter eleciricol,,'or solor e. squ;;E;ose or rotrotioill-I. exomple-!3I9 rq.foor house, 500 so. foot gorogr2. exomi'lE-iTilw proiecr, check-new.ii oddition, cioE;;i; F. Building permit informotion3 I. exomple-construct single fomily house with on olrgoroge r 2. exomple-remodel existing goroge inlo fomily roo3. :""-oE-convert single fomily rlsidence into resrouront (chonge of use) G. Volue of work os defined in Secrion 303 (o) of the Structurol Soeciolry Code H. DESIGN TEAIA AND CONTRACTORS To ovoid design or construciion deloys, Building Divi Stoff musf be oble to contoct oppropriote pu.ron, ,., design informction or iob site corrections, etc. ll. Abbrevioteci Plumbing, Mechonicol & Elecrricol Schedulr A. Except where blonk spoces occur in the descriotion p of the Mechonicol ond Electricol Schedules, the oppii need fill-in oniy the No. Boxes odiocent to ihe oppro item(s) ro be insrolled 8. Full Plumbing, Mechonicol, ond Elecrricol Schecjules ore ovoiloble ot the Buiiding Divisionl. To conserve spoce on the permit form the schedul hove been obbrevioted 2. lf the item(s) ro be instolled ore not covered on rh. oted schedules you should consult the fuil schedui C. 3UILDING DIVISION STAFF WILL FILL OUT ALL FEES I CHARGES ON THE SCHEDULES lll. ,Agplicont to sign ond dote Whenever possible, the initiol opplicorion will be used c worksheet oniy. Where possible, Builciing Division Stoff prepore o typewritten copy ond return it to the opplicor the rime the ocuol permit is issued for his signotuie. tV. Fees ond Chorger ( Plon check fees ore due ond poyoble ot the time of the f ,.. --. -ond no plons will be processed until these fees ore poid. Xll other feer ond chorges ore due ond poyoble when the permit is issued. V. FOR OFFICE USE ONLY PERMIT VALIDATION CITY OF SPRINGFIELD Ciry Holl Springfield, Oregon Deportment of public Works OFFICIAT RECEIPT ( ( ( (", ( ( C, ( r.' tL -l No. B 56315 I ( ( ( 44 Received For: ( (, ( (, ,) ( L) ( (- ) ari 4 CCL ( ( AY ( ( Amounl Received Permit Clerk THORIZEO SICNATURE PtrntEtt . EucErE oi 9raot ( PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Proiect lnformotion: signoture dotenome PLANS REVIEWED BY: (..l I (" / ..1 ,l ,I