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Home My WebLink AboutPermit Building 1979-10-16/o'/9- 72 INSPECTION LINE 726-37 69 CITY OF SPRIIIGFIELD COMBI NATION APPL ICATION/PERI'IIT INFORIIATION LINE 726-37 53 Job Address A62 )rb/ac€. 13 q o 'I rter e., ma n r fen CC perm ti urces accsy, descri be wo lue of work new Iition hangeTuse _other er9y dL l-ega1 Description r (name/address/phone) ,t -b/-/ 2a-8636 € Construction LenJer (name/address/phone) t\ N $rJ DESIGN TEAM hame address I i cs. no.exDI res ohone no. lrtl..,Oz, MPri ma ry St" ruc t ura I El ectri ca I l'lechanical + jPI El ectr i ca I l,'lechani cal MECHAN I CAL ELECTR I CALPLUI{B I NG FFF CHARGF Ito -FFF CHARGF NN FFF CHARGF Residence of FTSQ Each single fixture furnace/burner to BTLI , s FIoor furnace and vent New circuits alts or extensions 77tn oo /9nr4 /#Relocated building (new fix. additional) S . F. Res i dence(l hath) Recessed wal I Snace heatPr and vent SERVICES Duplex (l bath) each Apol iance vent cPnaraiF Temporary Constructi on/Additional bath /ooo Stationar.v evap cool er Change in existing res i dencel,later servi ce 1@ Indrrstria'l multifamily, comm. orSewer/Vent fan with sinole duct 0f .amps.Storm Sewer Vent systern apart from heatinq or A.C. Mechanical exhaust hood and duct c0Mt'1./IND. FEEDERS I,Jood stove/heater Instal 1 /a1 ter/re1 ocate di stri b. feeders 0f New circuits, alts nr trxipnqionq 300ISSUANCE OF PERIIIT TOTAL CHARGES /#TOTAL CHARGES <oa/0qTOTAL CHARGES WHERE STATE LAI\I REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be valid until the label has been siqned by an Electrical Supervisor and returned to the Building Division. I HAVE CAREFTILL and coffect, and I of Sprinofield and of any structure wi NAI'IE (please print)/z anyrof ,-) DATE?2 Y EXAMINED the completed application for permit, and do certify that all information hereon is true further certify that and all work performed shall be hereby done in accordance with the Ordinances of the City herein, and that N0 0CCUPANCY will be madethe Laws of the State pertainino to the work de thout the permission of 0regon the Bui l ding Division zfe ren /.c-<S I GNATURE FOR OFFICE USE ONLY Flood Plain _-- Bdrms + I Type Const Sq Ftg Sq Fts varue I3ialc).(_-L-)Zones ValueOccy Load 6bov_I+__ occy GrouplQ.f,_s-g[l- Qt- Fzm Stories I Units Storm Sewer ConnecPlan Ck. Comm/Ind 65"/,,/81C,o Per Fee Pl an Ck. Res 30%/B1do Per Fee 2n40tu BUILDING PERI,lIT Charges and S u rc ha rges 0therFence 0therSprinkler System lQ.o-o-PLUI4BiNG PERMIT Charges and Surcharges /D/,?2Total Comb. PermitDemo SDCA/C Paving /6@_ELECTRICAL PERIIIT Charges and Surcharges Curb Cut 4ot,qaTOTAL tidewal t MECHANICAL PEP.MIT Charges and Surc harges s@_ Z /^rr/rf n-A-. ,,/r*2-,UJ. ACTORS ( name COMBINATION APPLICATiON/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description l. example- Tax Lot 100, Lane County Map Reference 17 03 43?. example- Lot 1. Block 3, 2nd Addition to Springfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION 1. example- heat/electrical ceiling/2. example- waterheater/electricalToE. Square footage or valuation, etc. or forced air qas r sol ar 1. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - if addition,ffiEF add, etc.F. Building permit informat'ion:1. example - construct single family house with an attached garage 2. example - remodel existing garage into family room3. example - convert single fami)y residence into restaurant (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, Building [tivision Staff must be able to contact appropriate persons regarding design information or job sitecorrections, etc,II. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except r,rhere b)ank spaces occur in the descriptionportion of the Mechanical and Electr.ical Schedules,the applicant need fill-in only the No. Boxes adjacentto the appropriate item(s) to be instaIIedB. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Division1. To conserve space on the permit form the schedules have been abbreviated2. If the item(s) to be instal'led are not covered onthe abbrev'iated schedules you should consult theful I schedulesC. BUILDING DIVISION STAFF WILL 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 authorizedto sign the electrical labei.III. Applicant to sign and date Whenever possibie, the initia'l application wil l be used asa worksheet only. l,,lhere possible, Building Division Staffwili prepare a type written copy and return it to theapplicant at the time the actual permit is.issued for his s i gna tu re.IV. 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. V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Addi ti onal Project Informat'ion : PLANS REVIEWED BY: name s i gnature date "../8l/-Zf /o't9- 77I IIISPECTIOII LIIIE 726-37 69 CITY OF SPRIiIGFIELD COMBI NATION APPL I CATION/PERI,l JT IXFORXITTOI LntE 726-3753 2 /a {l-egai Description Job Address .'l Y./t/, #fu{-frd^., /Z 1**^ revrfqurces: er heater 'lue of work: f J q ma n f ence a er re accsy. hange/[se ne ea 'I ition othe r 0wn'er ( name/addres s/ptrone )ftoftttts B -ilr luildi rusle ng fa permit info.: describe worf (i.ell OuiTd m. res. with detached garage) 3l-; 6 3 6 E o Construction LenJer (name/address/phone) \\ IN ls\l-l I]ES IGi,I TEAI.I hame addres s lics. no.exot res phone no. Pri ma Structura l E I ectri ca I Mechani cal CONTRACTORS name ad{ress )lpxn'i resl ics. no. )ohone no. +Genera I El ectrical I'lec ha n i ca I PLUIIB I NG I,4ECHAN I CAL ELE CTR I CAL u0.FEE CHARGF un FFF CHARGF NN FFF CHA QNF Each sing'le fixture furnace/burner to BTU' S Residence of SQ. FT Relocated buildinq (new fix. additional ) FIoor furnace and vent New circuits alts or extens ions., at.ar:,.,. ,,4 S. F, Residence(1 bath) Recessed wal I Soace heater and vent SERVICES Ouplex (l bath) each Additional bath Apol iance vent seDarate Temporary Constructi on l,!ater servi ce Stationary evao cool er Change in existing resi dence Sewer Vent fan with sinole duct Industrial multifamily, comm. or Storm Sewer Vent syster-'r apart from heatino or A.C.0f S. Mechanical exhaust hood and duct cor.il'l./IND. FEEDERS l,lood stove/heater I n sta I I /a 1 ter/ re1 ocate di st-ri b. fpeders 0f -amps. nr pYl-pnc i nn< New ci rcui ts, a1 ts ISSUANCE OF PERI^1IT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LArrl REQUIRES that the Electrical woshail not be val id until the label has been siqned rk be by an done b EI ectr y an Electrical Contractor, the electrical. portion of this permitical Supervisor and returned to the Bui 1din9 Djvision. I HAVE CAREFTILL and correct, and Iof Sprinqfield andof any structure wi NAI'IE (please print) Y EXAMINED the completed applifurther certify that any and al the Laws of the State of oregon thout the permission of the Bui,/\ 't t,, cation for permit, and do herebyI work performed shall be done in pertaininq to the work described lding Division. u,,.-u', -'1 5IGNATURE -'i '? -':' certify that all informatjon hereon is true accordance with the Ordinances of the Cityherein, and that N0 OCCUPANCY will be made / i /Z /-7 "r.DATE FOR OFFICE USE OIILY Flood Plain _ Bdrms + I Tyge Const Occy Group I -, t \ - Stories i Units i^r"" \5,AD.u-)Sq Ftg Value 6 \ sq FtsOccy Load Zones i- c0til'tT s Plan Ck. Cornm/lnd 65%/Bldo Per Fee Storm Sewer Connec to-trk I EUILDING PERT1IT Charges and 5u rcha rges ee Plan Ck. Re 30i1l81 dq Pe srF Fence 0therPLUI4BIN6 PERMIT Charges and Su rcha rges Spri nki er System 0t her Demo Total Comb. Permit /,rt / Q1f.,:- a t.^ELECTRICP.L PERI,!IT Charges and Su rcha rqes A/C Pavi ng SDC Curb Cut TOTAL '{/oi.?R- I'lECHANICAL PERI.,IIT Charges and Surcharge.-. LL)Sidevral k 2n 471 t(Y .) COI4BINATION APPLICATION/PERI,III (CAP) I. Applicant to furnishA. Job AddressB. Legal Descriptionl. :lalplg- Tax Lot 100, Lane County Map Reference17 03 432. _examole- Lot ]. Block 3, Znd Addition toSpringfield Estates 9. Name, etc. of owner and construction lenderD. Energy Sources1. examo l e-2. exafi..lrTe-E. square-T6o-G hea t/e I ec tri ca cei lin or forced air gas wa te ea ec tr ca or solarge or valuat oll ,c L examol e- exQnp.l e- EIEEr<-Tad 1250 s It new q. foot house,500 sq. foot garage new - if add.ition,project, check F , etc Bu i lding perm it information II l. example - construct single family house with anattached garage ?. examole --rem6del existing garage into family room3. ExaffilE - convert single ia,iili'.esiaence into - restaurant (change of use)G. Value of work as defined in Sect.ion 303 (a) of the. Structural Specia lty CodeH. DESIGN TEAI.I AND CON1RACTORS Ig lrgid design or construct.ion delays, Buiid.ingDivision Staff must be able to contaii appropriatepersons.regarding des.ign information o. jbO iit.--correcti ons , etc. Abbreviated plumbing,. Mechanical, & Electrical SchedulesA. Except vrhere bl;;k sp;;;s-;;;r; ;;';;e descriptionportion of the Mechanical and Electricat Scflelujei,the applicant need fill-in only the lto. Aoxes aOjaient_ to the appropriate item(s) to 6e installed8. Full Plumbing, Mechan.icif, ara-ff"lirical Schedulesare avaiiable at the Building Division1. To conserve space on the-permii iorm tfre scheduleshave been abbreviated2. Ii tn:. item(s) to be installed are not covered onthe abbrev.iated schedujes you should consult thefull schedulesC. BUILDIIiG DIVISiON STAFF WILL FILL OUI ALL FEES ANDCHARGES ON THE SCHEDULESD. As noted on the CAp, the .label mustelectrical contractor for signaturesupervisor. The generai conlractor Applicant to sign and date be delivered to the by his electricalis not authorized III IV. Hhenever possibie, the initial application will be used asa-worksneet only. Where possiblb, eullding Div.ision Staiiwrtt.preoare a type written copy and return it to theappticant ar the time the actu;-t p;;mit-ii"irrrJJ io" niss i gna tu re. Fees and Charges Plan.check fees are due and payable at the time of theapplication, and no plans wiit-oe proieiiJa until thesefees are paici. All other tees anO'ciri"g.r"u.. due andpayable yrhen the permit is issued. FOR OFFICE USE ONLYV PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI,ICY: Addjtionai Project Information : PLANS REVIEWED BY: name signature dat 2 "' - --r'.? PERMIT VALIDATION rY OF SPRINGFIELD City Holl Springfield, Oregon Deporlmenl of Public Works OFFICIAT RECEIPT ( ( 0. B 519i4lo,,\ ( \ l For: U ( ( ,o (' ( Received AUIHORIZEO SIGNATURE SHELTON'IURNAULL PRINTERS . EUGEN! OR 97'OI Perm'i t Cl erk e //c { tt )t I-t ,J (u )c \-r Sa; (