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Home My WebLink AboutPermit Building 1986-07-08I 7 ON L I1!E - CITY OF SPRINGFIELD JOMBI IIATI ON APPLI CATION/PERI'I rT EIIERGY SOURCES Hea t l.later Heater Ranq , (L ,'tp 4t?t.S 2 a (e l-ega1 Description JobAddress iZo.l 0wner Dl,ttO 6 (tVOe Value of l,lork 5q. Ftg. Access Sq. Ftq. 0ther l'1a ter_Rep Chan 9elUse A1 Phone gg .1 -7 7,Address 2" g {e,+ 6' t.n, i s px:Bui kl Farni l q Re in .Y Pernrit Info: Describe [^lork( sidence llith Attached Garaqe e., Build Single €a".enn O,.o.u-, Construction Lender Addres s Phone -.a m name address lics. no.'exoirdd' Pri mary \,/U St ructura I E l ectri cal i'lechan ical CONTRACTORS n ame address lics- no.exoi res )ohone no. General (o rtn *-') l1 umbi no E.l ectr i ca 1 Itlechani cal PLUIlBI NG ELECTR I CAL MECHAN I CAL NO FEF CHARGF NN FFF CHARGF N0.FFF l HapllF Each single fixture Residence of SQ, FT furnace/burner to BTLI' s Rel ocated bui I ding (new fix. additional ) New ci rcui ts al ts. or extens i ons Floor furnace and vent S . F. Res i dence(l bath)SERV I CES Recessed wal I Soace heatpr and vpnt Duplex (1 bath) each Addi ti onal bath Temporary Constructi on Apnl iance vent sep;) ra te l,later servi ce i n exi sti ng natr Change res i de coo l er Stat I ondry evap Sewer Indrrstrial multifamily, comm. or Vent fan with si nol e duct Storm Sewer 0f Vent systern apart from heatinq or A.C. coMr.r./rND. FEEDERS Mechanical exhaust hood and duct Instal I /a1 ter/re1 ocate distrih fppdprs tr'Jood stove/heater 0f ISSUANCE OF PFRIlIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LlN REQUIRES that tlre Electrical work beshall not be vali,l until the label has been signed by an done by an Electrical Contractor, the eiectrical portion of this permit Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed application for nermit, and do hereb.y certify that all information hereon is true performed shali be done in accordance with the 0rdinances of the City'0regon Dertaining to the work described herein, and that NC OCCUPAI{CY will be made the Building Division. I further certify that m.y registration vrith the Builder's ubcontractors and ernployees who are in comcliance with 0l?S 701.055 r,rill be used on this oroject t,lAt'1E(please prinl D,p t , t.t [ ('C yZ;zF SI 7-r-rt and correct, and I further certif-v that any and all workof Soringfield and the Laws of the State ofof any s Board is tructure without the permission ofin full force and effect as requi red by ORS 701.055, that if exempt the basis for exemption is no , apd thatonly s Ftg Ftg Ftg Zone Tyoe/ Cons t x x XOcc.y Grouprsq LoadBed rooms Stories Val ueFlood Plain Fire Zone . l4ai ni ts Scr Acces s 0the r Value Val ue Plan Ck. Comm/Ind 65%/B1dq Per Fee Svstems Develocment Charqe ( 1.51) 'BUILDING PERI.lIT Charges and Surc ha rges Plan Ck. Res 30%/81dq Per Fee FencePLUI4BING PERMIT Charges and Surcha rges D6mo l.oo Sidewalk Total Cornb. PermitA/C Pavi ng Curb Cut I 6) ELECTRICAL PERI|IT Charges and Surcha rg-es 14ECHAI'iICAL PERMIT Chargr.s and Surci"arges TOTAL n TOTAL VALUATION Xrt+$ 53C+3 PERMIT VALIDATION Perm'i t Cl erk OO\EADN 1 I U) COMBINATION APPLICATION/PERMIT (CAP ) I. Appl icant tol furnish A. Job Address B. Legal Description 1. exampie- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot 1. Block 3, 2nd Addition to SlrligFietd Estates C. Name, etc. of owner and construction Iender D. Energy Sources 1. exampl e-2. exampl e- E. Square foota hea t,/e I cal or forced air qas or sol ar 'I.I wa ea ge or valuation, e 1. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check new - if addition, EI'ec[-add, etc.F. Bui lding permi t information: i. example - construct single family house with an attached garage 2. examglg - remodel existing garage into famiIy room 3. Cfg1tLlS" - convert single family residence into res'.aurant (change of use)G. Value of work as defined in Section 303 (a) of the Structural Specialty CodeH. DESIGN TEAI4 AND CONTRACTORS To avoid design or construction delays, Building 0ivision Staff must be able to contact appropr;ate persons regarding design infonnation or job site correcti ons , etc,II. Abbreviated Plumbing, Mechanica'1, & Electrical SchedulesA. Except r^rhere blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent tr.r the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Schedules are 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 on the abbreviated schedules you should consult the ful I schedulesC, BUILDING DIVISiON STAFF l,IILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULTSD. As noted on the CAP, the label must be delivered to theelectricai contiactor for signature by his electrical supervisor. Tht, 5enera) contractor is not authorized to sign the electrical label.III. Applicant to sign and date tJhenever possibie, the initial application will be used as a worksheet only. l,Jhere possible, Building Division Staffwill prepare a type written copy and return it to the appiicant. at the time the actuai permit is issued for his s i gna ture.IV, Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans will be processed until these fees are paid. Al l other fees and charges are due and payable when the permit is issued. V. FOR OFFICE USE ONLY e PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit applicant exempt from registration rvith the Bujlder's Board because: Additional Project Information : PLANS REVIEWED BY: da tename!ig nature INSPECIIiO+J 725-37 69 I i.'t ClTY OF SPRINGFIELD COIlBI iIATION APPLICATION/PERMIT 7 26-37 53 JobAddress iZal ,iL 52i {tz,i:,.-,,ttrc EIIERGY SOURCES Hea t llater Heater Ra Ftq. l''iain Sq. Ftg. Access._ So . Ftg . 0the r__ -___flew_Add Alter_Pep. _Fe nc ellEmo_C han gel U se 0ther -.t m Legal Descri ption i Val ue of l.lork Owner DlJ,O € ('i.t7rt€ Address 'o!-- 7 r.'t. y ( i -,< < rr;:Phone 67 .i-7 .,,n t scr e r Farni I d h Attached Ga e ,e., Build Single ia., r..e ()-r-...-, Constructi on Lender Address Phone t (0n ta oa i]LS I GN TEAI.I name address (lics. no.exD rds ,rone fU Pri mary Struc tura l E I ectni ca 1 l'lechan ica I CONTRACTORS n ame a ddres s (lics- no- )( exo i res ohone no- General (u ,- n , -' ,\ P l umbi nq Electrical tlechanical PLUIlBI IIG ELECTR I CAL MECHAN I CAL I FFF CHARGF Irn FFF C HARG F NO furnace/burner to BTU. s FFF I^IlARGF Each single fixture Residence of sQ FT Relocated building (new fix. additionai ) New ci rcui ts al ts or extensions Floor furnace and vent S.F. Residence(l bath)STRV i C ES Recessed wai I Soace heater and vent Duplex (1 bath) each Addi ti onal bath Temporary Constructi on Apol iance vent ssDa ra tp [,later service Chang resid e in existing ence Stat ionary evao coo,'er Sewer mul ti f ami'ly,comm, or Tndrrstrial Vent fan with sinole duct Storm Sewer 0f amps.Vent systern apart from heatino or A.C c0Mr.1./IND. FEEDERS Mechanical exhaust hood and duct Instal j / al ter/re1 ocate dictrib. feeders Irlood stove/heater 0f .amp s. ISSUAIICF OF PFRIlIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE 111.J REQUiRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this perrilit shall not be valil until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAI'lIiitD the completed application for oermit, and do hereb.v certify that all in and correct, and i further certif_v that any and all rvork performed shall be done in accordance with t of Soringfield and the Laws of the State of Oregon pertaininq to the work described herein, and that of any structure without the oermission of the Building Division. I further certify that my registra Board is in full force and effg61 35 required by ORS 701.055, that if exempt the basis for exemDtjon only subcontractors and ernoloyees who are fn comcliance with ORS 701.055 r,rill be used on this nro.ject forrnation hereon is true he 0rdinances of the City llC 0CCUPAI{CY will be made tion vrith the Builder'sis not he , and that I,lAtlE(please print)Drli,,;l .a (-( tzl9F S I Gi.l -/7-J-,f,, t D Zone e/Const.lln 'i ts S o. Ftq. llain Valu Fire Zone Bed rooms 0c cy Load Sq. Ftg. Access x Val ue Flood Plain Storie Occ.y Group S q.Ftg x Val ue TOTAL VALUATION- 0the r BUILDING PERI.lIT Charges anC Su rc ha rges Pl an Ck. Comm/ Ind 65iilBldo Per Fee Svstems Deve Charqe ( i.5q opment Plan Ck. Res 30%/Bldq Per Fee PLUI4BING PERMIT Charges and Surc ha rge s Fen ce D6mo loo ELECTRICAL PERIlIT Charges and Surcha rges Si dewa I k A/C Pav i ng Total Cornb. Permit I,1ECHts,\ICAL PERMIT Charges and S urc ha rge s Curb Cut TOTAL I i co \L\ l! \ft-\ ITY OF SPRINGFIELD City Holl Springlield. Oregon Deportmenl of Public Works OFFICIAL RECEIPT No. B 53940 O d I ( \ SIGNA SAELTON.TUiNAU!L PRINTEES . EUGENE OR 976OI 3A5II A Permi t Clerk COMBINATION APPLICATION/PERI4IT (CAP) I. App l i cant toi furni shA. Job AddressB. Legai Descriptionl. €xamole- Tax Lot 100, Lane County Map Reference l7-T3-T:?. example- Lot 1. Block 3, Znd Addition to Spri ngfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources1. examol e-2. Exar:rtl-e-E. squaiE-T6ota examo I e- h ea t,/e I tricaI cei !./a t ea e ge or valuation, e 1250 sq.if new p /or forced air sor s0 ar 'I I 2 foot house, 500 sq. foot ga ra ge i t'ion ,exarnp l e-alec(;d roj ect, check new - if addd, etcF. Building perrnit information:1. example - construct single family house with an attached garage2. exanc.le - remodel existing garage into family room3. exafiIe - convert single iami)y-residence inioiesiiliant (change of use)G. \ta lue c,f work as def ined in Sect'ion 303 (a) of theStructural Specialty CodeH. DESIGN TEAiI AIID CONIRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or job sitecorrections, etc. Abbreviated Plur:nbing, I'lechanical, & Electrica l SchedulesA. Except rvhere blank spaces occur in the descriptionportion of the l'lechanical and Electrical Schedules,the applicant need fill-in oniy the No. Boxes adjacentto the appropriate item(s) to be jnstal ledB. Fuli Plumbing, Mechanical, and Electrical Schedulesare avai labie 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 OIVISION STAFF l,llLL FILL OUT ALL FEES AND CHARGES OiI THE SCHEDULESD. As noted on the CAP, the label must be delivered to theelectrical contractoi^ for signature by his electricalsuoervisor. The general contractor is not authorizedto sign the electrical label. Appl icant to sign and date Hhenever possible, the initial applicat.ion will be used asa-worksheet only. l.Jhere possible, Building Division Staffwill prepare a type v{ritten copy and return it to theapplicanr at the time the actual permit.is issued for his s i gna ture. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans r.rill be processed until thesefees are paid. All other fees and charges are due andpayable vrhen the permit is issued. FOR OFFICE USE Oi{LY II III fv nl Received V 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: s i gnature da tename