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Home My WebLink AboutPermit Building 1986-09-29c k,@Lveo LINE COHBI NATI ON APPL I CATION/PERMIT Job Address / 5// Lesal Descriotion rd4l6T=,/7D ?.95"/l,later Heater Ranqe EIIERGY SOURCES Hea t CET/E 9Owner /-a d D/4 do Value of l,lork:22.%, Sq. Ftg. Access.-- Sq. Ftg. 0ther_ -l{ew-Addal ter-ReP. _Fen c e_Demo_C ha n ge/ U se 0ther Sq. Ftg. l'lai Address 3 s <,&z ntyt*vr> )).2'h"!"?t|?m,Builciinq Permit Info: Descril 3FaniI y Residence I'li th Attache( e., Build Single Construction Lender 2E Address 6PRt yfrQ€eD Phone ndme addre s s I ics. no.exDl res Pri Structura I .Kom.r /4, Y+rgtEl ectri cal Mechanicar b*elhZAS name a ddres s I (Iicq. no,exot res ohone no. Genera I Plumbinq El ectrical l''lec ha n i ca I PLUI{B I NG ELECTR I CAL MECHAN I CAL FEE CHARGE NO FFF C HA RGF NO FFF CHARGF Each single fixture Residence of furnace/burner to BTU' s Relocated building (new fix. additional)l/'New circuits alts or extens ions2 oF /VoRa ru5a Fl oor furnace and vent S . F. Res i dence(l bath)SERV I CES Recessed wal l Snaap heatFr and vpnt Duplex (1 bath) each &r*rve Qr.n td,(6 Temporary Constructi onAdditional bath Apol iance vent sepa rate l.iater servi ce Change in existing res i dence Stationary evap. cooi er Sewer I ndustri a I multifami1y, corm. or Vent fan with sinole duct 0f amps.Vent systenn apart from heatino or A.C.Storm Sewer cor"ff.r./IND. FEEDERS Mechanical exhaust hood and duct I nsta i I /a I ter/rel ocatedistrib. feeders l,Jood stove/heater amps0f ISSUANCE OF PFRI{IT 2?.50TOTAL CHARGES ToTAL cHARGES ffi/ry. E -oTOTAL CHARGES WHERE STATE LAll REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pernit shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed application for oermit, and do hereb.v certify that all information hereon is true and comect, 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 0CCUPAI,ICY will be madeof any structure without the permission of the Building Division. I further certify that m.y registration vlith 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 will be used on this project. l.lAl'lE (p1 ease pri nt ),/. )t/*)nr.t S IGNATURE ,TE?-za-% I U Ftg Ftg Ftg Zon"__-C€ ___tyoe/const. S- rV units al ue Val ue uatue29,3@. @-sq TOTAL VALUATION- Load .A:ZGroup 7) ., t*P<)lt?6 Bed ro omsFire Zone Flood Plain l4ain Stories / . Access x . 1therKl/YlozEz x rll*/p"?-za terns Deverqe tl.5iSvs cha opment N.A.Plan Ck. Conun/Ind 65%/B1dq Per Fee BUILDING PERI'IIT Charges and Surcharges {e--J-a-6.58 Plan Ck. Res 30%/B1dq Per Fee FencePLUI.IBING PERMIT Charges and Surcha rges Demo Sidewal k A/C Paving Tota'l Comb. Permit z/o. o8 ELECTRICAL PERIlIT Charges and Surcharges 7o 22.tu Curb Cut 2 /A,ogTOTAL 14ECHANICAL PERHIT Charges and Surc harges .6a 4 N s \) 0 \ sQ. FT. /(___LJ - COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference 17-m-,f32. example- Lot l. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources PERMIT VALIDATION I s 2E. Squ I 2 F. Building permit information:1. example - construct single family house with anattached garage ?, 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 Speciaity CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Bui)dingDivision Staff must be able to contact appropr.iitepers0ns regarding design information or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Eiectrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjaientto the appropriate item(s) to be installedB. Ful'l Plumbing, Mechanical, and Eiectrical 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 thefulI schedulesC. BUILDING DIVISION STAFF I.JILL 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 h.is electricaisupervisor. The general contractor is not authorizedto sign the electrical labeiApplicant to sign and date Whenever possible, the initial application will be used asa.worksheet on1y. Hhere possible, Building Divis.ion Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for hissignature. Fees and Charges PIan check fees are due and payable at the time of theapp)ication, 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 ONLY g II 6tY pbo to- t1*r6 III. IV. V Permit Clerk @- PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit app]icant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name L sig nature date /a- 13-*6 t': n k,@*,'9D CITY OF SPRINGFIELD COHBI NATI ON APPLICATION/PER}.IIT 726-37s3 Job Address / 5/4 Legal Descri prion /qtd/e,/ ZD ?.?5 "/ Hea tE!,IERGY SOURCES: I'later Heater Ranrle/2f z5baa Value of tlork:)3.%,Owne r N6Dr Sq. Ftq. Access._ 5q. Ftg. 0ther_ _l{ewJdd_Al ter ,9ep. _Fenc e_Demo_C ha n gel U s e 0ther . Ftg n_ Descr'it n t :e., Build Singtera,ress 3s <,&t o*trrvo ))-'n'lZtl?fu Eilce.v*, oP.2E . ,h/,Ez). Addres s 6 Pl<try fr rQ €e p Phone N 0 \) D \ ndme address 1CS. nO exDt res Structura l Prima ,Ozezr 4, *ra+El ectri cal Hechanicar j*e,D-l<AS CONTRACTORS name addres s I i cs. no.exD'r res Dhone no Genera l Pl umbi nq El ectri cal l'lec ha n i ca I PLUHB I NG ELECTRICAL MECHAN I CAL CHARGFFFF NN FFF CHA AGF Nn FFF THAPNF Each single fixture Residence of FTSQ furnace/burner to BTU' s Relocated buiIding (new fix. additional)l/' New circuits alts. or extensionsQ oE /VoRl ?z5c Floor furnace and vent 5. F. Res idence ( l bath)SERV I CES Recessed wal I SDace heatFr and vent Duplex (l bath) each &rave ?o.nnoE ,(ao.oo Additional bath Temporary Constructi on Apol iance vent seDa rate I^later servi ce ge in existing dence Chan res i Stationary evap cool er Sewer mul ti f ami 1y, cornm Industrial or Vent fan with sino'le duct 0f amps,Vent systern apart from heatino or A.C.Storm Sewer COI{TI./IND. FEEDERS Mechanical exhaust hood and duct- Insta l I /aI ter/rel ocate di stri h fpedcrs l,lood stove/heater 0f ISSUANCF OF PFRIIIT T0TAL CHARGE s H/.y . /f o'oTOTAL CHARGES 2?.5aTOTAL CHARGES WHERE STATE LAI'I REQUIRES that the Electricai work shall not be vali'l until the label has been signed by be done by an Electri ' an Electrical Contractor, the electrical portion of this permit ca1 Supervisor and returned to the Building Division I HAVE CAREFULLY EXAI1INED the completed application for oermit, and do hereb.v certify that all information hereon is true and comect, and I further certif-v 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 0reqon oertaining to the work described herein, and that l,l0 0CCUPANCY will be madeof any structure without the permission of the Building Division. I further certify that m.y reqistration with 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 project. llAt'lE (p l ease pri nt )S I GNATURE,V)ak)z.*-.?'za-glDATE Fire Zone Bedrooms 0ccy Load Sq Ftg Ftg Ftg . Access x Va4--. 0the"*€./YTaPEZ x Va S q I P'4Group 1ue29.8& * - 7)*#Pd) / 84 ToTAL VALUATI0II_ l4ain Val ueconst. f- /f/ Uni ts Flood Plain Stories Zone CC ?'?terns Deverqe ( 1.57 Svs cha opment N.,1.Plan Ck. Comm/Ind 65%/81dq Per Fee BUILDING PERIIIT Charges and Surcharges Se__J_6_ 6.58 Plan Ck. Res 30%/Bldq Per Fee FencePLUI4BING PERMIT Charges and Surcha rges D6mo Stdewal k Total Comb. Permit ELECTRICAL PERIIIT Charges and Surcharges ?a -- 3^.z z.)<2 A/C Paving Z/2. c8 Curb Cut 2 /0.o8TOTAL I,IECHANICAL PERMIT Charges and Surc harges .60 4> T/€ 9 Construction Lender PERMIT VALIDATION @ Perm'it Cl erk 11 . bbry pbc lc - t1*r6 @- COMBINATION APPLICATION/PERMIT (CAP) L Applicant to furnishA. Job AddressB. Legal Description l. examp.le- Tax Lot 100, Lane County l 17 03 432. example- Lot l. Block 3, 2nd AdditSpringfield EstatesC. Name, etc. of owner and construction lrD, Energy Sources I exampls- heat/electrical ceiling/or2. example- waterEeaTEiTEiEETiJci7orE. Square footage or valuationl-6TE.- Map Reference ion to ender r forced air gas !e.Lu.- II III. 1. examp-le- 1?50 sq. foot house, 500 sq. foot garagez. example- if new project, check-i-ew _ if additio;,EIecI-i-dd, etc.F. Build'ing permit information:1. example - construct single fam.ily house with anattached larage ?. exampje - remodel existing garage into family room3. example - convert single family-residence inio - 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, Building0ivision Staff must be able to contalt appropriitepersons_regarding design informat.ion or job sitecorrections, etc. Abbreviated Plumbing, Mechan.ical, & 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 adjaient _ !0 lhg appropriate item(s) to be instal.ledB. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Building Division1. To conserve space on the-permit form the scheduleshave been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult thefulI 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 electriiai - supervisor. The general contractor ii not authorizedto sign the electrical labelAppiicant to sign and date l,lhenever possible, the initial applicat.ion wi.l I be used asa.worksheet only. Where possible, Building Division Staiiwill.prepare a type written copy and returi it to theapplicant at the time the actuai permit.is issued for his s i gna ture. Fees and Charges PIan check fees are due and payable at the time of theapplication, and no p)ans wiil be processed until thesetees are paid. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY IV V PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from registration with the Builder,s Board because: Additional Project Informat'ion : PLANS REVIEWED BY: name L i gnatub/.7t e 6€,? s da te /a- 13-96