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Home My WebLink AboutPermit Building 1985-08-20L CITY OF SPRINGFIELD COHBI I'IATION APPLI CATION/ PERMTT 726-37s3 Job Address _{TH Legal Description EIIERGY SOURCES: Hea t l,later Heater Ranoe Value of l.lork aD7@' Sq. Ftq. l.lai n_ sq. Ftg. Rccess] Sq. Ftg. 0ther t T /y/r4 49 OloHst ? *atzPWr.*q Ga Pernit Info: t,,ith At .e., Bui ld Single ) Zqz = W€;;,,y-zp h. 3 / / ^ ?Z?A Dlt///tE SHap /^.,Tr' Tt,za gtya4' Construction Lender tayt eqqE I f,ocL /4P gaar( t t /nAl0rut? Addres s Phone I P,qnf tTro( h '*q \ name addre s s exDl res ohone no- Pri mary Structura I El ectri cal HechanicaI \CTORS n ame a ddres s exol res (ohone no. General 5"n nA ?HEIT nETr+L 2B '. ITTil ///1f/fl0 ?,4 72d-ilq / Pl umbi nq E I ectri ca l Itecha ni ca I PLUI,IB I NG ELECTR I CAL MECHAN ICAL FFF CHARGE NN FFF al..la PcF NO FFF CHAACF Each single fixture Residence of SQ. FT furnace/burner to - BTU's Relocated bui lding (new fix. additiona'l)New circuits altsor extensions FIoor furnace and vent S. F. P.esidence(l batn)SERV I CES Recessed wal i Soace heater and vFnt Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent sepa ra te tlater service Change in existinq res i dence Stationary evap. coo l er Sewer multifamily, conrn. or Industria l Vent fan with sinole duct Storm Sewer 0f amps.Vent system apart from heatinq or A.C. coHr.r./rND. FEEDERS Mechanical exhaust hood and duct-Instal I /al ter/re l ocate di stri b. feeders l'Jood stove/heater .amp s.0f ISSUANCF OF PFRI,IIT TOTAL CHARGES TOTAL CHARGES IOTAL CHARGES WHERE STATE !_l\H REQUIRES that ttre EtectrishalI nor be vali.l untiI the label has been s cal work be done by an Electrical Conigned by an Electrical Surrervisor and tractor, the electrical portion of this Dermitreturned to the Building Division I.lAl.lE( p lease pri nt),LLI E oarc&,O-85IGNATUREft Ci ty madet the perm and effect fy I 0 I HAVE CAREFULLY EXAIIlNED the comp Ieted apolicat'ion for oermit, and do hereby certi that all information hereon is trueand corect, and I fu rther certify tha t any and all work performed shall be done in acc ordance with the Ordinances of theof Soringfield and the Laws of the Sta te of 0regon oertai ning to the work described herein, and that NC oCCUPAt,lCy will beof any s Board is tructure withou ission of the Building Das required by ORS 701. vision. I further certify55, that if exempt the bai that my registration with the Builder,sin full force is for exemption is noted hereononly subcontractors and , and thatempl oyees who are in comcliance wi th 0l?S 701.055 rvilI be us ed on this oroject. . l'lainFtg Fts Ftg nd 1.5 Res x €6a .26 BI an an Valits Flood Plain Stories 0ccv t 0pmm Fire Zone Zone BUILDING PERIIIT Charges and Surcharges Access _ x Val i,tner fE?/?tpz* val. TOTAL VALUATI ue ?*.-v-- ON Load Sq eroup_fl1/._.sq FencePLUI,TBING PERMIT Charges and Su rc ha rges D6mo Sidewal k ELECTRICAL PERI1IT Charges and Surcharges A/C Paving Total Comb. Permit zr.% Curb Cut I,IECHANICAL PERHIT Charges and Surc harges TOTAL 0wner /t/E lics nn ___<4._ COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description l. example- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot 1. Block 3, 2nd Addition to SlFin!-fi e1d EstatesC. Name, etc. of owner and construction IenderD. Energy Sources1. exampl e- heat/2. Exam'iTle- waterE. Square footage or electrical c 'I 'I or forced air oas sol arre va I uat'ion ,l. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check new - if addition, check add, etc.F. Building permit information:1. example - construct singie family house with an attached garage 2. example - remodel existing garage into family room3. example - convert singie family residence into restaurant (change of use)G. Value of work as defined in Section 303 (a) of the Structural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or job site corrections, 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 instaliedB. 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 installed are not covered on the abbreviated schedules you should consult the ful l 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 general contractor is not authorizedto sign the electrical label.III. Applicant to sign and date Hhenever possible, the initial application will be used as a worksheet only. LJhere possible, Building Division Staffwill prepare a type written copy and return it to the applicant at the time the actuai permit is issued for his s i gna ture.IV. Fees and Charges P'lan check fees are due and payable at the time of the application, and no plans will be processed until these fees are paid. Ali other fees and charges are due and payable when the permit is issued. V. FOR OFFICE USE ONLY PERMIT VALIDATION 4 1,k bb q $, ?c (' \9 Permi t Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from registrat'ion with the Builder's Board because: Additional Proiect Information: PLANS REV I EI^IED BY : name s i gnature da te -tr -o S!"^{-d IiISPECTION LINE 726-37 69 ION CATI 7?6-3753 Job Address ^{./-rrH <7 Legal Description Sq. Ftg. Access._ Sq. Ftg. 0thef_ _l{ew_AddJl ter_Rep. _Fe nc e_Demo_C ha nge/ U se 0ther t Ra Hea nq Re1Fam'I 1s d Si ng e l.ta n aDValue of l,lork EIIERGY SOURCES: l,later Heater hAt D t rttoE .Ftg o: Describe Work Lr'A S 0wner o/ s Construction Lender Ma,vi EqeTE I FotL qP gaaq , t MAFDatt? I P,epTrTral h\n D.s \ Address Phone DESIGN TEAH name address I ics. no.exo i res ohone no- Pni mary Structura I El ectri ca l Mechani cal ACTORS name addres s exDt res ohone no. e"n""* fkt FP < ' 'tT " "Dt )13 l- l-f tlsltfuzlnna /4 72d-ilq/ Plumbinq E l ectni ca l l,'lechan icaI PLUI{BI NG ELECTRI CAL MECHANICAL N0.FEE CHARGE Nn.FFF l^HAAGF NO FFF CHARGF Each single fixture Residence of FTSQ furnace/burner to BTU' s Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S. F. P.es idence(1 bath)SERV ICES Recessed walI SDace heater and vent Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent qeoarate l,later servi ce ge in existing dence Chan res i Stationar-v evap. cool er Sewer multifamily, comm or I ndu stri a I Vent fan with sinolp drrct Storm Sewer 0f amps.Vent systenn apart from heatino or A.C. c0Mr.1./IND. FEEDERS Mechanical exhaust hood and duct Instal I /al ter/re1 ocate d'ictrih fppdcrs l'lood stove/heater 0f amps ISSUANCE OF PFRIIIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES HHERE STATE LAt,l REQUIRES that tlre Electrical workshall not be valiC until the label has been signed by be done by an Electri an Electrical Contractor, the electrical portion of this perfiit ca1 Supervisor and returned to the Building Division I HAVE CAREFULLY EXAI1INED the completed apfrlication for oermit, and do hereb.v certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accoidance with the 0rdinances of the Cityof Springfield and the Laws of the State of 0regon oertaining to the work described herein, and that N0 OCCUPAI{CY wil'l be madeof any-structure without the permission of the Building Division. I further certify that my reqistration vrith the Builder'sBoard is in full force and effect as required by ORS 701.055, that if exempt the baiis for Lxemption is noted hereon, and thatonly subcontractors and empioyees who are in comcliance with 0l1S 701.055 will be used on this project. ELLI Tl.lAl'lE(please print)S IGNATURE zone_4p7lQ_JyoelConst. e-r{. units sq. Fts. t4a.in x va Load 5q. Ftg. Access , x Value_ eroup-fl2/--sq. Fts. other/E?/aP&- uarue ?@.. lue TOTAL VALUATION Fire Zone Bed r00m5 Flood Plain Stories Plan Ck. Conrn/Ind 65%lBltlo Ppr Fpp /f,,ea Svstems Deve Charqe fl.57 opmentBUILOING PERNIT Charges and Surcharges .4z, Plan Ck. Res 30%/81do Per Fee FencePLUI4BING PERMIT Charges and Surcha rges Demo Sidewal kELECTRICP.L PERI,IIT Charges and Surcharges A/C Paving Total Comb. Permit z{.% Curb CutIIECHANICAL PERHIT Charges and Surc ha rges TOTAL ) 7q>q b,/ralon-or> AD 3 qq^?z?R COMBINATION APPLICATION/PERMiT (CAP)PERJ.4IT VALI DATION I App A. B. c. D. licant to furnish Job Address Legal Description l. EIgIPI9_- Tax Lot 100, Lane County Map Referencel7 03 432. example- Lot I. Block 3, Znd Addition toSpringfield Estates Name, etc. of owner and construction lender E Energy Sources l. examo-le- heat/electrical cei ling/or forc_g!__qjl-g!: ? . e x a m p l e- wa t e r hE aTEiTEiEETil c a =*i c a I / o r s oTl-r Square footage or valuationlEtEl-- l. examole- 1?50 sq. foot house, 500 sq. foot garaget. exampte-.if new project, check new _ if addition,check add, etc.F. Building permit information:1. example - construct singie family house with anattached garage ?. example - remodel existing garage into family roomJ. 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, BuildingDivision Staff must be able to contatt appropriitepersons regarding design information or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces ociur 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. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Building Division1. To conserve space on the-permit fonn 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 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 general contractor .ii not authorizedto sign the electrical labelAppiicant to sign and date l'lhenever possibie, the initial application wi]l be used asa.worksheet only. Hhere possible, Building Division Staffwill prepare a type written copy and returi it to theapplicant at the time the actual perm.it is issued for his s i gna ture. Fees and Charges Plan check fees are due and payable at the time of theappiication, and no plans will be processed unti.l thesefees are paid. All other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY E fi 1,r b b ,$'II.c (/? III IV v Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: name sig nature date EZt-,*- 7 \9