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Home My WebLink AboutPermit Building 1985-08-29f.r*A INSPECTION LINE 726-37 69 CITY OF SPRiNGFIELD COMBI NATION APPLICATION/PERMIT INFORI,IATION LiNt 726-3753 \ Job Address /o 7a A/9, ,/6e 57 EIIERGY SOURCES Hea t [,later Heater Ranqe Sq. Fto l.la i n Sq. Ftg. Access..-- Sq. Ftg. Other_ l,lew Add Al terx,D€o-. lence-oemo Chiilge/Use 0ther l-ega1 Description /60 Value of l.lork: 3czz>. aa0wner&-av*< Mrz*-e ,4Pz=- Address 44,q? /.bis< &,"4q flJy:q>.</!uilqiing Permit Info: Describe Work(i.e., Build SingleFaniIy Residence l,lith Attached Garaqe)/dE eUera O kzot-> SDrnl**r, .4n> Construction Lender Address Phone r'/H'aft?€?77 DES i GN TEAI'{name address I ics . no.exDt res ohone no. Pri ma ry Structura l EI ectri cal Mec han i ca I name add res s I i cs. no.exDt res ohone no- ) Genera I ?ws lsrspsry3 5ltr ?rs=z paacaa664 faz€/b. zsr/aa. Pr[mu,/nq lEj&?:Za.y a)7, e>T,f(f. EI trical PLUI.IB I NG ELECTR I CAL MEC HAN I CAL NI FEE CHARGE NO FFF .HA PGF NO FFF CHARGF Each single fixture Residence of SQ FT furnace/burner to BTU' s Relocated buildino (new fix. additional ) New circuits alts or extensions Floor furnace and vent S. F. Residence(l bath)SERV I CES Recessed wal I Soace heater and vent Duplex (l bath) each Additional bath Temporary Construct i on Apol iance vent separate [,later servi ce Chan g resi d e in existing ence Stati onar.v evap cool er Sewer multifamily, comm. or Tndrrstrial Vent fan with sinole duct Storm Sewer 0f amps.Vent systern apart from heatinq or A.C. COMI'I./IND. FEEDERS Mechanical exhaust hood and duct Instal I /al ter/relocate di stri h- fecders ['lood stove/heater 0f ISSUANCF OF PFRMIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAl.l REQUIRES that the Electricat workshall not be valiC until the labe'l has been signed by be done by an Electrical Contractor, the electrical portion of this permit an Electrical Supervisor and returned to the Building Division I comp e ted ap!-,I '|ca t 'I on fo r t a here b.y cert 1 ty th a t a I I I n fo rma ti on s t rueand correct,of Springfielof any struct an d I fu rther cert 1 f_v t ha t any and a I I work sha I I be do ne 1 n a ccordan ce wl th t he 0rd i na nc e of the ci ty d an d the Laws of the Sta te f 0regon the Buil 0e rta 'I n 'I n s to the wor k descr 'I bed here I n and tha t NC OCCU PAt'lc w1 I I be madeurew'l thout the permr s s 1 0n of d I ng Di vl s I on fu rther cert xempt the 5 wilI be 'I fy th at my reg 'I t ra ti on vn th the Bu I I der sBoard'|s '|n ful 'I fo rce a nd effect a s requ I red by ORS 701 0 55 th a t 'I f ba S 'I s for exemp t 1 on I s noted he re0n and tha tonIsubcontrtondIwhoIv'ac rs a ernp oyees a re n comD I 1 ance wl th 0r?s 7 0 1 05 u sed 0 n th 'I s pro.j ec t t'lAl.lE(pl ease pri nt)I GNATURE DATE Zo ne_______Tyoe/ Co n s t.ts S o. Ftg. l,lain Val ue Fire Zone Load S q. Ftg. Access x Val Flood Plain Stori Fq Group Value TOTAL VALUATION S q. Fts 0ther BUILDING PERI{IT Charges and Surc ha rges __3_4 aa 76 Plan Ck. Comn/Ind 65%/81dq Per Fee Svstems Deve charqe t1.57 I opmeot I il.4. Plan Ck. Res 30%/81dq Per Fee PLUI4BING PERMIT Charges and Surcha rges Fence D6mo ELECTRICAL PERIlIT Charges and Surcha rges Si dewa I k A/C Paving Curb Cut Total Cornb. Permit I,IECHAN I CAL PERMIT Charges and Surcharges TOTAL "/.% ) COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnishA. Job AddressB. Legal Description 1, example- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot 1. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construction Iender. D. Energy Sources PERMIT VALIDATION i. exampl e-?. exampl e-E. Square foota hea t/ el ec tri ca I or forced air gas or soTar n wa ge ter ec or valuati on, II III. IV. 1. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, checkl-ew - if aOaition, check add, etc.F. Building permit information:1. example - construct single family house with anattached garage 2-. examp]e - 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 Specialty CodeH. DESIGN TEAI4 AND CONTRACTORS To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriitepersons regarding design information or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fiIl-.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 form the schedules have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult thefull schedulesC. BUILDING DIVISION STAFF I^JILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be del.ivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is not authorizedto sign the electrical labelApplicant to sign and date llhenever possib)e, the initial application will be used asa worksheet oniy. Where possible, Building Division Staffwill prepare a type written copy and return it to theapp'licant 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 will be processed until thesefees are paid. All other fees and charges are due andpayable yrhen the permit is issued. FOR OFFICE USE ONLYV Permit Clerk 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: name sig nature date 3'?=€ L COHBI ICATI Job Address 4 EIIERGY SOURCES: tlater Heater Ranqe Sq. Fto. l'lain_ Sq. Ftg. Access._ Use \ LegaI Description a o Value of llork3aaaowner &.av*< bn*-e 4Pz=-A*aaf AJy*/></Builciin Fami I y q Pernri t I nfo: Descri be l,,lork ( ' Residence l,lith Attached Garaqe .e., Build Single /d)a /ye/4,7,b in k*-t->> SDrmt*-nt 4*> Construction Lender Address Phone t/%zr-aszr I]t5IGN IEAI'I name S exoi res ohone no. Primary Structura I El ectri cal Mechanica l IACTORS name I ics- no- )(pYnt rpq ohone no. Genera I TyVS O-t*-", ^ <.e 3Z,S=Z p4qcez6e3 f+<a/?o. 2S>/e6. Pr[mu,(nq A{&*yo.y aff , e>?!ff,. I PLUTIBI NG ELECTRI CAL MEC HAN I CAL FEE CHARGE NO FFF l^HA PNF NO FFF THAACF Each single fixture Res idence of SQ FT furnace/burner to BTU' S Relocated buildinq (new fix. additional)New ci rcui ts al ts. or extensions Floor furnace and vent S. F. Residence(l hath)SERV I CES Recessed wai I Soace heater and vent Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent sepa rate llater service Change in existing res i dence Stati onar.v evap coo I er Sewer mu1 ti fami 1 y,comm. or I ndustri a I Vent fan with sinole duct Storm Sewer 0f -amps. Vent syster,r apart from heatino or A.C. COI4I.I, /IND. FEEDERS Mechanical exhaust hood and duct I n sta I I /a I ter/ rel ocatedistrib. feeders l'Jood stove/heater 0f lmps. ISSUANCE OF PFRIlIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAI,I REQUIRES that the Electrical woshall not be valiC until the label has been signed rk be do by an El ne by an Electrical Contractor, the electrical portion of this perr,ritectrical Supervisor and returned to the Building Division Y EXAMI NED the comp I a pl-)c at on for Derm t t and do hereb.y cert I f v th at a I I I n forma t I on hereon 'I s trueandndIfuhecorrectartrcert'I fy that any and alI State of 0regon ssion of the Buil work performed shall be done i accordance with the Ordinances of the Cityof Springof any st Board is f I ld and the Laws of the pe rta 'I NI ng to the WO rk de SC rI bed here ,l n and tha t NC 0c CUPAI,ICY wt 1 I be maderucturewtthoutthepermid'|n9 D 'I vl s 'I on I furtherf exempt .055 wiI'l cert i fy th at my reg 'I s t ra t 'I on l,r1 th the Bui I der I s'l n fu 1 'I force and ef'fe ct as requi red by ORS 7 0 1 05 5 tha t t he ba s I s for exemp t 'I 0n 'I s noted hereo n a nd th atonIysbcontractorsandemp1oyeeswhoareIncomDItancewlthORS701beusedonthIsproject llAt''lE(p1 ease pri nt)S IGNA DA.TE : USE ONLY 7 Zone____Tyoe/Const. Units Sq.Ftg l,la i n Value Fire Zone Bedro Load Ftg Acces 0ther 'I uex Flood Plain Stori es Group Sq. FtS x Value ;ryl as ToTAL VALUATI0N---- s BUILDING PERI'IIT Charges and Surcharges __7_{aa 76 Plan Ck. Corrn/Ind 65%/Bldo Per Fee Systems Deve Charqe (1.57 opmeot il-4. Plan Ck. Res 30%/BIdo Per Fee PLUI"IBING PERMIT Charges and Surcha rges Fence Demo ELECTRICP,L PERIlIT Charges and Su rc ha rge s 5'ldewa I k A/C Paving Total Comb. Permit I,lECHAIIICAL PERMIT Charges and Surcharges Curb Cut IOTAL "/.% 0ther Address I coMBrNATr0N AppLrCATIoN/pERMrT (CAp) I. Appticant to furnishA. Job AddressB. Legai Descriptionl. SIaTplg: Tax Lot 100, Lane County Map Reference17 03 432. gxample- Lot l. Block 3, Znd Addition toSpringfield Estates - q. Name, etc. of owner and construction Ienderi .0,' Energy Sources .1. exampl e- heat/2. EIIEETTe- water Square-T6oTage or e l ectri ca i or forced qir ga:Received r-1Lr C'^I OF SPRINGFIELD It Clty Hall Sprlngfield, Oregon Dopartmcnt ol Publlc Workr OFFICIAL RECEIPT No. B d From Address dra 6s217 E r e e or sol ar ( (. ( (r (r () () val uation,I 2 giirp].- 1?50 sq. foot house, 500 sq. foot garageexample-.if new project, check-new - if additio;,check add, etc.F. Bui)ding permit .information: 1. example - construct singie family house with anattached garage ?. example - remodel existing garage .into fam.ily room3. example - convert single iam.i1y-residence inio --' - 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, Bu.ildingDivision. Staff must be able to contalt appropr.iitepersons.regarding design information or jbb iitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Lxcept where blank spaces occur in the descriptionportion of the Mechan.ical and Electrical Schedules,the appiicant need fill-in only the No. Boxes adjacent ^ !o-!h9 appropriate .item(s) to Le .instal.led B. Full Plumbing, Mechanical, and Eleiirical Schedulesare available at the Building Division1. To conserve space on the-permit form the scheduleshave been abbrev.iated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful l schedu lesC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAp, the label must be de.livered to theelectrical contractor for signature by his e.lectricalsupervisor. The general contractor ii not authorizedto sign the e'lectrical labelApplicant to sign and date lJhenever possibie, the initial application will be used asa.worksheet oniy. Where possibtb, gullding Division Staiiwill.prepare a type written copy and returi it to theapplicant at the time the actuai permit is issued ior^ t,ls s i gna ture. Fees and Charges P'lan check fees are due and payable at the time of theapplication, and no plans wii)-be processed until thesefees are paid. All other fees and charges are due andpayab)e vrhen the permit is issued. FOR OFFICE USE ONLY D 4a z II III. IV. . Amount Received 24,?4 {,) BY ,J, I(l ffiEf eusrrutss FoBMs, lNc (5031u'Er49 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: s i gnaturename dat KepurAtz {f,+tX* frf Ep*f Esw oF Bure*PlNhS ,+ I C- V \ €rrc*p Wa+z-Realztr.o $utr 5fi9/,4* l @sre* 7d B€ RL,}a*v6d* I ,(.