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Home My WebLink AboutPermit Building 1982-07-16INSPECTION LINE. 726-37 69 CITY OF SPRINGFiELD COMBI i{ATI ON APPL I CATION/PERMIT I NFORI1ATION LI NE 726-31 53 ilo (>a- \0 P Job Address //-3 ,4/, iA{EIIERGY SOURCES: ueat ELE ? lJater Heater ELfu Ranq e &t-Ec So. Ftq. l'1ain_ Sq. Ftg. Access.--_- So. Ftg. Other__ llew Add Al ter)< Peo. Fence Demo Chanqe/Use -Otner- - Lesar Descriotion //-93 -J6-3 I TL. 36oo Val ue of l.lork:t?.,,#0wne r iGnn ?e,ru Got->4# Zesl Ettaa,va , o e€. i Pernrit Info: Describe [,lork(' :esidence llith Attached Garaqe. .e., Build Single Op,y Par t€ap*rp ,E/s.+ flurrag Ktae,*te Construction Lender / .*AttECouutM 7 c btwotls DEleto Ps., OtAs> r4e ruaaaia{L aaaressf l) E,74 EuaeuL Phone DESIGN TEAI.I name address exDt res phone no. Pri ma rv Structura I E l ectri ca I l'4ec ha n i ca I name address I i cs. no.exDt res (phone no. Genera I Ou^/EE Pl umbi nq El ectri cal l''lechan ical PLUIIB I NG ELECTRI CAL MECHAN I CAL FFF CHARGE N0-FFF CHARGF NO FFF CHARGF q Each singie fixture --ao.>-/eo Res i dence of sQ FT furnace/burner to BTU' S Reiocated building (new fix. additional )X New ci rcui ts al ts or extensions /sc9 Fl oor furnace and vent S . F. P.es i dence(l bath)SERV I CES Recessed wal I Snacp heatpr and vent Duplex (1 bath) each Additional bath Temporary Constructi on Apol iance vent seDarate I,Jater service Change in existing rec i dcnce Stationar.v evap cool er Sewer multifamily, comm. or IndustriaI Vent fan with sinole duct Storm Sewer 0f .arnps. Vent systern , heatinq or A apart from .c. COMI'I./IND. FEEDERS Mechan i cal exhaust hood and duct Instal l /al ter/rel ocate distrih. feeders tr'lood stove/heater 0f amp s. ISSUANCF OF PFRIIIT TOTAL CHARGES /./10c TOTAL CHARGES /'r@ TOTAL CHARGES WHERE STATE LAI,I RE shal I not be val i,l unt QUIRES that the Electrical work be done by ,il the label has been signed by an Eiectri an Electrical Contractor, the electrical portion of this permit ca1 Supervisor and returned to the Building Division I CARE FUL L Y comp I ted apnl i ca and al I Oregon the BuiI t 'I o n perm t a nd do here b.y c ert 'I fy th a t a I I 'I n forma ti on hereon 'I s true a nd co rrec L an d j fu rth e r ce rt 'I f-v t ha t any te of nof w0 rk rJe rforme d s ha I I be done 'I n acco rd an ce wl th t he 0r di na nc e s of the Ci ty th work descri bed here 1 and tha t 0c ail PAI,IC wl 1 1 be madeof Spri of any Board i ngfi s tru s in bcon I d an d the Laws o f the s ta DC rta i ngD 701. n 'l ncl to e n ctu re wl +hou t the permi ssi nd gffect as ernployees rvho o d 'l 1 I S 'I 0 n I fu rt he r ce rt 'I fy tha t m.y re gi s tra t 'I on 1.r 1 t h the Bu 'I I der S f u I I fo rce a req u 'I red by 0 RS 05 5 tha t 'I t ex empt the ba s l s for exempt 1 0 n 1 no ted hereo n a nd tha t on 1y u trac tor S an d are in comcl ance wl t h OPS 707 0 55 l^i l 'I I be us ed on th 'I s p r0 ,]e ct t'lAl.lE(p lease print)/il*m S.*a-s IGiIA DATT It,Bzz D "Fire Zone / B.d.oor, - Occy Load Sq Ftg Ftg Ftg . l'lain Y Va'l ue . Access .0ther x I ilp Flood Plain Stories Occ.Y GrouP R -t X Val ue ,orrn ,*ro, ,0, /40@@ - BUILDING PERI'IIT Charges anC Su rcha rges Plan Ck. Comm/Ind 65%/81do Per Fee Svstems Deve charqe (1.52 opment Plan Ck. Res 30%/Bldq Per eFe PLU!4BING PERMIT Charges and Surcha rge s Fence DCmo ELECTRICAL PERI,IIT Charges and Surc ha rges _ /6qo_ , Sidewal k A/C Pav i ng Curb Cut Total Comb. Permit 14ECHANICAL PERMIT Charges and Surc ha rges TOTAL /2,4, to Address lbbg Hnr su Phone ACTORS ,,4 COMBINATION APPLICATION/PERMIT (CAP) I. Appiicant to furn'ishA. Job AddressB. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot I. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD, Energy Sources PERMIT VALIDATION sq.tq I 1. exampl e- heat/2. example- waterE. Square footage or electricai cei 'ln or forced air gas r e or solar tu, fi|Lva I uat o[,c II 1. example- 1250 sq. foot house, 500 sq. foot garage2. example- if new project, check-new - if addition, check add, etc.F. Bu i ld ing permit information:1. example - construct single family house with an attached garage 2. example - remodel existing garage into family room3. examp.le - convert single family residence into restaurant (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 construct'ion delays, Build.ingDivision Staff must be able to contact appropriatepersons regarding design information or job sitecorrections, etc. Abbreviated Plumbing, l"lechanical, & 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 installedB. Full Plumbing, Mechanical, and Electrical Schedulesare available at the Building Division1. To conserve space on the permit form the schedules have been abbreviated?. If the item(s) to be installed are not covered onthe abbreviated 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 h.is electricalsupervisor. The general contractor is not authorizedto sign the electrical label.Applicant to sign and date Whenever possible, the initial application wilI be used asa worksheet oniy. Where possible, Building Division Staffwill prepare a type written copy and return it to theapplicant at the time the actuai permit is.issued for his s i gna tu re. 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. FOR OFFICE USE ONLY III IV. V Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY Permit applicant exempt from registration with the Builder's Board because: Additional Project Information : PLANS REVIEWED BY: da te 7tr-8aznameSIgna tu re INSPECTION LII{E 726-37 69 CITY OF SP COMBIIIATION APPL LD /PERMII INFORIIAIION LiNt 7 26-37 53 E I ,T RI iaUJob Address /13 /t/, r-esa1 Descriotion //-93 -i6-J / TL. SGott EIIERGY SOURCES: Heat E/-E C- liater Heater ELEL Ranoe ELEa- So. Ftq. l.lain_ Sq. Ftg. Access._ Sq. Ftq. 0ther_ J'lew Add AlteEPEp. - _Fence_Demo_C ha nge/ U se _other-Va l ue of l.lork:l?,,#owner &.e., BuiJd SingleBuilciind'Perntit Info: Descni be l,lork( Fami I y lles idence I,lith Attached GaragePhoneAddress r6bg r4rcr sz O,zy Par t€ep&r,e , E/5.+ /Luaag Kr|lrtL-oe€Ecrca,va I Sraoa.e DE .k;taes., Ol;,s,. r(efl,acrufc construction Lender,l^o^, Cccuyt{ Hoos, tve4 g*g- BO \,b oa- \c) P Phonec*Z^ddress/7e E,74 Eoe ohone no.'lcs. no.add res sname Pri mary Structura l El ectri ca I l"'lec ha n i ca I (ohone no-lics. no.exD t resadd res sACTORSname Genera Pl umbi nq El ectri cal tlechanical MECHAN iCALEL ECTR I CALPLUIIB I NG FFF rHARG FTHAPGFNOFFFFEECHARGENON0.furnace/burner to BTLI' s--ao5-/eoPqEach single fixture /s6 Floor furnace and ventX New circuits alts or extensions Relocated building (new fix. additional) Recessed wal l Snace heater and ventSERV I C ESS. F. Residence(l bath) Duplex (l bath) each Apol iance vent seDarateTempora ry Constructi onAdditional bath Stationar-v evap cool erChange in existing res i dencetdater serv ice Vent fan with sinole ductTndrrctrial multifamily, comm. orSewer Vent systern apart from heatino or A.C.0f amps.Storm Sewer Mechani cal exhaust hnod and duct-COI4I.!./IND. FEEDERS l'lood stove/heaterI nstaI I /aI ter/re l ocate distrih. feeders 0f amps. ISSUANCF OF PFRIlIT TOTAL CHARGESTOTAL CHARGES 15aTOTAL CHARGES WHERE STATE LAI,J REQUIRES that tlre Electrica] work be shall not be vali,i until the label has been signed by an done El ect by an Electrical Contractor, the electrical portion.of this permit rical Supervisor and returned to the Building Division 0zz S lGI]ATl,lAtlE(please print)It Ci ty made exempt 055 wi] gffect loyees oncomp ny of Boa that all information hereon is truermit, and do hereb.y certI HAVE CAREFULLY E leted apnl cat ce with the Ordinances of thermed shall be done in accordanand correct, and I further certify that a and all work and that NC 0CCUPANCY will be0reqon pertaining to the work described herein'of Soringfield and the Laws of the State istration r.rith the Builder'sof the Building Division. I further certify that m.v regofstructure without the permission ion is noted hereon, and thatthe basis for exempt anyrdi s in full force and ired by ORS 701.055, that ifas requ I be used on this proiectin comcliance with 0l?S 701oniy subcontractors and emp who are DA.?furry S.*rr- ,tFoR 0F nits @ so. Ftg. l'lain Fire Zone / B.d.oo*, ccy Load Sq. Ftg. Acce Val u Flood Plain Stories V x x0therGroup.R"- I ue o,t /d)o@@- Val0cc.y SS Ftg TOTAL VALUATI Val ue Svstec:s Deve' Charqe (1.57'' o pmen tPlan Ck. Comm/Ind 65%/B1dq Per Fee Plan Ck. Res 30%/81dq Per Fee BUILDING PERNIT Charges anC Su rcha rges (@Aa Fence Dcmo PLUI4BING PERMIT Charges and Surc ha rges /-S-ul- SidewaIk Total Cornb. PermitA/C Paving ELECTRICAL PERIiIT Charqes and Surc ha rges l&qo_ a aCurb Cut /2,4,70 IlECHANICAL PERMIT Charges and Surc ha rges TOTAL AYN] TPSI LAtl A,o ) ^/E E Res idence of SQ. FT. COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Referenc 17 03 43 2. example- Lot 1. Block 3, Znd Addition to Springfield Estates C. Name, etc. of owner and construction lenderD. Energy Sources I. example- heat/electrical ceiling/or forced air2. example- waterheater/electrical/or sol'arE. Square footage or valuation, etc.1. example- 1250 sq. foot house, 500 sq. foot gar 2. example- if new project, check new - if additj check add, etc.F. Building permit information:1. example - construct single family house with r attached garage 2. example - remodel existing garage into family3. example - convert single family residence intr reJtaurant (change of use)G. Value of work as defined in Section 303 (a) of tht Structural Specialty CodeH. DESIGN TEAI4 AND CONTRACTORS To avoid design or construction delays, Bui)ding Div.ision Staff must be able to contact appropriatr persons regarding design information or job site corrections, etc.II. Abbreviated Plumbing, Mechanical, & Electrical Schedu'A. Except vrhere blank spaces occur in the descriptior portion of the Mechanical and Electrical Schedule: the applicant need fill-in only the No. Boxes adjtto the appropriate item(s) to be insta'lledB. Full Plumbing, Mechanical, and Electrical Schedulr are available at the Building Division1. To conserve space on the permit form the scher have been abbreviated2. If the item(s) to be installed are not coverer' the abbreviated schedules you should consult fu l I schedulesC. BUILDING DIVISION STAFF I.IILL FILL OUT ALL FEES AN] CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be deliveredelectrical contractor for signature by his electr supervisor. The general contractor is.not authorto sign the electrical label.III. Applicant to sign and date Hhenever possible, the initial application will be us a worksheet oniy. l,Jhere possible, Building Divisionwill prepare a type written copy and return it to the applicant at the time the actual permit is issued for' signature.IV. Fees and Charges Plan check fees are due and payable at the time of thapplication, and no plans will be processed until these fees are paid. All other fees and charges are due and payable when the permit is issued. V. FOR OFFICE USE ONLY PLANS REVIEWED BY: PERMIT VALIDATION CITY OF SPRINGFIELD Cily Hall Springlleld, Oregon Department of Public Works OFFICIAL RECEIPT Date Rec'd From No. B 53,+ n1 oC) ( Received For: Permit Clerk s'l gna tu re date { { nt ps ()O ( t 1 ( ( ( I ( (? ( Amount \{ ER'GGS PRINTERS/LI?HOGRAPHERS, EUGENE, ORE6ON PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information : name (I ( ( (. (. 8fz a (