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Home My WebLink AboutPermit Building 1986-03-25o^^Iffid COMBI T 'a> JEE\ut_tlr Ran 0wner -j- L NE \Sq. Ftq. l'la n l,later Heater Va lue of l,lork: IT Legal Description Sq. Ftg. Access._ EIIERGY SOURCES: Heat Job Address /E,OO f\J PhoneN t<rrAddress Bui l ii nq pernri t I nFol-- DescFiS6rl-6TrrFamily Residence llith Attached Garaoe .e., Build Single L]E,"6 ^o t hzr>.> C/**r* Construction Lender Addre s s Phone €/en/A< 4z/<.e,.7. t\\hb q Structura I E l ectri ca I Mechani ca I name addres s lics- no-exot res ohone no. PLUI{BI NG ELECTRI CAL MECHAN I CAL FEE CHARGF NN FFF CHARGF NO FFF CHARGF Each single fixture Residence of FTSQ furnace/burner to BTU' strRelocated buiiding (new fix. additional)/ New circuits alts.or extensions Floor furnace and vent S.F. Residence ( l bath)SERV I CES Recessed wal I Soace heatpr and vpnt Duplex (1 bath) each Additional bath Temporary Constructi on Apol iance vent seoarate Hater service ge in existing dpnce Chan res i Stationary evap. cool er Sewer multifamily, corm. or I ndustri a I Vent fan with sinole duct Storm Sewer 0f s apart from .c. Vent system , heatinq or A COMI.I./IND. FEEDERS l4echanical exhaust hood and duct Instal I /al ter/rel ocate distrih- fppdprq l,lood stove/heater 0f amps ISSUANCF OF PFRIlIT TOTAL CHARGES TOTAL CHARGES l.lAl'lE(p1 ease pri nt)IGNATURE DATE 3 Ci ty made0req the Bof any Board re permi effect eted 1 caI 'If oncompap!")aidoandcertIt 'Irmat hereonon s'In truehereb.y fyandcorrectndfuIcerrthertitthaand'II workfyany srmed Iha beI done ccorda nce wl th he nances0rdi oft theIf'Ie dof a thend ofLaws het-ng tas ofteSpri '|rta nlon theto rkwo cdes bedm npenghere i and NOthat OCCUPANCY I'|I beructutwlrehottuthssso'|ofn Iu d'|'|'IDI 'Is on I herfurt cert in9 ttha sI Itrat vJl0n theth uB rIIfyregmy sde sI n'I Ifu forceI nda 1u red 7ORSasreq I0 505 tha 'It f thet lbas fos rbyexemp onti s hereonnoted andexemp thatonsu bcon trac andtors I1y who 'Iare n 'IIempoyees WIance ht 7010r?s w1055 I'I usbe oned 'Icomoth s tproJ ec IIHERE STATE L..ll,J REQUIRES that the Etectrical work be done byshall not be valiC until the label has been signed by an Electri an Electrical Contractor, the electrical portion of this permit ca1 Supervisor and returned to the Building Division f ToTAL VALUATI0N_ x ue x Vaits So . Ftg. l'la in . Ftg AccessFire Zone Bedrooms . Ftg. 0ther Zone Cons t. Flood Plain Stories 1 0ccy Load So eroup7{-sq Plan Ck. Conrn/Ind 65%/Bldq Per Fee 1,:50 Svsterirs Deve' charqe (1.57'opment H r/7,Charges and Surcharges .2 BUILDING PERNIT Plan Ck. Res 30%/81do Per Fee FencePLUI4BING PERMIT Charges and Surcha rges Demo SJdewalkELECTRICT.L PERIIIT Charges and Surcharges * A/C Paving Total Comb. Permit Curb CutI,IECHANICAL PERHIT Charges and Surcharges TOTAL Vz-ga Ftg . Other L faddrmname )FXnl rP<ohonp no :I0R5 TOTAL CHARGES F0!1 \ COMBINATION APPLICATION/PER}4IT (CAP) I. Applicant to furnish A. Job Address B. Legal Description l. example- Tax Lot 100, Lane County Map Reference 17 0r 43 2. example- Lot 1. Block 3, 2nd Addition to Spiingf i e'ld Estates C. Name, etc. of owner and construction lenderD. Energy Sources l. example- heat/electrical ceiling/or forced air gas 2. example- waterheater/electrical/or solar E. Square footage or valuation, etc. 1. 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 single family house with an attacled garage 2. example - remodel existing garage into family room 3. example - convert single family residence into ieifaurant (change of use)G. Va'lue of work as defined in Section 303 (a) of the Structural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building 0ivision Staff must be able to contact appropriate persons regarding design information or job site corrections, etc.II. Abbreviated Plumbing, Mechanical, & E'lectrical 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 Schedules are available at the Buiiding Divisioni. To conserve space on the permit form the scheddles have been abbreviated2. If the item(s) to be instal'led are not covered on the abbreviated schedules you should consult the ful I schedulesC. EUILDING 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 is not authorizedto sign the electrical label.III. Applicant to sign and date I'lhenever possible, the initial application will be used as a worksheet only. Where possible, Building 0ivision Staffwill prepare a type written copy and return it to the PER}4IT VALIDATION app sigr 'licant at the time the actual permit is issued for his nature.,/ fva 7s- 6IV. Fees and Charges Plan check fees are due and payable at the t'ime of the app fee lication, and no plans will be processed until theses are paid. AII other fees and charges are due and payable when the permit is issued. V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY: Permit applicant exempt from registrat'ion with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name s't g nature ate 5-?t*A€ IIIsPECTION LINE 726-37 69 CITY OF SPRINGFIELD COHEI IIATI ON APPLICATION/PERfi IT InF0RrATmr IiXf 726-3t53 Job Address lboo t\r-Tfii\ Legal 0escription 6> Hea Ranqe EIIERGY SOURCES: llater Heater utOwner -T Value of llork:?a.+ Sq. Ftc . I'lai n_ Sq. Ftg. AcceJfl- Sq. Ftg.Other_ J{ewJdd_AlI-ilPep. - _Fence_Demo_Cha nge/ U se -other- N r<r\Addres s Phone Buiiciino Pernr Family Reside ..e., Bui ld Single u)*"4 Construction Lender I Address Phone @ AZ4e)/7. Ns\ b q name addres s I ics. no.exoi re<ohone no. Primary ObB. Structura I E l ectri ca I Hechani ca l RACTORS n ame addres s tcs. no.exot rPs ohone no. ? PLUl.IB I NG ELECTR I CAL FFF CHARGE NO FFF CHARGF M FFF Each single fixture Residence of FTsQ furnace/burner to BTU' strRelocated building (new fix. additional)/ New circuits alts. or extensions Floor furnace and vent S.F. Residence(1 bath)SERV ICES Recessed wal I Soace heater and vent Duplex (1 bath) each Additional bath Temporary Constructi on Apol iance vent seoa rate Hater service Change in existing res i dence Stati onar-v evap coo l er Sewer mu1 ti fami ly, Industrial corm. or Vent fan with s inole duct Storm Sewer 0f s.Vent systern apart from heatinq or A.C. coMr.r./IND. FEEDERS Mechanical exhaust hood and duct I nsta I I /a I ter/ rei ocatedistrib. feeders l,lood stove/heater amps.0f ISSUANCE OF PFRI{IT TOTAL CHARGES TOTAL CHARGES /5e TOTAL CHARGES l.lHERE STATE Lll,l REQUIRES that the Electrical woshall not be valiC until the label has been s.igned rk be done by an Electrical Contractor, the electrical portion of this pern.it by an Electrical Supervisor and returned to the Building Div.ision (please print)IGNATURE DATE 3 Dermi t rformed Ci ty made ' 0regon the Bui HAVE the e ted atc ncompapr)an d certidohe t a tiforman 0n reonhe treb.y fy ruendatc0rrecandfu rther cert t tha a nd a workfyany s ha be done0e accorda nce he na0rdi ofncesLl{l th thedoethandLawsoftheoStatefSpringfinltoworkthecrldesbednoe rta ng here i nda NO YOCCUPAI,IC WIttha befostructurethouwlthetspermr10nsofdnsoDhefurtcerrtIthattra tis v|lon tth Buhefymyreg der S any ,rdBoa n fu fo rce nd a ng 701effectsred0Rsrequby t the bas s forttha055 thaandexempttonnotedshereon texempsubcontractorsandvawhorenempoyeesWIance0r?sth 7 (.\7 055 wl be uscomD ed th0n s tnroj ec E Ftg Ftg Ftg . Access x Val.nrn""@u,l_<?! Flood Plain 5 tori es Uni ts So.ns Fire Zone Bedrooms -0ccy r Val Load So e"orp@s, . l'lain Plan Ck. Conm/lnd 65%/Bldq Per Fee Svstems Deve Charqe (1.52 opment /4,r7.2 BUILDING PERNIT Plan Ck. Res 3l%/Bldq Per Fee FencePLUT,IBING PERMIT Charges and Surcha rges Dgmo SJdewalkELECTRICAL PERI1IT Charges and Surcha rges @ ,€o A/C Pavi ng Total Comb. 0ermit Curb CutI,IECHANICAL PERMIT Charges and Surcharqes TOTAL 72,5a re Work /. MECHAN I CAL aHA OCF TOTAL VALUATION- ,2 C{TY OF SPRINGFIELD CltY Hall Sprlngfrcld, Oregon Dcpartmenl ol Public Workr OFFICTAL RECEIPT No. B 561-64COMBINATTON APPLI CATION/PERI,IIT (CAP) I. Applicant to furnishA. Job Address8. Legal Descriptionl. example- Tax Lot 100, Lane County Map Reference 17 03 432. exampie- Lot l. Block 3, znd Addition toSliTffiield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources 1. 2. Sql. 2. example- heat/electrical ceilinq/or forced air oi Ex-I nr pTe - wa t e r h e-a t eF,/cJEE t rltl-]7o r s o=TI-F-- uare footage or vaiuation, etc. example- 1250 sq. foot house, 500 sq. foot garagr example- if new project, check new.- if addition, check add, etc. ( d From ( Address /ZaO u3/c,4 Received o & OO f 12>-.b Trztf Qs* 4-Ea t Amount E.( ( ( ( ( ( ( ( II. III. IV. F. Building permit information:1. example - construct single family house with anattached garage f 1 4. example - remodei existing garage into family roc3. elalrple - convert singie family residence into FEi tEiurant ( change of -use )G. Value of work ai defined in Section 303 (a) of the .. Structural Specialty CodeH. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, BuildingDivision Staff must be able to contac! appropiite *persons regarding design information or job sitecorrections, etc. Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occur in the descriptionportion of the Mechan.ical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjaiento the appropriate item(s) to be installedB. Fu'll Plumbing, Mechanical, and Electrical Schedulesare available at the Euilding D.ivision1. To conserve space on the permit form the scheddles have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult thefu l 'l schedu l esC. BUILDING DIVISION STAFF I,JILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES0. As noted on the CAP, the Iabel must be de'livered to theelectrical contractor for signature by his electr.icalsupervisor. The general contractor is not authorizedto sign the electrical label Applicant to sign and date l,lhenever possible, the initial apptication wi'l I be used asa.worksheet only. lJhere possible, Bui lding Division Staffwill prepare a type written copy and return it to theapplicant at the time the actual permit is issued for hissignature. 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. Al l other fees and charges are due andpayable when the permit is issued. FOR OFFICE USE ONLY fsrz 7s- 6 I v Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY: Permit appf icant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: te 7-7E-8€name si gnature ( ( I tl<trvt c B _-)<- (-D :,,4 -9 J. 0 ) _E- 1] -: -:c-- t' t_ i I I J I a I I I -, I I I I L :./yt, fuoucr c c L I I I I v_ I , I a- cq o c aa l:-\''t.( IJL.' ) t; lwry.**t51 rl y o0/{4 r .L ,)lA, t- o o f'{) tl)5 I -l-'rIA I I !..N',A Fuw, D dU.lort\o l-q I cln arl df-n" n,-)u* 3 ---} l ,, Atl w. anQglwS 3'r^rall loclt,<- t? "( _9 -5 tLr\ Ao I t a I : tp, ^UOa*,). l,ls rrft !--t 'et['*< w"J. /\-. ,.,){ \ tl _ .--_} I <----*l I I _l -s -| rl I-tt H r- II I I l I I I I I b o l .lE