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Home My WebLink AboutPermit Building 1981-05-19CIIY OF SPRINGTIETD coMEINAIIoN APPTICATION / PERMII INFORMATION tINE 72e3753INSPECTION IINE 726.3769 23OLegol' , escription A.{d -New -Rep.Ron uf Use 5q. Ftg. Accesr. Wo ter Heoler EN ERGY Heot Sq. ttg. Moin Sq. Ftg. Other Owner Volue of Work: g Permit Info: rh Attoched Describe Work (i.c', Bui d 5in9le Fomil Bui I PhoneAddrerr Addre:r Phone no.) DESIGN TEAM (noma)no.)re s)(oddress) ress) Electricol PTUMBING Mc chonicol CHARGENO.FEE CHARGENO, EI.ECTRICAT CHARGE furnocef burner io --BTU'S Residence oi --_tq. ftEoch:ingle fixture Applionce vent se poro te New circuils, olterolion5 or exiension3Relocoted building (new fix. oddirionoi)Stolionory evop. coolerSERVICES S.F. Reridence (l both)Vent fon with single duclTemporory ConrlructionDuolex (l bolh) eo(h Vent syrlem oport {rom heoting or A.C.Amp:.Aciditionol both Mechonicol exhqust hood ond ductWdter lerYice Wood stove/ heoter Scwer Heot PumpFEEDERSSawarAir hondler to I0,000 cFMAmpr. Air hondler over r0,000 cFM tssuANcE oF.PERMIT FlooC Ploin--Storiel Occy Group---Sq' Ftg' Other- TOTAL CHARGEsTOTAT CHARGES 2-r/ TY Type/ Conrr. -------Units8c d room r --sJ)------O ccY Plon Ck. Comm/lndBUITDING PERMIT Plon Ck. Res Per Fee s- DATE C() Per 30% Fi re untilcolthisofsholivolidnolbeclc<tritha portion permitConlroclor,the E!ertricolbeworkdonelhsElectricslbythcIE5TA,wtA nEourREsWHERE nel,tha olectricolioondControdor PdottochedElactricalonhorlobclbcrnnedrt9by correct, ond of the Stote I ondIrue furtherlhotinformotionilhereon3dolorcer'tilyherebyond,YLL INEXA^{iheED oPPlicotion permil,I VEHA'CARETU compleied ofndLows Oregonofnonce 5 the iheoflhewith(JrO r City Springfieldlndoneocrcrdonceshollbeollorkondpcrformedthotonycertify the Buildi sron.Divi furtherrhewithou,5!ron olofmodeslructutepermi ngbeanywillndNOthotOCCUPANCYheri n,de:cribed oworktothcperto ining if lhe forbosis l5 noted70oRs.o5s,thot exemplionndo3effectexempttnf ull oforce byrequiredBuiBoordlder's t5nstrotiolhcwiththoterlilyrcAimy rhison7AloRswill.055 used proiect.bewilhncetnorewhocomplioctotroondrsthotondsubonemployeesonlyharon. System5 DeveloPment FOR OFTICE ATURE Bosir for Builder'; Eoord cxemPtion; NAJT1E (pleoso print) Chorger ond Surchorges a Volue I Yolue y -Volue TOTAT VAIUATION, Sq. Ftg. MainZone - Loqd Sq. Ftg. Access .ql*&AAFence fotol Comb. PermitDemo PIUMBING PERMIT Chorge: ond Surchorges \S Sidewolk A/C Povinq ELECTRICAI. PERMII Chorger ond Surchorge: C)O Curb Cut 5\ eoTOTAT MECHANICAT PERMIT Chor-oer ond Surchorge r c c MECHANICAT FEE TEE TOTAT CHARGES I ( L59',.) COMBINATION APPLICATIONI/PERMI *:IE1 l. Appliconr to furnish A. Job Address B. Legol DescriptionI. exomple-tox lot .l00, Lone County Mop Reference 'l 7 03 43 2. exomple-Lor l. Block 3, 2nd Addition ro Springfield Esrotes C. Nome, etc, of owner ond construction lender D. Energy Sources lectricol ceilin /or lorced oir gos 2.eoter,,e t:ricol i,or solor E. Squore footoge or voluq1le6. .1..l. exomole-1250 sq. foot house,500 sq. foot goroge2. erornElE-i?;& proiect, cleci new-ii odditi'on, cieck odd, e?c. F. Building permit informotion: l. exomple-construct single fomily house with on ottoched goroge 2. exomple-remodel existing goroge inlo fomily room3. ExomFie-converr single fomily rlsidence into restouront (chonge of use) G. Volue of work os defined in Section 303 (o) of the Structurol Speciolty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or consrruction deloys, Building Division Stoff must be oble ?o contoct oppropriote persons regording design information or iob site correclions, etc. ll. Ab6revioted Plumbing, Mechonicol & Elecrricol Schedules A. Except where blonk spoces occur in the description portion of the Mechonicol ond Electricol Schedules, the oppiicont need fill-in only rhe No. Boxes odiocent to the oppropriote. ilem(s) to be insrolled B. Full Plumbing, Mechonicol, ond Electricol Schedules ore ovoiloble or the Building Division I. To conserve spoce on the permil form the schedules .i hove been obbrevioted 2. lf the irem(s) to be instolled qre not covered on the obbrevi-. oted schedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES lll. Applicont to sign ond dote Whenever possible. the iniiiol opplicotion will be used os o worksheet only. Where possible, Building Division Stoff wilt prepore o typewritten copy ond return it to the opplicont ot the time the octuol permit is issued for his signoture. lV. Fees ond Chorges Plon check fees ore due ond poyoble ol the time of the opplicotion, ond no plons will be processed until these fees ore poid. All olher fees ond chorges ore due ond poyoble when the perrnit is irsued- V. FOR OFFICE UsE ONLY ,ERMIT VALIDATION Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ( Additionol Pro[ect lnformqtion: PLANS REVIEWED BY: signolurenome dole ES: Legol r Volue of Work: Addrerr Phone a Fomil Re Sq. ttg. Accerr. Sq. Frg. Orher EN €RGY Heof With Artoched Go -New-Add -Alter -Rcp Ure-, -Fen INsPECTION ItNE 776-3769 INFORMATION LINE 72&3753 CIIY OF SPRINGTIELD COMEINATION APPTICATION / PERMII Sq. tr9. Aloin Woter Heoler ----- Building Permil lnfo: Describe Work (i.e., Build 5in9le U dc w C- 7 PhoneAddre rr OESIGN IEA/I (nom ei (oddress)(expirer)(phone no.)(lic:. no.) Primory Strucluro I Electricol Mcchonicol (nomc)(oddrers)(lics. no.)(expires)(phone no.)CONTRACTORS I Plumbinq CeIL-.>\q)- ),t r)Nq \-EleoricoI (1 Mechcnicol MECHANICALPIUMEING NO. ELECTRICAT FiE CHARGENo. r r r-r5 I Cl-lAEGf i NO. furnoce/burner ro -BTU'S Residence oi ---rq. ft.Eoch rinqla fixrurc Applionce vent sepo rq tc New <ircvilr. olterolionr or exiension: Relocoted building (ncw fix. odditionol) Slofionory evop. coo IerSERVICES S.F. Reridencs (l both) Vent fon with sinqle CuctTemporory ConrlructionDuplex (l both) eoch I I Vent sytrem oport from heotinq or A.C.Ampr.Aciditionol borh Mechonicol exhou:t hood ond ductWo ler rcrvica Wood stove/ heoferI I Scwer Heot PumpFEED ERSSlcr-m Sewar Air hondler to r0,000 cF,|iAmpr. Air hondler over 10,000 cFM ISSUANCE .OF,PERMIT t' IrrHEnE SIAIE f.AW REOUIRES rhot rhe Elcctricol work bc donr by thc Elartriral ControctoT, tha clecrical portioB of this pcrmit rholi not bc volid unril o tobcl hor bcon :igncd by on El.(?ri(ol Conrtoclol ond ottothed to lhc clecrricol ponel' I HAVE CAREFUtty EXAMTNED the completed opplicotion for permit, ond do hereby certify ihot oll informotion hereon is lrue ond correct, ond I further <ertify thot ony ond oll work pcrformed sholl be donc in occordonce with fhe Ordinoncer of ihe City of Springfield ond lhe tows of lhe Storc of Orcaon pcrtoining lo lirc work dercriixd herin, ond thot NO OCCUPANCY will be mode of ony slrucrure without lhe pcrmisrion of the Building Division. I further eaify rh-ot my rcgi3rrotion with thc Builder,s Eoord is in full force ond effeci o: rcquireci by ORS 701.055. ?hol if exempt thc borir for cxemption ir noted hr.on, ond thor only rebontroctor5 ond cmploye.r who ore in complionce with ORS 701.055 will be used on lhis proiecl. TOTAT CHARGES S. DATE ,-r/SIGNATURE/" -ru EL,T4,,lr Eorir for Euilde/r Eoord cxemption: TOTAT CHARGES TOTAT CHARGES NAA{E (pleorc prinr) FOR OTFICE Ftood Ptoin ---Jtorier-Occy Group-Sq- Ftg. Othcr- I -Volue TOTAT VAIUATION ONIY fire Zonc- Zone loqd Sq. Ftg. Acce:s Type/ Ccn:t. -Unitr Bcdroom r ---S------OccY Sq. Flg. Atoin , Volue a Voluc Syrremr Development Chorqe ( I .596) BUIIDING PERMIT Chorgcr ond Svrchorger Plon Ck. Comm/lndq)s"o Fee Fee Plon Ck. Re: 30".,./ 8r do. rq-.QAA- Totol Comb. Permit PI.UMBING PERMIT Chorger ond 5urchorger \S Fence Demo ETECTRICAI. PERIAIT .C)o Sidewolk Povin Chorger ond Surchorge: TOTAL 5\ ,ec MECHANICAI. PERMIT Curb CutChorger ond Svrchorger FEE ARGE Qrtfi- 1n333 L)\rrft\€>ix\C\q \\h\ COMEINATION APPTICATION,'PERMI -:AE1 l. Appliconr ro furnish A. Job Address B. Legol Descriptionl. exomole-rox lot I00, Lone County Mop Reference2. e-iiliffi-tor l. Block 3, 2nd Addition ro Springfietd C. Nome, etc. of owner ond construction lender D- Energy Sources exomole-heot/'electricol ceilin /or forced oir gos2. eEin6lE-worer eo ?er,.tri t'or solor E. Squore footoge or vo1u61166. .g..l. exomole.l3!g .q. foot house, 500 sq. foot goroge 2. eEfrilE-iTiIw proiect, ct'eci new-ii oddition, c"he, odd, erc. f. Building permit informotion: l. exomole-construct single fomily house with on ottc gorqge 2. exomole.remodel existing goroge inlo forriily roorr 3. exompC.convert single fomily residence into restouront (chonge of use) G. Volue of work os defined in Section 303 (o) of the Strucrurol Speciolty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction cjeloys, Building Divis Sloff must be oble to conloct oppropriote persons reg design informotion or iob site correclions, etc. ll. Ab6revioted Plumbing, Mechonicol & Electricol Schedule: A. Except where blonk spoces occur in the description p< of the Mechonicol onci Electricol Schedules, the oppiic need fill-in only ?he No. Boxes od[ocent to the oppro;. item(s) to be insrolled B. Full Plumbing, Mechonicol, ond Electricol Schedules ore ovoiloble ot the Building Division l. To conserve spoce on the permit form the schedulr hove been obbrevioted 2. lf the irem(s) to be insrolled ore not covered on th,. oted schedules you should consult the full schedul C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES A CHARGES ON THE SCHEDULES lll- Applicont to sign onci dote Whenever possible, rhe iniriol opplicotion will be used o worksheet only. Where possible, Building Division Stoff prepore o typewrilten copy ond return it to the opplicor the rime rhe ocruol permit ir issued for his signotuie. +-lV. Feer ond Chorges PLANS REVIEWED BY: (- ctTY OF SPRTNGFTELD ciry Hqlt Springfield, Oregon Deportmenl of public Works OFFICIAT RECEIPT No. B 56535 (l I I9 ntc Received For: C .te\ (. AY( t Amount Rece ived I Plon check fees ore due ond poyoble or the time of the oppricotion,ond no plons will be processed unlil lhese fees ore poid. ell other fees ond chorges ore due ond poyoble when ihe permitir issued. V. FOR OFFICE USE ONTY IZED SIGTATURE s H E (ro t,TU R t 6u !t PRTNYEiS cucENE Oi graot 5A5r!_a Permit Clerk PROJECT CCNDITTONS TO 8E SATISFIED BEFORE OCCUPANCY: '(, Additionol Proiect tnformotion: nome signoture dole -rERMrr vALTDATtoN I ( (.. , ( (. ( (. ( i i t I