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Home My WebLink AboutPermit Building 1980-09-23INE COMBI CATI Job Address za rl Ranqe. l,Jater Heater EIIERGY SOURCES: Hea t Lr*,l-ega1 Description # owner J.uu n A4 r'//r-( Value of l,Jork: Sq. Ftg. Access._ Sq. Ftq. 0ther__ _i,lew_AddJ1 ter_Rep. _Fence_Demo_C ha n ge/ U s e 0ther l'1a n D I o engci'IAddres s f,t,\tn 6,"- / t .n v eiadq /r? ?/Ylova €ltszt,ya /Za>r<e /4ve c6nstr[6i1on Lender / ,t0.fg_<€ Addre s s Phone o0D TJ _o B n Structura I Pri ma E l ectri cal l''lechan ical name addres s 'l ics. no.ex o'i res ohone no- ) Plumbi J,A o/f*,) /\Lyz,a--El ectrical o l,lechanical ELECTRICAL 14ECHAN I CALPLUI.IBI NG FFF .HAQCFrHA RGF NN FFF CHARGF N0.FEE furnace/burner to BTU' s Residence of FTSQ Each single fixture Fl oor furnace and vent New ci rcu i ts al ts or extensions Relocated bui lding (new fix. addit.ional ) Recessed wal I Soace heater and ventSERVICESS. F. Residence(l bath) Duplex (1 bath) each Apol iance vent seDa rateTemporary ConstructionAdditional bath Stati onar.v evap cool ere in existing ence Cha ng residllater service Vent fan with si nql e ductT ndrrstri a I multifami ly, comm. or Sewer apart from .c. Vent systern heatinq or A0f amPs,Storm Sewer Mechanical exhaust hood and ductc0r,1r'1. /IND. FEEDERS6.nkbtte //*?aI trJood stove/heaterI n sta I i /a I ter/ rel oc ate distrib. feeders//qrue 0f amp s. ?EP b.nItfbtce rt/cntc ls ISSUAI]CF OF PFRIlIT TOTAL CHARGES S IGTIAtlAl'1E ( pl ease pri &<9 ,TE permi ffect 'I hereoon nnfIrrnaot'It tha at IIcerdoandtrmtfyhereb.y'I Lca onI ofr reItethe DCcompappLCARE FUL n'I nca 0ES fencthWIheLrd0ashIIdobe'Ine an ordaandIawo rkI rmedperfoIrtfurhe1certtthandtcorrecaf-v anynda 1 IInndaatthOCCUPANCI'lckrSCde.Ir hbed 'lere'ILd ,]n n theto WOofSteLd0ofthe'I If Ie ad thend Laws per oregonfn9spr Bu IS'I ttra 0n-l rhv/1 theertcI'l th ater m.y regfurthI.Id D 1 s'I onI vo.l of Bu lthee ngtutrucwtreththoutf0 t 0nI s1 henoted reonbatheIsfors7055'It exempAS,lu red ORS 01 tha exempts any rd 1 nI 1fu IBoa req byfrrceodane LonusedhtecS'Ibe proJND7CS0551'It/lwhoaren'l'i ncea ttl hSntru bco toAC ars nd I s COMDonempoyee1y by ni, LIrr1Ld'I of0n 'I sthItortractheet permidonEectIrcaConpo rtaIEtriecacwoIbenerkRESItthatheRELAIlQUREIiHESTTAEIu1,ld Di svl 0n1rnedretuttoheILd'I nd ngs0raEectInahasbeeSn1S upervbyIjIntuIiIthebeaIagnedash'II not be TOTAL CHARGES TOTAL CHARGES i s true the City be made I der' s and that Flood Plain Stories - Occ'Y Group x c I S o Ftg Ftg alConst. Uni ts Fire Zone Zone al ue-..-"=---Bedrooms Val ue. Access .0ther g. t'tuin ' , ToTAL VALUATI0N-- Occv Load S S Deve 7.51Plan Ck. Comm/Ind 65%/B1dq Per Fee Plan Ck. Res 30%/Blds Per Fee- BUiLDING PERT1IT Charges and a ___z .O Fence Derno PLUI4BING PERMIT Charges and Surcha rges 6,A c€ Sidewal k Total Cornb. Permi cA/C Pavi ng Curb Cut t/. oo TOTAL Et.ECTRICP.L PERIlIT Cnarges and Surcharges I,IECHAIIICAL PERMIT Charges and Surcharge s qa va iur :am )e l^Jork (I Garaoe UL5l UN I LAI.'!name aridrFqs 'I icc- nn pxnt rAq CONTRACTORS a COMBINATION APPLICATION/PERMiT (CAP) I. Applicant to furnishA. Job AddressB. Lega l Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 432. example- Lot 1. Block 3, Znd Addition toSpringfield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources ; r forced air gas:qbr- sq. foot garage - if addition, 1. examole- heat/electrical ceilinq/o2. exanrpi e-e- wa terhEa terle GEtFTcal-/orE. Square footage or vajuationl-Ecl-1. example- 1250 sq. foot house, 5002. example- if new project, check-new chec k add , etc . II III IV F. Building permit information:1. example - construct single family house with anattached garage ?. example - remodel existing garage into family room3, examp.le - convert single family residence iniorestaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specialty CodeH. DESIGN TEAI.I AND CONTRACTORS To avoid design or construction delays, BuildingDivision Staff must be able to contact appropr.iitepersons regarding design information or job s.itecorrections, etc. Abbreviated Plumbing, Mechanical, & E'lectrica'l SchedulesA. Except vrhere blank spaces occur in the descriptionportion of the Mechanical and Electrical Schedules,the applicant need fill-in only the No. Boxes adjaientt0 the appropriate item(s) to be installedB. Full Plumbing, Mechanjcal, and Electrical Schedulesare available at the Building Division1. To conserve space on the permit form the scheduleshave been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful I schedul esC. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noted on the CAp, the label must be delivered to thee'iectrical contractor for s.ignature by his electrrjcal - supervisor. The generai contractor ii not authorizedto sign the electrical labelApplicant to sign and date Hhenever possible, the initial application will be used asa.worksheet on1y. Where possible, Bu.ilding Divis.ion Siaiiwili.prepare a type written copy ina returi it to theapp.licant 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 theappl j cati on, and no p1 ans wi i I- be proceiied unti I theserees are paid. All other fees and charges are due andpayable when the permit is issued. FoR oFFICE USE oNLY PERMIT VALIDATION Permit Clerk PROJECT CONDITiONS TO BE SATiSFIED BEFORE OCCUPAI.ICY: eP irm t a iI aC Ln xeme t tpp rom re i tpS ra it Wong t th Bhe U dI re S Bo rdi ubeca eS Additional Project Informatjon :,1- x €, , bnas Pc<e* ;.isnature PLANS REVIEWED BY: name 7*>r-B c):da te I NSPE 726-3 ,L CITY OF SPTING-IEID- CONBI iIATION APPL I CATION/PERMIT -3753 I Job Address 2a N.ZI l',ater Heater Ranoe EIIERGY SOURCES Hea t Lrfr-Legal Description ^*t7\z owner l*n n fu/r'//r-(Val ue of llork Ftq. llain-- Sq. Ftg. Access.--- Sq. Ftq. 0ther_ J{ewJdd_Al ter_Pep. _Fenc e_Demo_C ha n gel Use 0ther Addres s Descr r eernri i den t I o cearnFII nf l.t i ng .rlvcqodq lrV ?/Yiev< $"qg7*,y.n .WaBt<e rfuwe c8nstrfiffion Lender ' i)ofU_i PA-7p {*w.a {*t**fr.ry Addres s Phone 5e7uP. [J t( I iisF d Struc tura i Pri ma Electrical l'lechanical nailre address lics. no.(pxo'i res (chone no. -trtf o a o q El ectri PLUIlBI 11G ELECTRICAL MECHAN I CAL FTF CHARGE FFF I csapnr N0.FFF r.HA PC F Each single fixture furnace/burner to BTL|' s Relocated buildinq (new fix. additional ) New ci rcui ts al ts or extensions Fl oor furnace and vent S.F. Residence ( I battr )SERV ICES Recessed wal l Soace heatcr and vpnt Duplex (1 bath) each Additional bath Temporar.v Constructi on Apol iance vent seoa ra te l,later servi ce qe i n exi sti ng dencp Chan rps i Stationary evap. cool er Sewer industrial multifamily, comm. or Vent fan with s inole duct Storm Sewer 0f .amp s.Vent systern apart from heatino or A.C. t rA,At€ i/e*?A ..F#c0Hil./IND. FEEDERS i,'lechanical exhaust hood and duct 7$141u=Instal I /a l ter/rel ocate di stri b. feeders l'lood stove/heater 0f amps. /,Vsgt<* ihvt,E /t{-q(aP ->. rs ISSUAIICF OF PFRIlIT TOTAL CHARGES /i-d<,I u.TOTAL CHARGES ".{..};U TOTAL CHARGES WHERE STATE Lli,J REQUIRES that the Electrical work be done by rir an Electrical Contractor, the electrical portion of thisshail not be valil until the label has been signed by an Elect ca1 Supervisor and returned to the Building Division perni t -l-13t1.I,lAl,lE(please prin S IGIJATU DATE fy ELL xAil D het c d ac t n De rm t d do rompanhe ti f ttha a n rmafo t heon reo napr)reb.y v tr ue c0 trrec a dn fu rnda cher ert hat t a nd a l,Jo rk p drfo rme has done accn da0r enc th het nabeany0rd i enc ofs th L ty efi d ndafoSpr th vJsLa theof teSta nng00 oe rta n n thto work crtCS herebed n a thnd adregg t OCCUt,lc PAIIC wt ma debe o a ucstr w1reLU thou r_heL erm s s 00n f tn-v p Bu d Di S ohe furt rhe rCE +L tha sng ttra on th he Bu der Sfyregm.y nsrdBoa fu rceo nd ffr +ec a th at f t bathe S forrequredSOR701s5exem0s on s henoted reon n0 +thabyexemDt on bcu t0n ct rs0 andv emr)rvho re con ance thwi 7Ol]S n 05 EoyeeMD usbe oned th roP I Va'l ue Bed rooms Flood Plain Stories Occ.y Group TOTAL VALUATION V X x x LoaC Val ue Val ue Fire Zone Access 0the r tq. i''la i n Ftg Cla Plan Ck. Comm/lnd 55iilBIdq Per Fee Sysiems Deve Charqe ( 1.51 opmen t Clra es anC BUILDING PERI'IIT aga6f fJ. Plan Ck. Res 3Ai"/Bldq Per Fee FencePLUI4BING PERMIT Charges and Surcha rges tirY- f- +!(i___! Dgmo SidewalkELL{IRICAL PERI|IT Charges and Surcha rges ,/6 Total Comb. Permi cA/C Pav i ng Curb Cut s5/.TOTAL I.IECHANICAL PERMIT Charges and Surcharges UL5l trN I LAI1 nante cxnr rac ( ohone no CONTRACTORS o/T*,) La-raa-4 Ilechani ca I Residence of SQ. FT. Zone Tyoe/Const. Uni ts So. a]^Dote \ ll0. 6 J4btig 9 (R d COMBINATION APPLICATION/PERIIIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Referenc, 17 03 432. example- Lot 1. Block 3, ?nd Addition to SEilngfietd EstatesC. Name, etc. of owner and construction IenderD. Energy Sources i l. examol e-2. exarDlE- E. SquaiE-Tiota he r forced air ci 9e1. example- 1250 sq. foot house, 500 sq. foot gar 2. ExamilerJT-new project, check-new - if addit' check add, etc.F. Bui lding perni I information:1. exarnole - construct single family house with ; attaahed qarage exanole - rernodel existi examc e-convert single ng ga fami rage into family Iy residence int iEl tallant (chanqe of use)G. Value of work as defined in Section 303 (a) of th Structural Specialty CodeH. OESIGi{ TEAI.I AIID COHTRACTORS To avc'id des'ign or construction delays, Building D'ivision Staff rnust be able to contact approoriat persons re_carding design information or job site corrections, etc. Abbreviateo Plumbing, i'lechanical, & Electrical SchedrA. Except irhere blank spaces occur in the descriptir pol"r.ion of the Mechanical and Electrical Scheduli the applicant need fill-in only the l{o. Boxes ad.1to the appropriate item(s) to be installedB. Full Plunoing, llechanical, and Electrical Schedules are avaiiable at the Building Divisicn1. To conserve space on the permit form the schedu' have been abbreviated ?. if ihe item(s) to be installed iie not cov-ered c the abbreviated schedules you shoujd consult thrful'i scnedulesC. BUiLDIiic DIVISION STAFF I.IILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULESD. As noteC on the CAP, the labe1 must be delivered to electrical contractor for signature b-y his eiectrica supervisor. The general contractoris not authorize to sign the electrical label Applicant to sign and date [,lhenever possibie, the jnitial application wi l I be used a urorksheet only. Where possible, Bui)ding Division Stawill prepare a type written copy and return it to the appiicant at the time the actua) permit is issued for hi s i gna ture. Fees and Charges Plan check fees are due and payable at the time of theapplication, and no plans trill be processed until these fees are paid. All other fees and charges are due and payable when the permit is issued. Amounl Received CITY OF SPRINGFIELD CitY Holl Springiieid, Oregon Deportmenl of Public Works OFFICIAL RECEIPT No. B ;4607- Do 19() Rec'd Fro Address Received For (r,O clo &:co c LID Amount Received For I ( CC I t ( f ( rat/electrical cei l ing/o terheater/ei ectri ca i /oror valuation, GTE. wa so ar ! ? ? { II III IV ( Llc \ t v. FoR cFFiCE USE Ciil,Y PROJECT CCNDITIONS TO BE SATISFIED BEFORE OCi Permit applicant exempt from registration wit 9Y * ( t (- (' AUTHORIZED 5IGNA sHELYON.TUiNaU!L PF|Xr€RS EUGaR€ OR 974Ot t6!tr_a +- Additional Proiect Information: frtS f.qo.Af<-rS ,.S I {ec*</*r€-D AS *- 4+x=y v.d.q, .-A /V,,P F ,'OZa ,{liy<* /7t<laVr <;-7.4?D{{=5: fifa ,?7-?otu>r*:> 1>Fap677 l7ret€ , PLANS REVI EI.IED BY : L***-name gna tu re date ?-27-B cjP.<'.oe ri ( ( ( ( ( \\ IffiE) TK, F,1a?7 excavation, but prior to setup offorms 2. UIIDEI?SLAB PLUI4BING ELECTRI CAL &\I TIY I o ema e ore anywork is covered. 3. FOOTINGS & FOUI,IDATION:To be made ated andafter trenches are excav PECTION PROCEDURES FOR THE CI - JF SPRiNGFiELDBUILDING DIVISION 346 I,IAIN STR'ii'-'INSpECTioNS 726-37 6s ilrF0Rr,lATrON iio_gzs: The fol lorvin g indicated ins pe ctions are required for your const ruction atoyr4It is the res p onsibil ityofte perm t hol er to see t ta i nspect ons are made at t e proper t.imethat each address is rea dable from t he street, and that the p ermit card islocated at the front of the property 1. SiTE INSPECTI ON:To be made after h forrns are erected, but prior topouring concrete. Steel location, bondg or verticals in ac- U.B.C. Section 2415. 11. FBAMI!'lG INSpEgTI0N: Ilust be requestedatter approval of nouqh plumbing, elec_trical & mechanical . Al1 roof .ino, bracfnq & chimneys, etc. rnust be com-pleted. lJo work is to be concealeduntil this inspection has been made andapproved. 12. DRYI./ALL INSPECTI ON To be made afterc€, but prior toall d rywall js in p1a any taping. 13. SEI^/ER l^IAT ER & DRAINAGE LII,IES:rior tb 1 1 r'ng n trenc S 14. SIDEI^JALK & DRIVEI^/AY:Required for all 4. MASONRY WALLS: be ams, groutin cordance with 5. UNDERFLOOR PLUMBi NG & MECHANICAL: e pavin!t w ; to be made a in street right-fter all excavat- llhen required by cr'al inspector tos in proqress. Astinq report toildinq Division. concre of -rvay or decking. 7. ROUGH PLUI1B]NG ELECTRiCAL & o wor 'is to e or to instalTffion ation or decking. To be made prior toof floor insulation il these inspections made and approved 'ing compiete & form r,,ork & sub-basemateriaf in p1ace. 15. I,J00DSTOVES : After i nstal lation is conrpl etE. 16. SPECIAL iNSPECTIO IJS: To be nr,adof floor e pri i nsul 6. POST & BEAirl: nstal a 0n C the B be pr uilding Code, sp€ esent when work i 8. FIREPLACE: Prior to olacinonA;g-maeriats. ' - r = Structural Concrete: In excess of 3000P.S.I.I-lj Structural t^lelds: performed on the job - Glu-Lam Beams: Inspectjon certjficate(by approved agency) suppl.ied to Build-ing Division before beams are placed.,I-l Fire Retardant Roofing: Before instal_ I ation. copy of the speclal te be furnished to the Bu 77. OTHER INSPECTIONS accordance wi th--Fui ind'icated in plans Bui I d'ing Inspector. tlofit<e ,?otWa covered un have been 9. FiRE & SEPARATION t,,IA LL: Located& const ructed according to plans U INSULATION VAPO R BARRI ER INSPECTI Oi'J:To be made a ter a tnsu at 0n an Jequ]red vapor barriers are in placebut-before any 1ath, gypsum board or wa I I cover.ing is appl ied, and beforeany insulation is concealed. May be required inldinq Code, to beor by notice from 5a-"f FINAL PLUMBING K FINAL ELECTRICAL FINAL MECHANICAL FINAL FIRE DEPT. All project conditions, such as the instailation of street trees, cornpretion of therequired landscaping, etc.' must be staisfied before the BUILDII,IG FINALcan be requested. FINAL BUILDING The Ft'nal Building Inspection must be requested after the Final Plumbjng, Electrical andMechanical Inpsections have been made and approved. No occupancy of the,ra;ises canbe made until the Final Build'ing Inspection has been made and approved, and a CERTIFI-CATE OF OCCUPANCY HAS BEEII ISSUED BY THE BUILDING DIVISION AND poslTo o I iHE-pnEIITsEs. Name of permit holder Phone 4 ra-(?t-a S'i gna tu re BUILDING WORK I4UST Da te 27 7o DI ION AP VED PLANS SHALL REMAIN ON THE BUILDING SiTE AT ALL TII.IES, AND ALLDCOMPLETED IN ACCORDANCE I,JITH THOSE APPROVED PLAIIS X v NOTE: All manholes and cleanouts are to be adjusted at no cost to the Cjty. 0lson & Ihompson, lnc. C&s,fht hgiuers & Survcyus n hntanpl lu\ / Eugctu, hag* 974O1 / ldc2lnu Ara hde 50r/4SS-16t1 LOT A gld; V."irrnu West 80.00 feet of Lot 4, Block 5 of First Addition to Adams na ' Plat as platted and recorded in Book 15, Page 2, Lane County Ore- qon PIat Records, in Springfield, Lane Conty, 0regon. nning at the Southeast corner of Lot 4, Block 5 of First Add- {rF l,o) ition to Adams Plat as platted and recorded in Book 15, Page 2, Lane County Oregon Plat Records; run thence North B9o 77'West Llu l6t.g5 feet to a 5/B inch iron rod; thence North Oo 3tr East 79.75 feet to a 5/B inch iron rod; thence South B9o 25' 26u EasL 76.95 feet to a 5/8 inch iron rod; thence South 0o 7t' West 59.71 feet to a 5/8 inch iron rod; thence South B9o 27 ' East 85.00 feet to a 5/8 inch iron rod; thence South Oo ilt OStt West 20.00 feet to the place of beginning in Springfield, Lane County, Oregon. ,ltr il /fl1, ,$il LOT C Beginning aL a 5/B inch iron rod marking the Northeast corner of Lot 4, Btock 5, First Addition to Adams Plat as plated and record- Ol^"a in Book 15, Page 2, Lane County 0regon PIat Records; run thence j* South Oo tj'0J,'i,lest 59.57 feet to a 5/B inch iron rod; thence B9o ' West 85.00 feet to a 5/B inch iron rod; thence North Oo t5' East 59.71 feet Lo a 5/8 inch iron rod; thenee South 89o 25t 26tt East 85.00 feet to the Place of Beginning, in Springfield, Lane County, 0regon. 3 I Y LOT B I 7 ilL CITY L)F SPRiIIGFIELD COIlBI iIATI ON APPL I CATION/ PER,{ IT -37 I Job Address ?A N,L4 l-egal Description Lr9.. Hea EIIERGY SOURCES llater Heater Ranqe Owner Value of l,lork . l.lain-- !q. itg. Access._ Addres s e., BuiFamiI u d it In o ng escr[,lork ched Gara <<,q Addres s Phone 5*7ut. ! Pri ma Structura i El ectr i ca l I'lechan icaI Genera I U PI .ttr -,d a cal c l.!echan i ca I PLUIlBI IIG ELECTR I CAL MEC HAN I CAL liU I FEE CHARGE NN FFF r HA PCF NO FFF CHARGF I Each single fixture Residence of FTSQ furnace/burner to BTLI' s Relocated bui Idinq (new fix. additional ) New ci rcui ts al tsor extensions Floor furnace and vent S. F. Res i dence(l bath)SERV I CES Recessed wal I Duplex (l bath) each Additional bath Temporary Constructi on Apol iance vent sepa ra te I,later servi ce Chan-oe i n exi sti ng res i dence Stationary evap cool er Sewer multifamiIy, comm. or Industrial Vent fan with sinqle duct Storm Sewer 0f amps.Vent system apart from heatinq or A.C. I ftLss<€ /i4we . r.A*J>/D.COMI.I./IND. FEEDERS Mechanical exhaust hood and duct #qt..p'I nsta I I ,/a I ter/ re l ocate dist-rih- fpcdprs l'Jood stove/heater .amps.0f I 'Wqtce rt**te *a (atP -12r er5 ISSUAIICF OF PPBIllT TOTAL CHARGES .1a .*&'TOTAL CHARGES TOTAL CHARGES I.'HER shal I no t be valil until the label has been signed by be an d E one by I ectri an Electrical Contractor, the electrical portion of this permitcal Suoervisor and returned to the Bu.ilding Division STATE L1t', REQUIRES that the Electrical r^rork I'lAl.1E(please print c ta t)A-TE of any Board perm ffect HAV XAIlL N tED che eom!)c +a 0n 0fr r rmr an d do herDE ce rt I ttha a n rmafoappeb.y v t on rehe on s t ruedfuco rrec tan and crther ert L tha a an d a t/0r Derk rmedfo hafyny donebe n 0racc ncda w1e tth 0rdhe na nce of the C ty S r1 f e andof d o the StaDthLar/s t of on rt a n toeng0reg het rkWO d c bedr1 he re n nda th0enq itt 0c NCCCUPA wtY mabe derutctureouththes0noethUAnfD0nCCtrttruhertgrhareSLtra0t/1 tth Buhe Sdefym.v gfnrcedanefoauedr07reclDCI\J 0 505 tha t ex t rh f rbyeSbas0 exemDt on s n0 aemptedrehe0n nd ha+tonsntru bco ca r5 andly enD whs areo c0mcno"yee ncea ht S 07n,r 55 usbe oned t h s u ro,j Uni ts So t/a I ue Bedrooms Flood Plain Stories 0cc.y Group TOTAL VALUATIOII X X x Load e,/Const Fi re Zone Tone val ue.......=--.- Value Acces s 0the r to. l'!ain Ftg Ftg Pl an Ck. Comm/Ind 65;lilBldo Per Fpp Systems DeveloDment charqe (1.52) BUILDING PERNIT Charges anC c rcu h ee Plan Ck. Re 30%/Bldq Pe s rF, FencePLUI4BING PERI'4IT Charges and Surcha rges "./f a€.-:.__,;_ .Fv D5lrno SidewalkELECTRICAL PERI|IT Charges and Surcha rges 't(} *lc Iotal Conb. Permi cA/C Paving Curb CutNECHANICAL PERMIT Charges and Surc ha rges TOTAL 6.>t.t o 0ther.Ftg. I cSnstrfiffion Lender / r)---o ,rp Ct]N IRACTORS narnP Iaddrpss 'I ic< nn Inhnna nn Sneap heil6r anrl vanl llo. 6 J4bb'u OO COMBINATION APPLICATION/PERMiT (CAP) I. Applicant to furnishA. Job Address B . Lega I Descr i pt'i on1. example- Tax Lot 100, Lane County Map Referenc, T7-T3-q32. examole- Lot 1. Block 3, Znd Add'ition to SpllngTield EstatesC. Name, etc. of owner and construction lenderD. Energy Sources l 1. examol e-2. examoTA-E. squai6-766Ta he or forced air wa ge 1. examole- 1250 sq. foot house, 500 sq. foot gar 2. examp)e- if new project, check new - if addit' El'eck Edd, etc.F. Building permit information: 1. exarnole - construct single family house with ; at-"ached garage 2. examole - remodel existing garage into family 3. exar,olE-- convert single family residence int iEstilrant (change of use) G. Value of work as defined in Section 303 (a) of th Structural Specialty CodeH. DESIGii TEAi,i AIID COI1TRACTORS To avoid design or construction delays, Building Division Staff must be able to contact approprial persons regarding design information or iob sile corrections, etc, Abbreviated Plumbing, i'lechanical, & Electrical SchedrA. Except r.rhere blank spdces occur in the descriptir portion of the l''iechanical and Electrical Schedul, the applicant need fili-in only the No. Boxes ad,1 to the appropriate item(s) to be instal ledB. Full Plunbing, llechanical, and Electrical Schedules are available at the Building Division1. To conserve space on the permit form the schedu have been abbreviated2. If the item(s) tc be installea iie not cov'ered r the abbreviated schedules you should consult thrfull schedules C. BUiLDiiic DIViSiOiI STAFF t,llLL FILL OUT ALL FEES AND CHARGTS Oii THE SCHEOULESD. As noteC on the CAP, the label must be delivered to electricai contractor for signature by his electrica supervisor. The general contractor is not authoriz€ to sign the electrical label. Applicant to sign and date Hhenever possible, the initial application will be used a worksheet on1y. Where possible, Building Division Sta wi'11 prepare a type written copy and return it to the applicant at the time the actual permit is issued for hi s i gna tu re. Fees and Charges Plan check fees are due and payable at the time of the application, and no plans will be processed until these fees are paid. All other fees and charges are due and payable vlhen the permit is issued. FOR OTFICE USE OXI"Y Amounl Re ceived CITY O SPRINGFIELD For: t' (. € (( ( atlqlsclrllgl_qStIIg/ terhea ter/ e l ec tr i ca I /oor valuation, etc. rso ar ( ( {( tr TII. III. IV. V. CiiY Holl Springfield, Oregon Deporlment of Public Works OFFICIAL RECEIPT N0. B 5+5S7 re8D Rec'd F Address \ ( (. - Received eor, g,f\\\LY) ()CJ cio sgoc qD C PR,OJECT CONDITIONS TO BE SATISFIED BEFORE OC( Perm'it applicant exempt from registration wjt ( L r (' Amount Received EY sHELTON.TUiieuLL PirxtEiS EU6ENE OF 9"Or !6511-e t- Additional Project Information:,frlrS y'4"srat*-<r r{otn;_LVt ,:-5r" Rera,;?rg-,> As ,# 4*Dt vaq .Ety,sr<r 57tr*en(€5 fua ,?77r>F€|5€-b traF*7? Lr,y€ , *- *>Fn€ r4<<€,.f iignature PLANS REVIEWED BY: name date ?-23-Ei 6 ( (