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Home My WebLink AboutPermit Building 1981-03-30CITY OF SPRINGf IEtD COMSTNATION APP[ICAIION /PERMII INFORMAIION I,INE 7?63753 T Legol Description ics. no.)(expires)ne no.)(nome) 72f}3769 @ Ro Phone Phone ( qb t)crut3 Woler Heolert1025 Owner Addre rs Addres: DESIGN TEAM Fomil With Aroched Sq. Ft9. Moin Volue of Work: \.1 Building Permit lnfo: Describe Work (i.e., Build Single 5q. Ftg. Access. Sq. Frg. Other -New -Add--Aller-ReP' - - -Fence--Demo-Chongef Ure tricq I Me,:honicol (phone no.)(expires)(oddress)CONTRACiORS (nome)(lics. no.) Ele ctricol b ,\Aeshonicol MECHANICALEIECTRICATPLUMBING FEE CHA.RGEFEECHARGENO.CHARGE NO.No. i i rEE furnoce/burner to TU'S Residence of ---rq. ft.Eoch sinqle fixture Applionre vent !eporq le New circuits, slterolions or extensions Relocoted building (new {ix. odcjitionol) Stolionory evop coo lerSERVICES S.F. Reridence (t both) Yent ion with :inqle ductTemporory ConslructionDuolex (l bolh) eoch Vent gystem oport from heoting or A.C.Amps.Additionol both Mechqnicol exhoust hood ond ductWoler rervice Wood stove/ heoier I I I Sewer t I Heot PumpFEEDERSSlorm Sewer Air hondler to r0,000 crMAmpr.i Air hqndler over i 0,000 crM ISSUANCE Of PERMIT WHERE SfAIE tAW REQUIRES rhot the Elecrricol work be done by the Electricol Conlrqclor, the electricql porlion of lhir permit sholl not be volid unril o lobel hos bmn signed by on Eleqtricol Conlroctor ond ottoched lo fhe electricol ponel I HAVE CAREFUtty EXAMINED rhe completed opplicoiion for permit, ond do hereby cerliry thot oil informqtion hereon is lrue ond correcl, ond I further (ertiff thqt ony ond oll work p.rform"J sholi be done in occordonce with the orCinonces of the City of Springfield ond lhe Lows of the Slote of Oregon pertoining to tire work described herin, qnd thot NO OCCUPANCY will be msde of ony siruclure wirhoul the permission of the Euilding Division. I further ertlfy th-ot my regisfrorion with rhe Builder's Boord is in full force ond effect os required by ORS 7O1 .A55, thot if exemPt tha bosis for exemption is'noted heron. ond thot oniy subcontroqtors ond employees who ore in comglione wiih ORS 701'055 will be used on this proiect. TOTAT CHARGESTOTAT CHARGES TUREo DATE 3 TOTAI, CHARGES Eosis for.Builder's Boord exemPtion: FOR OTfICE UsE ONLY Zone -Tyoe/ Const. Unitr Fire Zone -- Eedrooms --.-}--------o"., x Volue x -Volua x -Volue TOIAI, VATUATION Sq. Ftg. Moin Flood Ploin -stories-OccY Lood --.5q. Ftg. Access Group-Sq. Flg. Olher- Systems Developmeni Chorse (.l.51/ir-PIon Ck. Comm/lnd 6596/Bldg Per Fee Plon Ck- Re: 309'./Bldg Per Fee BUII.DING PERMIT Chorges ond 5 u rcho rge s R "q)OEFe nce Totol Comb. Permitff)-PTUMBING PERMIT Chorges ond Surchorges Sidewolt:----.4r)A/C Pqvinq ETECTRICAT PERMIT Chorge: ond Svrchorges Curb Cut TOTAT 1c\o MECHANICAL PERMIT Chorger onl Surchorger \| I EN ERGY Heot --Other NAI\{E (pleose print) i CO tScr;- Demo coMBtNATloN APpLrcATroN iPERM, ^roD Applicont to furnish A. Job y'iddress B. Legol Description I. exomple-tox lot.l 00, Lone County Mop Reference lZ 03 432. exomple-Lot I. Block 3, 2nd A,ddition ro Springfield Esrores C. Nome, etc. of owner ond construction lender D. Energy Sources 2. lectricol ceilin :/or forced oir gos eote r e iricoli or sololE. Sguore fooroge o. ,olrotioilr.- foot gorcge oddition, check L exollele-1 250 sq. foot house, 5C0 sq^ -.- l. exomple-rt new proier:t, check new_if odd, etc. F. Building permit informotion:I. exomple-construct single fomily house wilh on ortochedgoroge 2. exomple-remodel existing goi.oge into fomily room3. g:g-eC-convert single fomily residence into restouront (chonge of use) G. Volue of work os defined in Section 303 (o) of theStructurol Speciolry Code H. DESIGN TEAIA AND CONTRACTORS To ovoid design or construciion deloys, Building DivisionStoff must be oble to contoct oppropriote pu.rJn. regor.dingdesiEn informction or [ob site corrections, etc. ll. Abbrevioted Plumbing, Mechonicol & Elecfricol SchedulesA. Except where blonk spoces occur in the descripiion porlionof the Mechonicol ond Eiecrricol Schedules, tf,. " jpii."ii need fill-in oniy the No. Boxes odiocent to the opproprioteitem(s) to be instolled B. Fuil Plurnbing, Mechonicoi, ond Electricol Schecjules ore ovoiloble ot the Building Divisionl. To conserye spoce on the permit for.m the schedules :hove been obbrevioted 2- lf the item(s) ro be instolred qre nor covered on fhe obbrevi-. oted scheduies you should consult rhe fuil schedulesC. tsUILDING DIVISION STAFF WILL FILL OUT.ALL FEES,AND CHARGES ON THE SCHEDULES lll. Applicont ro sign ond dote Whenever possible, the initiol opplicorion will be used os oworksheet only. Where possible, builciing Division Stoff willprepore o iypewrifien copy onci return it to the opplicqnl otthe time the octuoi permit is issued for his signotuie. lV. Fees ond Chorges Plon check fees ore due ond poyobre or the time of rhe oppricotion,ond no plons will be processed until rhese fees ore poid. iil - other fees ond chorges ore due ond poyobre,"tr"n'ttt. p..iitis issued. V. FOR OFFICE USE ONLY RMIT VALIDATION Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additionol Proiect lnformotion: signoture dotenome PLANS REVIEWED BY: CIIY OF SPRINGTIETD COMSINATION APPUCAIIOT,I / PENiiII INFONMATION TINE 726hi75372U3759 i1 -))-uj) q b -r)crLll 3Job Addres: Dercri Heotil ('/e<'r 5/n,cZ 5q. Ftg. Accesr. Sq. Frg. Other -.-New -Add-Alter-ReP.-- -Fence--Demo-Chongef Ure --Other Y SOURCES:f1,/za?/.Heot ENER,G Wo ler Ro Sq. Frg. Moin O*i;ir. Work (i.e., Build Single8uiding Permit lnfo: PhoneAddre rr Do 0o q Phoneaddrer: no.)(expi re s) DESIGN TEAM no.)(oddres:)(nome) clricol Electricol Mechonicol MECHANIC.ALETECTRICATPTUMBING FEE i CHARGECHARGENO.CHARGE NO.I rerj FEE furnocef burner to -.---BTU'S Residence oi ft,I Eoch ringle iixture Appiionce vent sepo rore New <ircuiis, qlferotions or exlensionsI I Relo<oted building (new {ix. odciilionol) Stotionory evop. coolerSERVICES S.F. Residence (I both) Vent fqn with rinqle ductTemporory ConslruciionDuolex (l both) eoch Vent system oport from heoting or A.C.,Ampr.Additionol both MechsnicoI -exhourt hood ond ductWoler rervice Wood slove/ heoterSewer Heot PumpFEEDERSSiorm Sewar Air hondler to r0,000 crMAmpr. Air hqnciler over r0,000 cFM ISSUANCE OF PERI,UT I HAVE CARETULLY EXAMINED rhe completed opplicotion for permit, ond do hereby certify thot sll informotion hereon is lrue ond correcl, ond I further <errify thot ony ond orr *orf p.rform"i ,hoii be done in occordoncE with the OrCinonces of the Cily of Springlield ond lhe iows of lhe Stote of Oregon pe.roining to tire work de:cribed herin, ond that No occupANcy will be msde of ony sirucrure withou, ihe permission of the Building Division. I further erllfy thot my regisholion with rhe Builder,s Boord is in full fcrce ond effect os required by oRS 701.055, thot if exempt the bosi: for exemplion is noted heron. on.j thot oly subcontroctors ond employees who ore in emplione wiih oRs 701.055 will be used on thir proiect' tlood Ploin -sroriat----OccY GrouP- TOIAT CHARGESTOTAT CHARGES DATE 5q. Ftg. other v tood -5q. Flg, AccessFire REQUIRES lhot th. Electritol by on Elactricol Conlroclor ba until:lectricalrhc of thi:not volidshallpermirthaElarlricolbeworkooneConlroclor,portionbyIA5TAIEWIiERE loqttoched electricolthosnd ponel.lobel beenhos signad TOTAT CHARGES Bosis for4uilder'r Eoord exemPlion: NA {E (pleore print) FOR OFfICE U'E ONTY SIGNATURE Zone TOTAI VALUATION Sq. Ftg. Moinf voe/ Const. __-Units,\ Bed.oom r --!)r----------9 c c'Y x Yolue x Volue a -Volue Syslems Developmenl Chqrqe (1.59'.) Plqn Ck. Comm/lnd 65?i,/8lde Per Fee Plon Ck. Re: 309'0/ Bldg Per Fee BUITDING PERMIT Chorge: ond 5urchorge s "f,)rJot8Fe nce Tolol Comb. PermitDemo l_5-_=?_ .(aC) PTUMBING PERMIT Chorges ond S urchorges Sidewolt A/C Pcvinq ETECTRICAT PERMII Chorger ond Surcho rges Curb Cut 1o\oTOTAT MECHANICAT PERMIT Chorge: ona Surchorge r Volue of Work:v l' _/ o CD COMBINATION APPLICATION;PERMIT ICAP) l. Applicoru. to furnish A. Job Address B. Legol Descriptionl. exomple-tox lot 100, Lone County Mop Reference i- ^- ,t 2. exomEi,e-Lot l. Block 3, 2nd Addition ro Sprinqfield atC. N".nu, "rc. of owner ond construction lender ' ( . .:RMIT VATIDATION CITY OF SPRI NGFI ELD Gry Holl Springfleld, Oregon Deporlment of Public Works OFFICIAT RECEIPT No. B 56194 I q D. Energy Sources I . ex o m ol_e- h.o t / u.,1.!j.,Sglj.!l i n_g jor f orced c i r go sz. exomote-woter heoter eleciricoll'or soior r e. sqr;6;ose or "otuo,ioi]li:'-' :-- l. exomple-.EJg ,q. foot house, 5C0 sq. foot gorogel. ex.o.mote-rt new proiect, check new_if oddition, checl (.odd, etc. F. Building permit informotion:l. exomple-construct single fomily house with on ottocgoroge 2. excmple-remodel existing goi,oge into fomily room3. ;xA;;G-converr single fi,;ily iesidence intorGiiEiEnt (chonge of use) G. Volue of work os defined in Section 303 (o) of theStructurol Soeciolry Code H. DESIGN TEAIN AND CONTRACTORSfo ovoid design or ccnsrruciion deloys, Building DivisioStoff must be oble to contoci oppropriote p".ro-n, ."go,design informction or iob site ccrrections, etc. ll. Abbrevioted Plumbing, Mechonicol & Electricol ScheduiesA. Except where blonk spoces occur in ihe descriolion oortiof the Mechonicol onci Eiecf ricol Schedules, ti," "ppii.""need fill-in oniy the No. Boxes odiocent to rhe opjropri,item(s) ro be instolled 8. Full Plumbing, Mechonicoi, ond Elecrricol Schecjules ore ovoiloble ot the Buiiding DivisionI. To conserve spoce on the per.mit for-m the schedules hove been cbbrevioted 2- lf ,he irem(s) to be instolled ore not covered on the o oted scheduies you should consult lhe full schedulesC. SUILDING DIVIS|ON STATF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES lll. Agpliconr ro sign ond dote Whenever possible, the initiol opplicotion will be used qs q worksheer oniy. Where possible, builciing Division Sfoff willprepore o iypewritten copy oncj rerurn it to the opplicont otthe time the octuoi permit is issued for his signoture. lV. Fees ond Chorges Plon check fees ore due ond poyoble ot the time of the oppi.ond no olons wiil be processec until these fees ore poici. AilLother fees ond chorges ore due onci poyoble when'the puriit is issued. V. FOR OFFICE USE ONLY Dole l9 q il { I I J lt I ( ( ( EY t ( Amounl Received RIZEO sHEllon.tutxBULt PRtNTEtS EUGEXE. OR 97aO! !6!t!.t Permit Clerk PROJECT CONDITIONS TO 8E SAIISFIED EEFORE OCCUPANCY: Additionol Pro[ect lnformotion: nome signoture dote PLANS REVIEWED BY: