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Home My WebLink AboutPermit Fence 1980-5-29 'I Ir,splcTION ~~IIE 726-3769 Job Address \ \ Q?fJ l f\\'C'-\ '\\ \i I:Ir, I 'C\-OO I, {) ?:''2.S~ L.- Owner C '1(\. ~ t\- r-:l\ ~~\\C\ \) Address \ \ 0 ~ \ X\\{\ \\ $ <:l t , D\\J r>A-\n-?'?~ Legal Description constru~~ ) ,\ddress Ut.::'lliH H.Ar1 Primary Structural Electrical . . CITY Of SPRINGFIElD COMBINATION APPlICATION/PERMIT E!IERGY SOURCES: Heat \~a ter Hea ter Range_ INFORlIATION liNt 726-3753 Sq, Ftq, "lain ~q. Ftg. Access. Sq, Ftq, Other ~~Add_Alter-f.ep, ~nce__Demo__Change/Use _Other 1) ~ 1> Phone ValUE of ':l!t.~ 00 r-tl~l. Builtiina Pennit Info: Describe Work.(Le., Familv Residence With Attached Garaae) Build Single lname) t)fI~$ , " ~\\- ~mo ./ Phone (address) (lies. no.) (exoires) (ohane no, i ~ I ~ I (addres5) flies. no.) (exo; res) (phonP nn. ) t1echani Cd 1 CONTRACTDRS (name) Genara" ~\:l\ lj{\ <:l i\. Plumbina Electrical f.lechan; Cd 1 f10, Each single fixture ,I PlU!IBIrIG : ElECTRICAl MECHANICAl HF CHARhF NO FFF rlJARG.E. .JIll...... 1='1='1=' r~~ Residence of furnace/burner to BTU's SQ, FT, Relocated building (new fix. additional f S.F. Residence (1 bath) Duplex (1 bath) each Additional bath ~!ater service Sewer Storm Sewer New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wa 11 Sno'lcP- heatpr ilnrl vpnt' Temporary Construction Change in existing rpc;.5 rlence multifamily, corrrn. or Tnrlustrio'l.l Appliance vent c;.PDilriltp Stationary evap. cooler I Vent fan with sinale duct I Vent system apart from I heatino or A.C. I Mechanical exhaust hood and duct I Hood stove/heater I I I Of amps. CO~1,/IND, FEEDERS Install/alter/relocate dic:trih. feerlers Of amps. TOTAl CHARGES WHERE STATE l~W REQUIRES shall not be valij until the I SSUArIC, OF PFR!lIT TOTAl CHARGES TOTAL CHARGES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAr1INED the completed apr1ication for permit, and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that UO OCCUPAfKY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Bu;lder1s Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with OP.S 701.055 will be used~h~s project. IIAIIE(please print)GA~ c:1(L..S\R>~ SIGil^TURF.~(IIJ/tIl;>.j,/ DATE~ 'Fo~ OFF I CE USE OiIL Y- I J' Sq. Ftg. f1ain x Sq. Ft~. Access x Sq, Ftg, Other x Zone Fire Zone Flood Plain BUIlDIrlG PERI,I!T Charges an~ Surcharges PlU11BING PERMIT Charges and Surcha rges ~J' ECTRICAl PERI:IT arges and rch~rges ilECHAN I CAl PERMIT Charges and Surcharges Tyoe/Cons t, Bedrooms Stories Units Occy load Occy Group Value Value Value TOTAl VAlUATION I Plan Ck, ConmlInd 65~/Bldo Ppr FPfl ------------""""P"fan Ck. Res 3D%lBldo Per Fee Fence ISystems Development I Charqe (1.5~) \nDO D/llllo I Sidewalk ------------ I A/C Pav,ing ____________1 Curb Cut I Total Comb. rermit TOTAl \n,OO I . COMBINATION APPLICATION/PERMIT (CAP) I, Applicant to furnish A, Job Address B. legal Description 1. example- Tax lot 100, Lane County Map Reference 17 03 43 2, example- Lot I, Block 3. 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. examole- heat/electrical ceilinq/or forced air OdS 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. ----- I, examole- 1250 sq, foot house, 500 sq, foot garage 2. example- if new project, check-new - if ?ddition, check add, etc. . F. . Bunding permit information: ,J 1. example - construct single family house with an a ttaChed garage n 2. examele - remodel existing garage.into fqmily room 3. example - convert single family residenc~ into restaurant (change of use) ~ G, , Value of work as defined in Section 303 (a) 6f the . Structural Spec"ialty Code . H, DESIGN TEAl,! ArlO CONTRACTORS , To avoid design or construction delays, Building Division Staff must be able to contact apprORriate persons "regarding design information or job site corrections. etc. ~ II. Abbreviated Plumbing. Mechanical. & Electrical Schedules A. Except where blank spaces occur in the descrJption portion of the Mechanical and Electrical Schedules. the applicant need fill~;n only the No. Boxes adjacent to the appropriate item(s) to be installed, B.. Full ,Plumbing, Mechanical, and Electrical Scliedules "are ava;.lable. at the Building Division "; 1. ..To conserve space 1>n the permit form the:;schedules have been abbreviated ; 2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the full schedules C, BUILDING DIVISION STAFF WILL FILL DOT ALL FEES AND CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must be delivered to the electrical contractor for signature by his electrical supervisor. The general contractor is not authorized to sign the electrical label. Ill. Applicant to sign and date Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Division Staff will prepare a type written copy and return it to the applicant at the time the actual permit is issued for his signa ture. IV. 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 when the permit is issued. V, FOR OFFICE OSE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . PERMIT VALIDATION Permit Clerk , Permit applicant exempt from ,registration with the Builder's,Boardbecause: Additional Project Information: PLANS REVIEWED BY: name' signature -' date ,j 1 '. ! ~ 1 '/ , J 1 1 i " 1 ': ; ~ i 'I '. , ,1 ! ; , , ! t:' , j , ,I I ~I \1 d ;1 '! i ; 'i " I I ! . ,{ ,,' ,~ '..EEL .cJJAB.G.E. I I To' ~. ~:' .-," Of 1IllSPLT.lOII )1IiE 726-,169 Job Address \ \ () '?{) ( Legal De5cription . 1'\$\\ '\\ ~ ~\- , CITY OF SPRliIGFIE,D COMBHiATION APPLlCATlOilfPERMlT ErIERGY SOURCES: Heat Hater Heater Ranqe . INFORJIATION LINE . 726-3753 Sq, Ftg, I"a;n ~q. r=tg. Access~ Sq, Ftg, Other lIel< Add A Her Rep, T~ Demo Change/Use ValuE of ~m ,00 Other-- BuirfinQ Permit Info: Describe WQrk(i~e., Build Single Familv ~esidence '-lith A.ttached Gara<le) Owner ('1(\ 1l ~ \_ r'"')\ ~~\\\(\ \1 Address \ \ ()?--NI \ f\\\\ II, V $ f- ~('\ ,D\\'\ ~n-?'DY'f'\ construct:n~~~r ) , Phone ,...~f\'{'\v , ) \ ~\\~ b"1\O ./ Address Dl~jGlI IEAII Phone (address) (exo;res) (ahane no.') (1 ics. no.) {name) Primary Structural Electrical !1echanical CDNTRACTORS (namol . Genera h ,~\1.\ \. '){\ \) l\ (addrpsc; ) (lies, no.) (PXO; ff'S) (:ohanp no.' Plumbina Electrical ~Iechanical P,UIlBIIIG E,ECTRICAL MECHANICAL ilO. FFF CHARGF.l'O F='n: r':lARG..E. NO_ Each single fixture Residence of furnace/burner to BTU's sq, FT. Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (I bath) Duplex (1 bath) each Add i t i ana 1 ba th-'~ 5ERVICES Recessed wall l l\Oi'lr.P hP.ltpr .lnrl vpnt~ Temporary Construction Change in existing residence Imultifamily, corran. or Tnrlustriill 10f amps. I cor~'1. II NO, FEEDER5 I Install/alter/relocate r1ic;trih. fperlerc; Appliance vent ~POi!rilt.p Stationary evap. cooler Vent fan with sinale duct Vent system apart from heatinq or A.C. Mechanical exhaust hood ilnd duct Hood stove/heater ~!ater servi ce Sewer Storm Sewer Of amps. TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be valiJ until the ISSUANcr OF PFRIHT TOTAL CHARGES TOTAL CHARGES that tile Electrical work be done by an Electrical Contractor, the electrical l1ortion of this permit label has been signed by an Electrical SUl1ervisor and returned to the Building Division I HAVE CAREFULLY EXArHNED the completed application for permit. and do hereby certify that all information hereon is true and correct, and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining to the work described herein, and that rlC eCCUPAHCY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Board i.s in full force and effect as required by ens 701.055, that if exempt the basis for exemption is noted .hereon, and that only subcontractors and em~loyees ~a(r~sin ~\o:~n:I<ith O~S 701.05~~be usedJ)t/h~ec~~ IWIE(please print) GA~ L-:. '-' ''''--'1-'+--'' SIGilATURF. , -U.A (/I) D:/~ ~, Dm().9q,~.cJ FO~ OFFICF. USE DilLY / " Sq. Ftg. f1ain x Sq. FtlJ. Access x Sq, Ftg, Other x Zone Tyoe/Const, Bedrooms Units Occy Load Occy Group Value Value Value Fire Zone Flood Plain Stories TOTAL VALUATION BUILDHlG PERt,lIT Charges an~ Surcharges Plan Ck,'Comm/Ind 65%/Rldo Per Fp~ ------------ Plan Ck. Res 30%/Bldo Per Fee Fence I \ \\ DO I I Systems Development Charqe (1.5~) PLU'1BING PERI11T Charges and Surcharges Demo ~ECTRICA' PERI~lT ~~, a rges and ,\.;r rcha rges '~ ~HMIlCAL PERMIT Charges and Surcharges Sidewalk ITotal Comb. rermit AIC Paving ____________1 Curb Cut I I I TOTAL r \ n ,DO JJ 19 Ii , . COMBINATION APPLICATION/PERMIT (CAP) , ; 1. Applicant to furnish A, Job Address B, Legal Description 1. exarnole- Tax lot 100, Lane County Map Reference II OJ 43 '. 2, examole- Lot 1, Block 3. 2nd Addition to sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinQ/or forced air QdS 2. examDle- waterheater/electrical/or solar E. Square footage or valuation, etc. - 1, examole- 1250 sq, foot house, 500 sq, foot garage 2. examole- if new project. check-new - if addition, check add. etc. . F. . Bui"lding permit information: 1. examole - construct single family house with an attached garage .: 2. examole - remodel existing garage into fqmily room 3. examole - convert single family residence into restaurant (change of use) , , G, , Value of work as defined in Section 303 (a) <if the ,Structural Specialty Code H, DESIGN TEAl,! AlIO CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact approRriate persons regarding design information or job ,~.ite corrections; etc. II. Abbreviated Plu~bing. Mechanical, & Electrical Schedules A. Except where blank spaces occur in the description portion of the r1echanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate item(s) to be installed B., Full Plumbing, ~lechanical. and Electrical Scliedules .are avai'lable at the Building Division . 1. . To conserve space -on the permit form the :schedules have been abbreviated . 2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the full schedules C, BUIL'DIiiG DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES 0, As noted on the CAP, the label must be delivered to the electrical contractor for signature by his electrical supervisor. The general contractor is not authorized to sign the electrical label. lII. Applicant to sign and date Whenever possible, the initial application will be used as a worksheet only. Where possible. Building Division Staff will prepare a type written copy and return it to the applicant at the time the actual permit is issued for his signature. IV. 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 when the permit is issued. '; V, FOR OFFICE USE Q;ILY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . (. ., ~ PERMIT VALIDATION :lTY OF SPRINGFIELD f City Hall Springfield, Oregon Department of Public Works OFFICIAL RECEIPT No. B 5 3 5 9 9 4 I xm~a, 19C(G , J'F :650.' ~,a ~\{\ D rom ' '11 ~' ress \\0 c '\\~ '}CW Q, " -( c ( ived For: ,\ j ..10 n~Q -D ( \? ~ \\\ \1::' \f') DO ( ---\.~"-6-0 0~~L, ( Recelve~~ \ ~ _ -, >unt ,- \\['0) , ....uTHoiilzED SIGN....TUA;E "... .....'. f, S"lL~O...TU~".ULL "~,,,'U'$ . EUGENE 0" \ Permit Clerk Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name' signa ture date ) \ "