HomeMy WebLinkAboutPermit Miscellaneous 1990-1-26
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'\INSPECTION LINE ..... CITY OF SPRINGFIELD . INFO~~ATION LINE
726-3769 ~ COMBINATION APPLICATION/PERMIT 726-3753
Job Address 1C\ \ Ie-\: ~ ~ (\f)\(\. ~c1 ~~;~GY SOURCES: ;~: ~~~: ~~~~ss,
I.egal Description liater Heater Sq. Ft9. Other
New Add Alter Rep.
Range Fence_Demo_Change/Use
Val~{ l'EtxJ.ro _Other
Suildin<:! \iennit Info: Describe Work(Le., Build Single
Family nesidence With Attached Garace)
Owner 'ili\\I.,NY\ 11\ Y'l\()\l~ :J\S3
Addrcssqm I\J _ \/'I~C'vtpJ~onc41\!
Vnr-t\(). fY\ ~ C\Tc111
- J-
Construction lender.
Address
DES t GNI EAr~
Phone
(address\
(namel
Primary
*
(exni rp.~'\
(nhonp no.'
Structural
Electrical
I~echanical
CDNTRACTllRS
Genera 1 \ )''\
(name' {addressl
".e . (::l\\\(,~ \0 'i\ 'L.j_cArO ~ 0 I Il J
~~\I
Plumbina
Electrical
~lechanical
PLUIIBING
ELECTRICAL
MECHANICAL
NO. .
I'~ Each single fixture
Relocated building
(new fix. additional)
FEE '..QjARGF No
FFF rH1RGF No.
furnace/burner to
BTU's
Residence of
I
SQ. FT.
7--5 7):~ .
I'
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
(I bothl
Duplex (1 bath) each
Recessed wall
~Dac~ hpatp~ ~~rl vpnt
et~nt
se03 ra te
Sta'tionary evap.
c:oolrr
Vent fan with
sinflle duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
SERVICES
(
Additional bath
Temporary Construction
Change in existing
resJ df'flce
multifamily, conGo or
Industrial
/
~rater service
Sewer
Storm Sewer
Of
amps.
CO~1./IND. FEEDERS
Install/alter/relocate
~i~trib. feedprs
I'
Of
6~ 7-?7'J;v~ ,
..
amps.
ISSUANCE of PFRIIIT
TOTAL CHARGES
WHERE STATE L'li REQUIRES
shall not be valiJ until the
"75."- TOTAl. CHARGES
that tile Electrical work be done by an,
label has been signed by an Electrical
TOTAL CHARGES
Electrical Contractor, the electrical portion of this per~it
Supervisor and returned to the Building Division
2/.-50
I HAVE CAREFULLY EXM1INED 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 performed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Orel]on pertaining to the work described herein, and that UO OCCUPAHCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basi or exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 7nl.055 will be us n this project.
HAr-tE(please print)X~~tdA/ .7'. 007.-4 SIGrlATUR~
FOP. orFICE USEIOllLY
Zone L C- ~ Tyoe/const.-:5?'l-5~ Units Sq. Ftg. llain x Value
Fire Zone Bedrooms Occy load Sq. Fta. Access x Value
Flood Plain Stories I Occy Group.B--2 Sq. Ftg. OtherpQ;'.~i'iiC~ Value~'-'-~~
H~qo C::n<ld TOTAL VALUATION '
~3, 5~~ha~~~s(~~moP~t '-?/'.?>. =s>
F F ':...... .cHARfiE.
6'--
/-
.:;Y
17~
Y'-:Y
f-..€
I
DATE 1<2(; -Pd
Total Comb. Permit 2"%'~::0
TOTAL 5'c:6,26.
BUILDING PERflIT
Charges and
Surcharges
. / ~' Plan Ck. Comn/lnd
_...._~~-::::'=:::__~/BldO Pj!r ree
~ Plan Ck. Res
6- 7 __ 30%/Bldo Per Fee
____7~,~
r_
:?75 Demo
PLU'~BING PERMIT
Charges and
Surcharges
Fence
ELECTRICAL PERIIlT
Charges and
Surcharges
'Sidewalk
A/C Paving
____'7?/QI2..~ Curb Cut
/ .Of-3
,
.
11ECHANICAL PERMIT
Charges and
Surcharges
.
..
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address . ,
B. Legal Description
1. example- Tax lot 100, Lane County Map Reference
1/ 03 43
2. exa~le- Lot I. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. exam~le~ heat/electrical ceiling/or forced air qas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. exam~le- 1250 sq. foot house, 500 sq. foot garage
2. exa~le- if new project. check new - if addition,
chee Ie add. etc.
F. Building permit information:
1. exam~le - construct single family house.~ith an
attached garage
2. exam21e - remodel existing garage into family room
3. example - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or jOb site
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & E~ectrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available 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. BOILDING DIVISION STAFF WILL FILL OOT 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. ---
III. 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.
/-c9b-Qb
r b" '6' I
~ \?
V;P
V. FOR OFFICE USE ONLY
Permi t C1 erk
~
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name &J'?;c~e?f signature aD ~~ date /-.26-7~
,- "" """" '
l\).\,~S-t\[)~<:'~'l '\ Q. \j \ t'1Jl\> -' 2A -DBA';).,
l'INSPECTlON LINE . TV SPR NGFIELO
726-3769 OMBINATlON APPLICATION/PERMIT
\~ "(\11\0... \?<1 I ~~~~GY SOURCES:
1
N RHAT ON
726-3753
Sq, Ftg. t1ain
Sq. Ftg. Access.
Ilater Ileater Sq. Ftg. Other
New Add Alter Pep.
Range. ..'_~ -Fence Oemo Change/Use
val~~ I'~k' '1 Other- -
. - - ~ .6f:::)
I \ ~ '
BUlldinQ 1>ermit Info: Descr1be Work(Le. f Build Single
Familv Residence With Attached Garaae)
i.
i
I
i
,
.
legal De~cription
\C\ \ 'el
'.Jab Address
Owner ~\\\~ ~~<b9.1\ ~~3
Addrcss,Cl(X) I\j ."'" (\ I o!~onc411 (
V()\-t'~rY"\ ~ C{/c1lr
/ -
p
Construction Lender
Address
ODIGr~ II:..m1
Primary
Structural
Electrical
Hechanical
CONTRACP.'RS
Genera 1 '\ )f'~ 'l ~
Plumbino
Electrical~~~
~1echanical
NO.
Each single fixture
~c\. V'
6(CC7~/~~~C~~
[lics. no. \ (exDiresl (ohane
na.
(name1
Phone
(address'
II.
..J~
~
I',;. -:,.
!r .\
name I addre~c;.l
G\\\('~ \0)\ '\'1j\Uj ~ Q I Q
~y FCEz=7.
(lir-s. "l'
ffi~.\
(exnires)
(ohon~ no. \
)
::ZQ/~ L.('
"e?-/-~
~-~-
PLUlIBItlG
ELECTRICAL
~ MECIlAN1CAL
..llL D!AIlGE .JiQ.... -
furnace/burner to
BTU's
err
.r,,'lRliL
...ilL CHARGE ..lIO...-
Residence of
SQ. FT.
~ New circuits alts.
I' or extenslOns
"'2 -dJIR ~R~
SERVICES
2?.J
Floor furnace
and vent
Relocated building
(new fix. additional)
$.F. Residence
(I bathl
Duplex (1 bath) each
Additional bath
~Iater service
Sewer
Storm Sewer
Recessed wall
SD~r~ hPAtpr And vpnt
Temporary Construction
Change in existing
res i dence
multifamily, conm. or
Tndustr1al
App\ lance vent
seJarAte
Stationary evap.
coole"
- - Vent fan with
sln91e duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Of
amps.
COHl.t. II NO. FEEDERS
Install/alter/relocate
d~~trib. fppders
I
Of~
amps..
z<,.,-">'"
ISSUANCE OF PERIIIT
TOTAL CHARGES \. TOTAL CHARGES 71<;:- I TOTAL CIlARGES
WHERE STATE LW REQUIRES that the Electrical work be dane by an Electrical Contractor, the electrical port Ian of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building,Division
I HAVE CAREFULLY EXN1INED 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 performed shall be done in accordance with the Ordinances of the City
of Spri ng f; e 1 d and the laws of the Sta te of Orel)on perta i ni ng to the work descri bed herei n, and tha t UO OCCUPAUCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by O~S 701.0~5, 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 on this project.
EL.S:T. L"/Y7/? . II
IWtE(please print) YV 1,\Ct.
Zone
Fire Zone
Flood Plain
BUILOING PERf tIT
Charges an~
Surcharges
PLU'~BING PERMIT
Charges and
Surcharges
ELECTRICAL PERIHT
Charges and
Surcharges
MECIlANICAL PERMIT
Charges and
Surcharges
J.
Go",-,\V\.~
SIGNATURE Pl~
FOr. OEF t CE USE OItL Y
S~. Ftg, liain
Sq, Ft9. Access
S~. Ftg. Other
H~qO 15:.<64 TOTAL VALUATION
U';.l.. c=......, ~ ws~lte. ms oevelopment
('Ju. LJ~ Charae O,5~ '"
,-
pATE /-~ '1-'90
Type/Cons t.
Bedrooms
Stories
Units
Occy load
Occy Group
Va.lue
Value
,
x
x
Value
. Plan Ck.
____________ ~/Blda
Plan Ck.
30%IBlda
Fence
ConrnlI nd
p.pr Fee
Res
Per Fee
D~mo
4'S-
-n_-..LZ~
'Sidewalk
A/C Paving
Total Comb. Permit
Curb Cut
'/725:'
I
J
------------
TOTAL
.
/
i
I
COMBINATION APPLICATION/PERMIT (CAP)
.'
1. Appl icant to furnish
A. Job Address ' ,
B, Legal Description
I. exam~le- Tax Lot 100, Lane County Map Reference
11 U3 43
2. exam~le- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources' .';' I . : '
1. example- heat/electrical ceilinq/or forced air Qas
2. examele- waterheater/electrlcal!or solar
E.... Square footage or valuation. etc. .
1. example- 1250 sq. foot house, 500 sq. foot garage
2. example- T1Inew project. check new - if addition.
cneCk add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family ~oom
3. exam~le - convert single family residence into
restaurant (change of use)
G. Value of work as defined in, Section 303 (a) of the
Structural Specialty Code '
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact app.ropriate
persons regarding design infonmation or job site
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & E)ectrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules.
the applicant need fill-in only the NO. Boxes adjacent
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be instal,led are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT 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. ---
III. Applicant to Sign and date
Whenever possible, the initIal application will b~ 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 ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
~ I., ';,
-1.) ..,...
.
'['
i
PERMIT VALIDATION
Permit Cl erk
.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
,.'
PLANS REVIEWED BY:
name
signature
date
~., - - .......
:jdtV p ,\~G1.off' \S- VI Xvn.o.:J
Bcc77?/-4:f"-C 04 C. Y -() ~ L'
{lies. no. \ l@x~ir@sl (ohone no.
j
,
~\\~S+\\)fI<-~'l '( 'L \) \~\j)\> ...344-oA0)~,
I~SP[CTION LitlE TV SPR NGFIELD N R/1AT ON
7/.6-3769 DINATlON APPLlCATlON/PERIHT 726-3753
J;)b Address \ G\ \ tel % h (\ fl\ C\. \? ~ ~~~~GY SOURCES: ~~: ~~~: ~~~~ss,
Legal Description Nater Ileater Sq. Ftg. Other
1 Ilew Add Alter Pep,
Ranqe_ .~_. Fence_Demo_Change/Use
Val,\(.of '?t:.k' ro _Other
i\ O\~..l'X). .
Dul tdino 'Penlllt Info: Describe Work\ he.. Build Single
Family Residence Nith Attached Garaoe'
Owner m\\It0(\ l!\ ~\()\lQ~ ~~3
Addrcss_qm /\J. \tl~C'9tQ)~one4-1\(
V()\-t\~sY\ ~ CHcO-ll
I
'"
,
Construction lender
Address
Ul~tuN IlN1
Phone
(address'
(namel
Primary
Structural
Electrical
11echanical
CONTRAl',' i<~
Genera 1 .
~
j
~
; .
i
I
,
Ii
~.3
(~hnnp nn~
Plumbino
E1eetricalA1.E~ ~S';?:C?z;7.
2Q/~ L., ~./-~
(
./~./_~_r .-
....~'::.oc;.._~
~lechan1ccl \
PLUIIB I NG
ELECTRICAL
MECHANICAL
NO.
FfE CIl1BliL ..JI(l
~FF r.H~ _NO.
furnace/burner to
DTU's
Residence of
Each single fixture
SQ. FT.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
"'LL3JQ~R~
SERVICES
Floor furnace
and vent
/
Z28
Recessed wall
S~ace heater ~nrl vpnt
S.F. Residence
11 botbl
Ouplex (1 both) each
Additional bath
Temporary Construction
Change in existing
rl!si4f!J1ce
multifamily, conm. or
Industrial
Appliance vent
~eoarat@
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatinq or A"~.
Mechanical exhaust
hood and duct
Wood stove/heater
Water service
Sewer
Storm Sewer
Of
amps.
COMlt.IINO. FEEDERS
Install/alter/relocate
d~~tr1h. fppdpr~
I
Of ~..;>
amps.
Z<.,-""9'
:.EL LllAllG.E.
t
I SSUANCf OF PfRlIIT
TOTAL CHARGES . TOTAL CHARGES lJt::;:---1 TOTAL CHARGES
WHERE STATE L\1I REQUtRES that the Electrical work be done by an. [leetrical Contractor, the electrical portion of this pemlt
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Duilding.Oivision
om J-;;;2 '1-'10
I "^VE C^REFUlLY EXNllNEO the completed appl ication for permit, and do hereby certify that all infonnation hereon is true
and correct, and I further certify that any and all work oerfonmed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Ore~lOn pertaining to the work described herein, and that UO OCCUPAUCY will be made
of any structure without the permission of the Ouilding Division. I further certify that my registration with the Guilder's
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 OPS 7"1.055 will be used on this project,
ELB:T-L'//7?'? ..f)
IlN.tE(please print) rv 11\4.
Go'-.J\V\.~
.SIf,rIATURf f11 ~
FOP. OfFtCE USE DilLY
Sq. Ftg. liain
Sq. Ftg. Access
Sq. Ftg. Other
H~qO /5'"1<64- TOT^L VALUATlmt
(!..:( ';..l.. c=.. -=\~sAtems DeveloPll1ent
(-,0. ;: .J." IChorqe t1.5~ .
Zone
Fire Zone
Flood Plain
Type/Cons t.
Dedrooms
Stories
Units
Occy Load
Occy Group
Value
Value
Value
.
x
.
DUILOING PERHtT
Charges and
Surcharges
ptan Ck. Comm/lnd
65%/Bldo ~pr Fpp
PlanCk. Res
30%/Dldo Per Fee
------------
PLUI1BING PERMIT
Charges and
Surcharges
Fence
D~
'Sidewalk
A/C Paving
ELECTRICAL PERIHT
Cha rges and
Surcharges
~,5:-
------;LZ~
Total Comb. Permit
11ECIlANICAL PERMIT
Charges and
Surcharges
7'72>
Curb Cut
TOTAL
------------
.
I
COMBINATION APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A. Job Address
B. Legal Oescription
1. examQle- T~x Lot 100, Lane County Map Reference
II uJ 4J
2. examole- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources' :. ,
1. exam~le- heat/electrical ceilinq/or forced air aas
2. examole- waterheater/electrlcal/or solar
E . Square footage or valuation, etc. -
i. example- 1250 sq. foot house, 500 sq. foot garage
2. example- rr-new.project. check new - if addition.
check add, etc.
F. Building permit information:
i. examole - construct single family house with an
attaChed garage
2. exam~le - remodel existing garage into family room
3. exa"Ple - convert single famlly residence into'
restaurant (change of use)
G. Value of work as defined in. Section 303 (aJ of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building
~ivision Staff must be able to contact appropriate
persons regarding design infonmation or job site
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & E)ectrlcal Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical. and Electrical Schedules
are available at the Building Division
1. To conserve space on the pcnmit fonm 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 OUT 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. -
111. 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 ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
[:
CITY OF SPRINGFIELD
.
City Holt
Sprlngftotd, Oregon
Development Services
OFFtCIAL RECEtPT
I
.
15861
, -
· Date r~ -:2'1;.. 19~
... . ,
. Rec'd From..(l/'~ V~ "c-~7
~~c:n-..s
Address
. ~
Received For:nh?'~:~' '-Q"~ y~:
i - .
.
q.
· :f-~
9.S:~
.?~
h7r-Y ~?C/ / C~"7:
E_~ /~-~
· r-~ <;>~:;c> .
'?';/'?k' 97"- 5C>
~
.
.
4~Y6'>V
<0 Y.c;-o
Amount Received
.
~~
, , AUTHORIZED ~~hE" /
I -
!!L
.
...
Permit Clerk
..
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
i,
]
date
,.