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Home My WebLink AboutPermit Building 1990-6-8 . CITY UF SPRINGFIELD INFOPJ1ATlON llNt CO~BIIIATlON APPLICATION/PERMIT 726-3753 E!lERGY SOURCES: Sq. Ftq. I,'. i n Heat ~q. Ftg. Access. t. ,",:l.~ l'later Heater Sq, Ftq. Other I I Ilew Add Alter Rep. - Range -Fence Demo Change/Use ~ Valu€ of \'lork: Other- - Owner ,lLr>j-'. """ (L, \ tfj Y'Y\ '^~"V ',,,- V aAwl,.. J. Sf). 5?na. ' , Address -''CJ J S Phone., BUllolno Pen111t Info. Descrlbe Work(l.e., Build Single I =>OC-. \IV'\". "_^' -f- "I/-'- Farnilv Residence l'lith Mtached Garaoe) S~'I ~~"}-:..O\'^..es \N'.nu<<ole.t..lA.. '1 INSPECTlDN L1I1E 726-3769 e ..S> G o 00 ....... o Job Address ""'P...nc... 'v"Y"\':lI"I>"" ~, Legal Description \t.Q.:I ~c:., (') "2-:Jr):;). Mechanical CONTRACTORS (name 1 (addrpc;c;) General ~. 'vVI.hf~ - ~''''.,..l-,-,.I--Clu,r",,'J'\, Plumbino VY\o-.c...K VV\h9l\..l, Electrical VV"\ou:...K ~ 'lechanic'al 'W\.o,d \tv\...ezrv, Construction lender Address DESIGN TEAI1 Primary Structural Electrical -1!Jh Each single fixture (name) Phone (address) (px.oires1 (I)hone no.- (lire;, n'!..J + (lire; nn (~xDires' (~nnne no. ) ,.;0 J~", I-.v , 1'-i:.L_"'~ I...!...- PLUIIBING ELECTRICAL MECHANICAL FEE CHARGE Nn "F J:HAP.G.E. Nn, ~~ L J:HAP.G.E. Residence of furnace/burner to BTU's SQ. FT. Relocated buildin9 (new fix. additional) New circuits a1ts. or extensions Floor furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each Additional bath ~Iater servi ce Sewer Storm Sewer SERVICES Recessed wall ~n~rp hp~tpr ~nrl vpnt Temporary Construction Change in existing re'i.1 d_ence multifamily, corrm. or IndustriCll Appl iance- vent seoarate Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from heatino or A.C. Mechanical exhaust hnnd and duct Wood stove/heater Of CO~1,/IND. FEEDERS Install/alter/relocate rl;~tr;h_ fpprlpr~ amps. Of amps. ISSUANCF OF PFR'lIT TOTAL CHARGES TOTAL CHARGES WHERE STATE L.\\/ REQUIRES that tile Electrical work be done by an shall not be va1i1 until the label has been signed by an Electrical I HAVE CAREFUllY EXAMINED 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 UO OCCUPAIKY 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 basis for exemption is noted hereon. and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. IIAf.lE(please printlJ'y,\r..f',K ltv"\~rJVP.' SIGiIATURF'x ~ ~ FOR OFFICE USE miL Y Sq. Ftg. Sq. Ftg. Sq. Ftg, Zone Fire Zone F.lood Pl a i n BUILDlIlG PERI.IIT Charges an~ Surcharges PLUI~BlIlG PERMIT Charges and Surcha rges ELECTRICAL PERI~lT Cha rges and Surch~rges MECHANICAL PERMIT Charges and SurchariJes TOTAL CHARGES Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Division Dm~~O Tyoe/Const. Bedrooms Units Occy Load Occy Group riain x Access x Ot~ Y\ t ').Jr\~ x , \ Value Value Value\\ [)(X) TOTAL VALUATION Stories 2. fiV>-,. <:><'J Plan Ck, --J~' 01) 6S%)Bldo ------------ Plan Ck. \~, ()Lf 30%/Bldo __L'.d-.=1SD.__ Fence (.".3<6 ___5.:.:> SO ~, k,';l.., _____q~QQ___ Curb Cut _-.H5, COIll11/1 nd Ppr r:'pe Res Per Fee Systems Development Charoe (J.5~l Demo Sidewalk L.j (..,,:.2S A/e Paving Total Comb. rermit TOTAL I .~ J~S(.,D.l,~ I . . - ~, . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Oescription 1. example. Tax Lot 100, Lane County Map Reference 11 03 43 2. examele- Lot I, Block 3, 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinqlor forced air Q3S 2. exa~le- waterheater/electrlcalJor 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 addition, Check. add. etc. F. Building permit information: 1. example - construct single family house with an attached garage 2. examEle - 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 (aJ of the Structural Specialty Code H. DESIGN TE~1 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, & Electrical 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, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEOOLES 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. QJ>. f"-O'c.. \)S'~'O V. FOR OFFICE USE ONLY Permit Cl erk 19€> I PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Pro~ect Information: PLANS REVIEWED BY: name signature date IUSPECTIOU lIUE 726-3769 . CITY Uf SPRINGfiELD COtIBIIIATlON APPLICATION/PERMIT --. . lNFOPJIATION L1NL I 726-)753 Sq. Ftq. ",.in ~q. ~tCJ. ^Ct~ss. Sq. Ftg. Other lIew Add A Iter pep. Ranl'1e -rence Demo ChanlJe/Use _ Valur of Hork: Other- - Owner .x(lJ'V\'j~I'\IO Y'vI"^M.",,,.V(,'Avr(,",, 0Q<J(Y) , , 'ddress -,") '" Pho BUlk.ng Peml1t Info: Oescrlbe Hork(Le;. Build Single , I :::>nc... \tV'\!-, ;_^ ,__::,t- ne'l<iI," Fa~ilv nesidence l'lith Attached GaraDe' , S.~ \ I ~"fll , k'LA .of IN\,.., I ,I ::n / t~....", l~ Construction lender L/ 1- )1 (ahane no.) Job ^ddress ....T2.,nc... YY'\rA"A/>,) ~"'+ I.egal Oe<cription \ I{)"\ 2,.,;", 0 ::>,'7t)'J. t {):l, '1ri-', ElIERr,y SOURCES: Heat Hater Ileater ~ G o DC ..... o Address DE51Gfl IlAIl (namel Phone (address 1 (1 ics. no.) (exnires) Primary Structural Electrical 11echanical CONTR^CTORS (namel (address \ (1 in.. no.' (pxn;rps\ lohnnp nn. \ General 1'Y'\r.,,'..K VV\,f!1~"} - p^,.'<.'.rl,,, I- - <'"",,,,,,'1'\, nC};'d, kv Plumb i no '0r\ ou.:.K YV\ 1l1hl, - Electrical \iY'\Glc/K V'V\Pc\fo.Q... "echanical YY\('\C>~ \tV\A'lf}'\Q.. 1Y.'__c...~, PLUI1BIrlG ELECTRICAL MECIlANICAL UO, I HF r11^Rr.F' Nn '" J:IlAJllif. Jill """ :uAR!iL SQ. FT. furnace/burner to BTU's Each single fixture Residence of Relocated building (new fix. add;tional) S.F. Residence 11 b'th! Duplex (1 bath) each Additional bath New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wa 11 $nac~ heater ~nd vpnt Storm Sewer Of COMl,!' II NO. FEEOERS Install/alter/relocate d'strib. feeders amps. Appliance vent $.~naratp. Stationary evap. cooler Vent fan with sinole d\lct Vent syste~ apart from heatinq or A.C. Mechanical exhaust hood and duct Wood stove/heater Sewer Temporary Construction Change in existing re.sj ~CJlCe. mu'ltifamily. conln. or Inrluc;trial ~Iater service Of amps. TOT^L CHARGES WIIERE STATE L,\\I REQUIRES shall not be vali1 until the ISSUIINCr OF PFRlllT TOT^L CIIIINGES TOTAL CHARGES that the Electrical work be done by an Electrical Contractor. the electrical portion of this pemit label has been signed by an Electrical Supervisor and returned to the Building Division I lIAV[ CARErUlLY EXN1WED the completed aprl1cation for ~ermit. and do hereb,Y certify that all information hereon is true and correct. and I further certify that any and all \~rk nerformed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of OreC)on ~ertainin9 to the work described herein. and that He OCCUP^"CY 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 ons 701.055. that if exempt the basis for exemption is noted hereon. and that only suhcantractors and employees who are in comoliance wtth Or.S 701.055 will be used on this project. SIr.r1ATURfj !f&6~ /JJt9t~ r1I\!IE(ple"e print) '<Y\r;. ('.K. \tY'\CtJvt'.' om,"t6~u FO~ OfFICE USE o;lL y Zone Tyoe/Const. Units Sf!. FIg. ftain Fire Zone Bedrooms Occy Load Sq. FIg. Access flood Plain Stories Occ.v Group Sq. FIg. Other x x Value Value Value x TOTAL VALU^TlDrI BUILDIIIG PERIHT ~CO<;3~ Plan Ck. COI111l11 nd Charges an~ 65X1Bldo Ppr Fpe -- --------- Plan Ck. ROes Surcharges Ie::., 04 30%lBldg Per Fee PLUI~BHlG PERMIT __Ld-~SQ__ Fence Charqes dnd Surcha rl)(>s (., ,~ 2- 0_ CLECTRICf.,L PERI~IT ___SJ",SO Sidewalk Charges and Surch.;,rges ~, (,.;2., A/C Paving L!l,.,:)S 11ECIlANICAL PERMIT _nnCJ.:.QO_n Curb Cut Charges and ~1l"'C: h., ..,:.~.. t_,r:.., Systems Oevelopment I Charge (1.5~) TOTAL 1{SU).L;~ I TntaT Comb. Permit . . ~ I ...! COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Oescription 1. example~ Tax lot 100, lane County Map Reference II uj 43 2, exam~le- Lot I. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. exam~le- heat/electrical ceilin9/or forced air Qas Z. examele- waterheaterlelectrlcal/or ~ E. Square footage or valuation, etc. I. example- 1250 sq. foot house. 500 sq. foot garage 2. example- T71new project. check new - if addition. Check add. etc. F. Building permit information: 1. exam~le - construct single family house with an attached garage 2. exam~le - remodel existing garage into family room 3. examele - convert single family residence into restaurant (change of use) G, Value of work as defined in Section 303 (a) of the Structural Specialty Code II. OESIGN TEAll ANO 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, & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules. the applicant need fill-i~ 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. BUILOING OIVISION STAFF WILL FILL OUT ALL FEES ANO CHARGES ON THE SCHEOULES O. 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. QtY G {\Ji L' l.lO II-=> I, II V. FOR OFFICE USE ONLY Permit Clerk lP~ 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 signature date