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Home My WebLink AboutPermit Building 1981-9-24 I INSPECTI ON L1IIE 726- 37 69 . ,..... .~ .. . INFORllATION UNt 726-3753 Sq. Ftg. f.lain ~q. Ftg. Access. Sq. Ftg, Other flew Add Alter Rep, --Fence Demo Change/Use- Other - - I ~ ~. ~ I~ Job Address S / / :z.. CITY OF SPRINGFIElD COMBIIIATlON APPLICATION/PERMIT ElIERGY SOURCES: Heat !-later Heater S7. ~ Range /I./J 19 / ;./ II /7 -()"2 - ::l, ~ - 3.~ T J.., "3>4OCJ Owner kJ~. 1-1_ (.Z OO7L, Address S. KJIVI F legal De~cription;\ i _ J,,"" 1\7 Phone7W_ ~Y.l va~5W aJ Buildinq Pennit Info: Describe Work(i-.e., Buil~ Single Familv nesidence ~~tached Garaael ~ ~~,p',. ~..o~ )/ ri>-' /' Construction lender Address Ul:.)lur~ Il:.Af1 (name) Phone (address) f1echani ca 1 CONTRACTORS (name) (addr~$.") (1 ics. no.l (exoiresl (ohane no. I ~ " . I". j f1 ics. nn. ) (Plcn; rpc: \ {l]t,nop fl('l " Primary- Structural Electrical Genera 1 Plumbino Electrical ~1~~_hani Cc11 - - ===>==><o~"_==..:="---=:.....-_-=-"=~~-",,,_ ~--'-'-='.;<;o.;..~~==__..~_' PlUllB IrIG ElECTRICAl MECHANICAl NO. FEE~Q;AAGF- / Each single fixture s<?$:1 NO I Residence of -~-=-~=""'=-=-"":"="",*",='::""........- -~~ ~""~or.-~:o...:....::---"'_=~ "li.-..cJJARliE. Nn. SQ, FT, furnace/burner to BTU's 'FTfCHARGl! I! ~ ~ Relocated building (new fix, additional) New circuits alts. or extensions Floor furnace and vent Is.F. Residence (] bath 1 IDuplex (1 bath) each IAdditional bath I ~Jater serv; ce I Sewer SERVICES Recessed wa 11 Sn~rp hp~tpr ~nrl vpnt Storm Sewer Iremporary Construct;o~ IChange in existing r~sJ d..e.ncE! Imultifamily, camm. or lndustrhl 10f amps, ICOI~l,/IND, FEEDERS I Install/alter/relocate d;~tr;h. fppdpr~ . jOf amp~ I Appliance vent ~eoa ra tp Stationary evap. cooler Vent fan with sinale duct Vent system apart from heatino or A.C. Mechanical exhaust hood and duct Wood stove/heater . , II , TOTAl CHARGES WHERE STATE l~W REQUIRES shall not be valij until the ISSUANCE OF PFRr1lT .JJ, a:::> TOTAl CHARGES TOTAl CHARGES i 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 application for permit, and do hereby certify that all information hereon 1S true and correct, and I further certify that any and all work oerformed shall be done in accordance with the Ordi~ances of the City of Springfield and the laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPArKY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s 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 subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. IlAI-lE(please print) '\. Zone C!. - I-,t l'Fire Zone . , Flood Plain BUILDING PER/lIT ~ Charges anc Surcharges Type/Const. Bedrooms Stories Units Occy load Occy Group..l3-Z- SIGIIATURE FO~ OFFICE USE OIILY Sq, Ftg, 11ain Sq. Ft9. Access___ Sq. Ftg. Other DATE x . Value Value Value x TOTAl VAlUATION ~~~ PlUI1BING PERMIT Charges and Surcharges , C Do . Plan Ck, _______'"t!L___ 65%/Rlrlo Plan Ck, (;)..0 30%lBl da --____~'-CZ!?_ Fence I;LO D~o COIl1l1/l nd PI''''. i='f>P Res Per Fee Systems Development Charae (1.5%.) ElECTRICAl PERr:1T Cha rges and Surcharg~s 11ECHANICAl PERMIT \' Charges and Surcharges S1dewalk I I A/C Pavin9 ____________1 Curb Cut I Irotal Comb. Permit I I TOTAl ~o, ~\1 '. ~ . . .~. COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A, Job Address B. Legal Description 1. example~ Tax Lot 100. lane County Map Reference JI 03 43 2, example- lot J, Block 3, 2nd Addition to ~pringtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. examl!le- heat/electrical ceilinqjor forced air Qas 2. examole- waterheaterjelectrlcal/or solar E. Square footage or valuation, etc. ----- 1. 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. examole - remodel existing garage into family room 3. examjle - 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 TEM4 AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or jnb 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, FulJ 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 fu 11 schedu 1 es C, BUILDING DIVISION STAFF WIll FIll OUT All FEES ANO 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 ~ivision Staff will prepare a type written copy and return it to the applicant at the time the actual penmit 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: . PERMIT VALIDATION Permit Clerk Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature ,- " date .-.... ~ 'j , ,I i ,1 ,I .~~ , ., . .., ~ ".. I IrlSPECT 1011 LI IrE 726-3769 . ..- . . INFORlIATION liNt 726-3753 Sq. Ftq. /olain ~q. Ftg. Access. Sq, Ftq, Other lIew Add Alter ~ep, --Fence Demo Change/Use. Other- - ~ ~ ~ ,~ Legal Description ;:..:~. '..... , ~ . .', .. -~_..- I, "",,,-, - . CITY UF SPRINGFIELO CmlBlilATION APPLICATION/PERMIT EIIERr,y SOURCES: Heat \'/ater Heater Ranqe S7. Job Address 6' / / :l.. /V/ f-) j AI /7 -~?, - ~ ~ .- ~!? Owner k-' ..;.,.,., l-l. ~ Address <:.... ;Q AI\ ;::: T/-., '?:,4nO Phone7W_ ~YI va~sw (Xi Buil~ina Permit Info: Descrlbe Work{i.e., Build Single Familv P-esidence I-lith Attached Garaae) ~~r ~--/?,.. 00/1, . Construction lender Address Ut~llirl ItAr1 (name) Phone (address) flies. no.) (exoires) (ohone no.') Primary' Structural Electrical 11echanical CONTRACTORS (name) (address) (lire;.. no.' (pxnirps) j ([)honp nn. i ~ Genera 1 Plumbina i, i. Electrical ~1e~!tc:n~L i .;,,~_...,..,n PLUllBIrlG ELECTRICAL MECHANICAL' 110.1 ~IEach singl~ fixture 'IRelocated building (new fix. additional) IS. F. Res i.dence (1 bath' IDuplex (1 bath) each Additional bath ~FEF==-::r.HARr;F- Nr( SQ, FT. Llli:...J..cJiAlli. 'In--~". furnace/burner to ._j BTU's ' r:.E.LJ.CJlABJi.E. s<?9 I Residence of New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall So~rp hp~tpr ~nrl ~pnt 1 I Sewer ITemporary Construction IChange in existing rpe;.jdYJ1r:p Imultifamily, comm. or Tndlle;.tri~l 10f amps.1 ICO~1,/IND, FEEDERS IInstal1/alter/relocate I die;.trlh_ fppdpre;. IDf amps.1 I . I I Appliance vent ~p.oaratF! Stationary evap. coo1F!r Vent fan with sinole duct Vent system apart from I heatino or A.C. Mechanical exhaust hood and dUr'.t I flood stove/heater I I I '1 I ~Iater service Stonn Sewer ! ISSUANCF OF PFRIHT TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be valiJ until the ~ <:JO TOTAL CHARGES I TOTAL CHARGES that tile 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 EXA~1INED 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 Soringfield and the laws of the State of Oregon pertaining to the work described herein. and that NO OCCUPA!~CY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s 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 subcontractors and employees who are in como1iance with ORS 701.055 will be used on this project. IIAHE(please print) SI(:IIATURE FO~ OFF I CE USE biILY"- Zone U. -;.,L Tyoe/Const. Units Sq. Ftg. f1ain Fire Zone Bedrooms Occy load Sq, Ftg. Access Flood Plain Stories Occy Group B-7- Sq, Ftg. Other DATE , , Value Value Value x TOTAL VALUATION ~~C7'"'l BUILDIIIG PERI.IIT Charges an~ Surcharges , S; !J Plan Ck. ________L_fl_ 65%1Bldo Plan Ck. (;)..0 30%/Bl dQ ______;:z,_~!?_ Fence (';:;"0 0_ Conm/Ind Ppr FE>p Res Per Fee Systems .Development Charqe (1.5~) PLUi1BING PERMIT Charges and Surcha rges ELECTRICAL PERI:lT Cha rges and Surcharges rlECHAN I CAL PERM I T Charges and Surcharges Sidewalk I A/C Paving I Curb Cut I Total Comb. Permit ~. I TOTAL ~o,~\ ., " I. Applicant to furnish A. Job Address B. legal Description 1. examole- Tax Lot 100. Lane County Map Reference 1I U3 43 2, examele- Lot I, Block 3, 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examo 1 e- hea tie 1 ectr; Cd 1 ceil i nq/or forced , 2. example- waterneater/electrlcal/or SOlar E. Square footage or valuation, etc. - 1. examole- 1250 sq, foot house, 500 sq, foot ~ 2. exam~le- if new project, check new - if add; eneck. add, etc. F. Building permit information: 1. examole - cons.truct single family house wit~ attached garoge . 2. examole - remodel existing garage into famil 3. examOle - convert single family residence in restaurant (change of use) G, Value of work as defined in Section 303 (a) of t Structural Specialty Code M, DESIGN TEM1 A~D CD~TRACTDRS To avoid design or construction delays. Building Division Staff must be able to contact appropria persons regarding design infonmation or job site corrections. etc. II. Abbreviated Plumbing. Mechanical. & Electrical Sched A. Except where blank spaces occur in the descriptio portion of the Mechanical and Electrical Schedul. the applicant need fill-in only the No. Boxes ad. enf to the appropriate item(s) to be installed B. Full Plumbing. Mechanical. and Electrical Schedu are available at the Building Division . 1. To conserve space on the permit form the sCh, 'fe~ have been abbreviated 2. If the item(s) to be installed are not covert the abbreviated schedules you should consult fu 11 schedu 1 es '. C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AI CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must be delivered electrical contractor for signature by his electl f~. supervisor. The general contractor is .not autho, to sign the electrical label. --- Applicant to sign and date Whenever possible. the initial application will be u~ /as ../"1 a worksheet only. Where possible. Building Division \... Amount Receivecy J will prepare a type written copy and return it to the applicant at the time the actual permit is issued for signature. ( IV, Fees and Charges Plan check fees are due and payable at the time of tt. application. and no plans will be processed until the fees are paid. All other fees and charges are due an payable when the permit is issued. . COMBINATION APPLICATION/PERMIT (CAP) Ill. V, FOR OFFICE USE ONLY . ~ .... . PERMIT VALIDATION , i CITY OF SPRINGFIELD f. City Hall Springfield. Oregon Department' of Public Works OFFICIAL RECEIPT ( r '- ( No. B 19 'r/ &lIA., ( Date q - ~'-/ - 57344- f C Rec'd From k' ~ ;4. Address, </1:;2. "??/? ~ , ,- '. ( s: 00 , .20 ~<:;'. 0 c) . d/ i.I /r) , 20 .2[/(J. <I;] #=-X"/() C,.<:""9 Received For: RP q74' ( fJ.f1. ( ( , ( ( j ~' ~/.o '-W J/~~L . 1 AUTHOIUZI!fi SIG...ATURE ( SHlLTO...TU....U~~ ".'''U:.!I . ~uG~"~ 0" ."0' s..".. \... ( ( <- j.... ( I ' Permit Cl 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 signature ..-' . I date .