HomeMy WebLinkAboutPermit Miscellaneous 1980-2-25
INSPECTION LINE
726-3769
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INFORMATION LINE
726-3753
vaJR CIlY DESIG-lATED JOB NLtBER IS: 1'13552-
The following indicated inspections are required for your construction a~ 5344 Mcu'V\, S-t~
It is the responsibility of the permit holder to see"that-all inspections are made at the proper time, that each address is
readable from the street, and that the permit card is located at the front of the property.
~ SITE iNSPECTION: To be made
atter excavatlon, but prior to set-
up of forms
r-~ UNDERSLAB PLUMBING. ELECTRICAL &
MtCHANICAL: To oe made before any
work 15 covered
o FOOTING & FOUNDATION, To be
made after trenches=are' excavated
and forms are erected, but prior to
pouring concrete
r--l UNDERFLOOR PLUMBING & MECHANICAL:
10 be mace prIor to 1nstallat10n of
floor insplation or decking
o .PDST & BEAM: To be made prior to
1nstallation of floor insulation
or decking
o ROUGH PLUMBING. ELECTRICAL & MECH-
ANI~AL: ~o work 15 to be covereo
unt1 I these inspections have been
made and approved
D FIREPLACE: Prior to placing fac-
1ng i,Jatcrials and before framing
inspection
o FRAMING INSPECTION: Must be re-
questea atter approval of rough
plumbing, electrical & mechanical.
All roofing, bracing & chimneys. etc.
must be completed. No work is to be 0
concealed until this inspection has SEWER. WATER & DRAINAGE LINES:
been ma~e and aooroveg _ . "'rlor t.O TllllnQ 1n trencne~
c==] FINAL PLUMBING ~ FINAL ELECTRICAL .~ FINAL MECHANICAL
All project conditions, such as the installation of street trees, completion of the required landscaping, etc.,
must be satisfied before the BUILDING FINAL can be requested.
'c==] Construction projects that reqUi~ed approval by the City's Site Plan Review Board shall be inspected by the Review Board
before requesting a final building inspection. Requests for inspection by the Site Plan Review Board must be made 2 days
in advance of the date you wish inspection.
~FINAL BUILDING: The Final Buildin9 Inspection must be requested after the Final Plumbing, Electrical; and Mechanical
Inspections have been made and approved.
BlHLDING lNSPECTlOO,
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INSPECTIOlI PRo.':EDURE FOR THE CITY OF SPRINGFIELD
BUILDING DIVISION 346 MAIN STREET
~INSULATION/VAPOR BARRIER INSPEC- .
fION: To be made atter all 1nsula-
tlon and required vapor barriers are
in place but before any lath, gypsum
board or wall covering is applied,
and before any insulation is con-
cealed
~ DRYWALL INSPECTION: To be made
after all drywall is in place, but
prior to any taping
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MASONRY: Steel location, bond
beams, grouting or verticals in ac-
cordance with U.B.C. Section 2415
o
WDDDSTOVES: After installation is
completed
o
o
o
o
FIRE & SEPARATION WALL: Located
& constructed according to plans
ATTIC DRAFT STOPS:
ROOF SHEATHING AND NAILING:
to installing any roofing
PrIor'
SPECIAL INSPECTIOHS: When re-
quired by Building Code, special
inspector to be present when work
is in progress. A copy of the
special testing report to be
furnished to the Building Division
o
o
o
Structural Concrete:
3000 P.S./..
In excess of
SIDEWALK & DRIVEWAY: Required for
all concrete pavlng within street
right-of-way, to be ~ade after all
excavating complete & fonm work &
sub. base material in place
Structural Welds:
the jOb
Perfonned on
o
CURB AND APPROACH APRON: After
Torms are erected but prior to pour-
ing concrete
Glu-lam Beams: Inspection certificate
(by approved agency) supplied to Build-
ing Division before beams. are placed
o
Fire Retardant Roofing: Before Instal-
lation
'OTHER INSPECTIONS: May be required
'in accordance with Building Code, to
be indicated in plans or by notice
from Building Inspector
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~/ FINAL FIRE DEPARTMENT
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No occupancy of the premises can be made until the Final Building Inspection has been made and approved. ~nd a
CERTIFICATE OF OCCUPANCY HAS BEEN ISSUED BY THE BUILOING DIVISION AND POSTED ON THE PREMISES.
Signatur~:
MOBILE Her.ES-Your Job # Is:
o Blodking/Setup
,"f.~ .
r==J Plu~bing Connections
Sewer and Wa ter
o 'E1.~ctricaf Connection
From Service to Mobile Home
c==] Electrical Service
Ped;stal
c:=J Accessory Building - May require
Inspection as Buildings -.See Build-
ina- Insoections Above
D
Final ~ After Porches, Skirting, Decks,
etc. are completed
~lgnature
Date
Phone: ;'
SIGtJS-Your Job # is:
o
o
c==]
o
Site/location
Footing or Method of Attachment
Electrical
<:)RoU9h <:)Final
Final - After Installation is com-
pleted
Date:
OTHER-Your Job # is:
c==]
o
Fence - When Completed
Demolition - When Completed
~lgnature
Oate
Sl gnature
Date
BUILDING OIVISION APPROVED PLANS SHALL REMAIN ON THE BUILDING SITE AT ALL TIMES, AND ALL WORK MUST BE COMPLETED IN
ACCORDANCE WITH THOSE APPROVED PLANS.
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NOTE: All manholes and cleanouts are to be adjusted at no cost to the City.
PROCEDURE FOR INSPECTION REOUEST - Call 726-3769 (recorder) state your City desi9nated jab number, jOb address, type
of lnspect10n requested and when you will be ready for inspection, Contractors or Owners name and phone numbers.
Requests received before 7:00 a.m. will be made the same day, requests made after 7:00 a.m. will be made the next
working day.
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P\~ - 2 2
REV. 11-77
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CITY OF SPRINGFIELD
PLOT PLAN AND SITE DEVELOP~IENT
ADDRESS: 534f1,/ MI+JIII sr
DATE:
I hereby agree that the site development for the subject property and building will conform
to the details shO\m on the attached plot plan and to the fOllO\;ing statements:
1. EXCAVATION AND FILL: A site grading plan may be required in or accompanying the plot
plan, describing in full any excavation and/or fill necessary to prepare the building
site.
2. DR~INAGE: No drainage channels on the property will be disturbed or new channels cre-
ated except as shO\m on the site plan.
3. OFF-STREET PARKING: Private garages and/or automobile storage space required by the
Zoning Ordinance of the City of Springfield will be built concurrently with the main
buildings of which such garage or automobile storage spaces are accessory and will be
maintained as private garages and/or automobile storage spaces for such main buildings.
Automobile storage spaces will be completed for occupancy (curb cut, drive"ay installed
and area leveled, oiled, blacktopped or concreted)- prior to the final inspection and
clearance by the City Building Inspector.
4. GE'iERAL: I will obtain full information from the City on sewer locations and dep~hs
and street grades so that the building, plumbing and drive"ays "ill meet same.
I hereby understand that I am responsible for any damage to existing public improvements
caused by the building operation and agree to repair or replace damaged sections at my ex-
pense. I further agree that I will abide by the conditions imposed on the plot plan and
site development by the City Building Inspector, and/or the City Engineer and agree that
the City may delay any requested inspection and/or cease construction .until such conditions
are fulfilled. All information shO\m on the plot plan is accurate and correct. No con-
struction will be commenced until the filing'of this agreement and the final approval of
the plot plan has been given.
SIGNED:
ADDRESS:
DATE:
A. Approved as follo"s:
BUILDING INSPECTOR
LOT
DATE CITY PLANNER
BLOCK 53 '1'1 /Vf;g,'"" f(-e..vd~1
DATE
B. Approved subject to the following conditions:
1:3)
(1)
(2)
;( Under Contract Bond Required
In lieu of assessment charges due
road side ditch -To cut-off system
Dri ve"ay Cui-
No Connection
SAN ITi\RY SE\\'ER: Accepted
until accepted by City
DRAINAGE: To curb)( To
verts required Other
STREET: Graveled Improvement agreement required ~Iore R/W needed
Paved \;ith (oQI:I:l.') curbs 'to Under contract for paving - see obligation agreement.
SIDElI'ALK: 7' Wide €,urbsi.1P' on Setback
SPECIAL STRUCTURES REQUlI(ED: Retaining Walls Engineered Foundations
Floor Elevation Other _ Jet:: /!lorj71~ .
EASDIENTS: Platt'ej!' J? Recorded) fiddlt lonal requued. .
OTHER: Required adjustment of ~"n_n"t(or;-manhole(s), and/or catch basin(s), ..ill
be accomplished at no cost to the City. ..~
(4)'
(5)
(6)
(7)
Hinimllm
CITY E:\GI:\EER
REVIEliED BY
DATE
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C.Jll.Dllir, IIISPr.CTIO;1 DIVISIO:I
PW-25
'. COIU1ERC I/\L Pl.A:1 CIIEel: SIIEEr
/ 1. PLOT PL.^,;I
;, (""l u, Lots included.
(+ b, Streets - yurds & courts.
(..y- c. Area & location of bui Idings (existing included) .
2, FIRE ZO:IE
(..r a, Hull protection and opening protection,
3, oecupp,::CY GROUP ( ~ ~3 )
() a, Ch<lnge in use established,
{) b. Mixed occupuncies & separation determined,
[.. TYPE OF COI:STRUCTI O~I DETERillNED (iL-AI ),
s: ARE!I L1ll1T>\TIO::S def'ined by occupancy group & type of construction.
(..y- a. Allo\'lable increase.'
6, STRUCTURE I1EI(:;l1 establ ished by occupancy group & 'type of construction.
(~a. Allo\'lable increase.
7, OCCUPANCY LO,~,D
(~a. Exit facilities
'11,(-~ b, Light & venti l<ltion.
() c, Enclosure of vertical openings.
() d,
('-Y'e.
() f,
Fire extinguishing system.
Chimney & heating equipment.
Spec i u I h<lzards,
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(". Is,
COiISTRUCTIOt! - DetGiled reCluirements,
('1' a, StructuriJl frame, roof cover, unprotected material, weather protection,
,/ parapets, etc,
(~ b, General.,.,.,.Structural frame work, floors;' stiJir construction, roofs,
and exterior walls and openings,
9, Ef!G ltiEER H:G F, STRIICTU['}\l.
("'Y' a, "\ateriuls (General).
MiJteriuls specified and construction uses for wood, concrete, steel
. and iron, masonry, plaster, etc.
10, OTHeR OES 1(;11 - Oetai led Requi r.~ments.
( ) a, Exca'lut ions, "l'oundations, pi les, ( ) f. Fi re resistive standards.
and retaining \'lal1s. ( ) g, Temporary use of pub I ic
(~b. Veneered VIa lIs. property.
( c. Chirr.c:e.y, flues & vents. ( ) h. Permanent use of pub Ii c
() d ,_ St~gC$ & Platfonns. property.
( .y-;, \Ja 11 & Ceiling .finishes. ( ) i, Platering.
( ) j. Heat producing appli<lnces.
11.
1';UST
( )
( )
E'-!TIRE STC(UCTUP.E BE BROI:GilT Ill' TO CODE.
il. Is t.j~5 ~i1 iloditi"on? (i-:;re or-less
b. Change of occupancy?
than 50"10)
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INTERIO~ \/ALL E- CEILI,lG FII-IISH 1.\i\TER!i\LS
() a. Requircm~nts scJtisficd.
( ~ 12,
13.
FIRE
( )
( )
( )
( )
( )
PROT::CTIC:I RE0UIPE",nTS
B. Spl-ini(iillg system.
b, St~ndpipes.
c, F i redoor's & \'1 i ndO';ls.
d. Closillg dGvices.
e. Panic hardward.
DrlTE
2-26-%'0
VALUATI otf5.t....'5"Oc... ~
S'GnED&__d_,~z;-
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.PW-147
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CITY OF SPRING H"IELD
SPRI.~GFIELO. OREGON 97~77
DE?ARH1ENT OF
PUSLiC \'.'ORKS
Septemop.r 19; 1978
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3~6 MAIN STREET
726.3753
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r.lOT1CE TO O',':~I~RS. DE'j:LO?ERS, BUIUJERS. M'lD CONTRACTORS: ,"
>,j
The City of Springfield does not pennit dirt, rock, debris, etc., to be tracked
pnto and/or deposited on publicly-owned streets. Further~ore, the temoorary
storage of building mater'ials within the publ ic right-of-'.-Iay is only permitted
"hen authorized in "Iriting by the Building Superintendent and/or City Engineer.
If ~ during the cour~e of construction and whether conducted on public or
private property - any injurious or unsightly substance is deposited on any
publ'ic way, such substance shall be removed by the responsible party by 4:00 p.m.
of each working day. The responsible party is the prime contractor on a public
impro'.'er:!ent project and is the per;nit holder on a private" il;]prove~ent or building
project. Each per'mi t holder- is responsible for not .less than the entire frontage
of the affected pl'operty from the street centerl ine to the property 1 ine.
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Whenever ~n offense has occurred and the offending material has not been removed
and the public right-of-way cleaned to the satisfaction of the City, the City may
take two courses of attion:
(1) The prime contractor or permit holder may be notified by the Building Superin-
tendent or the City Engineer ~hat no further inspections "ill be made or
approvals granted until the public right-of-,.:ay has been cleaned to the City's
satisfaction. In effect, the City would issue a "stop work" order.
(2) The City may choose to remove the offending material and clean the publ ic
right-of-v,ay, or to contract for such I-fork. The cost of such "!ol'k shall be
billed to the responsible party at twice the City's incurred 'cost.
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One effect of injurious substances in the street - besides the obvious aesthetic
and safety aspects - is thJt pJ'/elllent da:nage results !,:hen the offending materials.
are run over by vehicles or are sCl'aped up in a car"eless fashion by loaders, back-
--boes, ere
pl~as~ he advis~d that the City will'~nsp~ct all sites where orrenses hav~'occurred
to assess ~.:l1e:ller or r,ot U1l'.;an'anted da1:l.l<]~~S to the pa'/e::lent. 2r)d Oth2t~ puol ic
i"'pro'leccents have taken p1<1ce. If ~hey ha'le, the Ci~y may \.,itlll101d fu,.ther inspec-
tions or iJpDrovals until tile repair's l1a'/e either' been ",ade or' gUMiJn[eed by a proper
deposit.or security. .'
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The City of Springfield requests your cocoerction in this effort' to reduce unsightli-
ness, safety hazards, daJl:age to public i"'pr'ovements, and COSTS. .... "'p ..... ,::,..:....
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REFE:RE::CE :.
Springfield Code, Sections 5-2-3 a~d 5-14-13;.
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1~'~SIECTIO\ Pi~n.r.L:'pI!i~r.~ I.(~l.: THE CITY.Oj: SPI~l~:C;rIELO
SUI Ll1I~:(; DI\.rSIU:-; 3.1() :.i:\I\ STj~~:ET
I~<SI'ECTIO:<S 726-3~1l~1 U\1-0l\..'l:\Tll;\ -; ':t)-37S:i
The t"ulloh'iltg indic:.1tcJ insp'-'(t.ilJ!1~ :Irc rcquir.cJ for !'0t1;' cOllstn:..:tiO:l .:1t
_~ff MIII'n/ <sr.eEE1" .________ It is.the 1'c,po,,,ibi!ity
of tilL' ner:::lt ht)IJcr to sC',~ t1~:it all ill~'1>l'ctio:l.:'i :I1'C r:;:ido:.-' :It the p;'np~.!' ~i::!,:"
th:lt C:l~:l :lddl'CSS is rc~c.l:lblc f:-ol!l the street, .:lilU t~l:1t the pCrI;tit cln.l 15
locJted '3t the',1'!"iJl1t of the properc)'.
l.OOSitc rns!"1cction:
cXC:l\::ittLlI1, but
tor::'lS.
:.00 ~~:'rs 1 ~lh PI Ulilhi n~ ~c:~.tri c:ll f,
:.It.'...:!.:Il\ic.11: To be mJGe before :lny
'~ol'l; is ~ovcred.
3.~::oo:in~s PI rOl.I.Tl(bs.i~~ To bc m:1dc
~ll.tC:: t rc~TlC!lL'S are eXC:lv:1ted .:lnd
for::~s DoTe ert'cted, but prio:!" to
pourin; cOJ~crcte.
-1.nU:ldcri:'"loor Plllmbil1.~ c. ~[("'l"]'~ni"""l'
____ " '.'-_ .,1 ~=--.:..
To be ril:1Jc prior to inst.:lllatlon
oi floor iilsulatioll or dc~killg.
5.0~lo.';~fl Gc~ To be m~ldc prio; to
inSi:~l !:ition of floor insulJ.tion
or l..kcking.
6.~~;)t:::h ~lu::;bin~, Elc~~'ic;l ~
;',.C.':~::lil; C;J 1: :\0 \.:o1'k is ...0 DC
.~O~.~l"cJ l:lltil tllcse illSpcctioll5
h:I\'C bccn I~Jde 3nd 3pprO\'eJ.
7,~1.~1'~:~i!l~ Il2.~~tion: ~.lust be
rC'qucstcd at'tel' appl'o\'al of rough
111l:i~bing, clcctric31.& mech.:lnical.
Ail roofing, bracing & fircblocki!lg,
etc. must be completed. ~;o l.:ork is
to be conc~alcd until tllis iJ1Spectioil
. h;:s bCCil n::J.Je ;Jnd ;Jp~lro\'cd.
8.0Fir0 S SeD2.:-.:~ion ~"~;1l1: LOCltc-d
fi constr~c:cd according to plans.
9. ~ ":"0: i lei t io~"'echnnic" I ) : Regu ired
\.;he:-c no open:lblt:: h.incioh'~ are pro-
vided.
10.0 I.:lt!~ fnsocction: The inspec~ion is
:.~tlui!'cJ fbr l)Ot}l interior & extc!'ior
I)13~t0;'i!lg. To be m~dc after ~ll
l:l:llillg is in p13ce, bllt prior .to any
. rl.1~tc:'ing.
11.rK1 !):....\.::111 rn~pccti0n: To be m3dc :1ftC'r
:111 u~.)':{:lll is in pl.:lcc, btlt prior to
:tn\' t:J!)ing.
l2.r&J ~.!:!~ojlr:.' :'::t11$:' Steel location, bond
bC:1:~s, groL:ting or verticals iIl ac~or-
d:J:~~~ \~itll U.B.C. Section 2415.
13.~ r-ir(':)l~jcc or Chi.mney; Pri~r to p!3C-
ill:::: l'"~!.cing n::ncri.als.
To be m:tJe a ft'cr
l',-io1'--.to setup of
o Fin:1l Plumbing
o ri":11 E18ctric:Il
1.1.IXJSj~le~\.:llk 8 Dri\'("'i.:a.':: Required for
ali cOile rete p~\:illg h'ii-hin street
rjght of h'ay_: to be f71:tc\c after :111.
exc~v3tillg co~plctc ~ [oI'm ~arl; &
SUil-b:IS~ m3tcri~1 in place.
.15.:00J.:!J.:....L\~.! _[)e~ Inspc~tioll Ccr~.
. (b)' approveJ agcne).) supplied to
B1Jiltli:lg IllS!lcctor 11eiorc bC:1ms ~re
pbccd.
IC rYl '~"er \,..t"e~' -= (lr'11T,~,.,.t:> Il','ns'
l'lLJj_.'\ ." ',~~~ . q ..,. ,,1<-':___ ''-..
Prior to fillin~ ill tl"cn~hcs
l7.D.Firc P.C'_~::~~_~on~"int: ~:~tcri:11
to be iIISPCC:CJ ~C~Ol'e inst~ill~ltio;l,
18,0 ~'?~,~l~:o\'cs: After ,iJls::lll~ltion. is
COi::n 1 (' t cd,
19."00 ~:;~r InE.l2cc: ion~.;: ~'l::y be ~('qt:ircd
in .JCco~d;'inc:= hiti! l3uilJing Code, to
be indic~ltcJ ill pl:lns or b). notice
fl"o):: 6llilJ~llg 111s!~c(:or.
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20.0~~~i.~1 I0.~2..c:'s:~ioli-;:-"kh('n !"Cqllit=C;j
by Building (ode, speci.:ll inspe~t()r
to be present h.hcn \.;ork is in pl'o~1'e
o Strt::.::tur:d (enCl:ete h:!\'ing a tlesigt1
stl"cng:ll ill excess of 2000 PSI, ,~itll
COP)' of s!lccinl tc~ting report to D0
fl!rnishcJ to Guil~i~g Divisioll.
o Strui.:ttlr':.ll \.::....1<.15 pcrfor:Jed 0:1 th0 jo
Kit}l ~O~))' of speci:;l testing report
to be :"urnished to Si..ljldin~ Di\:ision
o Fill:ll .'!ech::lnj ell
o rin,,1 Building
;\11 p!"oje.ct conLlitions, .~lIch as thC' inst:ll1:ltion of street trees, co::~plctioll of the
rC'qui r'~J I"all..!:.;.c:lping, etc,', must be satisfil'd before the Bui IJing f-in:ll C:li1 be rc-
qll('stl'd. ~. ..:-~
The
~nd
FillLlI Building Inspection must be l'CQUC'5tCJ 3ftcr the
:lcc!::::lic:lI Inspections h:n.C' bt'crl :::::ldc and :lllprO\'cd.
rjnal Pl::::':::!!l~, Ell..':..:t1'ic:11
\0 oCCUP:i1l"':..Y..O: the pr'c!!:i ses
;il:!(!c ~!J1d ;i;';i:.(".'''.C'cl. ~lllJ ~l
01\'lSI0~< ,\\;1 l'O.-)T1:D 0:< Tl~E
Cli. lJC ;:;;l\.k until the rill:ll
CE"T!;: I c.\T[ OF OCCUI'.-\\CY I! .
1'1;1:.'; r ~;i:S.
"',,"'0 ,,'" '''''iAp
Slgna,."re UU .
DUlIn;'"'' 11.\.1.0\' ."'~l"(V".I'n
. ...... .'1.' L. I If J " .\1, '" . "I
..\LL :':01::: : :~j.:;.~ !~i..: (l.";.'.;;ll.::';-U"
.1Ii Idill;": Ir:spcctioll has bCL'Tl
IS5iiCU CY Till: CUILlJl\G
rL.\~:s Sii.-\i.L .;~E:~\!.\
r~: :\CG}:::),\:<C!: I': I T!!
c:?.dII'I'~"L'-2~7' ~ '7 ~tQ.!J
~=17~___o",e_.--%!.- .?-* -S?~
G:,: TilE E[jIl.DI~~(~ SlT:>-;\T ..\LL TI:<::S, (\\[)
TJirJSr :'d'I':.'C\'[{) rL..\:~:?
:-:.JTE: ;\11 ;:;aJl:'ule~ :Jrld Cll':lllC~CS are to be ~h!.illStL'J :It ;10 cost '."' the Ci:y.
p, Oject ::u~ber: 7'7..1i.5'2;;<'
Le9al o..scrt~\!on: i'7 -07.. -. - 3 J
o~ner:YI'.fYI1//tS I"lf) F'OI/P /r}/J! 1^lfll~<;
Designer: Ow jlUJ,\,r
COI;tractor: L...I<, .3IJ/k'S()\A('". - PO Eo~ d)1o (c"5 EU{)('~YU..
J
70.. X 1-01 fo~')"T>t,
REQU I RE:':ENTS
Planning Co..";ss;on: Reference: '-;:;>r;l. --r s- ~S'1
iPlan SUbm.itted: /-,.::J - /q,~'()
Phone Number: 7~7- 7,.c::;(nA/
.Ohone NUr.lber:
/I
Phone Number:L/f!5-,"'),=<,</f5
eRA -\-oC-Ll..J
To be done before permit is issued:
(I) {')e(II'c()+I~,\f\ f.:lS' ROW~"\M ce,'At-<,v-( I~' N"\r~ /\."<,{."...,p+
(2) .c;' Pl)F =l- :s~deu)a.\\( pn"-"~,^-\- 1-J0"",, '/I"Sh-at-
(3) S\',.,."I- i 1911~ aev-ee.w-en-\- n \"'rtv1~ AI<':)tv-p,,\-
(4) I"", r.....""Jf'IN\.l'.V\'\- 9.']lrl"p\IY\,;lJl\+ ~('\V.t1^ 'A" Sh-n t-
To be done before occupancy:
(I)":~V-~\V1j le;-\- '~~ .QJl"l";^';---Vl"."",1(V'\'e(l+In\^fkfOo,r~te Accomplish"d:
(2) ---= - Qate Accompl ;sh"d:
(3) Qate Accomplish.d:
(4 )Qa te Accompli sh.d :
Site Plan Rev;e~: Reference: <; R 80 - (') ~
/- 7- FIlM)
..
Qate Accompl ishEd:,.;J ,,;:1 (- ) '1::;' 0
Date Accompl ishEd: c?-,.:;! /-/9;;;'0
Date Accompl ishEd:~ .;:)( -) "7hO
Date AccomplishEd:
To be done before permit is issued:
, '
(I) 10' f'>()i" rt.o,,,,,a\ WI',A SleU --In.v L"'+- (,.~O[, Date Accompl;shed:
(2),-.,r,' -"""Vl",l-vr)(:/-;~'V1 ea5I1Ap",~ l^f~<f"";cl 'hu u.r/;.SD(~ Date Accomplished:
(3)
(4)
To be done before occupancy:
(I) P0.\rJ,(, v:~ /-of- -I-r, MP
(2)
(3)
(4)
~+Hr"ri-f t:lnl!l' {~{((Ulrh o'r
l.P>"ee\ sfcp!> ,
Minor Partition Review: Reference:
To be done before permit is issued:
~ .'\.".
(I)
(2)
(3)
(4)
To be done befor2 occupancy:
(I)
(2)
(3)
(4 )
--"- -,---
.....
Oate Accomplished:
~ate Accomplished:
Date ~ccomplishcd:
Qate Accomplished:
Date Accomplished:
Oa te Accomp 1 ; s h(~d :
Date Accompl ishtld:
Date Accomplishl~d:
. Dat.e_Accomelishl~d:
Date Accompl ishl~d:
Da te ACCOiilP 1 i Shl~d:
Date Accompl,ishl~d:
Date Accomplishf~d:
Date Accomplishl~d:
..;... . ~,
S~MP,t>ij
'I !rISPECTIOr:..~
716-3769 .
-
I\OT:;:. FF:R 2Q 1$80__
CITY UF SPRI:iGFI'[LD" INFOIUIATlON ll.k
COIIBI:lATlON APPLICATION/PERMIT 716-3753
EilERGY SOURCES: Sq. Ftq. l'lain /7.7.:1
Heat-0,q.S El EL~ ~q. ftg. Access.
Hater Heater . Sq. Ftg. Other
/ flew<1Add Alter Rep.
i Ranqe_ ....r.--. U'.) Fenc _Demo_Change/Use
ValuE of Hark: 2.l.../\-.A--'. _Other
$28,889.00
BUlltllnQ Permit Info: Descnbe Hork( i.e., BU11d Single
747-7 }fiaelilv nesidence Hith Attached (jaraae'
..--
Job Address5344 Main st. SprinC'field. Ore.
Construction Lender Veterans of ForeiaIl Nnr~
Address 534.1 Main St, SprinGfield plo~.7-75G4,
Ut~luU ItAf1 (name I !address I
Primary Vetp-rar1~ of ForeiqJ"l---1lar~ SnriI'l('f-F; pl n.
'--.-J
interior' fini~h)
~
01
I
ilJl
~
Legal Oe~cription
...ax Lot 6506
Map No,
17 02 33 31
Owner Veterans
.5~4'if5Main'St.
of Foreiqn WClrs
Sprinqfield. Ore Phone
747-7564
(lics.no.)
Orf'gorfi,
{exnires}
(ohone no. \
747-7'il;J
Structura 1
Sane
Electrical
Same
(t~:;'R~.CTG:1S
(na;;:e}
(address)
(l iet;. no.
(pxoi r'f"C; r
(qhonp' nn.~
..
=hi::,:bir.t::
"~
I
I
I
I
I
General
~jec':.rical
"~r:~~"~-::~l
~~~cn s~nqie fixt~re
i CHf..RGE
I
I
I
I ~Jn
I
ELECTRiCAL
MECHAflICAL
?LU~mw::;
'_..1
r:c;:
. r:HJ1RG.;: ~JO.
. FFF"
r;lt,t;'f,Fi
SQ. FT.
furnace/burner to
BTU's
Residence of
.?ejoca~2c ~uildir.~
I (new fix. ddditional)
I'S.F. ;'esioence
f1 bHh1
Duple, (1 bath) each
New circuits aits.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
C;otl.ca he~ter and 'Ipnt
Additional bath
I~Jater service
I Sewe r
IStorm Sewer
Tenporary Construction
Change in existing
rpc: j dPJu.p
multifamily. comm. or
TndlJ<;trial
Apoliance vent
SP'l}arate
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent syste~ apart from
heatina or A.C.
Mechanical exhaust
hood and rlUl"t
I
I
I
I
Of amps.
I cor.Ut.IIND. FEEDERS
Install/alter/relocate
4i<;trih. fpe~prc;
Wood stove/heater
Of
amps.
ISSUAIICF OF PFPJ1lT
TOTAL CHft.RGES
WHERE STATE L~W REOUIRES
shall not be valii until the
TOTAL CHARGES
, TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor. the electrical portion of this perrilit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXN1WED 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 ~ertainin9 to the work described herein, and that He OCCUPAllCY. will be made
of any structure without the permission of the Building Division. I further certifYt.that my registration with the Builder's
Board is in full force and effect as required by DnS 701.055. that if exempt the basis forJex~ion 1S noted hereon. and that
only subcontractors and emnloyees who are in comoliance with ORS 701.055 Wi~l~?be "sed onf/this~6ro ,rt. .
. -iff tI ~ /' P' -'"
~. ~. (
IIAnE(please print) Le..~f(-I' ,1/ ();kd -rei f-. SIG:IATURE DATE/O ~.J~--SO
. j
FOP. OfFIC~ USE Oiil Y
Sq. Ft!].
Sq. Ftg.
Sq. Ftg.
Zone (1 -4-
Fire-~ne --rrr:
Flood P1ainjdD
Tyoe/Const. V-IJ
Units I
Occy Load ~t)
Occy Group - '3
114 i n-1 1 7,'(.
Access
Other
x
Value
Value
Value
Bedrooms
x
Stories
x
TOTAL VALUATIDrI
?ro{J 00
. t7-(j-e-e
. _b---:AAn-
PlUl1BHIG PERI~IT ~Fe~ I 0 ~';.9-
Charges and 1k -----------
Surcharges ".w~ 0,4,9
Plan Ck. Comm/Ind
65%/81do Ppr Fpe
Plan Ck. Res
!?~/~l~a Ppr Fee
Fence
. Sys tems Deve 1 opment I
Charoe (1.5~)
BUILDUlG PERfllT
Cha rges an~
Surcharges
Of-RIO
ElECTR IC..l PERr~ IT
Cha rges and
Surcharges
Sidewalk
TOTAL
~ / O. 43
~ <57J
..__..~_.___._ .-__0"
AIC Paving
Total Comb. rermit
MECHANiCAL PERMIT
Charges and
Surcharges
Curb Cut
.---)
,..'......,
.....ol....-c -.,...,.~~_...,"'... ~"'r
./"
1!t~.J
.,
,
":f ~~.~I,~'~~.~~~.:v;lJCATJON/PERMIT (CAP)
I. Applfcant to furnish
A. Job ~ddress
B. Legal Description
1. examole- Tax Lot 100, Lane County Map Reference
II OJ .3
2. examole- Lot 1. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ceiling/or forced air Qas
2. exam~le. waterheater/electr1cal/or solar
E. Square footaqe or valuation, etc. -
I. examo.le- 1250 sq. foot house. 500 sq. foot garage
l. examDie- if new project. check-nfw - if addition.
cheCK add, etc.
F. Building pernit information:
1. exar.1~le - cons:ruct single .family house with' an
do t.:.:!.cr.ed gar~ge
exa~~le . re~odel existing garage into family room
exa~Jie - convert single family residence into
restdul'Jnt (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Soecialty Code
H. OE51 G:: TEAI.I AlIO 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. Abbreviat~d ?lur.:bing, :.lechanical, & Electrical Schedules
A. :xceJt where biank soaces occur in the description
=or:ion of t~e Mecr.anical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
t~ tne aODro~riate item(s) to be installed
8. full Plumbina, ~echanical. and Electrical Schedules
are available at the Suilding Division
1. To conserve space en the permit form the schedules
have been abbreviated
2. !f the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILDI1:G DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES 0,', THE SCHEDULES
O. As nated'on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
sUDervisor. The general contractor is not authorized
to sign the electrical label. -
[II. Applicant to sian 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 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.
-':1::.2.
PERMIT VALIDATION
'.
!
j
.'
I
,
j
J
"
. - -.~..
.
I
j
I
I
'J
1
J
,
;
2.
3.
l
I
V. FOR OFfICE USE ONLY
Permit Cl erk
r
i
PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY:
i
1
1
.1
!
i
Permit appl i cant exempt from l"eg i strati on with the Buil der' s Board because:.
I
I
!
j
I
Additional Project information:
,
I
PLANS REVIEWED BY:
name
signature
date
-,
'-...... -, -~..'
.:..._-,.......~~...<" .
}o-<,_ll-'
, ~.-
. .
-_..~....-..~~ -' _....~~...
. : .~..'\
-
I HISPECTlOII-~;" .
726-3769 . .
FJ::R .2 Q l!lBO_
NOTi~
CITY U, SPRliIGFIELD
COMBlilATlON APPLICATION/PERMIT
Job Address5344 Main St, Snrinafie1d', Ore.
Legal Description Tax Lot 6506
Map No, 17 02 33 31
EilERGY SOURCES:
Heat tafl.5 If EL~
Ha ter Hea ter
Range ___-.._
ValUE of Hark:
of Foreian Wars $20,000,00
BuilriinQ Permit Info: Describe ~lork(Le.,
Snrinafie1c1. Ore Phone 7 -1 7-7 )~ilv ~esidence Hith Attached Garaoel
Construction lender Veterans of Foreian TrJArR
5344 ..' St co .' f; 11 747-7564
Address l"Ja~n, .,pr~na .~e ( PHone ~
Ul:.~lliN It.AU (namel !addressl
Primary Veteran~ of Foreian t'1flr~ Sn,...i nCT-F;~' r1.
Owner' Veterans
S~4'7fsMain'St.
Structura 1
Electrical
f1echanical
CONTRACTORS
(namel
General T.~ T(~ ,,-Ta~k~nn ("'0_
Plumbino l<,T,...rIo....
I Electrical
f,1echanical
None
None
PLUIIBIIIG
NO.
FEE . CHARr.E
Each single fixture
IRelocated building
(new fix. additional)
IS. F. Res i dence
(1 bath)
louplex (1 bath) each
IAdditional bath
I ~Jater servi ce
I Sewer
IStorm Sewer
'.
"
I
I
I I
I ~I
Lf I
A I
^,m I
f/'( I I
/V I I
I I
I I
I I
747-7564
Sane
~;'Imp
Same
(address1
P. '0. 1lf'l" 2fil1
Eugene, Oregon
INFORlIATlON LINt I
726-3753
Sq. Ftg. I,'ain J7.:l:l
~q. Ftg. Access.
Sq. Ftg. Other
~ew)(Add Alter Rep.
~FenC1 Demo Change/Use
Other- -
~
UI
(j')
~
Build Single
141' X 42' ShR11 f'l"lv nf'l
interior' fininh)
(lics. no.)
I
(ohone no.\
(exoires)
()rpannn .
747_'1';1;.1
(lics. no.1
(pxoire~)
(ohonp nn.)
1 1.3];1
97402
111JlLJll1
485-51Ml
ELECTRICAL MECHANICAL
Nn ccc r~AR(.';1=' NO. CCC r1-lllQr.r
Residence of furnace/burner to /
SQ. FT. BTU's
~ New circuits alts. I/5.'O{i' Floor furnace
. or extensions t!.. and vent
:J.l'llZ. All 012.
I SERVICES I I Recessed wall ~1
~nnrp hPntpr nnd vpnt
I I I
lTemporary Construction I I Appl iance vent ~ I
~eoaratp I
!Change in existing I i I I Stationary evap. I
res.idf'nci;' cooler
Imultifamily, comm. or I r! I I I Vent fan with I
Tndustrial sinale duct
IOf amps. ..IF I I I Vent system apart fro I
heatina or A.C.
I COI~'I.II NO. FEEDERS ff I I MeChanical exhaust ~I I
hood ,lnd dud
I Install/alter/relocateyl I I \'lood stove/heater '1 I
rli<;trih. fppdprc;. I
IOf amps. I - I I I I
I I ;Z I ~f+~ .1.,.rU(l~ I-I.( 11",01.:z.C1t:.
I I I :t""""...u- III' &11'- ,aM..r I~.oo
I ISSUANC, OF PFR!HT
TOTAL CMARGES TOTAL CHARGES /$.O{) TOTAL CHARGES . "l tJt'J
WHERE STATE L~W REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
Val ue~ .-;"iJla. ~iJ
Value
., G..;20
I 5'"l.'&0 pO, c.u.J
13,-,1./0"- Stt'::'.
I
I
I
I
I
I
Value--1..n. 7/.!':"~
TOTAL VALUATlOI' "'lj;J. 7/. 7.$-
'Joq.OP,
I HAVE CAREFUlLV EXArl1NED 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 rw OCCUPAIKV will be made
of any structure without the permission of the Building Division. I further certify that my registration with the B~ilderls,
Board is in full force and effect as required by ORS 701.055. that if exempt the basis for exempt' is noted hereon. and that
only subcontractors and employees who are in comoliance with ORS 7nl.055 w~sed on this p . ct.
1lAf.IE(please print) L, K. JaCkson r"mnanv SIhllA ~~ -;:(!-
FOP. OFFI~E DIlLY ?f3 /
Zone C -l{ Type/Const.~ Units -- s~./tg. 11ain j. x
Fire Zone~ Bedrooms Occy Load~1J SQI'Ft9' Access x
Flood Plain_NO Stories I Occy Group....F-"> Sq. Ftg. Other ;/3.Q:23 11<. x
Plan Ck. Comm/Ind
______l~g~_ 65%'Rl"~ po. <00
Plan Ck. Res
.5:92 30%/Bldo Per Fee
I Fence
------------, D~mo
lS"'o I Sidewalk
------- ,(ptJ I A/C Pavi.fcfJ""5'.,f'
_ _ _ _ _ _ _ .fS..OC?_ Curb Cut
,;;0
BUILDING PERI-IIT
Charges an~
Surcharges
PLU'1BING PERMIT
Charges and
SurCharges
L
ELECTRICAL PERI:IT.
Cha rges and
Sur~harges
MECHANICAL PERMIT
Charges and fORs
Surcharges
Syste~s-Developrnent
Charo' (1.5%)
IDVLDN Pl,fJ1Jc.K..
I
I
.1l1".~f'1.
ITotal Comb. Permit
SI..oo
.,a ~O. '1..1
s?" q 7t,.;).0
I
I TOTAL
.
.,
.~
.,
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
~. Legal Description
I. example- Tax Lot 100, Lane County Map Reference
II 03 4j . ....
2." examp 1 e- Lot 1. Block 3, 2nd Add iti on to
~pr1ngt;eld Estates I,....~::
C. Name, etc. of owner and construction lender
O. Energy Sources _~" I'
1. example- heat/electrical ce;l;n~/or forced air QdS
2. examcle- waterheater/electr;cal/or solar
E. Square footage or valuation, etc. -
1. example- 1250 sq. foot house, 500 sq. foot garage
2. exa~le. if new project, check-new - if addition,
cnecl< add, etc.
F. Building permit information:
1. example - construct single family house with an
a ttached garage .
2. example - remodel existing garage into family room
3. examole - 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 TEAr.! 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 scnedules 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. ---
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
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:
p,,., p,'-;n O,J.-4,-" p~
(f' .
Pn,v'''':2J OJ- ~ \0'\-:-,1.1)
.
'. .~..~. --~~\~
,.'
.................. .... .. -..---..
. . I
TV OF SPRINGFIELD (I
City Hall
Springfield. Oregon
Department of Public Works
O.FFICIAL RECEIPT
No, B 52921n
Z.2A lRD .
;om\\t\~-~\'- ~,~\.fu '\~( t.
. tn3~\.\: m" '^ d-. .
-.
~ For~ ~'Cl\ \~~
l:J l\9n K f{ "2-
('.C\ (l:tf:. \ 5.0 q,
'--"-\ \..\9() , tat,L c.
,-ffi~~ ~.oD
l\91l ; W Ct
if) - ( q./:L/..fO
tl- ~topo
. ,.., ffi ,Of!
(I
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Ct
/
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Received .L{J] o. ~.P - ~
~'
.v,'o"';~,
(1
"U~TO".TU.".I.~~ ......fI.' . ~uo~,,~, o. '7"0'
..."., c.
<I
Permit Clerk
. J
ill 00.. IImK\h ".-,...01 (f'lLJ"'U\cl- O{V,/\t1\..o\.cr> '""'~ \ "'^ "R-ol-78-3S':U
v 0 ~I ~ . , ~, . .
."th""~ -\- (,.,"(JJj^I':/f1..h.d&-br^-- ron_:>-Q 80-02,
Permit applicant exempt' from registration with the Builder's Board because:
Additional Project Information: ~ ~~~ zf~'~' .e,4~
~~r'~ ;:.t;;:,'A.A -,-f)~, .'
'111J'~ /_~ ,t:/./~ ~() ~.:vt....AL4#/.A,JJ
6
PLANS REVIEWED BY:
name
signature
J)~ L__:rj-->
date d ~~ ,s--l<"o
..f
Ow:ner' Veterans
5~4'ijiSMain 'st.
f\:OT;pe . FI=:R 2 Q l~BD_
CITY OF SPRI1lGFIELD -' INFORlIATION LBlt
CDMBHIATlON APPLICATION/PERMIT 726-3753
-. EtlERGY SOURCES: I Sq. Ftg. "'ain~.7
Job Address5344 Main St. Sprincrfie1d. Ore, Heat..1Of1.5 H E~ ~q. !'tg. Access.
. Hater Heater Sq. Ftg. Other
Legal Description ",ax Lot 6506 New)(Add Alter Rep.
Ranqe ) -Fen~ DOmo ChangelUse
Map No, 17 02 33 31 1.. ~ u'
Va 1 UE of Hork: ,'-"-'-' . Other - -
$29,9ge.eQ
Builciina Permit Info: Oeser be Hork(i-.e., Build Single
Sprinqfie1c1. Ore Phone 7-17-7~6alhi1v Residence Uith Attached r,araoe'
. ,
-
. -....
.:
.....(...
'llUSPECTIOIl-~ .
726-3769 .
Construction Lender 'Veterans of Porp.:icrn t-T::\rs
534'1 .' S S . f. 11 747-7564
Address 'Ma~n t,. pr~ncr .~e C Plione
DESIGN Tt:AI1 (nameJ laddressJ
--...
interior' fini~h)
~
UI
(j')
I~
of Foreicrn Wars
747-7564
(l ics. no.)
(exoires)
(ohone no'-)
Primary Veteran's of Poreicrn \'liU:-~ Sur.illrr-Fi <"J.d.. Or<"O'orli,.
7..A:L=.:.1 ~.i L ~1
Structural
Sane
Electrical
c"t~Ii'R:A.CTG.:fs
(narr:e)
SaMe
(address)
(l ir:'i.. no.
(pxni res r
(ohone nn.)
Genera I
Plu::;biTi~
ciectrical
"-:r:." ~ ~ i tal
?LU1$ItlG
ELECTRICAL.
I MECHANICAL
i nHIRr:::: NO. I
I n'~
I
I "'IIIH.\r.~ ~
FEF i CHAR(;E
NO ! I F~
I Res idenc: of
SQ. FT.
New circuits alts.
or extensions
furnace/burner to
BTU's
Eacn singie fixture
~ejocatec ~uildinQ
(new fix. additional)
Floor furnace
and vent
S. F. Res i aence
(I bath\
Duplex (l bath) each
Additional bath
SERVICES
Recessed wall
SOnrp hPntpr nnn vpnt
Sewer
I Temporary Construction
IChange in existing
rpc;; i qp_nrp
multifamily, comm. or
lndu<:;trial
. Storm Sewer
Of
I COI'~1. / HID. FEEDERS
I Install/alter/relocate
di~trih. fppnprc;;
10f
amps.1
Appl iance vent
seoarat~
Stationary evap.
conl~r
Vent fan wi th
sinole duct
Vent system apart from I
heatino or A.C.
I Mechanica 1 exhaust
hoar! and duct
I \'Iood stove/heater
~Iater service
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 oerformed shall be done in accordance with the Ordinances of the City
of Sari ngfi e 1 d and the laws of the Sta te of Oregon oerta i ni ng to the work. descri bed here; n, and tha t flO OCCUPAIlCY wi 11 be made
of any structure without the permission of the Build1ng 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 ~ereon, and that
only subcontractors and employees who are in comoliance with OP.S 701.055 will be used on thls,pr~ct. .
HArIE(p!ease print) Le..;;J(..p t'f (};k.d -rei. f-. SI"ilATURE I[:~qf i5t;~ DATElof --,2'ii-yO
FO~ OFF I CE USE DriLY
Sq. Ftg. t14in
Sq. Ft/]. Access
Sq. Ftg. Other
Zone (l -A-
Fi re - ~ne -r7T
Flood Plain /dD
Tyoe/Const. V-kJ
Units I
Occy Load ~
Occy Group - - ~
1/7,'7,
x
Value
Value
Value
Bedrooms
Stories
x
x
TOTAL VALUATION ?rYJn Oti
BUILDING PERMIT
Charges an~
Surcharges
'<70 00 PlanCk.
':k__~. ______ 65%/Blda
n Plan Ck.
. 30%/BldQ
. - I Fence
Comm/l nd
Ppr Fpe
Res
Pt:'r Fpp
Systems Development I
Charo. (1.5%)
PLUI~BHiG PERHIT
Charges and
Surcharges
Demo
ELECTR IC?L PERr~ IT
Charges and
Surcharges
f1ECHAN ICAL PERH IT
Cha rges and
Surcharges
Sidewalk
AIC Paving
Total Comb. rermit
TOTAL
to, 80--'
-. ~-
Curb Cut
. . .. .
,
....\: .
.(
-
'.
. .
.-
COMBINATIDN APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
,
1
1. Applicant to furnish
A. Job Address
B. legal Description
1. examole- Tax lot lOa, lane County Map Reference
1/ U3 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 Qas
2. examJle- waterneater/electrical/or solar
E. Square footage or valuation, etc. ------
1. examoJe- 1250 sq. foot house. 500 sq. foot garage
t. examOle- if new project. checkr;ew - if addition.
chec~ add. etc.
F. Building peroit informatiol1:
1. examole - cons~ruct 5ingle family house with an
iittached garage
2. examole"- remodel existing garage into family room
3. examoie - convert single family residence into
reStaul'.lnt {change of u-se}
G. Value of work as defined in Section 303 (a) of the
Structural Soecialty Code
H. OES I Gil TEAi.[ Aim 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. Abbrevlated Plu~bing. Mechanical. & Electrical Schedules
A. ::xceot \'Inere blank spaces occur in the description
~:)rtion of the :'lechanical and Electrical Schedules.
the applicant need fill-in only the No. Boxes adjacent
t~ tne aopropriate 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 ANO
CHARGES ON THE SCHEOULES
D. As noted"on the CAP. the label must be delivered to the
electrical contractor for signature by his electrical
suoervisor. The general contractor is not authorized
to sign the electrical label.
III. Applicant to sian and date
Whenever possible. the initial application will be used as
a worksheet only. Where possible. Building Division Staff
will orepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signature.
TV. 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
Permit Clerk
-~ . .
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt frQm registration with the Builder's Board because:
l
j
Additional Project information:
~
?
.
PLANS REVIEWED BY:
name
s i 9na ture
date
cln Of SPRIIlGflELD INfDR/IATlON UII"
COI1BHlATlON APPLICATION/PERMIT 726-3753
E!IERGY SOURCES: Sq. Ft9. 1.lain /7.:7.:1
Heat r;,A5 a: ELEC.. ~q. Ftg. Access.
Hater Heater Sq. Ftg. Dther
Uel<iXAdd Alter P.ep.
Ranl'le ~ . . __ _ ) -FenC1" Demo Change/Use
OCO D' - - -
ValuE of l'lark: 1., . _Other
of Foreian Wars $~:,::~
BUllc;ina Permit Info: Describe \-Iork(i..e., Build Single
Snrinafielc1. nre Phone 7.17-7::ifilmilv nes;dence l'lith .A.ttached Garao:.l
, .
,-.
I FISPECTIOIl-~
l!26-3769 .
Job Address53 4 4
legal Oe~cription
.
...or
. ,
. ~ ; . ~ (' r
~O'T,~
FrR Q Q 1980__
":'ax Lot 6506
Main St. Sprinqfie1d, Ore.
Construction lender Veterans of Forp.:icrn I'1ArR
5341 . S ~ . f. 11 747-7564
Address ,Ilaln t. "prlnq .le ( P~one
UI:.~luU f!:.Atl lname) (address)
Map No,
17 02 33 31
Owner' Veterans
5~4'ifsMain'St.
747-7564
I~
KJ\
Irj]
~
----
interior' fini~h)
(lics. no.l
(exoi res)
(ohane no. I
Structura 1
Primary Vp-tp-raii~ of Foreian t'lAr!1 Snr~n(l-Fi 101 n _ ()rprrnril"l
. Sane
I
I
I
I
I
I
j
I
I
I ISSUAIICf nf PfR'HT
TOTAL CHARGES I TOTAL CHARGES I TOTAL CHARGES
WHERE STATE L'H REQUIRES that the ~lectr;cal work be done by an Electrical Contractor, the electrical portion of this "pernit
shall not be val;i until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXt~lINED 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 Orel]on pertaining to the work described herein. and that rlC OCCUPArlCY will be made
of any structure without the permission of the Guildjng 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 exemntion is noted ~ereon. and that
only subcontractors and employees who are in com~lian.ce with ORS 701.055 will be used on thls~o~. ct..
11AI.IE(please print)Le.-2J(~ Ilf(!;hc rd...... h._.. S[r.llATUREh4:Vqffi;l~~ Dmlo' ~;;,?-'jO
fOR nffICE USE OllL Y 1
So. ftg. l1~in--flZ-'7, x Value
Sq. Fta. Access x Value
Sq. Ftg. Other x Value
Electrical
c"t~n'RtCTG::fS
(narr:e)
General
\:1u::,:bir.':
~iectrical
"':!O:~~"~-::!l
?lW$IrlG
1" ~t i rHf,Rr;F
:~acn sinqie fixt~re
)-
;?eioca~ec ~~ildino
I (ne'~ fix. addi tiona 1)
I'S.F. 2esioence
f1 b,uh)
Duplex (l bath) each
Additional bath
I ~rdter
Sewe r
service
. Storm Sewer
Zone r' -4-
fire-ZC;-ne --rrr
Flood Plain_f.. II)
Tyoe/Const. V-IJ
Bedrooms
Stories
7 <17- 'hl;.~ .
BaMP
(addrpss)
(l ics. no,
(pxnirpc;.)
(ohone no.)
ELECTRICAL
1
MECHANICAL
NO I
Residence of
p:; i n~ARr,~ !!rL
I
1=1=":: 'fIL;.Pr.r.
furnace/burner to
BTU's
So. fT.
New circuits aits.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
SOALP heAtpr ~nrl vpnt
Temporary Construction
Change in existing
rpc;.iqenrp
multifamily. camm. or
InrllJc;trinl
Apoliance vent
seoarate
Stationarv evao.
cooler ~ .
I Vent fan wi th
sinole duct
Vent system apart
heatino or A.C.
MeChanical exhaust
hnod i1nd rlurt.
Of amps
Icm,U'I./IND. fEEDERS ".
Install/alter/relocate
rlic;.trih fpprlpr,
from
Wood stove/heater
Of
amps.
Uni ts I
Occy Load~()
Occy Group ~~~
TOTAL VALUATIOII
7 rYJn Or,
BUILDHlG PERflIT
Charges an~
Surcharges
. '7'0 00 Plan Ck.
. ~ . 651/Blda
. -----I)-n----- Pian Ck.
rJ . lM/Rltjf1
.. ~.-
Systems Development
CharQ. 0.5")
PLUl1BING PERHIT
Charges and
SurCharges
ELECTR I CP.L PERr~IT
Charaes and
Surcha rges
IIECHAIIlCAL PERHIT
Charges and
Surcharges
-
Conrn/lnd
Ppr Fee
Res
p"'r I="pp
Fence
Of-mo
Sidewa 1 k
AIC Paving
Total r.omb. rermit
Curb Cut
I
I TOTAL
to, 8P J
... . ~ .
e
,..... &
.
~ . . .
I
,.. ... '. .., ~
COMBINArrON APPLlCArrON/PERIIlT (CAP)
I.
PERMIT VALIDATION
II.
Applicant to furnish
A. Job Address
B. Lega i Description
1. examole- Tax Lot
11 03 43
Z. examole- Lot 1. Block 3. 2nd Add'"
~prlngtield Estates r
C. Name. etc. of owner and construction \~r
O. Energy Sources
1. examole- heat/electrical ceilinQ/1
2. exam:)le- waternear:er/electrlcal/Ot ~..I.
E. Square iootaqe or valuation, etc.
1. examo]e- 1250 sq. foot house. 500
? e~amoje- if new project. check-new
enee!: add, ete.
F. Building pemit infonr.atioJ'1:
1. exar::!Jle - cons::ruct $ingle.. family h
at::lcnea gdr~ge -
e~a~!Jle.- re~ode1 existing garage if
eX~m~ie - convert single family resi
rest~UrJnt (ch~nge of us~)
G. Value of work as defined in Section 303
Structural Specialty Code
H. DESIG:: rEM.l AilD CONTRACTORS
To avoid design or construction delays, B
Divisior. Staff must be able to contact apl
perscns regarding design information or j(
corrections. etc.
~bbreviated ?lu~bina. Mechanical, & Electrical
A. :~ce't where blank soaces occur in the des,
=~r:~on of t::e :'!eciianical and Electrical St
ene d?~licant need fill-in only the No. Bo~ (~~-
:~ t~e aooro~riate item(s) to be installed
B. Full Plu;;;Dina. r.!echanical, and Electrical S.
are available at the Building Division
1. To conserve space on the permit form thE ~hF_
have been abbreviated
Z. If t.he item(s) to be installed are not CI
the Jbbreviated schedules you should con~ ('
full schedules
C. aUIL9EIG ilIVISION STAFF WILL FILL OUT ALL FEE
CHARGES 0,'1 THE SCHEDULES
D. As noted.on the CAP. the label must
electrical contractor for signature
suoervisor. The general contractor
to sign the electrical label.
Applicant to sian and date
Whenever possibie. the.initial application will be G
a worksheet only. Where possible, Building Divisio
wi 11 prepare a type Ir/ritten copy and return it to tl
applicant at the time the actual permit is issued fl
signature.
Fees and Charges
Plan check rees are due and payable at the time of tl
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.
lOa, Lane County Map Reference
OF SPR\NGF\ElD
CIty Hall
fl Id Oregon
Spring eol' public works
Department C E I P T
OffiCIAL RE No, B 55033 C
( oo.~ ,Q-;j;i U~Ul~(
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Permit Cl erk
V.
FOR OFFICE USE ONLY
I... _.". . . ,.."
. _ --.,... .., _ . u. ~, , a... I. . .
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,
I
I
'.
Permit appl icant exempt from registration with the Builder's Board because:
I
Additional Project information:
I
~ .. .. .'.' u .. __ .. _ ,,_ _".. ..
- ..1
1
PLANS REVIEWED BY:
name
signature
date
. _.0... ..
. .. ,.,. '-..'
"