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Home My WebLink AboutPermit Miscellaneous 1981-7-28 INSPECTION L1~E-. ~ CITY OF SPRINGFIELD 72~769 ,......\ ,. COMBINATION APPLlCAflON/PERMIT .-. 1. mA~A.l ~e.\- '~""" '/Iii_ "?,j,.. -fi1 A2A? Job Address ~r.1 ,4 ~ '.901 Dmdpt;on)>",,.y- 7.t-.. fb4>. /'7-o2-?:3- 't . INFORMATION LINE 726-37 S3 ~~. ENERGY SOURCES: Sq. ftg. Main 2~ Heat Sq. Ftg. Accen. Wgter Heater Sq. Fig. Other Ranqe _New_AddXAlter_Rep. ~ ~olue of Work: 1__Fence_cemO_ChangefUs. #15J060 .00 _0',., Building Permit Info: Describe Work (i.e., Build Sing I. Fomil... Resid,.nce With Attached Gorace) c~ E: n ..:::so\-\D (~~raVl.V 722~ M,T:: ~ ~.ll.~ vAACcu.\rt."] Wl~,,&'u Construction lender Owner Address ~~6T~~4iMcF ~L ~ tt:. '5nt:>RwS. ~c.tE ~~~ Address Phon. DESIGN TEAM (nome) (address) (expiru) (lies. no.) Primary Ai2c.\\ i"\ELtS Ass~..1/~1'!u-e. , ?(aJ~ 1Iu.r=.. H<oLl i&.U..A.ueJ I ,.tQI.L(Q.,.." ~. Structural Electrical Mechonicol rnNTRACTORS (name) (addreu) (lies. no.) (expires) G..neral C.. E. ~,",l\) Co,^~oV\ 17V/N R'YEfl~ rt.. 7!c-' . A -..IL- ~ ,,~ MECHANICAL Plumbinq Electrical Mechanica~~')~~r~ PLUMBING ELECTRICAL I NO. I I feE . CHARGE NO. " s:- 7a=-1 Residence af Each single fixture s~: ft. I Relucafed building I New circuih. alterations (new fix. odditional) or extensions I S.F. Residence I (I bath) SERVICES I Duoll!!K (1 both) each I Temporary Construction I Additional bath I Amps. I Water ,.rvice I I Sewer I Storm Sewer FEEDERS Amps. -:200 FEE CHARGE NO. I furnace/burner to l';l~.~ ll.TU's Appliance vent separate Stationary evap. cooler Vent fan with single d;Jct Vent system aport from . heating or A.C. Mechanical exhaust hood and duct Wood stove/heater Heat Pump 15:60 Air handler to 10,000 CFM Air handler over 10,000 CFM I c;~.S l}P/hG.-,-: I I I I r I TOTAL CHARGES I ISSUANCE OF PERMIT JJ~; ""'" I 'O'A' CHARGES /~-:.:>o TOTAL CHARGES IX:) (). ~ '\l N ~ (phone no.) '7R/lJG>.<:" (phone no.) FEE I CHARGE I 17.;0 I s.:- z. "'.. /0. ..... 2.2. ~o WHERE SlATE LAW REQUIRES that the Electrical work be done by the Elc("~rical Contractor, tho .Iectrical portion of this permit shall not b. valid until a label has been signed by an Electrical Contractor and attached to the eledricol panel, I HAVE CAREfULLY EXAMINED the completed application for permit. ond do hereby certify Ihat 011 information hereon is ttue and carred, and I fUrther certify that any and 011 work performed shall be done in occordance with the Ordinances of the City of Springfield and the lows of the State of Oregon pertaining to the work described helin, and that NO OCCUPANCY will be mode of any structure without the permission of the Building Division. I further certIfy that my regiSITotion with the Builders Board is in full forca and effect as required by ORS 701.055. that If exempt the basis for exemption is noted heron, and that only subcontractors and employees who are in compliance with ORS 701.0.55 will be used an this project. Bo,is for Builder's Board exemptiohl SIGNA'URE ~h~ dlvp-.- FOR OFFICE USE ONLY /" (.- .~---- NAME (please print) VIA .,',1'" l=:::l IA.N-'f C-'I Type/Const,~'" 5edrooms~ . J ;2""":> Unih _Sq. Ftg. Main f'lccy Load _Ll~ Sq. Ftg. Access "ccy Gtoup--,R-7. Sq. Ftg. Other Value Value Value TOTAL VALUATION Zone Fire Zon.--'Y.:....A . Flood Plain_.No x ~foriet BUILDING PERMIT Charges and Surcharge, plan Ck. Comm/lnd 65%/ Bldq Per Fee Plan CIt. Re, 30%/ Bldq Per Fee O/~. SQ Systems Development Charqe (1.5%) 7Z'.~ "2.88 3<::). ..... /.-:2<> 1::;-. 0_ PLUMBING PERMIT Charges and Surcharges Fence: Demo Total Comb. Permit elECTRICAL PERMIT Charges and SloIrcharges Sidewalk I A/ C Pavina <So MECHANICAL PERMIT Charges and Surchargu .___2"Z.sO _, /f~ I TOTAL I Curb Cut DA'E~!fl,( /~_aoc::>. oC> /.~o:x>. co . } '-15. os, /<1/,.88 , - COMBINATION APPlICATION/PE. (CAP) . I. Applicant ta furnish A. Jab Address B. legal Description 1. example-tax lat 100, Lane County Map Reference 17 03 43 2. example-Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D.. Energy Sources 1. example-heat/electrical ceiling/or forced air gas 2. example-water heater/electrical/or solo; E. Square footage or valuation, etc. 1. example.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. examole-construct single family house with an attoched gorage 2. example-remodel existing garag~ into faniily room 3. example-convert single family residence into rest'CLi'rOnt (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. Abbrevioted Plumbing, Mechcmkol ,& Electrical Sched~les A. Except where blank spaces occur in the description portion of the Mechanical and Electri(al Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate iteOl(') to be installed . B. Fulll-'Iumbing, Mechonir:at, and flectricul Schedules . ore available at the Building Division , 1. To conserve spC'lce on the permit form the sched'ules have been abbre,jiated 2. If the item(s} to be installed tire n01 covered on the abbrevi- ated schedules you shollld consult the full sched~Jes C. BUILDING DIVISION STAFF WILL Fill OUT AI.!. FEES AND CHARGES ON THE SCHEOULES III. Applicant to sign and date Whenever possible. the initial application will be used os a worksheet only. Where possible, Building Division Staff will prepare a typewritten copy and return it to the applicant at the time the actual permit is issued for his signaturt.. 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 otner fees and charges are due and payable when the permit is issued. V. FOR OFFICE USE ONLY ~:_' i!:~~~MI! :~ALlDATlrN .,\ \ . . " "_~..'~"'__~""_.'~'_._~"......~~~.".- .,..,,_"'_....-.... .".- ._~~ '0...-....-.......__.. Permit Cieri- PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: 1- F;F!t!: .zEn. ~"..,"" /N5~<r/c>,y go-::..-.. ~RcP. , Additional Project Information; PLANS REVIEWED BY: nam" ~6: ?"G::::.cFR' ",ignaturp' ~ato 7-2.8-8 J I i INSPECTION L1W~J 7260-3J6~ , ., .~ - :...... .,", CITY Of SPRINGfiELD COMBINAflON APPUC:AflONJPERMIT . INFORMATION LINE 726-3753 I ENERGY SOURCES: Sq. ftg. Main 2~ Heat Sq. fig_ Access. I Water Heat.r Sq. Fig. Other Ronqe _New_Add KAlter_Rep. .~'~a[ue of Work: 1___FenCtl_OemO_Change/Uul #l.S~JCJeo .00 _O,h" Building Permit Info: Describe Work (i.e., Build Singl. Farnil... R"lid.."~" With Attached Gorooel Job Addreu S~JI 7fJ""~ I I'-EE' \ ~2\~LA2A 7. t-. 6~~ / ;:.'""() ;: -~... .::;:. "'I c~ E: ,,~~IJ CO^"(lQ'^Y 7v_~ IJE: ~?0.1 ~U_~ 'V~c.cu..~~J ~C<..~\V.:Sih.A (on"'u(lio" lender legal Description :PA 'J?'"T Owne, Add'en Add,." DESIGN TEAM (name) AQc.\-\ 'i\tc.\S k';;<;l'c..V~J)u-e , 7G:;1~ h'U.~ !-\<l2cl ~Ai.lt'; {'""Co..,,,,-,, t.e.q. Primary Structural Electrical Mechanical CONTRACTORS (nomel C., Eu ~'t-\/\) Co,^~dov, General Plumbinq 1/.///11 Rly,~;:-~*j 7L 7'!'c... . El~ctrical Mechanical t:Ec-"'?f"-.::? /'I.n::.:... PLUMBING I -CHARGE f NO. ;-0.=1 I I I I I NO. I fEE , . Each single fixture Relocautd building (new fix. additional) S.F. Residence (1 both) Is:- I I i I Duol..... (1 bOlh) each Additionol bath Walllr s.rviclJ Sewer Stor.m Sewer TOTAL CHARGES '3CJ; ~ "7Ne.~ ~~GT~ c..~~#? ~L c: c:::: 'Sn::>Rr:S" . ~t::-E \JJ C). ~ "\I N ~ (phone no.) ,?,freco,,," (phone no.) FEE CHARGE I 7.rC, Phone (oddress) (Iics. no.) (expires) 3'.-1 I .,1 I z. 0" /0...."'. 2.2.50 WHERE SlATE LAW REQUIRES thaI Ih. Electrical work b. don. by the Elet~rical Contractor. the electrical portion of this permit shall not be yalid until a label has heen signed by on Electrical Contractor and attached to the elearicO'I pO'n.l. 1 HAVE CAREFULLY EXAMINED the completed opplication for permit, and do hereby certify that 011 information hereon is true and correct. ond I further certify that o;'y ond 011 work performed sholl be done in accordance with the Ordinances of the City of Springfield and the Lows of the Stote of Oregon pertaining to the work described helin. and that NO OCCUPANCY will b.. made of any structure without the permission of the Building Division. I Further certIfy that my re-gistration with the Builder's Boord h in full force and e-ffect os required by ORS 701.055. that if exempt the basis fOl exemption is noted heron, and that only s\.Ibcontroctors and employees who ore in compliance with ORS 701.0.55 will be used on this project. Basis for Builder's Boord exemptionl NAME (pleosft print)~~I.e... (;,(~ Zon. C - 'f Fire Zone IV..4 . Flood Ploin-IY~ ~ Type/ Const. '-.njr . Bedrooms ).J. ,.f. , / "torier BUILDING PERMIT Charges ond Surcholges 72', ....~ 7.88 PLUMBING PERMIT Charges and Surcharges ."3'.0. :....., I. "2'" ELECTRICAL PERMIT Charges and Surchorges "":::- <>- ~.;..." MECHANICAL PERMIT Charges and Surcharges "22~:;-O .96 Volue x Value x Value TOTAL VALUATlON-...L.~~' O~ (address) lIics. no.) (expires) ELECTRICAL MECHANICAL FEE CHARGE NO. t furnace/ burner to 1"20, ~ I)TU's Appiionce vent separate Stationary evop. cooler Vent fan with single duct Vent system apart from . heotinq or A.C. Mechonicol exhaust hood and duct Wood slon/heater Heat Pump /5.~o Air handler to 10,000 CFM Air handler over 10,000 CFM I ~~~ 71p,,.G-,: Residence of Sq: ft. New circuits, alteration, or extension, SERVICES Temporary Construction Amps. FEEDERS Amps. "2~ ISSUANCE OF PERMIT TOTAL CHARGES /"--,00 .... TOTAL CHARGES SIGNATURE (f?JI J,)~_ tJWP- FOR OFFICE USE ONLY Units I""ccy Load _Llf1 "'kcy Group_.R.-"2 Sq. Ftg. Main Sq. Ftg. Access Sq. Ftg. Other :2~"""O Plan Ck. Comm/lnd 65%/ Bld~ Pel Fee Plan Ck. Rei 30%/ Bldg Per Fee I-(,,:.~"" I I I I 1- I Systems Development Charqe (1.5%) Fence Demo I Totol Comb. Permit Sidewalk A/C PaviM Curb Cui TOTAL . DATE~!fI,( /~a=. , .,= 1 '15. o~ 1<:f/..8S A. Job Address B. legol Description 1. exomple-tox lot 100, lone County Map Reference 17 03 43 2. example-Lot 1. Block 3. 2nd Addition to Springfield Estates Name, etc. of owner and construction lender Energy Sources 1. example-heat/electrical ceilinq/or forced oir gas 2. example-water heater/electrical/or solar E. Square footage or valuation, etc. 1. exomple-1250 sq. foot house, 500 sq. foot garag' 2. example-if new project, check new-if addition, ch add, etc. F. Building permit information: 1. example.construct single family house with an at: garage 2. example.remodel existing garagE:- into family roo ( 3. example-convert single farnily residence into res~nt (change of use) G. Value of work os defined in Section 303 (a) of the Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Oivi ~: Staff must be able to contact appropriate persons re! design information or job site corrections, etc. COMBINATION APPlICATlONiPE'JIAt (CAP) I. Applica~ to furnish C. D.. 11. Abbreviated Plumbing, MechC!ni.:al ,& Electrical Schedule A. Except where blank spaces occur in the description p of the Mechanical and Electric-al Schedules, the appli need fill-in only the No. Boxes adjacent to th~ appro item(,) to be installed B. Full Plumbing, Mechanirot. and Electricul Schedules are available at the Building Division 1. To conserve spC'ce on the permit form the schedul have been abbre':iated 2. If the item{s} to be installed ore not c..:overed on th ated schedules you ShOLlld consult the full sched~1 C. BUILDING DIVISION STAFF WILL FILL OUT AI.L FEES P CHARGES ON THE SCHEDULES III. ^pplicant to sign and date ( Whenever possible, the initial application will be used c worksheet only. Where possible, Building Division Staff prepare a typewritten copy and return it to the applicor r . 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, (;,. and no plans will be processed until these fees are paid. other fees and charges ore due ond payable when the F~. is issued. V. FOR OFFICE USE ONLY ~-' PROJECT CONDITIONS TO' BE SATISFIED BEFORE OCCUPANCY: - PERMIT V ALIDA TJN~ I \ CITY ( OF SPRINGFIELD City Hall Springfield. Oregon Department of Public Works OFFICIAL RECEIPT ( ( _ No. B 5 6 9 7 7 ( Dale \.1~~~~19~ J ' Reed F~jm\ Lj) f\ f\ TJ\- b \ at .,Qj) ( Address - Y\ 1St n r\ I 051-1'\ ~, ' /' . ) Received c ( FO~W~ ib,<60 0~\. 1)/J.Cf-J ( () f')(, dJ.BO ( c.._~~ ...- CiJ DO ~>>) (,EO ( _oQ~ . \~.o~.' ~} . ({;JU~. f'\\ \ t-J-,\ rO.9 . SO 4m . C/() c " ( (" ~ . - Amount Received \ ();. ~~ 'lJu C I "'''''-':'C"~''''~~l (' ( ( Permit CierI- 1- FR<E' Z,!~;?'7.. ;:;'tC"AC- ~^.,..:: "::=':1;:-< 7/0",/ . .--" --. ,,~~~~-~, /"':f?cZ::>. Additional Project Information: PLANS REVIEWED BY: / .r :Z:>,~C::: ~-. nom'" ~./V~ r .:...,or.---.t;!:""....... ~ignatur,... , ". "7_2 ~- ""'I --iote /' -- c::::\