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Home My WebLink AboutPermit Miscellaneous 1990-2-21 J INSPECTION LIIIE 1726-3769 . CITY UF SPRINGFIELD COMBIIIATION APPLICATION/PERMIT . INFORlIATION liNt 726-3753 Sq. Ftg. 1.lain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. -Fence Demo Change/Use -Other- - ~ N ~ Job Address 55 // /77A"/A/ -::V--. Legal De,cription/7_oz_;,;:J3_</.:<:. ~-33-= EiIERr,y SOURCES: Meat Hater Heater Range ValuE of I'Jark: Owner 0,""?;..~ ~(.Jf1'9"'" Address ~v.6l?~~~. S-S# h'?~..., 5pp?-.Z:> Phone BuilriinQ Permit Info: Describe Work(i.e.. Build Single Familv Residence With Attached Garaoe) Construction lender Address Ut~HiN lEAn (namel Phone (address) (1 ies. no. \ (exoires) (ohone no.') Primary Ii. ~~ y~ ',<, "" Structural Electrical Mechanical CONTRACTORS (name) (address 1 flin no.) (~xairp~\ (ohonp on Genera 1 Plumbina Electrical "lJ4VEJ ~EZ:r. ~::22<~ /77~~~e!",f<r '.y. ~~ .&0. ~?y)../ ?~~~.' /~-/-qc> ~~-"39Y2 . ~'echanical PlUlIB I NG ELECTRICAL FEE rHI1.Rr.F Nn Residence of SQ. FT. I New circuits alts. or extensions SERVICES MECHANICAL .l!Q.:. ~~~ r~8R&( Nn 'IL. .cliARliE. Each single fixture furnace/burner to BlU.s Relocated building (new fix. additional) /;)~ Floor furnace and vent S.F. Residence (1 bathl Duplex (1 bath) each Additional bath Recessed wall S~hp~tpr ~nrl vpnt Storm Sewer Of amps. Appliance- vent s€'oar~tj:l Stationary evap. coolj:lr Vent fan with sinale duct Vent system apart from hea t i no or A. C. Mechanical exhaust hood ~nd rlurt_ Water service Temporary Construction Change in existing rj:l)j4f1!'1t.p multifamily, corrm. or Tnrluo;trial Sewer COMM./IND. FEEDERS Install/alter/relocate rlic;.trih. fpprlprc;. Wood stove/heater Of amps.. ISSUANCE OF PFRllIT TOTAL CHARGES TOTAL CMARGES /.,,--:. --e> TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be done by an Eiectrical 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 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 rw 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 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 7Ql.055 Wi~sed~his project. HAI-IE(please print) ~~~/?S>(!"/ SIGHATURE~~~ d'~ DATE-;:2-d~7b> FOP-OFF I CE USE'OIll Y So. Ftg. Sq. Ftg. Sq. Ftg. Zone Fire Zone Flood Plain Tvpe/Const. Bedrooms Storie!=; Units Occy load Occy Group riai" Access Other x Value Value Value x x TOTAL VALUATION BUILDING PERfllT Plan Ck. Corrrn!l nd Charges an~ ------------ 65%1Bldo Ppr Fee Surcharges Plan Ck. Res 30%lBldQ Per Fee PlUt~BING PERMIT Fence Charges and ------------ Surcharges Demo ELECTRICAL PERIHT I~-- Sidewalk Cha rges and ---- --:...._--- Surcharges -7)- A/C Paving 11ECHAN I CAI. PERMIT I Curb Cut Charges and ------------ Surcharges I Systems Development Charqe (1.5~) Total Comb. rermit /S- ;>s-l TOTAL , . COMBINATION APPLICATION/PERMIT (CAP) . - I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax Lot 100, lane County Map Reference 17 03 43 2.exa~le- lot 1. Block 3. 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinQ/or forced air Qas 2. examjle- waterheater/electrical/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. exam~le - 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 (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 , p~rsons regarding desig~ jnform~tion ~r jpb.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 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. --- 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. III. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: \ . - PERMIT VALIDATION - . Permit Clerk t Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date i ~ob Address 55 //. /77A"/A/ --::Y'. legal Description /7-P2--'33-'>'':::. ~ -3 3-= I Owner 0/<a~ ~<H'.,q--= kV..s:ol'~.,....~1 - - -; - - Address .., c?r/ ~4/;A? Phone 5JiPPt:-p 4IIt CITY Uf SPRINGFIELD CDMBIIIATIDN APPLICATION/PERMIT EilERGY SOURCES: Heat Hater Heater Ranqe , INFDRllATIDN LINE " 726-3753 Sq. Ftg. I.lain ~q. Ftg. Access. ~ SQ. Ftg. Other lIew Add Alter pep. -Fence Demo Change/Use \J; Other- - \} ,N As I II! INSPECTION 1I11E Jr26-3769 Valu, of l'Iork: Bulldina Pennit Info: Describe l~ork{i~e.. Build Single Familv rlesidence Hith Attached Garaoe) Construction lender Address UtSIGN ItAIl enamel Phone (address) (lies. no.l Cexn;resl (ohane no., Primary Structura 1 Electrical Mechanical CONTRACTORS (name) (addr~5o;.l (1;(".,,_ nn.' {E:XDir".~l ("none no.) Genera 1 PlumbiM Electrical ~f/E:7 L:L EZ:r. . ~;r:;1;.r~ /17~~~~-__'I>'. ~~ .&r.? .::n_Y'~/ 709::>2~,' /~-/-qq B'%"-"39Y2 ~1echan; ca 1 PlUIIBING ELECTRICAL FFE CHARGE Nn Residence of SQ. FT. / New circuits alts. or extensions SERVICES MECHANICAL NO. FFF r~ARGE NO ~I'l=' r~llRGE.. Each single fixture furnace/burner to BTU's Relocated building (new fix. additional) IS floor furnace and vent S.F. Residence (1 hath) Duplex (1 bath) each Additional bath Recessed wall ~n~rp hp~tp~ ~nrl UPnt Storm Sewer Of amps, Appliance- vent c;,~oa ra tp Stationary evap. cooler Vent fan with c;,inole duct Vent system apart from hea t i no or A. C. Mechanical exhaust hnnd and rturt Wood stove/heater Sewer Temporary Construction Change in existing rec;1 cteflce multifamily, corrm. or Indus.trial Water service CD~~./IND. FEEDERS Install/alter/relocate rli~trfb_ fppdpr~ Of amps. TOTAL CHARGES WHERE STATE l'W REQUIRES shall not be vali1 until the TOTAL CHARGES that the Electrical work be done by an label has been signed by an Electrical ISSUANCE OF PFR!1IT I ")~ ~ TOTAL CHARGES Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Division . 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 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 UO OCCUPAr~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 subcontractors and employees who are in compliance with OP.S 701.055 Wi~sed~his project. IlMlE(please print) ~~t::::r.<'r7S'Af:/ SIr,Il^TURE,~ ~ ~....r.<t<l DATE.;2-d/-9o FOP. OFFICE USE'DrlLY Sq. Ftg. rlain Sq. Ft!J. Access Sq. Ftg. Other Zone Fi re Zone Flood Plain Tvpe/Const. Bedrooms Units Occy load Occy Group x Value Value Value x Stories x TOTAL VALUATION PlU'~BING PERMIT Charges and Surcharges Plan Ck. Comm/lnd ____________~/Bldo PJ'r Fee Plan Ck. Res 30%/Bldo Per Fee Fence Systems Development Charoe (1. 5~) BUILOIIIG PERfIIT Charges an~ Surcharges Dell10 ELECTRICAL PERrm Cha rges and SurCharges /.""- -P -' Sidewalk ---- --~---- _ :7'>--- AIC Paving Total Comb. rermit 11ECHANICAl PERMIT Charges and Surcharges -.__-.1 Curb Cut TOTAL /5'- ;?S- .. . . . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Oescription I. example. Tax lot 100. lane County Map Reference II UJ 4J . 2. .exam~le- lot I. Block 3. 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceiling/or forced air Qa: 2. example- waterheater/electrlcal/or sOlar E. Square footage or valuation, etc. I. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check new - if addition, cneck add. etc. F. Building pennit information: 1. example - construct single family house with an attached garage 2. examele - remodel existing garage into family roan 3. examyle - 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. OESIGN TEAM ANO CONTRACTORS To avoid design or construction delays, Building Oivision 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 8. 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 SCHEDULES O. As noted on the CAP. the label must be delivered to th.---- electrical contractor for signature by his electrical supervisor. The general contractor is.not authorized to sign the electrical label. --- Applicant to sign and date Whenever possible. the initial application will be used as a worksheet only. Where possible. Building Oivision 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. III. V. FOR OFFICE USE ONLY f 1 ~.. .~ CITY OF SPRINGFIELD . City Hall Sprlngfteld, Oregon Development Services OFFICIAL RECEIPT I 16086 .- Dale ~.2 / 199.&> . I' Rec'd From ~~ <!:=/" ec;r-. ~~~ ~~.F....tt::".. Address ~~~~_ 9>ci/713 ,? Received For;;h? #9a:::>Z~~ -.2> ~..r ' ~-C> /5- - ~ ~y-- ~ ~ /5"":: ~/ ~ ~#3'/b /..5::7,y-- Amount Received ~~~/? ~ ~iHORlZEO SIGNATURE ' !!L r . "'" BUSINESS ~ORMS. INC 4503IJ41".' 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 date J