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Home My WebLink AboutPermit Building 1981-11-3 ~ ~ INFORMATION LINE 726-3753 INSPEQION't1th: 72~769 NOTIFIFn OCT 3 oW CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT Owner r.. F _ .1nhn Add,...7223 N.E. Hazel Dell Ave Vancouver. WA Construction lender Ca 11 - Ed Zo 11 Phonol-283- 5365 $28,000.00 Building Permit Info: Describe Work (i.e., Build Single Familv Residence With AHoched Garage1 I Sq. Fig. Main .jl:UU Sq. Ftg. Access. Sq. Ftg. Other _New_Add_X_Alter_Rep. _Fence_Demo_Chonge/Us8 _Other co ...... o ..... U"1 N Job Add,." .~51q M"in Strppt 10.01 Oo",;pHon 17-02-33-04 T.L. 400 I ENERGY-WURCES: Heat t I ec Water Heater E -I ec Range I Value of Work: r.f'lllpJptp I p"caSperp Address DESIGN TEAM Phone CONTRACTORS (name) (address) (liel. no.) (expires) (phone no.) <~ . , ,l (lies. no.) (expires) (phone no.) (name) (address) Primary Structural Electrical Mechanical G..n@ral Plumbin(l Electrical Mecha nical PLUMBING ELECTRICAL MECHANICAL FEE 'CHARGE NO. FEE CHARGE 2 furnace/burner to WO ,oon BTU', Ii. OiL 12.00 Appliance vent separate Stationary evap. cooler Vent fan with 1 sinRle duct 1.00 .1. ()O Vent system apart from ,,; nn heating or A.C. Mechanical exhaust hood and duct Wood stove/heater Heat Pump Air handler to 10.000 CFM Air handler over 10.000 CFM NO. FEE CHARGE NO. Residence of II. I I I Each single fixture Relocated building (new fix. additional) S.F. Residence (1 bath) ~---OO 2Q....O(1 ~'l. ft. New circuits, alterations or extensions SERVICES Duplex (1 both) each Temporary Construction Additional both 1 Amps. ?nn 1 1 Sewer lOnn In.nn Water service Storm Sewer FEEDERS Amps. ISSUANCE OF PERMIT 10.00 25.00 TOTAL CHARGES dl) nn TOTAL CHARGES I ~ nn TOT Al CHARGES WHERE STATE lAW REQUIRES thot the Electrical work b. done by the Electrical Contradar, the electrical portion of this permit shall not be valid until a label has bHn IUgned by an Electrical Contractor and attached to Ih. .ledrical panel. Zonel? I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that 011 information hereon is true and correct, and I further certify that any and all work performed sholl be done in accordance with the Ordinances of the City of Springfield and the Lows of the State of Oregon pertaining to the work described herin, and that NO OCCUPANCY will b.. mode of any structure without the permission of the Building ,Division. I further certify that my registration with the Builder's Boord is in full force and effect os required by ORS 701.055, that if exempt the basis for exemption is noted heron, and thot only subcontractors ond employees who are in compliance with ORS C55 will be used on this project. Bolis for Builder's Board exemption' ~ ~ NAME (ploo.o pdnt) Ed bJ:tJ {!. 2~ LL "GNATUR.E/ZP.~ (J / {./ / // C/ x A 7~ Voluo$?A ,000 00 x Value x Value TOTAL VALUATION $28.000. 00 'ATE IJIr / <:;torj... Units 1 Occy load ~ I'\ccy Group B 2 FOR OFFICE ,USE ONLY 'Sq. FIg. Main ..3.2.O.D Sq. Frg. Access Sq. Ftg. Other fire Zone flood Plaln Type/Const...JI-N Bedrooms BUilDING PERMIT Plan Ck. Comm/lnd Charges and _____121.00 65%1 Bld!:l Per Fee Surcharges Plan Ck. Res dAd 30%1 Bld!:l Per fee PLUMBING PERMIT Charges and 40.00 Fence Surcharges 1. liO Demo ELECTRICAL PERMIT 15.00 Charges and Sidewalk Surcharges .60 Ale Paving MECHANICAL PERMIT 25.00 Charges and Curb Cut Surcharges -------- 1.00 , Systems Development 7A_li~ P,L 10-n- l~ho,.o (1.5%l #B57504 420;00 Total Comb. Permit 20Q.04 TOTAL $S?\l O~ I" ~.~ . _or. ',,,__"'" " APPlICATJON/PE""CA~~ ~ ,. . "ERMlt~\tALlDATIO~=~~' ,~ '. of j COMBINATION L Applicant to furnish .-~........_.-..- '. A. B. Job Add ress legal Description 1. example-tax Jot 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 solar 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. example-construct single family house with an attached garage 2. example-remodel existing garage into family room 3. example-convert single family residence into restaurant (change of use) G. Value of work as defi'ned 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. Abbreviated Plumbing, Mechanical & Electrical'Schedules A. Except where blank spaces occur in the description portion af the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate item{s) to be installed B. F.ull 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 abbrevi- ated schedules you should cansult the full schedules C. BUILDING DIVISION STAFF WILL Fill OUT ALL FEES AND CHARGES ON THE SCHEDULES III. 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 typewritten 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 na 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: , , Additional P~oiect In~~)(mation: .',..." . ~.~---_.... \. - - - _.- - ,. PLANS REVIEWED BY, ,,"o'"-~1l2-~~ name nAn Smith . .~,.' ~"., I. ..1.' " ~ i <.! ....-..... Ill' 'I' ',< ,\ " , . ~-' --- -' date lQ-26-Rl .... , ,~/- :.'.'./ '-~. ,:,,:~~_'!.,.~I!II,~J~~ ~~tifl.:t.....~~~...:.~,'~;~... ~ '-".'L~!-.~. _,~J!e.!.!,.".1 , ._I:'!"_',~~ "-":"':~l~.!;;"~}.",,;,,~.:,,.;~~._!!t- '.':_ 'I~~~.!~~'~_;~'~~,-o.~:",~ INSPECTION LINE 72~769 \!nT!::Ir-~ OCT 3 u i531 CITY OF SPRINGFIELD COMBINATION APPliCATION/PERMIT I ENERGYJPURCES: Heat I:.lec Water Hoater I:. I ec Ronge Value of Work: . INFORMATION LINE 726-3753 Add,o.. 7223 N. E. Hazel Dell Ave Vancouver. WA Construction Lender Ca 11 - Ed Zo 11 Phonol-283- 5365 $28,000.00 Building Permit Info: Describe Work (i.e., Build Single Fomil., Residence With Attached Gorooe) . I Sq. Fig. Main j~UU Sq. Fig. Access. Sq. Fig. Other . _New_Add~X.Alter_Rep. _Fence_Demo_Chonge/Use _Other co ...... o ..... U"1 N JobAddrllU ~!i1q M;:dn <::.trj:lj:lt logoIDmdpt;on17-02-33-04 T.L. 400 Owner r._~ ,lnhn r.n~~lptp rp~~j:l <:;'n~r~ Address Phone DESIGN TEAM (name) (address) (Iics. no.) (expires) (phone no.) Primary Structural Electrical Mechanical CONTRACTORS (name) (address) (lies. no.l (expires) {Dhone no.~ General Plumbinq Electrical Mechanical PLUMBING ELECTRICAL MECHANICAL Nn I FEE I CHARGE NO. I FEE I CHARGE NO. I I FEE I CHARGE Temporarv Construction 1 furnace/burner to l-Ill4flGfl-BTU" Appliance vent separate Stationary evap. cooler Vent fan with sinAle duct Vent system aport from heating or A.C. Mechanical exhaust hood and duct h.OQ 12.00 Residence of 2 II. Each sinAle fi:dure Relocated building (new fix. additional) S.F. Residence (1 both) ~.O.o. .2O.....Q(1 ".ft. New circuits, alterations or extensions I I I Ii Ii I I I I I SERVICES Duplex (1 bath) each 1.00 1.00 Additional bath 1 Amps. ?nn g nn Sewer lnnn 1(1 on Wood stove/heater Water service Storm Sewer FEEDERS Heat Pump Air handler to 10.000 CFM Air handl.r over 10,000 CFM Amps. ISSUANCE OF PERMIT 10.00 25.00 TOTAL CHARGES 4n nn TOTAL CHARGES 1". nn TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electricol portion of this permit .hall not b. valid until.a label has been signed by an Electrical Contractor and attached to the electrical panel. I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true and conect, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Lows of the State of Oregon pertaining to the work described herin, and that NO OCCUPANCY will be made of ony structure without the permission of the Building Division. I further certify that my registration with the Builder's Board is in full force a!"d tlffect as required by ORS 701.0SS, thot if exempt the basis for exemption is noted heron, and thot only subcontractors and employees who ore in complionce with ORS 7.00} })SS :will be used on this project. Basis for Builder's Board exemption: (' , / / NAME (ploa.o p';nt) EJ lAC J'rJ (', 20 LL <IGNATUR. /'z:.-)tA.r--z,---- (J {./ .f1 DATE / Y3 /f I / Zone r: , Fire Zon- Flood Plain Type/Const.~N Bedrooms c.torie~ Units 1 FOR OFFICE,USE ONLY <:'q. Ftg. Moin ..l?nn Sq. Ftg. ACCOJ' Sq. Fig. Other 32 B2 c/ X R 7~ Valuo$?R,OnO 00 Occy Load ,., "cy Group x Valu'- Value TOTAL VALUATION $28 .000. 00 BUILOING PERMIT Plan CIc. Comm/lnd Chorges and _____12Lon 6S%/SldQ Per Fee Surcharges Plan CIc. Res 4.1\4 30%/SldQ Per Fee PLUMBING PERMIT Charges and 40.00 Fence Surcharges 1. hO Oemo ElECTRICAL PERMIT 15.00 Charges and Sidewalk Surcharge. .60 Ale Pavino MECHANICAL PERMIT 25.00 Charges and Curb Cut Surcharges -------- 1.00 Systems Development 78.65 Pd. 1 O-~ lQho,ao (L5%' #B57504 420.00 Total Comb. Permit ~09.04 TOTAL ~/;'O n~ " . ., .' t! .'... ../ -/ 1 . . I'~ ." ,'. .... , ",. ,.... "', v,., ::'.::.,~;i:::'tI.lt:JlI,1';:.~!-;'::~~~;:iilj"'.z.~}'!;.'::'."".;e'.J",,:li,'j r;J.!:::~!.llIl,.,:I~,.;".*..."'!~~~c.t;2J.'!,:~tilE~~~::~J;l\l , '. COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Jab Address B. Legal Description 1. example.tax lot 100, Lane County Map Reference 2. example. Lot 1. Block 3, 2nd Addition to Springfiell C., Name, etc. of owner and construction lender D. Energy Sources 1. example-heat/electrical ceiling/or forced air qas 2. example-water heater/electrical/or solar E. Square footage or valuation, etc. 1. example.12S0 sq. foot house, 500 sq. foot garage 2. example-if new project, check new-if addition, che add, etc. F. Building permit information: 1. example-construct sing.le family house with an afte garage 2. example-remodel existing garage into family roorr. 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 ovoid design or construction delays, Building Oivisi Staff must be able to contact appropriate persons rege design information or job site corrections, etc. II. Abbreviated Plumbing. Mechanical & Electrical Schedules A. Except where blank spaces occur in the description por of the Mechanical and Electrical Schedules, the applicc need fill.in only the No. Boxes adjacent to the approp' item(s) to be installed B. Full Plumbi~g, Mechanical, and Electrical Schedules are available at the Building Division 1. To conserve space on the permit form the schedules hove been abbreviated ' 2. If the item(s) to be installed are not covered on the, ,. ated schedules you should consult the full s~hedules . C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AN CHARGES ON THE SCHEDULES ( ,CITY'OF SPRINGFIELD City Hall Springfield. Oregan Department of Public Works OFFICIAL RECEIPT n -. No. B 19 ~ / ~. Rec'd From /1 [' Q..d~ ( Address S:) ,"3 cf/ rYJ.o ~ . . , 57564(1 (L II' .3 Date n ( Jt .L/ ;/11 ./ ......; .~ 1 n Received Far: ( 'fZj,.jJA ( G'" , ( 9d., th\ CI 'h1 ( ..J ..,b 1;),,1, nD /I. ff'l (I 1./0. H) /./. 0 (I IS t70 ,~o C1 ~s. tl 0 (j "iu f.oo (I (' kH/.,1 /' -'I ;).. 0, ,HZ- Uk.) v.# -zJ9. 0</ (I I G31>~ 1/ "I (J ~'~~ L{ . ) {?.R~ .1/ 7" (X~ ,... n '. ~~~l , Amount Received ( (.~r ( ;:jE... (1 AUTHOAIZI:D SIGNATUIU: ''''t,.lO".TU"..'ULl .......u.... IUOI..I,;Oll .?..o. ,.. ...".. \ ~,., d j..,.. III. Applicant to sign and date Whenever possible, the initial applicaJion will be used as a worksheet only. Where possible, Building Division. Staff wjll prepare a typewritten 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. . ,aA"~;;;d V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: PLANS REVIEWED BY: nam'? Dan Smith "ignature . Permit Cler~ " date 10-26-81