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Home My WebLink AboutPermit Demolition 1980-9-12 ~I 1 IrISPECTION LINE 726-3769 Job Address 41iDct r=: tv{ C'A.LY\ ~'S:t-" Legal Description 2 bDo . ".- . INFORlIATIDN liNt 726-3753 Sq. Ftg. 1.lain ~q. Ftg. Access. Sq. Ftg. Other / Ilew Add A I ~er Pep. --Fence Dem~ Change/Use Other- .- r;:l) CJ o r:A ~ l}J .1 (ohone no.l CITY ~f,'PRII';;FIELD CDrlBIiIATlON APPLICATION/PERMIT ., E!lERGY SOURCES: Heat Hater Heater ( 102 "'3 Z "'7-z..., Owner5hE'..vmn..f\ +' \ r:;F; Address kl ~O J() (' \ A U 0 J,rPhone q4n S. 43vr:1 ~-jy.pfJ f ,40- .~ 2..,'3(') Range ValuE of Work: Construction Lender Buil~inQ Pernlit Info: Describe Work(i~e" Build Single Family ~esidence With Attached Garaae) nO YY'A--€.Lfl)I ~jJV {J 1\ ,;> OJ! orJr )--.111 Hl rlJ . -' ~, Address DESIGN TEA/1 (name) Phone (address) (l;es. no.) (exo;res) Primary Structural ~~ I , (phon~ no. I I i I Electr;Ctd f1echanical CONTRACTORS Inamel General tn J J'Y/ 0 r (address) (lies. no.) (F'xoi res) tf Plumbina Electrical ,!lechan; ca 1 ___..~",r-_~, "'-"-r--.o:J PLUIIBIrIG ELECTRICAL MECHANICAL ---'1 NO.1 -----lEach single fixture I Relocated building (new fix. additional) IS. F. Res i dence (1 bath) IDuplex (I bath) each IAdditional bath I ~Iater service 1 Sewer I Storm Sewer I I I I I I FEF cHARGF NO -FFF rJjARGF NO, _".__L"""=4~ FFF Residence of SQ. FT.; furnace/burner to BTU's New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall ; So~ce hentpr nnrl vpnt Temporary Construction. Change in existing res.i dp"nce Imultifamily, comm. or Industrial IOf amps. ICOMM./IND. FEEDERS I Install/alter/relocate. distrib. feeders IOf amps. q I I I I I Appliance vent seoarate Stationary evap. cooler 'Vent fan with sinole duct Vent system apart heatino or A.C. Mechanical exhaust hood and duct , ., from Wood stove/heater I I I I , I I SSUANCF OF PFR/lIT TOTAL CHARGES I TOTAL CHARGES TOTAL CHARGES WHERE STATE L~W REQUIRES that tile Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be vali~ 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 Orel.:lOn 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 ORS 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in comoliance with OP.S 7n1.055 will be used on this project. IW.IE'(please PrlnttS:'/"cf'h,.;?.{/./Z-r /J';1Le(/7-r.c!f:;SIGIIATU0.Ln~ ~~~r;1- /2-<;?() "Fo~ OFF I CE USE orlLV Sn. Ftg. liain Sq. Ftg. Access Sq. Ftg. Other Zone Tyoe/Const. Bedrooms Stories Units Occy Load Occy Group x Value Value Value Fire Zone , Flood Plain x TOTAL VALUATION BUILDING PER/lIT Charges and Surcharges . 4:;; . Plan Ck. _~'-________ 65%/Bldo . Plan Ck. 30%/Bldo Fence CO<m1/1 nd Ppr Fpp Res Per Fee Systems Development Charoe (1.5%) . PLW1BING PERMIT Cha rges and Surcharges I Demo I'Sidewalk I A/C Pavi ng I Curb Cut I 1,00 ELECTRICAL PERI~IT Cha rges and Surcha rges 11ECHAN I CAL PERHIT Charges and Surcharges Total Comb. Permit TOTAL /.00 ., ~..., . { .1_ . ,."{ .' , \ ., , . j d " I I , , i :~ it. ... J d ., 1 ~ ~" '. i ~ ' - . ( " I \...-. I ., ~ ~ I ~ ji n 'J ! , i . " , . , " . . i) } , , ! . PERMIT VALIDATION J'!mlit Clerk ; ! ! .; , I :1 ., .j ; . ; ! :1 'j 1 :1 1 I '4 ~ I .J ., , " .; --..--.- ",,~.....----,..j_._-~, , Permit app"l'icant exempt from regi strati on wHh the. Buil Mr.' s Board because; COMBINATION APPLICATION/PERMIT (CAP) \ I. Appl icant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 11 oj 43 2. example- Lot I. Block 3, 2nd Addition to sprlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinqjor forced air QdS 2. examole- waterheaterjelectrical/or sotar E. Square footage or valuation, etc. ------ I. examole- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project. check-new - if ~dd;t;on, check add. etc. ,~ F. 'Building permH information: .;. I. example - construr.t 5ingle family house ~ith an , altdc:hed gerllge ' 'll 2. ~xample - r'(;'model existing gar<:\ge into f~mi Iy rOOlll 3., examole ,.. COllVert singh~ family residenr.~ intll ' ,restaurant (c!lange of use) \ I 'I', (~. ,Vahle of work as defirled il'l Section 303 (a) af thz ,Structur~l Specialty Code ~ . H. . OESIGN .TEAH ANU CONTRACIORS ,1 " '(0: avoid'design or constructioil' de'!~ys J Bui1(JinU . " Divi,sion Staff must be ab.le to contact'apprORriate pGrSOf)53"egard.,ng desigi+1 irrfonTIClt.ion or job'SitE': ' , corrections ~ Gte. ...;; Abhrev'ia-ted..Plumb.iny. Mecl')t:.nical, & f.lectr.icill Sclhedules A. Exc:ept where blnnk. spaces occur in.the descr,i,ptioll portion of thE: Mechanical and [-Iectr'ical Schedules," the applicant need fill..in only the'No, Boxes-'adjacent .to the appropriate Hem{s) to be' installed 'l,~ .' H., Full Plumbing. ,Mer.hanical, and Electrical Schedu~cs .'~re,available at; the Building O.;v;s;on ,\,;' 1. ,To c;on$erve. sPl1:ce on the p~rmit f(,Jrm the?:~chedules , have ,been abbr'evia,ted ' ':i' 2. If the item(s) t.o be insta1.led are not cOvered on the abbreviate,d schedules you should cons:ul t the full schedules ;~ C. BUILOING DIVISION STAfF WILL FILL OUT ALL FE~ ANO . CHARGES ON THE SCHEOULES . ~; O. As noted on .the CAP, the 1 abe 1, mus t be deli ve:rcd to the 'electrica1 contractor for signature by his ei~ctrical supervisor. . The.general contractor is .not au,thorized ' to sign the electrical label. --- ~. . Ill.. Applicant to sign and date Whenever p05sible,.the.initial application will be used as a worksheet only, Where poss_ible, Building Divis.ion Staff will prepare a type written copy and return it td the " appli~ant at the time the actual permit'is issued for his signature. I IV. Fees and Charges Plan check fees are due and payable at the time of the app 1 i ca t ion, and no plans wi 11 be processed unt il' 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 SATISFI ED BEFORE OCCUPANCY; . -. - ~~-----...z;- -~ _..--... Additional Project Information: PLANS REVIEWED BY: name signature date :,; ,.o; ;i !; ! :1 i ;j i: '1 1 1, il. '. ? I ,j TI q ~ i l f ~~-- ! " }--.'.~I (,: .. I IrlSPECTIOII LlIIE 726,3769 Job Address '1'/ (DOt . '. ~(. .).]<:'('~.,.n,,,,~,(;t~~~~1':!;"1~if\ ." ., . . .. . . " It. ~,~). . .t.....'" .. C'I';y ~"5V~I'::'I~L'~"""'~"'l!":"" . COIIBI:IATlON APPLICATION/PERMIT E!lERGY SOURCES: Heat Hater Heater INFORltATlON LINt 726-3753 Sq. Ftg. 1.lain ~q. r=tlJ. Access. Sq. Ftg. Other / Ilel< Add Aller Rep. -Fence OemIN' Change/Use -Other - - . r-: f-.-lo..LYl ,S~L legal Description ,: '!L v'" .ft>,. .' , Ranqe _' Va 1 UE-' of Hark: Ol<ner 5heym0.Y\ +\ F-.J~-" . \ Address fJ .J...A.J J. 0 )1', r t t ..u 0 jrhonc " . . Q405. 43vn .s+V-.p{Jj- ,4trr :~ '2_,'=3() Bull~ina Permit Info: Oeser be \4ork(Le., Build Single Familv nesidence \'Iith Attachpd ~araae) C'JO n~-I!. Lfl.Jh ~j~1Y{?j\ J OC~ pTf -r ) (}r, IVl r U Construction lender Address onll,I'ItAlI Phone (address) (lies. no.l (exnires\ (name) Primary Structura 1 Electrical f1echanical CONTRACTORS Iname) Genera I . It? n'n 0 ,r (address) (lies, .no, (~xoirpc;' Plumbina Electrical ~lechanicil.l ~U~.-~.. --...------=.' PLUflBIrIG MECHANICAL ELECTRICAL -'!9 ........------......~--............,.,-,,_.............. NO I ~~~ furnace/burner to I BTU's Floor furnace I and vent Recessed wall I Soacp hpil.tpr rlnrl vpnt FEE rHMH~F "0 .J:'~J:' r'illflliE. Each single fixture Residence of SQ. FT.. Relocated building .1 (new fix. additional) New circuits alts. or extensions S.F. R.esidence (J bath) Duplex (1 bath) each SERVICES Additional bath Appliance vent seoari'lt.f> Stationary evao. cooler" ' Vent fan wi th sinale duct Vent system apart from I heatinq or A.C. I Mechanical exhaust. hood and duct_ I \-load stove/heater ~!a ter servi ce Temporary Construction Change in existing rp~idp"n('p' multifamily, conlfll. or Tnrll/<;t.r;?l.l Sewer Storm Sewer Of I I I I amps, CDl1J.1./l NO. FEEDERS Install/alter/relocate. rli<;tr;h, fpprlpr<; Of amps. --- ~ () Q r:A ~ uy (ohone no. I II i: ~ '! . " . , (fhonp no. ) i. rHJlJl.Uf. ' ~ : i I ,I 1 I I I 1 I I TOTAL CHARGES TOTAL CHARGES WHEnE STATE L\ll REQUIRES that the Electrical I<ork be done by an shall not be valiJ until the label has been signed by an Electrical ISSUANCE OF PFRlIIT TOTAL CHARGES Electrical Contractor. the electrical portion of this pe~it Supervisor and returned to the Building Division I HAVE CAREFULLY EXAtlIf1ED the completed aprlication for permit, and do hereby certify that all infonnation hereon is true and correct, 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 laws 9f the State of Ore(]on pertaining to the work described herein, and that HO OCCUPAIlCY will be made of any structure without the permission of the Building Division. I further certify that my re~istration 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 hereon, and that only subcontractors and emnloyees who are in comoliance with ORS 701.055 will be used on this project. . 0./ /C? // ,-#7- HAI.IE(please print! S,i.lr.f~;'4-(/' R;rrl=;~hT.c~IG;IATURE0_ __'/-:h.~?7 (/..w4.h:1'At!ioATtri- /2-~() "rO~ OFFICE USE DIlLY Zone Fi re Zone Flood Plain Type/Canst. Bedrooms Stories x Value Value Value Units Occy Load Occy Group S<"!. Ftg. 11ain Sq. Ft~. Access Sq. Ftg. Other x x TOTAL VALUATIOtI BUILDING PERfIIT Charges anG Surcharges &t- Plan Ck. _~?_________ 65%/Bldo Plan Ck. 30%lBldQ Fence Syste~s Development Charqe (1.5~) Comm/l nd Ppr Fpe Res Per Fee PLU'1BING PERMIT Charges and Surcharges Demo 100 ELECTRICP.L PERI~IT Charges and Surcha rges Sidel<alk AlC Paving I Curb Cut L Total Comb. Permit TOTAL 11ECHAIIICAL PERMIT Charges and , Surcharges /.00 ... -". ..- .. , I ~! " 1 j 'I " 1 l I I I l. 1 I I J . I I I. J ,J I I I I I I - . . ./ . "" ~"..I COMBINATION APPLICATION/PERi-lIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. legal Descr~Ption 1. examole- Tax lot 100, lane County Map Reference 17 03 43 2. examole- Lot I. 'Block 3, 2nd Addition to Springfield Estates C. Name. etc. of owner and construction lender D. Energy Sources '. ( 1. examole- heat/electrical ceiling/or..fOfe 2. example- waterheater/eJectrlcalior sOliU E. Square footage or valuation, etc. - I. examole- 1250 sq. foot house, 500 sq. f( (ila 2. examole- Tfinew project. check-new - if check add, etc. F. 'Building perm'it information: :r.. example - construr.t single. family house D"-Etdc:hed gar~ge 2. ~nample'-' remodel er...;sting.garage, into f .3,':,E:xamole.- con'./ert s;ngl~.famHy residene, ,r'est.ilural1t (change of use) ( Ci. ,Va-lLle of work as defined in Section 303 (a) ( "' _Strllctur~l Sper.iaHy Code . H. . DESIGN .TEAi.1 AND CONTRAODRS .fo,avoid-design or construction del~ys, Buil~ (' Oivi.sion Staff must be ab,le to contact appro~ persons ,i"ega,rci-rng des1gi" in-;:onT1~t.ion or job S . corrections, c::tc. " :; II. ^bbrp.via-r.ed 'Plulllb"ing: Mcd1(~nical, & ElectT'icill 52 ~.1. A. Exc:ept \.,here b1c:nk. spClces OCCur in the descri portion of thE: Mechitnic.:al and Electrical 5chc the applicant ncp.d fi1"l..in only. the r~o. Boxei .to tho appropciate item(s) to be installed ." ( :L, Full Plumbing~ M~r:h;:;ilical, and Electrice.1 5ch! ,'t:re.available Cli.. the Building O"ivision ""; 1. Tc con~erve" space on the p~rmit form the::~~ " have been abbreviated t' 2. If the item(s) to be installed are not ccTv '''-l the abbrev i a ted schedul es you shou 1 d cons:u full schedules . C. BUIl.OING DIVISION STAFF W).l.L FILL OUT ALL FEE,' ,u.' . CH>lRGES ON THE SCHEDULES . \ O. As noted on the CAP, the label. must be deliver " 'electrical contractor for signature by his eJ:e, supervisor. The,general contractor is not autl (Z< to sign the electrical label. - ; Applicant to sign and date Whenever possible," the.initial application will be a worksheet only. Where possible, Building Divis"ic wi 11 pr"epare a type written copy and return it to. t applicant at the time the actual permit is issued f signature. . IV. Fees and Cha rges , Plan check fees are due and payable at the time of ~ ; application, and no plans will be processed until t: fees are paid. All other' fees and charges are due; payable when the permit is issued. ~ CITY SPRINGFIELD OF ( . , (li City Hall Springfield, Oregon Department of Public Works OFFICIAL RECEIPT' No B ~5 4 5 5 3 ( . , Dat/l -!1-. 19 'Z() " (~'S . Rec'd From !/J/11i n flU 1 llirb J?-::J.. .AJ( II) . t- j Q4()::,'T JVn Addr';rs rn fir fL. _ '. -i. ' ~ ( >( Received For: c }.o~ I,OU O-e.-vv1() f) 0 ),r{! ()' n t' \.Q Amount Received 7..00 ('/~ 0 () (r, . () (0 " J ---I ~ Qp ~ AUTHORIZED SIGN..TURE S..[HO..'A.....""LL ~"I..n"S' [11(0["[. 0" 97.0' " (I ..,.., ( V. FOR.OFFICE USE ONLY c. 1-. T , ":":_',:''': '~ :.. ......._ l-,_,'____.--._~....._.~__,_,:;____., -.,-----. -......'----,...~r __ _".__ ._",,-~ ,~_.- .PROJECT COND1TIONS TO BE SATISF1ED BEFORE OCCUPANCY: "-'~ , . -- --,---<---.----.- I J . Permit ,app'i 'icant exempt from registration wHh the Builde-r.' s Board because; -,':-'-"- Additional Project Information: ---~: 'I ! PLANS REVIEWED BY: , I i I i name signature date