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Home My WebLink AboutPermit Demolition 1980-9-12 (2) l I INSPECTION LINE 726-3769 Job Address 1\ III . WOAlfl ,<,-1 C!Ti:"Or5P,K-INGf I ElD COMBINATION APPLlC~TION/PERMlT EIIERGY SOURCES: Heat Hater Heater Address Ut~ J!.iN I tAf1 (name) Phone {address} INFOR/IATION UNt 726-3753 Sq. Ftg. I.lain ~q. Ftg. Access. Sq. Ftg. Other ~__A~d Alter Pep. Ranqe Fen1i;.LDemo_Change/Use ttp~k: Other BuilriinQ Pernlit Info: Describe Work(;~e.. Build Single rJJ y()(i{)7l:!3~~d :~a~. r j A ~ ./\J .nfJ.I ) VJUII If? , f . o()" 8 ~ --J us I Lega 1 Oeser; pt; ~n2J..cC() 1,0 z::i:. '5 '2... owne6hpnY\(lVl + lAA b 1m J1( D..l Address Oil 0 s 43Y71. 6X Jhone - 14~?{l'3n Construction lender (l;es. no.) (exoires) (ohane no.') Primary Structural : E"I ectri ca 1 Mechanical CONTRACTORS Inamel . General tJ1/1Vl 0 j/ (address) (l iC$. no.) (exoi res). (o'honp nrL ) ; I Ii II ~ 'i 1:-," ~ Pl umbi no Electrical ~lechan;cal ."'-.,,--""....:.._...~I PlUIIBHIG ElECTRICAl MECHANICAl Ii ---', "NO-:--'-'- -~ -~ .." - FEf:'~ f:HARGF i;;~ -~,-, Each single fixture ~-c'crlJARliE AI I furnace/burner to SQ. FT. BTU's New c i rcu.its a lts. Floor furnace or extensions and vent Residence of I=~I= rl-l~RG.L Relocated building (new fix. additional) . S. F. Res i dence (j bath) Duplex (1 bath) each SERVICES Recessed wall Sn~cp hp~tpr ~nrl vpnt Storm Sewer Temporary Construction IChange in existing rp<;5 rlencp Imultifamily, COlml. or Tnnu<;trinl IOf .mps.1 ICOMM./IND_ FEEDERS 1 Install/alter/relocate d;<;trih. fppdpr<:; IOf amps.1 II I I I 1 I I Appliance vent seDar~tp Stationary evap. cooler I Vent fan with sinale duct I Vent system apart from I heating or A.C. : I Mechanical exhaust .: I hood and duct I ~'Jood stove/heater I I I , (I '1 I Additional bath I ~Jater servi ce Sewer ,I I ISSUANCF OF PFR'lIT TOTAL CHARGES . TOTAL CHARGES . TOTAL CHARGES . WHERE STATE lA\~ REOUIRES that tile Electrical work be done by an.'Electrical Contractor, the electrical portion of this pemit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building DivisioQ ------1 I HAVE CAREFULLY EXAMJNED 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 OCCUPAHCY 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 ::r::(:~::::t:::::~;;::~: W~~:;:~~~th :::II::~~::;;:::: (?~/ FOP OFFICE USE Olley '-' Sq. Ftg. r1ain Sq. Ftg. Access Sq.. Ftg. Other -tl.-X() ! Zone Tyoe/Const. Bedrooms' Units Occy Load Occy Group x Value Value Value Fi re Zone x Flood Plain Stories x TOTAl VAlUATION BUILDING PERIIIT Charges anc Surcharges I Plan Ck. ComrnlInd 65%/Bldo Ppr Fpp ------------ Plan Ck. Res 30%lBlda Per Fee I Fence ISyste,ms Development Charoe (1.5%) PlUt1BING PERMIT Charges and Surcha rges Demo 1/.00 I ElECTRICAl PERI~IT Cha rges and Surcharges 11ECHANICAL PERMIT Charges and Surcharges Sidewalk A/C Paving I Curb Cut I Total Comb. Permit I I TOTAl t- 00 .,.' ;- -I l Pol U m ,'(J !i , (1 ~ ! ~ i ~ . . i.!. ., ~ l l ] , J ! " 1 1 ! . Ill. . r.J...... COMBINATION APPlICATION/PERMIT (CAP) Applicant to furnish A. Job Address B. legal Description 1. exa~le- Tax lot 100, lane County Map Reference 17 03 43 2. example- -Lot I. Block 3, 2nd Addition to ~pr'ngfie1d Estates C. Name, etc. of owner and construction lender D. Energy Sources 1: example- heat/e1ectrica1'ceilinq/or forced air Qas 2. exa~le- waterheater/electrical/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, , check add, etc. "'~ F. . 'Hui'l-ding -permit information: :-i L 'example - construr.t single. fami"ly housp- w'Jth an 'attache"d gange ;! 2. exal~ '- remode'f ~xisting; garage il,to fa'mily room :L . example~'- convert single fami1y resic1enceU-intlJ . -', restiHlrant/{cl1ange of use):-i " ~~ Vf!.)ue 0"[ \'!ork asde.fined in Section 303 (a) Or the .i.. 'i:;~~ ~;,tructu'ra 1 Spec i a lty Code :'1 l-l:" 0"" lGN TCAI.l AND CONTRACTORS '. 'J~~:.-'i'O"avoiddes'j'gn or construction 'd~lays. Bui"ldjng Division Staff must be ablf! to contact approp:jiate "peT$OnS .l-ega.rding_ design informat=ioi"r or job SJtr. . corrections:: et.c. ,;', AlJbreviatEd:P1umbing, Mechanical, & Electrical Sdledules A. Except where blank spaces 'occur in the descr;,ption , portion of the Mecha-nica,l a"d 'Electrical. Sehe-dules, the appli-cant 'need fill..in only the No. Boxes~acljacel1t to the appropriate item(s). to be itistalled t; B. ' Full :Plumbing.; Mechanicall and Electrical Sch~dules irre'o.vaiJable, at' the Building Division h 1. -To conserve--sp(\ce,on .the-'-permit: form t.he ischedules , hav.e been abbreviated ','~ . 2. If the item{.s)' to be installed' are not co"~ered on the abbreviated schedules you should consolt the . fun schedules .: r.. BUIlDING DIVISION STAFF WIll FILl OUT AlL FECS AND CHARGES ON THE SCHEDUlES 1 D. As noted on the CAP, the label must be'deliv~red to the 'electrical contractor for signature bY his en~ctrical 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 actLlal permit 'js issued: for his signature. Fees arid Charges, Plan check fees are due and, payable a.t 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. I. IV. V. FOR OFFICE USE ONlY ,~,,,. . . ~-~~'~'-"'..r _.~.. II . ,.._.....~" . ,____. -~ ~, . PERMIT VALIDATION 'I 'I if :1 ,~ ! i l ~ . . j . ~ i, , " '. :1 ; " .'j 11 " , J .~ ;, ~ " '1 , :1 " -j ! " ,! J 1 :t ., ::1 1 ;, ~ '-. ,r,E!nni t C1 ElTk ., - "--.-- -'''--~-'''~'---'----~.~-.-'--- ~ ~--...- -~-,-_..& .PRO,JECT CONDITIONS TO BE SATISFIED BEFORE .OCCUPANCY: ~J 'j , .' ,,' . ,,,.. ". :~;:i~_:::~" k.:,i";-:;'} '," ' ;'JJJ'/'. " t.1,,...j-. g:;;"~~l . t , ~-'t- ;r*.' I , l -': , 'I , " -' I .; , i J ~ 'Permit'app1 ican'~ e!(empt from registration-,wHh the.Sunder's -Board because: 1- i i J~, , " _.~_.,~.__.______.______._~~,_.*,_,"..L_.___.___ ., AddHional Project Information: PLANS REVIEWED BY: name signature date '~ . INFOR/IATlON UN, 726-3753 Sq. Ftq. l'lain ~q. Ftg. Access. Sq. Ftq. Other 1~_A~d Alter Pep. F en1i;.LOemo _ Cha nge/U se owne6hPnY)(1v\ + I-P:R t2_utioOC1!.rttU'oOc~k: _Other. . Address q/L{) C 4'---:2 '.---Yl~'.'+- Ph Buildna Permit Info: Des,cr be \'lork(Le., BUlld Slngle ~-' ~ ,~ '~L1G~1.~n (1Yrrus~1;^6~"d :~1. fJ A ~ Construction lender ,<\ 0 Y\ T j J ) \:::JiJ.AI! r.;p I " n, . 1 INSPECTION LINE 726-3769 Job Address L\ 1/J.J:J. n. iI. . CITY OF SPRINGFIElD COIIBIIIATION APPlICATION/PERMIT EilERGY SOURCES; Heat' Hater' Heater , . Range . ,<,-f i I/l -" LJ'. ..0, Legal Description Address Ui:.~I(jrl ItAl-l Phone (."dress I (name) (lies. no.) (exo; res) Primary .......:i.;:-',- ..-'- ".' Strucfu~a 1 Electrical.' ">" ~i;,;:-.~;~ ~ ~l' Mechanlca-l . CONTRACTORS (name) (address) llics. -no.) (exoirp~) 'General (') II,Vl 0 j/ Plumbino Electrical r.lechanical PLUlIBIrlG -,,', ,"'110":" _._."~ -....... .....FEF.l [HiiRr7 jj;;- -~- ElECTRICAl MECHANICAl ~....,... =>~'__n...'~._~_.....~ ._._~- ____~ ~ 'IL...ClIARJiF NO. Each single fixture Residence of furnace/burner to BTU's SQ. FT. IRelocated building (new fix. additional) IS.F. Residence (I bathl .:'louPlex (1 bath) each jAdditional bath I ~!a ter servi ce I Sewer 1 Storm Sewer I I INew circu~ts alts. or ex tens 1 ons ISERVICES I Floor furnace and vent I :1 Recessed wall SOn~P hPntpr ~nrl vpnt Temporary Construction' Change in existing rp'S-; (tpnr", multifamily, comm. or Tnrlllstrinl I Appliance vent seoaratp IStationary evap. cooler I Vent fan with sinole duct I Vent system apart heatina or A.C. I Mechanical exhaust hood and duct 1 \'lood stove/heater I I I Of amps.1 COW~./INO. FEEDERS Install/alter/relocate distrib. feeders IOf I amps:- ISSUANCf OF PFR!IIT TOTAL CHARGES I TOTAl CHARGES WHERE STATE l,;I.1 REQUIRES that tile Electrical work be done by an shall not be valiJ until the label has been signed by an Electrical dJ' 8 cA --J ()J (ohane no~ I i ! ~"" ..,~ ..' . ~J~~_;:~:/:" ":. ' ';(o~hon.f'lnn. ) "'J. !_,'i" . "f';t j ti ..,;-_m._ ----I ~~~ r"i~~.B.GfJ / I II :1 '1 I from " ~ I I I I TOTAL CHARGES Electrical Contractor, the electrical portion of this per~i~ Supervisor and returned to the Building DiviSiOQ J HAVE CAREFUllY EXNtINED the completed aprlication. 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 Spri 09 fi e 1 d and the la"/s of the Sta te of Oregon perta i 0 i 09 to the 'work descri bed herei 0, and that IW OCClJPAHCY 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 ~~~~orrd-that only subcontractors and employees who are in comoliance with OP.S 7nl.055 will be used on this nroject. ~ 1lA:IE(please ~rin\l~/ Ek'f<"1''''/ e./~:,?'dZ-?, SIGIIATURF.-~ p;j~/~ r:?M~lij1::.tl. - >in FOr. OFF I CE USE OIH:V ' ./ Zone Fi re Zone Flood Plain Tyoe/Const. Bedrooms Stories Units Occy load Occ,Y Group riain Access Other S<1. Ftg. Sq. Ft!). Sq.. Ftg. x x Value Value Value x TOTAl VAlUATION BUIlOHlG PERI.IIT Charges an~ Surcharges Plan Ck. Comm/lnd 65%/Blda Per Fpp ------------PTan Ck. Res 30%/Blda Per Fee Fence ------------ I Demo . I Sidewalk - --- -- --- ---I AIC .Paving Curb Cut Total Comb. rermit Isyste,~s Development CharQe (1.5r,) PLUI1BING PERMIT Charges and Surcharges ;.00 ELECTRICAL PERI~IT Cha rges and Surcharges 11ECHMIlCAL PERMIT Charges and Surcharges I TO,TAL /'Q0 'I ---~-~ II ~ j. , '1 ~ ,,; ~ I , . ' " ,~ , {:J ~ I.:~ ; " , I I 1 j . . ;-~ . .~ PERMIT VALIDATION ( CITY OF c COMBINATION APPlICATION/PERMIT (CAP) ". I. Applicant to furnish A. Job Address B. Legal Description . 1. examole- Tax Lot 100. Lane County.Map Reference 17 03 43 2. examole- lot 1. Block 3, 2nd Addition to Springfield Estates I C. Name. etc. of owner and construction lender D. Energy Sources .: 1. examole. heat/electrical ceiling/or forced a~ 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - 1. examo1e- 1250 sq. foot house, 500 sq. foot g' 2. example- if new project, check-new - if addit check add. ete. F. . 'Ru;1-ding pernit informilt;on: 1. 'example - construct single. family house wlth .a ttached garl,ge _, ? ~xalnDle - remodel ex;stiny, ga"rage il,to famil~ 3. . examole -' convert single famPy reS;dei1c~~'ini restaLlrant. (change of use) ~ . G. ViI,lue of....!orkas de_fined in Sect.ior. 303 (a) of tl Structu.ral.Spe.fialty Code l 'H. DlSIGN TEN-IAlW CONTRACTORS .ra avoid dE:5"i-gn or' construction delays. Bunding Division Staff must be ablp. to con~act approp~ia' '.persons -l"ega)~ding design informat4on or jOb s~itr. (' . correr.tions. etc. . ALbreviatEd'Plu~bing, Mechanical. & Electricill SCtledl A. Except I.there blank spaces 'occur in the descripti( . p'ortion of the Mechanical aild Electrical Sr.hedull Lhe applk.ant need fill..in only the No. Boxesiad: G;. to thf': appropriate item(s) to be .ilistalled ~: B. Full .Plumbing-; Hechanici'll.) and Electrical Sch~du' crre'ovaiJable i.lt the Building Division 1. To conserve Spnce on the-.permit: form t.he schl (~~ . have been obbreviated ' 2. IJ the item(s) to be installed are not coven . . the abbreviated schedules you should cons'lilt ( fu,l"! schedules C. BUIlDHiG DlV.ISroN STAFF WIll FIl.l OUT All FEES AI CHARGES ON THE SCHEDUlES , D. As noted on the CAP. the label mustbe-'de'('ivered [1 'electrical contractor for signature bY his elect: q supervisor. The gener'al contractor is ,not autho: to sign the electrical label. --- Applicant to sign and date Whenever possible, the initial application will be u: (~~ a worksheet only. Where possible. Bu,ilding Division wi 11 prepare a type ...witten copy and return it to thi applicant at the time the actual permit is issued fa' signature. Fees and Charges. Plan check' fees are due and, payable at the time of t: appl ication. and no plans will be processed until 'th, fees are paid, All other fees and, charges are due a: ( payable'when the permit is issued. SPRINGfiELD ( City Hall Springfield, Oregon Department of Public Works OFFICIAL RECEIPT r- , j I. III. IV. V. 1---. r ,,,00 , , '1 PE:l"mjt - O~'-,' k, h__ '" -..:.-.:2..:x.....-_.-::-=-:---~ _ _,,_,. FOR OFFICE USE ONLY .------'.,1......_............ (n C]o~o. B 54553( Dote'--"'f - / 'L 19 () ('" Rec'd From 1fJ, [tt D .flO 1 .tU ,Lt2CO 's . ( Addrelt?rnnD rtu q~~2f.=lyf(J . . - I' \.' , "f ( -( Received For: ~() n 0 J,rv! () ( 109 I,OU ( ( ( ( Amount Received 7-.00 ('/~ GD r AUTHORIZEO SIGNATURE s.uuo...,I.,......ULL ....,..YE..S. EUGENE. 0" IlY.ao, "15""'15 (' ( ~. (I ( ( --'--;-n----1 .h_~ J ._--,-- '---------_.--..~-'---,---,I .PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: 'Permit:applicant exempt from registratiori'.with the.Sunder's -Board because: ,. . AddHional Project Informat.ion: I l PLANS REVIEWED BY: name signature. '~ date