The URL can be used to link to this page

Home My WebLink AboutPermit Sidewalk 1985-11-15 'Bn~~mOII LlIIE j\ \ . -.~ (A) INFORllATION LlNL 726-3753 Sq. Ftq. 1,Iain S:q. Ftg. Access. Sq. Ftq. Other lIew Add Alter ~ep. Fence_Demo _Change/Use _Other I I~ 111 ~ ~ tJ ~"'" Job Address 30/5':5" MA-/A/ Legal Description /'-t1'Z-""3/-JI, , Owner VA-At ,1C5JtiKI"<<;~P Address ::;'~ ~~ ~-r . 5;z>~?Z?/~? . Construction Lender Address Ulo!(;N ILAI,' Primary Structural Electrical Mechanical CONTRACTORS (name) Plumbina () W~ . lnamel General Electrical ~1~rhani ~~ 1 --1ill..,.1 PLUllBIIIG Each single fixture I FFF J rHMr,F Relocated building (new fix. additional) l's.F. Residence (1 bathl -----IDuPlex (1 bath) IAdditional bath I ~Iater service I Sewer I Storm Sewer I I I I I I each I I I .1 I I I I I CITY OF SPRIIIGFIELD COMBIIIATlDN APPLlCATlON/PERMI1 E!IERGY SOURCES: Heat Hater Heater Ranqe ~r. b~6<!J-:3 ~~--~ ValuE~o~:~ :) CAe? ~ Buildina Permit Info: Describe Work(i.e., Build Single Familv Residence With Attached Garaae) //j5~~t:.. ?o I 6..c:- 5'(W/~ .:::::u/tZ/i'S/z>t? :r/~WA'-CA". ..., '/ Y ::>.ii! Phone (address) (f!'xoires) . (ohane no. I (lies. no.l ... ~J-... i~:::r ...., (address) f1 ice;. no.) (pxoirpc;.) (ohonp nn. 1 'MECHANICAL t eeL 1...c.HAB.G..E~l I furnace/burner to BTU's I Floor furnace and vent -recessed w~~l ~~p hp~tpr ~nrl vpnt --I- I, App 1; ance vent seoarittp I Stationary evap. cooll=!r I Vent fan with sinolE' rluct Vent sys tern apa rt from I heatina or A.C. Mechanical exhaust hood i\nd dur.t. ELECTRICAL .1!O..-1 I Res i dence of SQ. FT. INew circu~ts alts. or extenSlons . I SERVICES I I eer; I ruJl8.G.E. ITemporary Construction IChange in existing ,rpr;;j1p.:nr-p Imultifamily, comm. or Tnrlllc:.trhl '/ IOf i ICO~1./INO. FEEDERS I Install/alter/relocate ~ r1ic:.trih fpprlprc:. IOf I I I amps.] Wood stove/heater amps. TOTAL CHARGES TOTAL CHARGES WHERE STATE L.'II REQUIRES that tl,e Electrical work be done byan, shall not be vali1 until the label has been signed by an Electrical ISSUANCE OF PFRrlIT I TOTAL CHARGES Electrical Contractor, the electrical portion of this pe~it Supervisor and returned to the Building Division I HAVE CAREFULLY EXN1INED 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 Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that rm 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 701.055 will be used on this project. IWIE(please print) Zone ./,-;. Fire Zone Flood Plain BUILDING PERflIT Charges and Surcharges PLurlBING PERMIT Charges and Surcharges ELECTRICAL PERI:IT Cha rges and Surcharges MECHANICAL PERMIT Charges and Surcharges ~,{J ,';;#~j~5Ph SIGIIATURE ~~ FOR OFF I CE USE O!lL Y =-- Sq. Ftg. Sq. Ft9. Sq. Ftg. ;;:,~~- Type/Canst. Bedrooms Stories DATE //~5-j? ~ Units Occy Load Occy Grouo riain x Value Access x Value Other S~w",..CV"/ Value TOTAL VALUATION Plan Ck. Comm/Ind 65~/Rldo Per Fpe Plan Ck. Res 30%/Bldo Per Fee Fence Systems Development Charoo (1.51,) , I I I D/llllo -__________J Sidewalk ?C>' lAIC Pavi ng ___ _ __ _ _ _ ___I Curb Cut I $. C/O ITotal Comb. Permit I. I TOTAL B- tft:::) , , ~ COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. legal Description 1. examp.le- Tax lot 100. lane County Map Reference If OJ 43 2. examole- lot 1. Block 3. 2nd Addition to Sprlngfield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. exam~le. heat/electrical ceilin~/or forced air Qas 2. examole- 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. .Buildin'g pennit 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 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. 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. --- 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 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. V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: I Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: . ' PLANS REVIEWED BY: ~ . ,~..,,., -. date //-YS-~ name LtflJ/Yt? ?~ff Signature~<o'. . " . . IIIISPECT 1011 L1IIE I 726-3769 Owner V~ !C5JtiK/A'<<;;OP Address::; , ~h' ~-r . 5;z>~?Z? /~? Construction lender I' ~~.-:-:::;, ...,:::> Y ~ CITY OF SPRINGFIELD INFORlIATIDN LINE . COIIBIIIATlON APPLlCATlON/PERMIT 726-3753 EIIERGY SOURCES: Sq. Ftg. 1.lain l\l\ -;>T. Heat ~q. Ftg. Access. ""JI ""........ <::J-'" I/ater Heater Sq. Ftq. Other 111 ,,~~ ~ New Add Alter Rep. Range -Fence Demo Change/Use ~ ValuE~~t e>.- -Other- - I;) BUll~in(] pe~t Info: Describe Worldi-.e.. Build Single ~ Familv nesidence With Attached Garaoe) ~ /1'5r;.,~t.. 70 I 6F' S"IW/~ .c:ul't~/2)t? 5/.z;::Ii!=WA'-CA"'. Job Address 3 0/5':5" MA-/~/ I.egal Description /7-C;'Z-3/--:J1. , Address ULoI(;N ILAH {name) Phone (address) flies. no.l (exo;resl (ohane no.l Primary Structural Electrical Mechanical CONTRACTORS (name) (address) f1 ice;, I'm.' (exo;rpc;.) lohnnp no ). Genera 1 n WH~ . Plumbino Electrical f..lechani ca 1 PLUIIB ING ELECTRICAL MECHANICAL NO. I , FEE '(H~ _NO SQ. FT. furnace/burner to BTU's I ~I=I= rl1ARGf., Each single fixture Residence of <<.LIJ:liAll.IiE. flO Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (J bathl Duplex (1 bath) IAdditional bath -1~later service Sewer SERVICES Recessed wall ~nncP hp~tp; ~nrl vpnt each Storm Sewer Temporary Construction Change in existing rp~.; q~nr:~ Imultifamily, comm. or Tnnu,t.ri;11 10f ICO~1./IND. FEEDERS IInstall/alter/re1ocate 1 rli,trih fpprfpr~ 10f amp..1 I I I amps.1 Appliance vent seoa ra te I Stationary evap. cooler I' Vent fan with sinale duct I Vent system apart from I hea t i nq or A. C. I Mechanical exhaust hnnd nnd dur:t I Hood s tove/hea ter I I I I TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES WHERE STATE L'\\~ REQUIRES that the Electrical work be done by an."Electrica1 Contractor, the electrical portion of this pemit shall not be va1i1 until the label has been signed by an Electrical Supervisor and returned to the Building Division I SSUANCf OF PFRIIIT I HAVE CAREFULLY EXArlINED 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 og fi e 1 d and the laws of the S ta te of Oregon pe rta i n i ng to the work descri bed herei n, and tha t HO OCCUPAUCY wi 11 be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Doard is in full force and effect as required by O~S 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and em~loyees who are in compliance with ORS 701.055 will be used on.this project. IWIE(please print) ~p :;;;; ,,4J~ .5Lk 20ne / C Fi re Zone Flood Plain Tyoe/Cons t. Bedrooms Stories Units Occy Load Occy Group SrGI~^TURE ~~____n_""'OATE //-/S:-J, ~ FO~ OFFICE USE OIK Y .z.- Sq. Ftg. f1ain x Value Sq. Ftg. Access x Va 1 ue Sq. Ft9. Other 5~w~o// Value;'-, ~~- - TOTAL VALUATIOII BUILDIflG PERflIT Charges an~ Surcha rges Plan Ck. Comm/lnd 65%/Bld~ Per Fep Plan Ck. R-es 30%/Bldo Per Fee Fence Systems Development CharQe (1.5~) PLUllBING PERMIT Charges and Surcharges Demo ____________, SIdewalk 70 I A/C Paving ____________, Curb Cut I 8.C(0 ELECTR I CAL PERI:IT Charges and Surcharges ITotal Comb. rermit , I TOTAL " 11ECHANICAL PERMIT Charges and Surcharges 8- t(O . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, lane County Map Reference If 03 4j 2. examole- Lot 1. Block 3. 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. example- heat/electrical ceilinq/or forced air qas 2. examole- waterheater/electrical(or solar E. Square footage or valuation, etc. ----- 1. examDle- 1250 sq. loot house. SOD 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 a ltached garage 2. example - remodel existing garage into family room 3. examele - 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 TEM1 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 Pl~mbin9, 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 O. 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. - 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 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 penmit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: , -"v OF SPRINGFIELD Clly HIli Springfield, Oregon Department 01 Public Work. OFFICIAL RECEIPT' No. B 65643 ~_?S: '9~ Rec'd FromV,f#Jl!?'IYKlht50~~~ Address ?!J 'I/""/ ~;y 12.T' I Received For: jc;'it i/C8'5'"/O~? . ~ - ~~ i ?f 8. l(t:? I . ~ L~#f~<)" Amount Recelvedd e, 9"p__ ____~ ----=-.i--~ ~THOAIZEO~GN<l~~'/ I ID:.. ~Ier aus.tOtSS FORMS. INC. '5031~2,"" . Permit Cl erk Permit applicant exempt from registration with the Builder's Board because: Additlonal Project Information: PLANS REVIEWED BY: name L.0i9/'ie= n~7? signature ~-P':7 _ I'~_.f> date //-y"S-~ ~"." ~ t I '" "'"" ~ '" \ ,,,'\-.... ,:" ~~., ':~~t" '- ~. 011, ;.,,~,.\i''t!,,~ "". P:~ ~i'~ "- /I l ,. " "'" ~ l '" '..".' tl" \ " ''"- : I ~7 '''he'''. '-:_~, ~ "' "'" ,." '" '" ~.~~ ~ "" ~' ~,"" ." "Q~~. t ,,~ . "'", \' \J.~ . "', '" "-. '\~" \ "-. ~ ~ ~\ " '" ~~ \i,~ ,l''''' ~, \.~ ~ '\ " ~~ "" " ~'i ,~ " \ "~~,, \~ ~( " ,,/ " " ,,~'C:,.. \ , " . "'... \ '~ " '" \. ~~ ~--(" .. " " -l"""& ~ {lilt. 1/" ;"~i '->,..,.- _ _ '- _ ~"-/ ~ \," :'C'i' f';""411( ./llPo,c~;//'//r~/~/$"Yf:1'M-4/1r/// / //J#~ d {f; 'il~'i.1,,, ; " yJQ, .,y , I " " "" N ~, '" ~ "" "-.. " ~, C \, \; I '" ~ "-., ~' I ~ i '''\..,'~ , t ,lhih~, ,_ "~'- ~~" I' \ ;: i:'~>' ,:.'~rn[u]wi. ,. :E,R~~F:C~,~I~N ,',., "I:-'~' ..:. lJ1.I ' . " ';\ ., p." 1r1:l~'l. \"ro,.\l, i -.I...,-;i,~' , ~:lf,;,:"t". 't ., ~,11! 'I;. "i';'~;11\" II' ; >:f'><' !,' . \: . j 'I ' ,..' , i' J, ' ' , " ." ~ ...' '_'.. \ ,.~ '; " i.',)" !i' ~ "i .." <,;.; - "': j,' ," .- :~.., '~kll-. i,.! ..:,\""V',"H ,- ;. ~~ ~ ~" i'1 " 5:':" l't,. '.' I' "; I.": If ~, ~:" ' " . ,. , I ,., ~.......-.,....- '. - ---j '" I '...L ,\ ~ FOR VEHICLE REGISTRATION '.t. r. ~ , , J: ;.) . ' .1. ~, i ;'" . I,. \ .' ~.' ~ -. ? ""I'~.t-...,.;i.,~~,t:!.,A,~':::-- ~~.A J . ' -",/'Tl \ I J. ...' ,._'''4 ,.a ^ , .. I " ' . "oJ IPLATE NUMBER" ~. ~'. ,.; .; , II. I' ~'I I ) ,/ i YEAR- I ~_AKE .., . : I I ":l,t!.~CL~-~Q.~-NJlf~C/lllCN f..U(l.~n{~ , ,~::;~;~~~ 'OR ;;,o;;;~AT'O' m, ;~H:"';~~~~~'~t~ H":" 1, THAT I AM DOMICILED IN OREGON, 9_~ '- , CERTIFY THE , c' " " . : .. 2, THAT THE VEHICLE IS SUBJECT TO REGISTnATION IN OREGON UNDER ORS, .181 155,Ofl 3. THAT IT'MEETS ALL OF Tf:lE FOLLOWING QUALIFICATIONS FOR OREGO~I REGISTRATION' A, THE VEHICLE IS USUALLY LEFT IN OREGON WHEN I M1 AWAY FROM THE STATE. I ' , B. IT'IS USED PRIMARILY FOR PERSONAL T.RANSPORTATION IN ORt;GON, AND . , C, IT IS A PRIVATE PASSENGER VEHICLE OR A Vi:HICLE HAVING A LO!\OI"D WEIG' 8.000 POUNDS. AND, , D, 2S NOT A MOTO~,t~~~AMP~~ SIGNATURE o~ OWNER (If BU~3INESS.II~CLl~SINrs:'~" .' 'I~,~ " ... i ", , -_._- - - t ; 735-6727 (8'f;5) ..~-'" .-' ",