HomeMy WebLinkAboutPermit Building 1981-1-22
~ CITY UF SPRINGFIELD
_BliIATlON APPLICATION/PERMIT
Job Address -? 0 ':1/ _/'/ / / /~ /.1 /J E!IERGY SOURCES: I
\..., 0 ,") /7/~/;V U/V//<?'- VI"" Heat<5K"tSr. "tZ'~<'r.
Legal Oe<cription H.+P/~-O:il.~/' 11-/ r.~. ~S"':"- I'/ater Heater~R'.A'r.
Range 1'T',4 .
ValuE of Hark.:
/< OC-Z:;>
BU11riinQ Pernlit Info: Describe Work.(i~e..
Familv nesidence With Attached Garaae)
.'
,
jINSPECTlON LINE
726-376g
Owner
4LP:,e/~
/
Phone
~~.A
Address
'2"l.c:.r 4~~
Construction lender
~
/
(address I ./
;t9- ~ +-
(lies. no.)
Address
DES I GN TEAr~ (name)
i
Primary ALA!?
Strur.tural /~ ):0//<"
Electrical
Phone
.
INFURllATlON LINt
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other"J'eIP
flew Add JCA Her Rep.
Fence_Demo _ Cha nge/Use
_Other
~.
......
()
I~
~
/J)
Build Single
{exniresl
(a.hone no. ')
41:'/'~~~J//V_
"
/-O/)
/
. AhJ1) -/?!5<Jk' '''7
,
/
I
MEC+NICAL
I
furna,\/burntr to
BTU's
I
Fl OOf f~naCr
and vent\
Ref ~ssed '/a 111 I
SO~'\hP" P~ "nn T\I
App I' alQ' ve lt \
Soeo at.p "
Sta :. onary ~ lap. '\
coo r ............,
VenJ1 fan wit 1 --..........'
sino)e duct
I Vent system lapart fr
hea t i nq or ". C.
...... If} I Mechanical dxhaust
'\'1(",-.41 '1 hood t1nd rlLJh J
~ ~.Waad stove/~eat~r
,~~" I I
I V
I
I I
I~ GO I TOTAL CHARGES
f1echanical
CONTRACTORS Inamel
General ./7,... /A)L/~1
tC'7.i- .It) ~LC
(address)
/ -
~_, ckH""'h-.-k,
(1 ics. no.)
;#' .:219YV
ql4f)4-
s-X
e-4
P'1..-Lin6
Electrical
!~"p_........,.ot)
I ,
// .J/,p ~...'-r::"./
"
:'10.
I
PLUllBljlt
I
i ng1 e fi xtfre
Relaca d bUildIng
(newf;. additonal)
ence I
(I bath)
[r,\ex (I lath f each
Ai(it~nal_bat\
II'ler s~ce
I Ser I
St rm Sewer I
I
I
I
I
Ii
amps.
r~echanical
ELECTRICAL
FEE
r.HARC,F yn
1='1="..L1 r~.!lQr.:1="
Residence of
SQ. FT.
New circuits alts.
or extensions
:z- 15:-
I
I
I
I
I
SERVICES
ITemparary Construction
I'Change in existing
rp<;.idenC':~
Imultifamily, comm. or
lnrlustrin:l
IOf
I COMI-I.IIND. FEEDERS
I Install/alter/relocate
rli<;.trih. fpprlpr<;.
IOf
amps.l
TOTAL CHARGES
. WHERE STATE L'I~ REOUIRES
shall not be valil until the
TOTAL CHARGES
(pxnirp<;.)
(ohnnp nn )
,0;:::-5'=-8/
h'$"7'/ClJ
NO.
j.lli-r
I I
ISSUANCE OF PFR!IIT
l
that the Electrical \'mrk be done by an, Electrical Contractor, the electrical portion of this perlilit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXN1INED 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 UO OCCUPAUCY 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 emrloyees who are in compliance with ORS 701.055 will be ~n t~oject.
IW.IE(p1ease print) rl7AJ/lJ:J ,U/kk SIGI1ATURE A U_ / P/A ~TE/-.?'::>-81
FO~ OfFICE USE DIlLY
Sa. Ftg. 1lain
Sq. Ft~. Access
"'""""~"r-~
Sq. Ftg. Other ~cL.
fIo7'rk: 7ft:~ r= e,)Ce#;?-'3'<o.s--!J<&:JG..
I
____J~.~O
. 'Ie>
Zone
Tyoe/Const.
Bedrooms
Units
Oecy load
Occy Group
Fi re Zone
Flood Plain
Stori es
Value
Value
Value
TOTAL VALUATION
x
x
~tW.i)e-
/"...",., -
ConvnlI nd
Ppr Fpp
Res
Per Fee
::We;!;" <.<.. .
I Systems, Development I
Charqe (1.5~)
BUILDING PERfllT
Charges anc
Surcharges
I Plan Ck.
65tlB1da
I' Plan Ck.
30t/BldQ
I Fence
I Demo
~.... I
I ~. 'Sidewalk
-------~(;-.;:_I A/C Paving
PLur~BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERI~IT
Cha rges and
Surcharges
11ECHANICAL PERMIT
Cha rges and
Surcharges
Curb Cut
Total Comb. Permit
.,. ......
TOTAL
;z~_-
\, ..
.
.
, " ,. - ~
II.
CQI.IBINATION ~PPLICATION/PERI'IIT" (CAP)
..
~ PERMIT VALIDATION
l.
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax lot 100. Lane County Map Reference
JI oj 43
2. examole' Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources '
1. examole- heat/electrical ceilingjor forced air Gas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. examoJe- if new' project; check----riew - if addition,
check add. etc.
F. Building permit inforrr"';tion:
1. example ,- construct single family house with an
a ttached garage
2. example - remodel -existing garage into family foom
3. examole - convert Single family residence ir.to
restaurant (change of use)
G. Value of work as defined in Section 303 (al of the
Structural SpeCialty Code
H. OES I GN TEAl.' AND CONTRACTORS
To avoid design or'construction delays. Build~r.g
Division Staff must be able to contact appro~riate
persons regarding design information or jOb site
corrections. etc.
11. Abbreviated Plumbing. Mechanical, & Electrical Schedules
A. Except where blan~ 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. rf the item(s) to be instalfed are not covered on
the abbreviated schedules you 'should consult the
full schedules
C. BUILDING OIVISION 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. ---
II I. Appl icant 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 rees 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:
.
Permit app 1 i cant exempt from regi 5 trati on wi th the Buil der' S Board because:
-j . I..... " ~
Additional ProJect' Information:
'.
-. ~ ..
PLANS REVIEWED BY:
. . ~ ~
name L..oRNO:- ?<:::'~G"~Signature~~-;('___~-
date I-:z.,~e(
I
.&. CITY OF SPRIrlGFIELD
~MBI;IATIDN APPLICATION/PERMIT
" ,,/---r"", ,,/l EilER GY SOURCES: 1
t l' /l'.' /,r. '" t'-"- Hea tc,asr. .ec ~c:r .
Legal Oe<cription ~"'_''''__''''''/'''I ...., ,-,' i'later Heater~R'A'
~,-,,--c "'" T" '.,,",.~~...J""""-- -
Ranqe' H..s. .
ValuE of Ijork: ,.
/. 0'::-0 .
Bu11(;100 Permit Info: Describe Hork(Le.,
Familv nesidence With Attached Garaael
... J'
'I ItlSPECTIOtl LIIIE
726-3769
Job Address
\.<P,,:?/ ~/~
Owner
./>::f?L/'IC/ .(:r-="",
. / ///
Phone
&-/ A
Address
'l '"L '7>- 4 QG1 ~
Construction lender
~
/
./
'" -+=""
--~ ,
Address
Ul:.~l(jr~ 1 tAro' (name)
Primary A'.c,o .
Structural /-:)..<' //:::-
Electrical
Phone
(address)
.
INFORlIATION Ulll I'
726,3753
Sq. Ftq. i'lain
~q. ~tg. Access.
Sq. Ftg. Other ~~
ilel< AddJ'Alter Rep.
--Fence Demo Change/Use
Other - -
~
.......
()
~
-C
IJ)
Build Single I
/h'/>
/
;eY-
(lies. no.) (exoires)
/l$"") -..t?b'R" )>1/~
. / /
(ahon€! no.
:4l'/'~~~'//~'"
/
I
I
I
I
I
I I ISSUAtlCf OF PFRI\IT
I TOTAL CHARGES I~OO I TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor. the electrical portion of
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXi'\r1IflED the completed application for Dermit. and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work Derformed 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 rlC OCCUPAlKY ,...ill 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 emoloyees who are in comoliance with ORS 7~1.055 will ~e.us 22thi oJ'ect. .
. .. .' //
HAI.IE(please print) ~Y//,.'l //J~k SIGilATURE _/ :.=_ I ;:/A"~ATE/-.?-.:o.:-81
FO~ OFFICE USE miL Y
SC!. Ftg. f1ain
Sq. FtlJ. Access . x
~~o-rC:' -..C1or.,O).e--
Sq. Ftg. Other ~cL. x
f/t> 7"';:: 7ft: ~ r= VoO" # ;>~ ::t <.oS- -ll<z::x::.. 5'V.:5 <.c... TOTAL VALUATIOII
I }'-' Q C I Pl an Ck. Co"",lInd
~- 65%/Bldo Ppr Fep
---- ----------pran Ck. Res
. c.{</> 30%/Bldo Per Fee
Fence
11echanical
COli TRACTORS (name)
General /7 r /"'}A~'/;;"~
,C''9<l /";~h/'c
(addrpss)
/_. ~ kJ':'C:://~;
f1 ir.s. no.)
s#' ,2/97/$/
'1 14(i 4-
.<;/:
EU~
pl.._,- ~
Electrical
!~p_". .'....~ n)
, ,
// ),.p i ...4-'-/
- ,/
';Q.
I
PLUIIBI!lC
,
fi xtfre
Reloca d bUildlng
(new fi . addit anal)
S~ F. Res 1 ence I
Ir bath)
(pl.ex (l a th j each
A Ilit~nallbat~
~!j er s~ce I
s~,'er I
Stbrm Sewer I
I
I
I
I
l
amps.
I~echa ni c~ 1
ELECTRICAL
FEE
(H~ Jj{l
""
rIJA9JiE.
Residence of
SQ. FT.
New circuits alts.
or extensions
1;2- 15':-
I
I
I
SERVICES
Temporary Construction
Change in existing
rp<;,id~nr.p
multifamily, COIl1l1. or
Tnrl\Jc;tri~l
Of
amps,
Cor~.I./IND. FEEDERS
Install/alter/relocate
dic;trih. fppdprc;
Of
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
Zone
Tyoe/Canst.
Bedrooms
Stories
Units
Dccy Load
Occy Group
Fi re Zone
Flood Plain
BUILDING PERfllT
Charges and
Surcharges
PLUl1BING PERMIT
Charges and
Surcha rges
Demo
Sidewalk
ELECTRICAL PERI~IT
Charges and
Surcharges
_____l~_~:_
.~O
AIC Paving
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
(pxoirpo;)
(onnnp nn, l
...-< -j'=-.:~'"
h'<~7/a :;
,
(
I
MECflllCAL
NO I I
furna\/burntr to
BTU's
,
:~~O:e~~rnacr
Ret'oessed a 111
'Ol{\ he, e~ ,orl v
Ape \ia~ ve It
SP.O I 'ate
Sta. ionary ~ lap.
coo ~r ,
Venr fan wi tr
sinole duct
I Vent system lapart fr m
heatina or n.c.
I'MeChanical !xhaust
hood <Jnd dlJ!t i
r Hood stove/ leat~r
I
I
I
""CI..c.JiAJlliE.
./
I'
I
I
I
I
I I
V
this pemit
x
Value
Value
Value
/C>Ot::>. C>e
Syster.:s Development I
Charoe (1. 5r,)
I
I
I
!rotal Comb. Permit
j
I
I TOTAL -
.:z~ .......
.
..
COMBINATION APPLICATION/PE~1IT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description (
1. example- Tax Lot 100. Lane County Map Ref
11 03 43
2. examole' Lot 1. Block 3. 2nd Addition to
Sprlngfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or fore!
2. examJle- waterheater/electrical/or solar r"
E. Square footage or valuation. etc. -
1. example- 1250 sq. foot house. 500 sq. fa,
2. examoJe- if new project, checknew - if .
chee k add. etc.
F. Building pemit inforrr"'.tion:
1. eXdmDle - construct single family hOUS2
a ttached garage
2. exar.mle - remodel existing garage into f ('J
3. examole - convert single family residenc ~~
restaurant (change of use)
G. Value of work as defined in Section 303 (a)
Structural Specialty Code
H. OESIG;~ TEAl.! AlW CONTRACTORS
To avoid des ign or- construction delays, Su; r
Division Staff must be able to contact apprc
persons regarding design information or jab ~C
corrections. etc. i,
Ii. Abbreviated Plumbing. Mechanical, & Electrical ~
A. Except where blanK spaces occur in the desc:
?ortion of the Mechanical and Electrical Sc~ Id'
the applicant need fill-in only the No. Box, \
to the aooropriate item(s) to be installed
B. full Plumbing, r.1echanical. and Electrical S
are available at the Building Division
1. To conseive space on the 'permit form th (ch'
have been abbreviated
2. If the item(s) to be installed are not
the abbreviated schedules you' should co
full schedules
C. .BUILOI1;G OIVISroN STAFF WILL FILL OUT ALL F
CHARGES ON THE SCHEOULES
0.. As noted on the CAP. the label must be deli
electrical contractor for signature by his
supervisor. The general contractor is not
to sign the electrical label. -
Applicant to sign and date
Whenever possible. the initial application wil"
a worksheet only. Where possible. Building Oi'
will prepare a type written copy and return it
applicant at the time the actual permit is iss'
signature. C
IV. Fees and Charges
Plan check fees are due and payable at the timb-~,
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.
,
'.
.
.'
PERMIT VALIDATION
CITY OF SPRINGFIELD
City Hall
Springfield, Oregan
Department of Public Works
OFFICIAL RECEIPT
n
t
'"
I No. B
Dotf!\/A././. 42. 19 'Fi/
( Rec'd From ]).~. WHrros
Address &%'" K'/<'Z>A-.k,.z;"
55647
!
CQNS?
6'v<::'~'Ye--
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Received For:
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r~"loofp<'<!:'TG (eAl5e?- ~~.@- . ( ."
r-~,.....c/-'fL~ r .-
bP 10.00
~(h 40
t>-P JB00
40)6 .Id)
(~t
;-~mount Received
I I 1.
~'l BY
("
V. FOR OFFIr.E .U5E ONLY
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'2...(0. 00 CfZ:,.
Qf:u,"o.".o SOG."u",
'''''LTO'''T "lUll ""'''T..".. I[UG....I[. O. .'.Dl ,..".,
Permit Cl Elrk
~
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 L.Ol?N..?c:::.~G"""=;-signature/~ 0-
I"
. '.
(
,
'.
(
(
( I
( ,
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date /-2.~~e (
.
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