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HomeMy WebLinkAboutPermit Miscellaneous 1981-7-20 INSPECTION lI~E 72r..J769 ... . CITY OF SPRINGFiElD COMBINATION APPlICAJION/pERMIT . INFORMATION LINE 726-3752 .~ 8 I~ '~ " ~L\ mOin logal OO""pria. II 7...- Il_ 0 z. ~ I L) 1- (7lfJ ,ftll ffJfllJ.Lfi..l1 ') I Ow... \~__ ' ~ y r'1;';:) I Add.... \ ~~C (y)t1 p 1\ ) Pha.o I .....~-.~,M: \ Uo , I Construction 1ndt ) I Add,... , DESIGN TEAM I Primary I Struttural I electrical I Mechanical I CONTRACTORS G~n.rol t Plumbinq I Electriml I Medlonical I Job Add,,,,, I ENERGY SOURCES: Heat I Waler Healer Rcnqe _ I Volue of Work: . I ' ..., ,j _Olho' Building Permit Info: Oelcrib. Work (La.. Build Sing I. fomil># ResideriC'" With'A.ttached Cefolu' : Sq. fIg. Main Sq. FI~. Acean. Sq. fig. Othe' _New _Add_Alte, _Rep. ___Fence_Oemo_Chonge! U'tI f\ U q-I)~ lUc.. 4f)' .i\/J~) , Phone (namel {addreul (Iin. no.). (expire1) (phon. no.) , A .1t( (namlt) (addreu) mes. no.) {expires} (phone no,) . ~'I.: '" PLUMBING ELECTRICAL MECHANICAL NO. I fE~ I CHARGE I NO. FEE i CHARGE NO. FEE' I CHARGE Residence of furnace I burn.r to 11U's Applianc. ....nt separate Stationary e...ap. cooler Vent fon with singl. dud V.n' system aport from heating or A.C. Mechanical .xhaust hood and duct "~/ Each lingl. fillture Relaca fed building (new fix. additial'loi) S.F. Re.iden~. (1 bOlh) S~: ft. New circuits. alterations or extensions SERVICES Duol.. (1 both) each Temporary Construction Addilional botho Amps. Water .er...ic. Sewer Wood sto..../h.at.r Star,m Se.....r FEEDERS Heat Puma Air handler to 10000 CFM Air hClndler o....r 10.000 CFM I I I I I I Amps. I I I I r I TOTAL CHARGES TOTAL CHARGES ISSU-ANCE 'OF ",peRMIT I TOTAL CHARGES WHERE STATE LAW REQUIRES thoat the Electrical worlc be don. by the El.rtrical Contractor, the .Iectricol portion of this permit shall not b. yalid until Q label hos b-n si9ned by an Electrical Contrador and attached to ,h. eledricol ponel. I HAVE CAREFULLY EXAMINED ,he completed application for permit, and do heleby certify thot 011 information hereon is true and correct, and I further certify that any and all .....ork performed sholl b. done in accordance with the Ordinances of the City of Springfi.ld and the Laws of th. State of Olegon pertaining to the work de.crio.d herin, and that NO OCCUPANCY will be made of any structure without Ihe perminion of the Building Di...ision. I furth.r c:ertlfy that my registration witn the Builder's Boald is in full force and eff.ct as required by oas 701.055, that if u.empt the basis far exemption is noted.. heron, and Ihot only subcontractors and employ.es who are in compliance wilh ORS 701.0'5 will b. used on this project. Basis for Byilders Board uemptionl NAME (please print) han {p ~ ! B/'I9-/Jf SIGNAYUR~~ FOR OFFICE USE ONLY ~~TE (/ , ( . ','olue Value Valu. Zone Type/ Canst. Units Fir. Zone Bedrooms I"'\ccy Load Flood Plain Ctorief n...., Group BUILDING PERMIT Plan CIt. Comm/lnd Charg.s and 65%1 BldQ Per Fee Surcharges Plan Ck. R.s 30%1 Bldr'\ Per Fee PLUMBING PERMIT Charges and Fence Surcharges Demo ELECTRICAL PERMIT Charge. and Sidewalk Surcharges A I c; Payin~ MECHANICAL PERMIT Charge. and Curb Cut Syrcharges -------- Sq. Fig. Main c:...; Ftg. Acceu Sq. Ftg. Other . . TOTAL V AlUA TION Systems O.....lopment Charae t1..s~' Total Comb. Permit '7,op vrn,LI7 j nll un...J TOTAL '700 ~~. L ,.... -' . ~'". . .....~..... .:.-.;.\.;;;..t.'w..i_'"-......"'. ..... '1'., COMBINATION APPUCA TlON/PER" (CAP) I. Applica~ ta furnish A. Job Address B. legal Description 1. examole.tax lot 100, lone County Map Reference 17 03 43 2. example.lotil. Block 3, 2nd Addition to Springfield Estates C. Nome, elc. of owner and construction lender , D.. Energy Sources I 1. exomole-heo't/electrical ceiling/or forced oir gas 2. exam ole-wafer heater; electrical/or solar " E. Square footage :or valuation, etc. 1. exomole.1250 sq. f,oot house, 500 sq, foat garage 2. exomoJe-if new project, check new-if addition, check odd. etc. F. Building permit ,information: 1. exam ole-construct single family house with an !=Jttoched garage 2~ examole.re~,odel existing' gorag& into family room 3. eJtomple.con'vert"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 TE'>,M AND CONTRACTORS To avoid design~:or construction delays, -Building Division Stoff must be able to contoct oppropriate persons regarding :design information or job site corrections, etc. , II. Abbreviated Plumb'ing. Mechanical & Electrical Sched~les !, A~ Except whereblcnk spaces oallr in the description portion of the Mechanical and Electrical Schedules, the applican~' need fill.in ani/the. No. Boxes adjacent to the appropriate iteh'l{s} to be ins~alled B. Full Plumbing. ~echonicol, and Electrical Schedules . 'are available or:i,"the Building Division , ' 1. To conserve space on the permit form the schedules have been oqbreviated 2. If the item(s) ;to be installed ore not 'covered on .the abbrevi~ ated. schedul~s yOu should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON HiE SCHEDULES , III. Applicant to sign a~d dote Whenever possible'llhe inifial application will be used as a worksheet only. Wh~re possible, Building .Division Staff will prepare 0 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. V. FOR OFFICE USE ONLY II , PROJECT CONDITIONS I!TO , BE SATISFIED BEFORE OCCUPANCY: , Additional Project Information: PLANS REVIEWED BY: nam'" pignotur... " ::. " . L' PERMIT VALlDATrON_.. --. Permit, Cler~ < .Jate- ~ '.-. . ~....--...".. I J.b Add.... '. d38L\ }'iht~',,"h.n II r - all _ I _ \ Own" ~C\{f!f.N'; \ t?~'L0 I Add,... \ ~~L..j (YJi? P 5\ -) P~.no I c.n..,u:::~f.tV ... G_o , I\Uf)../)~)U~ I Add".. DESICN TEAM j P,imary I Structural I Elt!ctrical I Mechanical I COI'olTUCTORS G..n..ral INSPECTION L~E 726-3769 p ~ 0- . CITY OF SPRINGFIELD COMBIHAl'lCN APPllCAJlON/PERMlt . INFORMATION LINE 7'J:6-J1S3 ~ 8' I~ ...) ffillin i Sq. fIg. Main ISq, Fig. Ace.... Sq, Ft9. Oth.r . I _N...... _Add _Ah., _RItP, I' ___Fence_Dtlmo_ChangeiU.1t _Otk.r Buildil'l9 Permit 1,..fOl Ceu:rib. Work (i,II., Build Single Fornil.. Resiti..nl'l" With "Attached Cgraoe' ENERGY SOURCES: Heat Wal., Heat., Ronqe _ Value of Work: 4t~) i"f'i.~) Phone (nome, (addreu) (Iiel. no.)' (expire.) (phone no.) (nomel (address) (lies. no.) J I J I i 1 .' ! CHARGE~! I // i 1 \ J I '1 J j Cu'p;res) (phOMe noJ Plumbitlq Eleetriml ~..!,: Methanical PLUMBING elECTRICAL MECHANICAL FE: 1 CHARGE' NO. FEE FEE CHARGE NO, I NO.1 I I I I I I I I I I I I I r' I TOTAL CHARGES I WHEiilE nAIE LAW REQUIRES Ih.al Ihe Eledricol worlc b. dan. by the E!.rtrical Cantrocfor, the el.ctrical partior& of this permit .hall not b. valid until a label has b_n signed by an Elecrrical Conlractor and attached to the e!.ctrical pan.l. '\. Re,idenca of furnac./burner !o llTU', Each ling I. fi.-tur. ~q: ft. R"locaTed b",ildin9 {new fi.... additional} 5.f. R:a,iden~. (1 bath) New c:ircuih. alleration, or e...t.n,ion, Apj)/icmc. ...ent ,eparala SERVICES Stationary ...-op. cooler Venl fan with ,ingl. duct V.nt sy,tam aport from healinq ar A.C. M.chanical ....hau't hood and duct Dual...: (1 bathl each Tamporary Con,truction .Addilioftal bOlh Amps. Warer ,ar...ic. Sewer Wood 'Io...e/heatar Slor,m Sa_.~ FEEDERS Heat Puma Air handler to 10.000 CFM Ama'. Air handler a....r 10.000 CfM ISSlMNcf~.Of..peRMIT I ~ I HAVE CAREfULLY EXAMINED the completed application for permit, and do hereby certify that 011 information her.an is true and co"ect. and 1 further I certify that "'ny and all ....ork performed shaU be done in accordance with th. Ordinance, of th. City of Springfield and tho law, af the Stat. of Or.gon 1 p.rtaining to Ih. work de,crii:Md herin. and thai NO OCCUPANCY will b. mado of any ,tructure without the permission of the Building Ci..-ision. I furthar I certify that my registration witn Ihe Builder', Saard is in full force and effoct as required by ORS 701.0S5. that if ex.~mpt the basis for exemption is noted". heron. and that only ,vbcontra~" and employ." who ore in compliance with ORS 701.0S5 will be used on this project. I TOTAL CHARGES TOTAL CHARGES .' Basis for Build.r'. Board uemptioRl NAME (pleo.. print) h.an ("(:J ~ ~~TE {/ , ( / R"'thT SIGNATUP~~ FOR OFFICE USE ONLY Zone Type/ Const ;:lnits fire Zone ll,edrooms ""ccy load flood Plain "'Iari.r "ccy Group BUILDING PfRMIT PIon ex. Comm/lnd Chorgo' and 65~:.1 Bld~ Per Fee Surchargll' Plan ell. Res 30%1 BldQ Per feo PLUMBING PERMIT Charga. and Fenc. Surcharges Oemo ELECTRICAL PERMIT Chorg., and Sidewalk Su,charges A/c PavinCl MECHANICAL PERMIT Chargllt and Curb Cut Surchargu --------- Volvo Value Value l:,. ftg. Main Co;; Ftg. Ac~" Sq. frg. Oth., . . . TOTAL VALUATION Sysrctm' Oct..-.lapmant (harQa ll..5'!'8 \ Total Comb. Permit I '7.0P i JYU .I7JffU J.bLJ TOTAL r;oo . .... ... H--':~_.:;"':'.""";''''''''''_ 1. Applicant. to furnish A. Jab Addre.. B. legal Description 1. examale,tax lot 100. lane County Map Reference 17 03 '43 2. examale-La. 1. Black 3. 2nd Addition to Springfield Estates Nome. etc. of owner and construction lender Energy Sources (" 1. examole.heot/electricol ceilinq/or forced air qc 2. cxamol~.water hearer: electrical/or solor E. Square foofage or valuation, etc. ( 1. exomoie.1250 sq. foot house. 500 sq. foot gara 2. exomole-if new project. check "MW-if addition, ( odd. efe. F. Building permit information: 1. exomolp.-construct single family house with an c garoge 2. exomole-remodel existing' gorogE:: into family fa ( 3. example-convert 'single family residence into restaurant (change of use) G. Value or work as dofined in Section 303 (a) of the, Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction delays. 'Building Div Stoff must be cole 10 conloct appropriate persons re fdi 'design informction or job site corrections, etc. COMBINATION APPlICA TlON iPERMt(CAP) C. Do. II. Abbreviated Plumbing. Mp.cnonicol & Electrical Scheduh A. Except where blcnk spaces occur in the description p of the Mechanical and Electrical Schedules, the appli need fill-in only the. No. Boxes adjacent to the appro. item(s) to be installed B. Full Plumcing, Mechanical, and Electrical Schedules 'are available at the Building Division . 1. To conserve space on the permit form the !chedulE hove been abbreviated 2. If the item(s),'IO be instolfed are not 'covered on thE ared schedules you should consult the full schedulE C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES At CHARGES ON THE SCHEDULES III. Applicant to sign ora date Whenever possible; the initial application will be used as worksneet only. Where possible, Building .Division Staff 'W prepare 0 typewrilten copy and return it to the applicant the time the actual permit is issued for his signaturE.. ( IV. Fees and Charges Plan check fees ore due and payable at the time of the ap . and no plans will be processed until these fees are paid. ~ ~.. other fees and charges are due and payable when the pe'4- is issued. v. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project InFormation: ." PLANS REVIEWED BY, name_ sigt1olur,.. · PERMIT VAlIDATr.JN.... . CITY OF SPRINGFIELD ( ( City Hall Springfield. Oregon Depanment of Public Works OFFICIAL RECEIPT No. B 56929( D .~ k~;;.n lS\ - ole, ~;.."( c::::::, Rec'd (ro ('MXC\\\Lr ~ Address- ~ \\'(\JI'\'0 ( (, <: ( Received For: .( ( (' "0 ..j') uv ( " " ~\) ,') ,{ ( ( ( -~=(. ) ( ...... ( 'j-,vC/_ Amounl Recei~,ed _~ _I AUTt4"aalolIl:O tlGNATURIt "(, .""'0""0""'"" "","un' '00'"' 0" "... ( . . . . , ' ~ , '. Permit, Cler;- ( , ~I I I .Jaff"