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Home My WebLink AboutPermit Building 1990-3-15 jINSPECTION LINE 721io3769 ">, Job Address n;;'1 {) . CITY Uf SPRINGFIELD COMBIIIATION APPLICATION/PERMIT EilERGY SOURCES: Heat \~ater Heater Range . INFORltATION liNt 726-3753 Sq, Ftg, '.lain ~q. Ftg_ Access. Sq. Ftg. Other Ilew Add A Iter Rep. -Fence Demo Change/Use -Other- - ~ JtreU- Address (I Jtu.-y vh /J r t;h.viJ f- ~;;q () I/Il.fU"... f rrW- Phone 7~t::~.? d.-d-7~ ~7Y??""~ ~...&..~ 4-~<-~--= ~ '<..O~/C~ -W ~~~ ~~~ ~cc.r..z:::,,,__"'_1-, (lies. po.l {exniresl (ahoM no.) ValUE of Hork: ~~ d>-'" BuilGlnQ Permit Info: Describe 14ork.(Le., Familv nesidence With Attached Garaael Build Single ~ \S "- ^J O. Legal De5Cription /7'''~-~6 -'-1'2.. ':2 9~CJ Owner Construction lender Address UI:.:)H:ir~ II:.Ar1 (name) Phone (address) Primary Structural Electrical Mechanical CONTRACTORS (namel f address) f1 ;t'c;, nn.) (p'Irdl"pc.\ (ohnnp nn, \ General ~/V,c-~ . Plumbino ~. ~. Electrical ~1echan;cal PLUI1BING ELECTRICAL MECHANICAL --1iQ" FFF l":HARr,F Nn ~~~ r~~ NO n.~ ru~ Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated bui,lding (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (] bath) Dup I ex (1 ba th) . . ISERVICES I Storm Sewer IOf amps. Recessed wall ~nrl"r 'lef'trr. ~rtt! YJ"nt _ / 1'~~:5...:> Appliance. vent S~Oil ra tp Stationary evap. cool~r Vent fan wi th sinal~ duct Vent system apart from heatina or A.C. Mechanical exhaust hnnd il:nd durt Wood stove/heater each Additional bath ~Iater service Temporary Construction Change in existing , rp~ i qp.nr:p Imultifamily, comm. or , tnrlllc:trial Sewer COMI-I./lND. FEEDERS Install/alter/relocate dic;trih. fppdprc; IOf amps. ~/r.--/'~~~'? ~!??hc ~i9-;;;?-,,:.v./ ~ ~/=- !.~____;:7'. ISSUANCF OF PFR!IIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES ~^'" /..;: <::?C> WHERE STATE L,'l~ REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion -o{'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 Oregon pertaining to the work described herein, and that lIe OCCUPAllCY 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 OP.S 701.055 will be used on this project. . UA!IE(please print) 111q.1( P;" F Fl'/-vu,U/ SIr.!IATURE~//!~ FO~ OfF I CE USE DillY Sq. Ftg. r1ain x Value Sq. Ft9. Access x Value Sq. Ftg. Othe~~.....,"",~ Value TOTAL VALUATION ~ om 3-15~-Ilo Zone 0/ Tyoe/Const. Fire Zone Bedrooms Flood Plain Stories ,I Units Occy load Occy GroupA-2./ 4"~""'" BUILDING PER~IIT Charges an~ Surcharges //u ~ Plan Ck. ---rit.::---___ 65%/Bldo ~ Plan Ck. ;2'_~ ~ 30%/Bldo Conm/lnd Ppr Fpp Res Per Fee :::<>.B9~ Systems Development Charqe (J.5~) PlU'~BING PERMIT Charges and Surcha rges Fence Demo ELECTRICAL PERIHT Charges and Surcharges MECHANICAL PERMIT Cha rges and Surcharges Sl~ewalk A/C Pavi ng - Tota] Comb. rermit, 62.5/8 __..L2:~_:..._ Curb Cut -/5" TOTAL I ~'/'r/ J . !--: - .,'.- COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 1I U3 43 2. example- Lot 1. Block 3, 2nd Addition to >prlngtield Estates. " C. Name, etc. of owner and construction lender D. Energy Sources 1. examyle. heat/electrical ceilin~/or forced air oas 2. example- waterneaterjelectrical/or solar E. 'Square footage or valuation, etc. - 1. example- 1250 sq. foot house, 500 sq. foot garage 2. examole- if new project. check new - if addition, Check add. ete. F. Building pennit information: 1. examele - construct single family house with an attached garage 2. example - remodel existing garage into family room 3. exa~le - 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 Plumbing, Mechanical, & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fillcin 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. Ascnoted 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 . PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: " . 1.:..... 'Ii PERMIT VALIDATION ~ f LoZq G o ~.~O Permi t clerkHfi;) . Permit applicant exempt from registration with the Builder's Board because: < Apditional Pro~ect.Informati9n: . .- PLANS REVIEWED BY: . hame/~/~'YL&: ;z?-~E?f ( Signature~~~ < '/ - .~-r:> . "'-", I date ""3-/3'- '7~ Address INfORJtATION llNe 726-3753 Sq. Ftg. I.lain ~q. Ftg. Access. ~ Sq. ftg. Other ~ Ilew Add Alter Rep. l'\ Ranqe -Fence Demo Change/Use \) Va 1 u' of Hork: Other - - '-.. (')u..vydrt IJf .[)u/iJ I- 9"~ e>-~ '" -'l"'~(J nA r..-. r.J..-......u L.Phone Buil,,;n. Permit Info: Describe l~ork(Le.. Build Si"91e I 0 ~~-I III~ ~V,~ Familv Residence With Attarhpd r.~r~o~l 7~~~;;; ~-?.i'/?'k- ~;;;.;~~.~ ~~JI 4~,,\.4-'-,~ -? <".P~/C.c-""" I Phone # /l/c:-~ ~~~ ~~=~'">7..-"....-LC (address) (lies. no.l (exniresl (ohone no.) n;JC! D /Y/atA-, Jfrw- ~ CITY Uf SPRINGfiELD COHBIIIATION APPLICATION/PERMIT E!lERGY SOURCES: Heat Hater Ileater . IItISPECT lUll LI liE 726-37b9 .., Job Address I.egal Description /7.ttJ'?-~<:;-<f-:z. '29.&':::' Owner Construction lender Address DI:.:>HiN II:.A!-' (name) . Primary Structural Electrical Mechanical CONTRACTORS (name) (address) (lice;. no.) (pxoir"pe;) (ohon~ no.\ Genera 1 t""':)~.A',.c::-,.2(l' Plumbina Electrical AL-e.g:' fiU:::-c....T ~ . IQ10 tJ 2.8 ~,~y ~A.-f//.':t ~~ . ~~BIrlG V 0 SPPLl>. ~ .,;JO-S5"c- /o/; I<KJ '1 {7-),). /"<, I ~l) f') ~ ,0 ~(P . .\7~ 12..'2..IC? 0 MECHANICAL ELECTRICAL NO. fEE CHARGE NO. Ff LIJ:IlARlif. NO. IIL L1JARliL Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (l bath) Duplex (1 bath) each Additional bath Storm Sewer Of amps. Recessed wall <;pa,e h.l'~tpr ~nJl yo:.ut I i?9c~ CR ~~:> r~"'R/-< App 1 iance. vent s@oarate S-tationary evap. cooler iient fan with !iinole duct Vent system apart from heatinq Or" A.C. Mechanical exhaust hood and duct SERVICES Sewer Temporary Construction Change in existing residence multJfamily. COnIn. or Inr1l.lstri<tl Water service COI~.I./IND. FEEDERS. Install/alter/relocate di~trib. f~pders I I 6:: C:C...J 8/ /.8c. 6 n"7/f:? ~~~ O~~N-/~' I -5~.~g.rl'~ < ~,,:,-;_.--/lr. Wood stove/heater Of amps. ISSUANCF 'OF PFRlllT' .TOTAl CHARGES WHERE STATE L~W REQUIRES shall not be vall1 until the TOTAL CHARGES I TOTAL CHARGE~ ~# /<:"..::X> that the Electrical work be done by an Electrical Contractor, the electrical portion of-this pemit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXM1[NED 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 OreCJon pertaining to "the work described herein, and that 110 OCClJPAIKY will be made of any structure without the permission of the Duilding Division. I further certify that my registration with the Builder's \ Ooard 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 OP.S 7~1.055 will be used orr this project. UNIE(please print) 111ft f( P), F ri?-vAltf<l SIf,Il^TURE~~ .....-. om3'-/J--9'O FO~ OFF I CE USE Olll Y Zone /:/ Type/Cons t. Units Sq. Ftg. tiain . Value Ft re Zone Bed rooms Occy load Sq. Ftg. Access x Value Flood Plain Stories / Occ'yf,roupA-2./ Sq. Ftg. Othe~~;~ Value ~~~ TOT^L VALUATION BUILDING PERfl1T Charges an': Surcharges . //. ~ . Plan Ck. ---z7'2------ 65%/Rldo Plan Ck. 2_ Z3 30%/Bldo ConmlI nd Ppr r""". Res Per Fee ::?..8. 9=3 .Systems Development Charqe (I.5~) PlUI~BING PERMIT Charges and Surcharges Fence Demo ELECTRICAL PERI~IT Charges and Surcharges d?~) '51.2 ---1~ (,~ __-L;2:.~___ -?S Sidewalk A/C Paving Total Comb. Permit 62.YB TOTAL 7'/ r/ A liECHAN! CAl PERM IT Charges and Surcharges Curb Cut " . I _. I COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Oescription 1. example- Tax Lot 100, lane County Map Reference 1I uj 43 2. example- Lot I. Block 3, 2nd Addition to Springfield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. exam~le~ heat/electrical ceilinq/or forced air oas 2. examyle- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - I. example- 1250 sq. foot house, 500 sq. foot garage 2. examp.le- if new project. check new - if addition, check add, etc. . "F. Building pennit information: 1. example - construct single family house with an attached garage 2. exa~le - 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 ANO 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, & El~ctrical Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules. the applicant need fillcln 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 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. --- 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 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . ." -. PERMIT VALIDATION , ~\loo22- 3.lP3 ex, qe) o-'dD J { lOZq p-> 01~.SO Permi t ClerkHmJ Permit applicant exempt from registration with the Builder's Board because: Additional Pro~ect Information: PLANS REVIEWED BY: ~ Signature~",_ {/,r name / ~I(/c R$TE/'r , t .. -~~~ I " date -;:;-/5"- 5'c:>