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Home My WebLink AboutPermit Building 1985-1-28 ~ . . INFORlIATION LINt 726-3753 Sq. Ftq. /.lain ' ~q. Ftg. Access. Sq. Ftq. Other Ilew Add XA, ter Pep. -Fence Demo Change/Use -Other- - I~ ~ ~ I INSPECTION lINE CITY UF SPRINGFIELD 726-3769 COMBIIIATION APPlICATION/PERMIT Job Address ;:( ~ 5"/ Mf/uJ sr SP"~Lct ~~;~GY SOURCES: legal Description \\()~~lrA-7 _O~ I~ater Heater - - - - Range I lovalu, of Hork: ;)..,S"tlO. Buildino Permit Info: Describe Hork(i,e., Build Single Family nesidence Hith Mtached Garaoe) D. uo-. 'I\A..~ "'....slO o....v:P co..o_ . '" . II ~ ~...... I.) / Jl!fe<.J?;i;;?;/),,'lf) fW ::l ...".....,... I Phone ~ 1'1JLr/7.t."~C.~I.-,~lQ (address) - flies. no.l lexoiresl ''{.bhone no. ~ ~ ~T " Iq):!;~ b- Owner',~ "'7?'iJ"."': U"-'(J ~ Address % "B.). ;:qc.s:r~ ?~.R . ~'X /<~_ ~~.D, . Construction Lender Address Ut~I"N IlAI1 (name) Primary Structural Electrical Mechanical CONTRACTORS General .a PPl'i:] 4-+.,.. ('\1'>1.)<:, i- {namel (addre~~l (lic~ nn 1 -r,?>L~ 't /e:( :3.~ r;~ e v~L.t.l~ It l""~""r (ohnnp nn. 1 4./f!:"'- :z. &"99 Plumbino Electrical ~'echanical PlUlm I NG ELECTRICAL MECHANICAL NO. FFF rHARr,f NO ~~~ r~ NO. ~~~ r~ARGt Each single fixture Residence of SQ. FT. furnace/burner to BTlI's Relocated building (new fix. additional) New circuits alts. or extensions Floor fu rnace and vent S.F. Residence (1 bath) Duplex (1 bath) each Additional bath SERVICES Recessed wa 11 ~n~~p hp~tpr ~nrl vpnt Storm Sewer Of amps. Appliance vent s~oa ra tp Stationary evap. cool~r Vent fan wi th sinole duct Vent system apart from 1 hea t i no or A _ C. I Mechan i ca 1 exhaus t hood and dUI"'.t I Hood stove/heater Sewer Temporary Construction Change in existing rps- i r:l~.nc~ multifamily, corrrn. or Indllc;trial Water servi ce COMM./IND. FEEDERS Install/alter/relocate rlic;trih. fppdprc; Of amps. ISSlIANCF OF PFRIIIT TOTAL CHARGES WHERE STATE lAH REQlIIRES shall not be valid until.the . . TOTAL CHARGES TOTAL CHARGES that the Electrical work be done by an,'ElE!ctrical Contractor, the electrical portion of this permit label has been signed.by an Electrical Supervisor and retur.ned 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 performed 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 IW OCClIPAllCY 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 employees who are in compliance with ORS 7nl.055 will be used on this project. Zone Fire Zone Flood Plain Type/Const. Bedrooms Stories M'e'l""o'w'1~ SIGII^T~RE ~~~ DATE..!/~tyJy~ FOr. OFFICE USE DriLY ~/''' Sq. Ftg. /1ain x Value Sq. Ft~. Access x Value Sq. Ftg. Other x Value Units Occy load Occy Group IlAHE(please print) fdwo'l..... d TOTAL VALUATION BUILDING PER/lIT Charges and Surcharges -;;: L/ ~ Plan Ck. _____7~_____ 65%/Bldo eI/ Plan Ck. . ~ 30%/Blda C0111l11l nd PPf Fpp Res Per Fee /S~ Systems Development Charoe t1.5~) , IY.~ ELECTRICAL PERI:IT Cha rges and Surc.harges MECHANICAL PERMIT Charges and Surcharges Demo I'Sldewa 1 k ------------ I AIC Paving . 1 Curb C~t ------------1, 1 I I', I I I I PlUI1BING PERMIT Charges and Surcha rges Fence ITotaJ Comb. Permit I' I TOTAL 'I~~.~ . COMBINATION APPLICATION/PERMIT (CAP) . I I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax lot 100. lane County Map Reference 11 uj 43 2. examele- Lot I. Block 3, 2nd Addition to sprlngt;eld Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. examole. heat/electrical ceilinq/or forced air Qas 2. examDle- waterheater/electrlcal/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. Building permit information: 1. examele - construct single family house with an attached garage 2. examele - remodel existing garage into family room 3. exam~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. OESIGN 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. BUILOING OIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEOULES 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 VALIDATION '. ~ '. ,. , . : .. . , .- Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: IJ;.p/'N6~~ ~/~ _r~;>~~~h'S h,..c:->~Pc:-~/.H~ ~ ~ li.~/~~. .~~.-/~ ~ ~V~?3'/~ ~~ /~~J"TC j.,s?, .4h&:- ~~O'pA......C~ .~,,/~ ~, ~-< .l:>"". <=Z5 ;""-~c..... ~..../~.-:;~ Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: -, .' PLANS REVIEWED BY: name LL>RNrF ~~~ignature...~ - -. , r -- ). .. ~e~ date /":2~ ~ , . . "I IrlSPECTlON L1r1E 726-3769 Job Address ;( ::<. 5"1 Legal Description Mf/I rJ ST CITY OF SPRINGFIELO COMBHIATlON APPLlCATlON/PERMlT EIIERGY SOURCES: Heat I/ater Heater Ranqe SPN ^'<K.Q Ld. '" INFORllATlON liNt 726-3753 Sq. Ftq. Hain ~q. !='tg. Access. Sq. Ftg. Other Ilew Add XA lter Pep. --Fence Demo Change/Use Other - - t\() ~ or. ~ Address Ul~l"N IlAH (name) Phone (address) l. Va I UE of l'lork: ~ I S-tlO. Builoina Permit Info: Oescrlbe Work(i.e.. Build Single Family nesidence With Attached Garaoe) o <J..o>-.o . 1\L~t ..../l>.!:lO a...v:P r...n .~ " cc...."<",,,-, I.) / I~ 7:..~'.f> e..p ~ .-')rra.r- ~ ,'~t..r"' /7'(." ~C.hQ....,~ flies. no.) lexniresl '1.bhone no. Owner' .~~ :7.?~ Ut!)Cl r<< Address% "E.).H'~ ?~R Pc> ;Ti;.PK I~~ ~u> Construction Lender Primary Structural Electrical Mechanical CONTRACTORS I name I Genera I .a P P l= 4-1-.,.. V ...... (" I'l~ )"'.' (addreso; 1 ;q :3$.7 ct..e,fd...oJo)"t'I (1~!;S_ M_) ""~4l;)'f lr c;~"".r (p)(oirp,,' tif}13/8"- (ohnnp nn 1 "If:~- .'2.~"9 "1 Plumbina Electrical t.techanical PLUIIBING ELECTRICAL I._EEL 1J:l!ARliE' ...llll......' MECHANICAL riD. HF I fHARr.E 'ill.....! I Res 1 dence of SQ. FT. I'New circuits alts. or extensions ISERVICES -I furnace/burner to BTU's 1~I'LI..cliAR.G.E., Each single fixture Relocated building (new fix. additional) Floor furnace and vent S.F. Residence 11 bat.h) Duplex (1 bath) each Additional bath Recessed wall Soace heatp.r ~nrl I vpnt Sewer lTempOrary Construction IChange in existing rp~ i dJ'J1~p Imultifamily. camm. or Industrial IOf ICOMfl./IND. FEEDERS Ilnstall/alter/relocate di~trih. fppdpr~ I amps.1 Appliance vent "~Da ra te Stationary evap. cooler Vent fan with sinole duct I Vent system apart from I heatino or A.C. I Mechanical exhaust hood ilnd c1urt I \~ood stove/heater I I I ~Jater service Storm Sewer IOf I I I amps. ISSUANCf OF PFR'lIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LW REQUIRES that the Electrical work be done by an. Electrical Contractor. the electrical portion of this pemit shall not be vali1 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 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 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 on this project. NAf.lE(please print).Yd '^)~ ..... d "'l.'t;!. ..;/t:> ~,1'2...... SIGrlATURE FOP. OFFICE USE a~e..../JI/;~~"OATE 1/:J.'yJy';' I Zone Fire Zone Flood Plain Tvpe/Const. Bedrooms Stories Units Occy Load Occy Group Sq. Sq. Sq. Q;lLY Ftg. Ftg. Ftg. riai" Access Other (I .- x ,\ x x Value Value Value TOTAL VALUATIml BUILDING PER~llT Charges and Surcharges ~ L/ ~ Plan Ck. _____7~_____ 6S%lBldn eJ/ Pl an Ck. ....."" . 30%lBldo I Fence I Ot/mo COIl1llII nd Ppr Fpp R-es Per Fee IS (;&> Systems Development Charae t1.5~) H./f PLU'~BING PERMIT Charges and Surcharges ELECTRICAL PERI~IT Cha rges and Surcharges 'Sidewalk I I I MECHANICAL PERMIT Charges and Surcharges AIC PaVin9 ~ I Curb Cut ------------1 ITotal Comb. rermit I I TOTAL I ~t!J~.~ t COMBINATION APPLICATION/PERMIT (CAP) ( ~ OF SPRINGFIELD Clty.Hall Sprlngfiold, Orogon Department ot Public Work. OFFICIAL RECEIPT No. B 54189 Oata tlp_ :2 ~ 19 !?$" Rec'dFromA~~tF~~ ./- y~-.. Address Ing ~~l!!rc.AhC ~ , . r L.l 1. Applicant to furnish A. Job Address B. Legal Oescription I. ~xamp'le- Tax Lot 100, Lane County Map Referen ( 17 03 43 2. exam~le- Lot I. Block 3, 2nd Addition to sprlngtield Estates C. Name. etc. of owner and construction lender ( D. Energy Sources 1. exam~le- heat/electrical ceilin9/0r forced a; 2. examole- waterheater/electrical/or solar Eo Square footage or valuation, etc. - ( 1. examp 1 e- 1250 sq. foot house, 500 sq. foot gal 2. example- if new project. check new - if addit. cneck add, etc. F. Building pennit information: C 1. example - construct single family house with ( attached garage 2. example - remodel existing garage into family 3. example - convert single family residence intc ( 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, & Electrical Schedul 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 adja, 4[ to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedule, are available at the Building Division 1. To conserve space on the permit form the schedl ~, have been abbreviated ~ 2. If the item(s) to be installed are not covered the abbreviated schedules you should consult tt 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 penmit is issued. , ' Received For: Jt:IJ$~ ~~tD ~ r.c. ~7? ~~- C- 7 k . I.ftJ,<SG (~<;>~o ~,,~ - ,,-?6 , /' ~7L:> Y<3 - ",.~ . ,. r 9' Amount Received ~ ("'-- L- #.- '-~,i:/' _"" ~ , r AUTHORl~D S1GfIIAT~ ~ q~," 7tb - l 71 FI'1IntIrr BUSINESS FORMS. INC IS03I:M2..IU ,,,, V. FOR OFFICE USE ONLY Permit Cl erk I PROJECT CONCITIONS TO BE SATISFIED BEFORE OCCUPANCY: ,I-PP/:J/o/6N#L ~....~ r.~~~e:s",..S ~~r~c~/n-~ j:-,.... ~ li.E2:J7'f'/tC;P-~. .JY/~~/~ -.F .A:v~~/~ /....~c; /~~,............__!:>:> ~ hd=" ~C"G:'/':)A.../eY /~~ ~/~ p~,<=.6 jC?~'~//':.-t""'~ Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: . 1 name LoR#€' ~~ ~ignature~....~- - ~_.-'" date "'; ~ /"::215~ . ,