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Home My WebLink AboutPermit Building 1982-6-7 ~ "'-IINSPECTlo.-,"lINE 726:-'769 . I JOb:ddreU . CITY OF SPRINGFIELD COMBINATION APPlICAT10N/pERMIT ENERGY SOURCES, . INFORMATION LINE 726-3753 Owner X Address X. YA<'JM_ '71c7K RAn.., j., ",,,,Tv " " s: LV <:c-'.Lts..~".Y. /,. e; "Jon.~ \( 3;1..<70. "" Sq. Frg. Main Sq. Fig. Acatu. Sq. Fig. Other _New_Add_Alter_Rep. _Fonce_Duma_Chongel Use _Other :>0- t ~ S' legal Description .:2 ~ n Jl? /'1 ,,"yo 11~o~-~0- /..j L sr () ~'I (JiJ Heat Water Heater RonQIl Value of Work: Building Permit Info: Describe Work (Le" Build Single (/'f-L/.t, IFomilv Residence With Attoched Gorooo) \ /"!:,jJ;oV"'" r""" /) ~._-ra-/ l' X "0!.J<" nFr= /' Jlts' Qo....1=- Construction Lender I'-Addrllu DESIGN TEAM phone (nome) (addrllu) (lies. no.) (axpirIlS) -*~-' Primary Structural Electrical Mechanical CONTRACTORS {nome} General X ).I~""o-J JI 5TA Y'~- j (address) (lies. no.) t t, !l.~ (exDires) :l - ,,- s> ..,.(phone no.' p. 0_ J] "'-" :) 3 9 " I.?<:r-~ q:}vD.Sl ~i'1I 'J,. Y 71 Plumbing Electrical Mechanical PLUMBING ELECTRICAL MECHANICAL NO. I FEE I CHARGE NO. I FEE I CHARGE NO. FEE CHARGE Residence of furnace/burner to ~TU's Appliance vent separate Stationary evop. cooler Vent fan with sinl=lle duct Vent system apart f,am heating or A.C. Mechanical exhaust hood and duct Each sin~l. fixture Relocated building (new fix. additional) S.F. Residence (1 bath) ..,.ft. New circuits, alterations or extensions SERVICES Duplex (1 bath) each Temporary Construction Additional bath Amps. Water service Sewer Wood stove/heater Storm Sewer FEEDERS Heat Pumf) Air handler to 10.000 CfM Air handler over 10.000 CFM Amps. ISSUANCE OF PERMIT TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall not be valid until a label has been signed by an Electrical Contrador and attached to the electrical panel. 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 011 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 herin. and that NO OCCUPANCY will be made of any structure without the permiuion of the Building Division. I further certlfy that my registration with the Builder's Board is in full force and effect 0 s required by ORS 701.055, that if e~empt the basis f01 exemption is noted heron, and that only subcantractors and employees who are in compliance with ORS 701.055 will be used 0 IS project. Basis for Builder's Board exemption: Il:IGNATURE /L (2 . ~ fOR OffiCE USE ONLY "--""" .... NAME (please print" , DATE ~ .:-?- ~ 3.... Zone Fjre Zone Flood Plain Type/Canst. Bedroom' Ctorie' Units nccy load f"lccy Group Sq. Ftg. Main Sq. Ftg. AccOl' Sq. Ftg. Other Value Value Value TOTAL VALUATION . , BUILDING PERMIT Charges and Surcharges 1J..2J?1>P I./~ Plan Ck. Comm/lnd 65%/ aide; Per Foe Plan Ck. Res 30%/ BldQ Per fee Systems Development Charae (1.5%\ PLUMBING PERMIT Charges and Surcharges Fence Demo Total Comb. Permit ELECTRICAL PERMIT Charges and Surcharges Sidewalk Ale Pavina MECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL ; 11.2. {'/2.. " .' ..... '.I~ ,.} COMBINATION APPLICATION/PEA (CAP) \w::.,- I. Applicant to furnish '. A. Jab Address ' B. legal Description 1. example-tax lot 100, lane County Map Reference 17 03 43. 2. example-lot 1. Black 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lehde"r: .:: ~. D. Energy Sources .' 1. example-heat/electrical ceiling/or forced air gas (':.:.... '., 2. example-water heater/electrical/or solar -' -", E. Square footage or valuation, etc. .,.. 1. example-1250 sq. foot hause, 500 sq. foat 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 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 Stru.ctural 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 abbrevi- ated schedules you should consult the full schedules C. BUILDING DIVISION STAFF Will Fill OUT All FEES AND CHARGES ON THE SCHEDULES 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 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 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ,. ", Additional Project Information: PLANS REVIEWED BY: name "';gnatur"" "i,'; if' .'~"if- "". .- '" -~. ...., .: , PERMIT VALIDATION .......... '" , .J _. '( f.~ ,;~ .... " '7'. " .., " cr' Permit Cler~ ~ate :. .:,.: .....;.;;.!:;,~.~~~~~~~-~~:~:. ;t.,:::~:'~:::..~/.: ".:. ~:. '<,.,,,1 ..~. .~. ,.ru~ .L.,I,.II.,,~~..tLl... \. . ,,-'......., -'--'''''.. - '. ,I I.,JI IIIH. II". i.lo.. ,1..;.....~IU.!i..L~-.-.... ..;.--::::.o1J._..':-~>,:.~:'......:_:'~ .-sr-:~':':.. ., ~..' ......;;, 'X- ~~ ~7 - /'1"",.-v ."r CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT I ENERGY SOURCES: Heat Water Heater Ran!=!e Value of Work: INFORMATION LINE 726-3753 INSPECTION LINE 726-3769 Owner )( 'YA ..5Jl.fl-:--13 A {L J I-; '" ,/ r/~ Building Permit Info: Describe Work (i.e., Build Single ~ 9t?K s: ,v r-c;.,j"Ltc:. ;;RJjJne.X L f/..'r.L/~? _Familv Residence With Attached Garat'e) - - ... l X 3)..<.'70. <''' t Sq. Ftg. Main Sq. Ftg. Accen. Sq. Ftg. Other _New_Add_Alter_Rep. _Fence_Demo_Chango/ Use _Other '''''' t:; :a ;)' Job Addren Legal Description Addren /.. f~C.AV~6rpV LJ h.-9.J'a.-' '9700"'- 2-U1<" o~r '" Jlt:' R.P~J;:.. , Construction Lender Addren Phone DESIGN TEAM (name) (address) (lies. no.) (expires) (phone no.) Primary Structural Electrical Mechanical CONTRACTORS (name) (address) (lics. no.) l /" .:l ..;- (expires) 1. - t.t - So "?(phone no,) GI'!Mrnl X /'/;IJ&7 Plumbin!=! 1/ 5TA .,.""",..r_ p. 0 /] D", ') l '7' " tfV'".~___ q? V'O~ ,l '7' [('II ). Y YI Electrical Mechanical PLUMBING ELECTRICAL MECHANICAL NO. I FEE I CHARGE NO. I FEE I CHARGE NO. I FEE . CHARGE Residence of furnace/burner to llTU's Appliance vent separate Stationary evap. cooler Vent fan with single dud Vent system aport from heatin!:l or A.C. Mechanical exhaust hood and duct Each sin~ll!' fixture Relocated building (new fix. additional) S.F. Residence (1 bath) s9. ft. New circuits, alterations or extensions SERVICES Duplex (1 bath) each Temporary Construction Additionol bath Amps. Water service Sewer Wood stove/heater Storm Sewer FEEDERS Heat Pump Air handler to 10.000 CFM Air handl.r over 10,000 CFM Amps. ISSUANCE OF PERMIT TOT At CHARGES TOTAL CHARGES TOT At CHARGES WHERE STATE lAW REQUIRES that the Electrical work be done by the Eledrical Can'rador, the olectrical portion of this permit shall not b. valid until a label has been signed by an Electrical Contractor and attach.d to tho elodrical panel. I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that 011 information hereon is true ond correct, Gnd I furthor certify Ihat any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Lows of the Slate of Orogon pertaining to the work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I furthor cerUfy that my registration with the Builder's Boord is in full force and effect os required by ORS 701.055, that if e;o:empt the basis for exemption is noted heron, and that only subcontractors and employees who ore in compliance with ORS 701.055 will be used 0 IS prOject. Basis for Builder's Boord exemption: "GNATU" /L..(2 FOR OFFICE USE ONLY ~ ... --- DAT,h:-?-~J..... NAME (please print'- Zone Fire Zon~ Type/Const Bedrooms C,torie" Inits nccy Load Occy Group Sq. Ftg. Main Sq. Ftg. Access Sq. Ftg. Other x Value Value Value flood Plain x TOTAL VALUATION BUILDING PERMIT Charges and Surcharges ~>>?tJi; 1./:2- Plan Ck. Comm/lnd 65%/ Bldq Per Fee Plan Ck. Res 30%/ Bldq Per fee Systems Development Charae (1.5%1 PLUMBING PERMIT Charges and Surcharges Fence Demo Total Comb. Permit elECTRICAL PERMIT Chargos and Surcharges I I ________J I Sidewalk A/ C Po vi no MECHANICAL PERMIT Ch::Hges and Surcharges Curb Cut TOTAL It..2f 12. ~.~', ~~~_..:.;.. ',... :'r,. ...;~~r.=7S':/:': ;::.~,"" ',:.:~_::.W.' ';', .".'., '.; ...... .~ .... , f,., .ill':' ;:;'<';"'.~':'~:;:~~'''~:':::'':t>'.." -~:,,: , COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Jab Address B. legal Description 1. example-tax lot 100, Lane County Map Reference 2. example-Lot 1. Block 3, 2nd Addition to Springfield C. Name, etc. of owner and construction lender D. Energy Sources 1. example-heat/electrical ceiling/or forced air gas 2. example-water heater/electrical/or solar E. Square footage or valuation, etc. 1. example-1250 sq. foot house, 500 sq. foat garage 2. example-if new project, check new-if addition, chee add, etc. F. Building permit informution: 1. example-construct single family house with an atta 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 Oivisi Staff must be able to contact appropriate persons regl design information or job site corrections, etc. II. Abbreviated Plumbing, Mechanical & Electrical 'Schedules A. Except where blank spaces occur in the description po of the Mechanical and Electrical Schedules, the applic, need fill-in only the No. Boxes adiacentto the approp item(s) to be installed B. Full Plumbing, Me<:hanical, and Electrical Schedules are available at the Building Division 1. To conserve space on the permit form the schedule have been abbreviated 2. If the item(s) to be installed are not covered on the ated schedules you should consult the full schedule C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES At CHARGES ON THE SCHEDULES ...... .~ "';;;'''''i~.., '\ , , :..\. I ,/ I > .,:....,..Vl.~.~ . '.'.., ..> ( I CITY OF SPRINGFIELD " CllyHall Springfield, Oregon Department 01 Public Works d OFFICIAL RECEIPT No. B 59146 (I ( ( ( Date t, .. 1 19 l' 2-.. ( Rec'd From "I1(ljVuo/, a JG '!-' 'A ; .0' Address tJ.[i, Ill-I' ::J::<,q J~ i H.1..f;f-,",,{l2- (' R~celved FOrPt P 2JI C)7/ /., ~J1 n d I,J,\ KI..-r- t./~,j '" ( ( ( " ( Ii :2J'. t-o I./:L (I Aniou~t Received " L t' ", ('~] ~ AUTHORIZED SIGNATURE DRIGGS PRINTI:IlS/LITHOGRAPHI:"S, I:UGENI:. OlllrGON >.", ., III. Applicant to sign and date . Whenever possible, the initial application will be used~; c- , .. worksheet only. Where possible, Building Division 5taff will prepare a 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 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: PLANS REVIEWED BY, nam~ ",ignaturp (I (f (I (I 11.:<, 9. h ( .1 Permit Cler~ (I \, (. J "at-