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Home My WebLink AboutPermit Building 1982-9-21 ,- ~.:: . . Range INFORlIATlON liNt 726-3753 Sq. Ftg. 1.lain ~q. Ftg. Access. Sq. Ftg. Other lIew Add Alter Rep. -Fence Demo Change/Use Other- - "{j ~ Job Address ~ \11 ~~. SweeT. _ Legal Description \1D3 3~ 02..1LV ciTY UF SPRINGFIELD CDrlBlIlATlON APPLICATION/PERMIT EilERGY SOURCES: Heat Hater Heater I INSPECTION LINE. 726-3769 Address ,\t91tN Av,....') "'\Cl!?:7_ "'~~ f.D Phone 717 5b~L Valu, If Hork: ~o. BuiltiinQ Permit Info: Describe Work(i.e., Build Single Familv nesidence With Attached Garaae) ~""'.-?>'-'~C/A-c:.. ~L~/97/C&- 70 L~S.6 $~.:.c;::: - g-oN&..I9~Cc: T~ ~. kS' ~ ;ZCU??:B/#&;, (exoires) (ohone no. flies. no.) Owner Construction lender (Ju.J ()E'r Address Ot~IGN TEAll (name) Phone (address) Primary .~ F Structural Electrical Hechanical . CONTRACTORS (name) ( addrps!:;) fl ire;,. no.) (€!xnires) (nhone no. ) Genera 1 -()LL.)'f\<;l.Y - Plumbino Electrical ~leehanical PLUIIBING ELECTRICAL MECHANICAL I Each single fixture SCl> I Residence of I FFF I rHIlJllif. ...Illl..-' I FFF I fHARG[. NO.1 I FEE I CHARGE .lID. SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (] bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall Snace heatpr and vpnt Storm Sewer Of CDril'l. /IND. FEEDERS Install/alter/relocate dic;trib. fppdHC; amps. Appliance vent spoarate Stationary evap. cooler Vent fan with sinole duct Vent system apart from I heatino or A.C. Mechanical exhaust hood i1nd duct Wood stove/heater Sewer Temporary Construction Change in existing re<;5 d_e.nce multifamily, comm. or Industrial ~later service Of amps. TOTAL CHARGES WHERE STATE L~H REQUIRES shall not be valiJ until the ~.... TOTAL CHARGES that the Electrical work be done by an Electrical label has been signed by an Electrical Supervisor I SS~ANCf OF PFRlllT TOTAL CHARGES Contractor, the electrical portion of this permit and returned to the Building Division 1 HAVE CAREFULLY EXM11NED 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 IlO OCCUPAIKY will be made of any structure without the permission of the Building Division. 1 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 annoY~es who a~e in. compliance w~th DRS 701.055 "ilr*\ used ~n this project. WAt.IE(pl..se print) ~ "" ~\ ~~" Ak In SIGilATURE ~ ~ DATE ~ FOR OFFICE USE mil Y / Sq. F~ain Sq. FtlJ. Access Sq. Ftg. Other f j ~nst. Bedrooms x Zone Fi re Zone Flood Plain Stories Units Dccy Load Occy Group x Value Value Value x TOTAL VALUATION BUILDING PERfllT Charges and Surcharges .e:::::- .0:>0 Plan Ck. Z-J . 65%/Blda ____nn~_?~ ~6~~Bi~~ ______s-=:_-:~_ Fence . :< t> Demo I Sidewal k I A/C Paving I Curb Cut I Conm/lnd .. Ppr Fpp '\ . Res Per Fee 3. ";<6> Systems Development Charqe (1.5%) PLUiiBING PERMIT Charges and Surcharges ELECTRICAL PERI:IT Cha rges and Surcharges Total Comb. rermit MECHANICAL PERMIT Charges and Surcharges TOTAL ,- ~~ j ,_. .,. . . ."/ --" COMBINATION APPLICATION/PERMIT (CAP) < PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 11 oj 43 2. example- Lot I. Block 3, 2nd Addition to Springtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. exam~le- heat/electrical ceilinq/or forced air Qas 2. examole- waterheaterieiectr;cal/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. 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 Structural 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 abbreviated schedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES O. 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. --- Ill. 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~~LY Permit Clerk ,I 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 I c>/7Ji/Z;: k.?:G:;:-='Signature4~ 'J da te ":7-;:V-a:::> --II.I.............UI',' ... ..-...; .........-- ........- , .'".__. .1.._.. \\'"1 .'-..,' " . . I ItISPECTIOII L111E: 726-3769 Job Address ~ l-4r1 ~~. S'tREE.1 CITY OF SPRINGFIELD COIIBHlATlON APPLICATION/PERMIT E!lERGY SOURCES: Heat Hater Heater INFORlIATlOil UNt 726-3753 Sq. Ftg_ 1.lain ~q. FtIJ. Access'. Sq. Ftg. Other flew Add Alter Rep. -Fence Oemo Change/Use Other - - ~ LeIJal De~cription .. - Range Address ,\t<llt,.;) A.VI...l -1'1 f':-?_ '- ~D.::-i2 f.D Phone 7-17 5(,32 ValuE Jl Work: bWO. BuilciinQ Permit Info: Describe Hork(Le.. Build Single Far.lilv l1esidence 1.lith .A.ttached Garaae) ~/,>/?>~~C/,,4-<,- ~L~/?7/<!!:>~ ;0 C~SC;; ~.::: - g;./~~.r?c:.<s ,T~ ~ k'5 -i ;ZC~?3'/#<:;. (lies. no.) (exD'irt:l's) (ohont:l' no. :=J Owner Construction lender IlU.J (leT I Address \ UES I Grl I EAlI (name) Phone (address I Primary Structural Electrical f1echanical CONTRACTORS (name) (address) nics. no.) (exnire~) (ohont:l' no. 1 General -0 l..u'C\ <2... \{ - PlumbiM Electrical f<lt:l'chani ca 1 PLUIIB IrIG ELECTRICAL MECHANICAL SQ. FT. furnace/burner to BTU's I .EEL' .cJJARG.E. ,/ NO. FEE CHARGE Nn FFF . rH'\&liC-llil..... ! Each single fixture SOl> Residence of Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall ~nnrp henter nnd vpnt Storm Sewer Of amps. Appliance vent ~eDaratt:l' Stationary evap. cooler Vent fan with sinole duct Vent system apart from I heatinq or A.C. , Mechanical exhaust hood and duct Sewer Temporary Construction Change in existing res.; dJ.nce . multifamily, comm. or TnrltJc;trial ~Iater service COI~I./INO. FEEOERS Install/alter/relocate dic;trib. fee~pr~ Wood stove/heater Of amps. ISSUANCf OF PFR!1IT TOTAL CHARGES :;:'-.>oA TOTAL CHARGES TOTAL CHARGES WHERE STATE L~W REQUIRES that tl,e Electrical work be done by an 'Electrical Contractor, the electrical portion of this permit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division . I HAVE CAREFULLY EXMilNEO 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 pt:l'rtaining to the work described herein. and that rw OCCUPAfKY 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 a~e, loyees who are i~ compliance w~th Or.S 701.055 Wil~ used on this project. IWIE(ploaseprint) . ",,'\J\I'\ AklC"'\ SIG;IATURE ,.)-<j'{}-L rt'L DATE ~ I FO~ OfFICE USE Dijl Y / Zone ~nst. Units Sf!. F~ain x Value Fire Zone Bedrooms Occy" Load Sq. Ftg. Access )( Value Flood Plain Stories Occy Group Sq. Ftg. Other x Value TOTAL VALUATION BUILDIrlG PERfllT 5'". _c> Plan Ck. Conm/lnd ~. Charges an~ 65%1Bloo Ppr Fpp ------------ Plan Ck. Res Surcharges ~ ;::?D 30%/Bldo Per Fee PLUr~BING PERMIT ______:'J_._-:~_ Fence Charges and Surcharges .=<t;> Demo ELECTRICAL PERI:IT Sidewalk Charges and ------------ Surcharges A/C Paving liECHAN I CAL PERM IT Curb Cut Charges and ------------ Surcharges _... ..L. :I. ::?<P Systems Development Cha roe (1. 5r,) Total Comb. rermit TOTAL \~;P ~ . COMBINATION APPLICATION/PERMIT (CAP) 1. Applicant to furnish A. Job Address B. Legal Description 1. example. Tax lot 100, lane County Map Refere < II U3 43 2. example- Lot 1. Block 3, 2nd Addition to. Sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceiling/or forced ( 2. examyle- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - ( 1. examole- 1250 sq. foot house, 500 sq. foot ( 2. exa~le- if new project, check-new - if add: check add, etc. F. Building permit information: ( I. example - construct single family house witl . attached garage 2. example - remodel existing garage into fami 3. examole - convert single family residence;! ( restaurant (change of use) G. Value of work as defined in Section 303 (a) of Structural Specialty Code H. DESIGN TEM1 AND CONTRACTORS ( To avoid design or construction delays, Buildin. Division Staff must be able to contact appropr; persons regarding design information or job sit corrections, etc. (", II. Abbreviated Plumbing, Mechanical, & Electrical Sche ~ A. Except where blank spaces occur in the descript portion of the Mechanical and Electrical Schedu the applicant need fill-in only the No. Boxes a ~.' to the appropriate item(s) to be installed \ B. Full Plumbing, Mechanical, and Electrical Scheo are available at the Building Division 1. To conserve space on the permit form the sc ,<1-" have been abbreviated \ 2. If the item(s) to be installed are not cov, the abbreviated schedules you should consul full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ( CHARGES ON THE SCHEDULES 0, As noted on the CAP, the label must be deliver, electrical contractor for Signature by his elee G'. supervisor. The general contractor is .not autl _ to sign the electrical label. --- Applicant to sign and date Whenever possible. the initial application will be a worksheet only. Where possible. Building Divisi. (it' will prepare a type written copy and return it to - applicant at the time the actual permit is issued' signa ture. IV. pFe]es and Charges ( an check fees are due and payable at the time of application, and no plans will be processed until tnese fees are paid. All other fees and charges are due and payable when the permit is issued. .. Ill. V. FOR OFFICE USE-.Q~LY " . ,/. ...-. , PERMIT VALIDATION r' " 'T CITY OF SPRINGFIELD City Hall Springlleld. Oregon Department 01 Public Works OFFICIAL RECEIPT J... No. B 59721 Date\ . ~0L ~ ,LggG 4 Rec'd Fro~ b\\)\ J\ L\Jt\ 4 Address 4C\ ~G ",\\ f) 0fA- 'X' ~ l lkCY)' f ( c' Received For: . . .. \ 'n\['\ f'L ~.cJU '11 --: . ()4KJ ,;J( ) ~~ffiV? S.da (. / ("'7? . (.)..U <-to (/ ) ('Y't ,-~-Q.J') (. (I ..' CD ()\ Amount Received . y~ _LD ( ') rnh~ ) - AUTHORlZfDSlGRXnJRE () BY ,/ I :-'. ," C (~ IlIIUGGS P'RINTERS/LITHOGRAP'H.RS, EUGENE., OREGON -'- Permit Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: \ j Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: ] name I c:::>7Y.</&: ;z;2;P--;,,::::--,-signature4--.b2..- ~.... -"--", d ate '::?...:;:v -.e:::> , . "'."_""l~," ,--~., !. i , , , I' , I J T ., , , i , 1 .1- 1 N i , ld , I I . ~ i .- j' " , " N I', ~\ ~ I' . 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