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Home My WebLink AboutPermit Miscellaneous 1981-9-30 I I'lSPECTIOtl lI'lE . CITY Uf SPRINGFIELD 726-3769 ' COHBIIIATION APPLICATION/PERMIT #" E!IERGY SOURCES: ~::a~d:::::i= ~i!;rorJ:rY/J I ^)sx ~:;~r Heater ~ ~-J..-.IcI-l- Range ValuE of Hork: 6 Owner R /Jp. E.e.S cr FL tPAAI(1}k 5P/2./AJG, FIE L i) . I J1:liJ... 'I-M'. Builti;nQ Permit Info: Descr,be Workli.e., Bu;l~ Single Familv np.sidence With Attached GaraQe) Mila [)". Address Phone ,5 illfLJ I Construction lender Address UI:.~lliN HAl.' Phone (address) (l ics. no. 1 (name) . Primary Structura 1 Electrical r~echanical CONTRACTORS (name) (address 1 (1i(':~. no.) General !JWNEi .e- r)/ l)AJ;; Pc () /1) IV f3 /!.-- Plumbino Electrical ~lechanical PlUlIBItIG ELECTRICAL NO. INFOR/IATION liNt 726-3753 Sq. Ftg. t.lain ~q. Ftg. Access. Sq. Ftg. Other new Add Alter Rep. --Fence Demo Change/Use. Other- - ~. \'- ~ ~ (:x) I#MI E lexniresl ~ {ohane no. I ~! .~ (p)(oirp~l lnhnnp nn. ~ ! ~ u MECHANICAL, Each single fixture FFF CHARGF NO ~~~ r':lAB.G.E. Nn Residence of furnace/burner to SQ. FT. BTU's ':Ef_ .QlAJlIl.E. : I Relocated building (new fix. additional) New circuits alts. or extensions S.F. Residence (1 bath) Duplex (1 bath) each Additional bath SERVICES Temporary Construction Change in existing rp~ j d.ftflcp multifamily. COITlTl. or tndu<;.trial I Water service Sewer Storm Sewer Of I I I I //{;!fo I / amps. 1M H-- 5.ctu..;, I l(l,{)o COMfl./IND. FEEDERS Install/alter/relocate rli~trih fpprlpr< Of amps. /J1 II d..u.. Floor furnace and vent Recessed wall ~o~rp hp~tpr ~nrl vpnt Appliance vent <;.poar"'atp Stationary evap. cooler V-ent fan with sinalp. duct Vent system apart from I heatina or A.C. Mechanical exhaust hood and rlur'f. Wood stove/heater ISSUANC, nF PFRrlIT TOTAL CHARGES I&.~ TOTAL CHARGES 1S'.{)o TOTAL CHARGES WHERE STATE L'H REQUIRES that the Electrical work be done by an:Electrical Contractor, the electrical portion of this permit shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXN1INED 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 NO OCCUPArKY 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 OP.S 701.055 will be used on this project. HAf.lE(please print) .M ~~ 'K ~ r-, E R S ' SIGNATURE?t F~t7A/.1../ FOR OFFICE USE :~,. (/ Sq. Ftg. t1ain Sq. FtQ. Access Sq, Ftg. Other Zone M fI41 Fire Zone Tyoe/Const. Bedrooms Units Occy load Ocey Group Flood Plain Stori es BUILDING PERfIlT Charges an~ tY' ~~.,yesi.i.- D . PlU'1BING PERMIT Charges and Surcharges , Plan Ck. COf\1l1/1nd ______~~__ 65%/BJdo Pj'r F.. Plan Ck. Res 30%/Bldo Per Fee Fenee _n___Jf,ppn ,101) 0_ ELECTRICAL PERt~IT Charges and Surcharges _ _ _ _ _ _ JJ)J1j)_ _Sldewal k LtO A/C Pavi ng MECHANICAL PERMIT Charges and Surcharges Curb Cut DATE '1- J/)- 51 / x Value Value Value , , TOTAL VALUATION Systems Development Charqe (1.5~) Total Comb. Permit fI IPf . 0iJ \ IJ (PI. HJ\" TOTAL , '. , . .. 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. ~xample- Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examyle- heat/electrical ceilin~/or forced air Qas 2. examole- waterheater/electrical/or solar E. Sq~are footage or valuation, etc. ------ 1. examole- 1250 sq. foot house, 500 sq. foot garage 2. example- if new project, check-new - if addition, chee k add. etc. F. Building permit information: -1.. example - construct single family house .with an - a ttached gar~ge ' 2. examele - remodel existing garage into family room 3. example - convert single family residence intn restaurant (change of use) G. Value of work as defined in Section 303 (a) ?f 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. Abbrevjated Plumbing. Mechanical. & Electrical S,hedules A. Except where blank spaces occur in the descrlption portion of the Mechanical and Electrical Schedulps. 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 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. --- 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 signa ture. 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. II. III. IV. V. FOR OFFICE USE ONLY Permit Cl erk .., . .",...,~...... ..._,.... ...11 ..11'_."'...... 11........0 ,.....,....-.......'"..,~.._,......~.III._ .......1."'.'............... PROJECT CDNDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: \ :i .' ," t 1 ~ " :'. i :~ , .~ 1 j 1 , I , .~ ~i i , 1 j I 1 <....... ............"... I , < , . . ..""" ..- ._....., "..... ..1_1.. . _III . PLANS REVIEWED BY: name signature date ";0_, I Owner MAR.K'- ,'I/J/;FL-S Address r- /J c:-r r J /( 1lJ11{1 i-U\ SPf!../AJG, F IF- L i) } IIIISPECTIOtl LItlE 726-3769 JOb Address . I).? F, Legal De~cription Construction lender Address DES I Gfl TEAll Primary Structural Electrical /1echan; ca 1 CONTRACTORS General i Plumbino Electrical ~1echanical Sewer Storm Sewer IMH- 5auf . PAl!),' I.:./) CITY OF SPRHlGFIELO CQrlBlllATiON APPLICATiON/PERMIT ~ EilERGY SOURCES: S/' S3" Hea t ~\ !'Iater Heater Ranqe Valu' of Hark: . 1)1 1''';''''''1' (lies. no.) (1 ;("5;.. no.' I ~1~tlA&J '10 I I I I I I I I liCM I I l'i:tJo lNFORJ1ATION Ui'lt 726-3753 So. Ftq. f.lain ~q. Ftg. Access. Sa. Ftg. Other New Add Alter ~ep. --Fence Demo Change/Use' Other- -- IS" ~ '-Sl <::l ....... Co OP.. =iLtuL/ I Builriino Permit Info: Describe Work{i.e.. Bu;19 Single Famil v nes i dence Hith JI..ttached Garaae) /)p Phone I+W ;= (exoires\ (exoirp.s) MECHANICAL '''L'.l:JiAB.IiE.d furnace/burner to BTU's Floor furnace and vent Recessed wall ~n~r~ hp~tp~ ~nrl V~nt Appliance vent separate Stationary evap. cooler Vent fan with 5inole duct Vent system apart heatiM or A.C. Mechanical exhaust hood and duct Wood stove/heater from ISSUANCf OF PFR!1lT TOTAL CHARGES Ig,~ TOTAL CHARGES WHERE STATE L~W REQUIRES that the Electrical work be done by an 'Electrical Contractor, the electrical portion of this permit shall not be valii until the label has been signed by an Electrical Supervisor and returned to the Building Division TOTAL CHARGES tlO.1 -----lEach single fixture I'Relocated building (new fix. additional) Is.F. Residence (1 bath) IDuplex (1 bath) each IAdditional bath ~Iater service I HAVE CAREFULLY EXM1INED 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 Oregon pertaining to the work described herein, and that no OCCUPArKY will be made of any structure without the penmission of the Building Division. I further certify that my registration with the Builder1s 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 OP.S 7nl.055 will be used on this project. 1JAr.IE(please print} .M R-1< \-Z ~ (.; E R ~ SIr,lI^TUR(;J1;AA'~t7.A/.1/ FO~ OFFICE USE DilLY (/ Sq. Ftg. r1ain Sq. Ftg. Access Sq. Ftg. Other Zone M H--[P Fire Zone Flood Plain BUILDING PERfIlT Charges an~ rtr::J~1yes/k...u P. PLU'1BING PERMIT Cha rges and Surcharges ELECTRICAL PERI~IT Charges and Surcharges I1ECHAN I CAL PERMIT Charges and Surcharges (name) Phone (addressl (name) (address) IJWN5.e ()11JIJ;:;/l. ()IJJN&I!-- PLUIIBIIIG ELECTRICAL I HE I CHARr,F: 'lll.....' Residence of SQ, FT. New circuits alts. or extensions SERVICES Temporary Construction Change in existing resicteJlce multifamily. comm. or Industrial Of amps. IO.(}o COMH./INO. FEEDERS Install/alter/relocate di~trih. f~erlerc; Of amps. /tJ I/- d.LL Tyoe/Const. Bedrooms Uni ts Occy Load Occy Group Stories Plan Ck. Comm/Ind ______~~__.M!/Bldo Ppr Fpe Plan Ck. Res 30%IBldo Per Fee __n__JG,-OP__ ,,;;) Fence Demo ______j..f)j)J)__ Sidewalk /fO' I A/C Pay; ng I Curb Cut ------------ I OAT.E '1- 3/)- $( /_ .x Value Value Value x x TOTAL V ALUA TI ON Systems Development CharQe (1.5~) Total Comb. Permit fI &/ M lJ?l.t1-O_1 TOTAL . . COI~BINATlOl~ APPLICATION/PERMIT (CAP) CITY OF SPRINGFIELD (. Ill. I. Applicant to furnish A. Job Address B. Legal Description ( I. examole- Tax Lot 100, Lane County Map Refe II 03 43 2. examole- Lot 1. Block 3, 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinqlor forced 2. examole- waterneater/electrlcal/or sorar-- Rec'd ( E. Square footage or valuation, etc. - I. examole- 1250 sq. foot house, 500 sq. foot 2. example- if new project. checknew - if adl cneck add, etc. F. Building permit information: 1. examole - construct single family house W;l attached garllge 2. examole - remodel existing garage into fame, C" 3. examole - convert single family residenci i restaurant (change of use) G. Value of work as defined in Section 303 (a) of Structural Specialty Code ' H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Buildin Division Staff must be able to contact appropri persons regarding design information or jOb sit (,. corrections. etc. II. Abbreviated Plumbing, Mechanical, & Electrical Syhe A. Except where blank spaces occur in the descnpt portion of the Mechanical and Electrical Schedu the applicant need fill-in only the No. Boxes a, ~er to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedr are available at the Building Division 1. To conserve space on the permit form the :sct (lp have been abbreviated 2. If the item(s) to be installed are not cover the abbreviated schedules you should consult ~, fu 11 schedu I es ( C. BUILDING DIVISION STAFF WILL FILL OOT ALL FEES ft Amoun!....Received CHARGES ON THE SCHEDULES D. As noted on the CAP. the label must be delivered . electrical contractor for signature by his elect ~l supervisor. The general contractor is.not autho to sign the electrical label. --- Applicant to sign and date Whenever possible. the initial application will be u: Ja! a worksheet only. Where possible. Building Division \~ will prepare a type written copy and return it to thd- _ - . 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. City Hall Springfield, Oregon Deportment of Public Works OFFICIAL RECEIPT (. ( No. B "-7')""73 ~ ..J I (. Dale J.J n ~ 11 19 ~ , 1 Il From 1'l1/1^~' i.I),;;~ _) Address !if!, t; fJ J) Ai 6 S; '. ( (~ Received For: Mf-I ut" f 1l!(,~ tJ-iJ 'I ( 'f.b- M If ~lH~tj; IJ\../J. P iuA . Ie &r:J .Iov If). iJn ./llJ 1& c ,~ ~ ~11-~ .p 10 I t-O << ~I )-A !.":.O""D ",o."u" ."I[LT~N'TU"N'U~L ~IIINT(oI. . I[\,GIO'I[. Oil ",.0' f "'11" (.. ( V. FOR OFFICE USE ONLY . Permit Clerk I .~ .;. ., .... ... . ". ." .. ,...... ... ,. ..__~.,,_..... ~.I~ .::,."."..... 'w...,.. .__ ..... I....~...,--,. PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ___I Permit applicant exempt from registration with the Builder's Board because: " Additional Project Information: r " , < , ... .. ,. --' ,. -." . PLANS REVIEWED BY: name signature date .... ~ I ,..-.. .,.