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Home My WebLink AboutPermit Building 1984-2-10 I INSPECTION LItlE 726-3769 . CITY Of SPRINGFIELD COMBItlATION APPLICATION/PERMIT EilERGY SOURCES: Heat l~ater Heater Range ValuE of Work: tJ),tJOO r) INFORltATION LINt 726.3753 Sq. Ftg. i,lain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Pep. --Fence Demo Change/Use Other - - \Xl ~ Cl ~ Job Address ;2&, 50 'fY\...0...:,.... ~ Legal Description Il-"~.'3t:''I1 . Pe>~bO , Owner ,~~l~ ~ q I '3~ ~ fbO.Phon'Q~.?99i ~ BuilrlinQ Permit Info: DescTlbe Work(i~e," Build Single Familv Residence Hith Attached Garaael ~M. i )".to.IV /lM A~ eM, J f;J'Z I Address Address Ut~lliN It:.Af-1 (namel Phone f address I (lies. no.) fexoiresl (ohane nQ. :::;- \X) I Construction lender Primary Mechanical CONTRACTORS (name) (address I f1ic~.nn.' A. ~h- (Pxo;r"~ (ohnnp nn Structural Electrical General -~ Plumbina Electrical f<~~ lIn:J..UJ.//{.fd&1 1& ..21, / ,1t)(J , 2/l{~<f Hechanical -1!Q.,. PLUlIBItlG #.1/-. FFF cHARr.F Ij(\ ELECTRICAL ~~~ r~~ NO MECHANICAL ~~. ~~1=' fl-l.;&G[ Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) ~ New circuits alts. or extensions ~ ::2 ~",AA"""'" SERVICES 'S:- Floor furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each Add1tional bath IWater service I Sewer Istorm Sewer Recessed wall ~n~rp hp~tpr ~nrl ~pnt I I TOTAL CHARGES TOTAL CHARGES IS-:- 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 valid until the label has been signed by an Electrical Supervisor and returned to the Building Division Temporary Construction Change in existing rp~ i dJ'nrp Imultifamily. comm. or TndlJf;triill IOf amps.1 iCOMM,/IND. FEEDERS I IInstall/alter/relocate I dif;trih. fppdprf; IOf amps.1 I I I Appliance vent seoariltp Stationary evap. cooler Vent fan with sinole duct Vent system apart from I heatina or A.C. Mechanical exhaust hood and dud. Wood stove/heater ISSUANCE OF PFRrtIT 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 oerformedshall 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 ORS 701.055 will be used on this project. IlAl,IE(please print) fforJ e- f1 r (;-Ro s 5 SIr.lIATURE ~ ~ DATE;)-It7 -f'l '--Fbr.-ofFICE USE OIlIY Sq. Ftg. Sq. Ftg. 8-2 Sq, Ftg, Zone oM./I Fi re Zone Flood Plain Type/Canst. Bedrooms Units Occy Load Occy Group BUILDING PER/lIT Charges and Surcharges ~~. c>co ~~~~R~~~ ------------PTan Ck, ,$0 30%/Bldo ConmlI nd ppr Fpe Res Per Fee riain x Value Access x Value Otherft~L Value \~ TOTAL VALUATION '1".O(] Pd{.?8<( ~I::~~~s(~:mopment '2.c:llQD.- Stories #.A-. PLUt1BING PERMIT Charges and Surcha rges Fence ELECTRICAL PERI~IT Charges and Surcha rges /IECHANICAL PERMIT Charges and Surcharges I D~mo IS". - I'Sidewalk .-_nn~-j'6-1 A/C Paving I Curb Cut I I I ITotal Comb. Permit I P~e<<'i I TOTAL Fce ~6. yo 72.,8'IJ I - ~ . L 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 JI 03 43 2. exa~Je- Lot I. Block 3, 2nd Addition to ~prlngtleld Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceiling/or forced air Qas 2. example- waterheater/electrlcal/or solar E. Square footage or valuation, etc. ------ 1. exam~le- 1250 sq. foot house, 500 sq. foot garage 2. example- 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. example - remodel existing garage into family rcom 3. examJPle - conver~ single family res1dence into restaurant (change of use) G. Value of work as defined in Section 303 (a) of the StructuraJ 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 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. 4 V. FOR OFFICE USE ONLY Permit Cl erk h PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: Lv.6RA' C/.:>~~_c:F";:;;' ~.rH'c:>~;r- ~~~.....;r- So. )?~'~t:.F ~ ./~~,~. . PLANS REVIEWED BY: 'name L .e.RNe ~ E<:::; €~ signature ~. ~^-.., P' ;" ". date ""2-/e>~B Y I INSPECTION LINE 726.3769 Job Address ;2.&, 50 \'Y\..~ Legal Oescription Il-t>?J. '3t;;-'-I1 . 4-~ CIn OF SPRIIIGFIELD COMBltIATlON APPLICATION/PERMIT E!IERGY SOURCES: Heat ['later Heater Ranqe . INFORllATlO~ lIC,t 726.3753 Sq. Ftq. I-la;n ~q. ~tg. Access. Sq. Ftg. Other flew Add Alter Pep. --Fence Demo Change/Use Other- - 'Xl ~ Q r.::J . PC:J6bO Owner ~~ iv.-i.- ~ q I '6~ ~ ecO.Phon'Q'l'~.;>997 ~~'- ValUE of Hark: JJ;;., &00 BuilciinQ Permit Info: Describe Hork{i,e.. Build Single Familv Residence With JI..ttached l1araoel ~-M 0/ JJ1.a./V /l.MA_ .;},?, J )( l7' :::;- \)<) Address Construction lender Address Ut~ Hir~ I tAn (name) Phone I address 1 nics.no.l (exni res) (ohane no.) Primary Structural Electrical Mechanical CONTRACTORS (name) (addrpss) (1 ;("0;.. nn. \ (pxoirps) (ohnnp no,) Genera 1 -~ Plumbina Electrical R~ Z'-~ 'ItJ:J..{., (j),/IJ.fSI.tC., P- ..2/, I <;'/{)() 2/1.(~'1 "1echanical PLUIIB IIlG L I A ;)< .,,-. ELECTRICAL MECHANICAL ~~. -'!!hI Each single fixture FFF CHAR(;F Nn I='~Ll...!J:lAR.G.E.. NO Residence of furnace/burner to SQ. FT. BTU's ~~I=' ru~ Relocated building (new fix. additional) ~ New circu~ts alts. or extenSlons ~ :z ~"JW.,vJ....- SERVICES (~ Floor furnace and vent S. F. Residence (l bath) Duplex (1 bath) each Additional bath Recessed wall ~n~rp hp~tpr ~nrl vpnt Storm Sewer Of amps. I I I I I I I IS:- Appliance vent seoaratp Stationaryevap. cooler Vent fan with sinole duct Vent system apart from I heatina or A.C. Mechanical exhaust hond i\nd dlJrt Sewer Temporary Construction Change in existing rp'l; dJ'nrp multifamily, comm. or Tnduc;trii\l ~ater service CO~1./IND. FEEOERS Install/alter/relocate rl;c;tr;h_ fpprtprc; Wood stove/heater Of amps. ISSUANcr OF PFRIIIT TOTAL CHARGES WHERE STATE L'W REQUIRES shall not be vali1 until the TOTAL CHARGES TOTAL CHARGES 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 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 lW 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 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 7n1.055 will be used on this project. IIAf.lE(please print) ffi?TJtf-f5r {;-& S5 SI"flATURE ~~ ~ot-a- D~.TE"-/t1-i(.L FO~ OFF I CE USE om Y So. Ftg. Sq, Ft9. 8-2 Sq. Ftg. Zone M~ Type/Canst. Bedrooms Units Occy Load Occy Group Hain x Value Access__ x Value Other~~,"- Value TOTAL VALUATION 'Z,dQD.- Fi re Zone Flood Plain Stories BUILOING PERIIIT Charges ane Surcha rges -, __ ~ Plan Ck. ConmlInd ~~, 65%/Bldo PPf Fpp ------------P"'f"an Ck. R"es ,$0 30~/Bl do Per Fee Fence d J.~,{)O 't~ p.'dJ ?S:{ Systems Development Zo' CharQe (!.5~) filA PLU'1BING PERMIT Charges and Surcha rges Demo ELECTRICAL PERI:IT Charges and Surcharges IS: - Sidewalk ___n_-~-j'6-1 A/C Paving I Curb Cut I ITotal Comb. rermit I j)OUS<tS I TOTAL Fee ::16. yo ;7 2.2tJ 11ECHANICAL PERMIT Charges and Surcharges I . . 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 II OJ 43 2. example. lot 1. Block 3. 2nd Addition to Springfield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinqlor forced air Qas 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - I. examole. 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 garllge 2. example - remodel existing garage into family room 3. exa~le - conver~ 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. & 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 8. 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 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. - 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. l( V. FOR OFFICE USE ONLY Permit Clerk /J l 1 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: W6RA D~'lfi(~ . C:L:,~E'_cF.D ~TA'e:::>(_J;r- /1._ f~/.?- Sn ~,.--- ~ - -- /~~-..., ~ r - ~ 1 PLANS REVIEWED BY: name Lot!>RN€ h E<:::; e:-~ signature ~. ?.eq......., date ~-/e>~B S' P'