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Home My WebLink AboutPermit Building 1981-5-22 T3-~/'-/:)IN4 "IS . CIT~'Or. 2RIWGFIELD ....- COMBINATION APPLICATION/PERMIT INFORMATION LINE 726-3753 ~ ~ ~ N INSPECTION LINE 726-3769 Address Phone ENERGY SQ..URCES: Sq. FIg. Main _/ 4.C5" Heet ct..~e....T Sq. Ftg. Access. Water He~~<<"'7". Sq. Ftg. Other Ranqe <. r. _New_Add-.l{Alter_Rep. Value of Work: \_FenCe__oemoXChonge/use "",~ ~..:::sr=> _Other I . Building Permit Info: Describe Work (i.e., Build Single Familv Residence With 4.ttnch..d Go:E.9!.' ~,,'~..,.. eYQZz_~l)UJ>t.6X ~o/ /?tte./vr/r-~/ Q<."'ci"~ R......~ ~ ~"'" ??==v?>5 . I ~ I ~ , f'OR~"fc.."" 1$"2. f ISY :S-./~ 1"4 f'L.9,c:- Job Add,... C:'ll.iA~ r'l!!J /0"7 MA/,v ""T, l.goIO."';p';on I:?'() 3 -~S'"~o/I. !>A;1Jr Or ,T.'t.. ~-)~ Own., .::7PRIN4, F/e:'!"p Address :z.s--O fi. t/n.k.f..ZY L-57". ~~ Phon. 7'16-$,,/5'( Construction lender DESIGN TEAM (name) (address) (liu. no.) . (eltpires) P,;mo'y 725/.::0,<,( ~T~1?'aa..x "?; <./3-C: &:~ 7':?YC:::>*. _ Structural Electrical Mechanical (phone no.) ~--' 3V-~ CONTRACTORS (nome) (address) (lies; no.) Gen.,ol VAH<~..N4.RD Lo~r: Plombln" jO}J,(/<S'SG rf.8~. 'S'lcJ5" N~/N ~r. . '5?R"P EI.<loI,ol U7'r V/E=W' Bl.e<7: ~<::) /MJ'j'lJ:,W );>D. _ ,z:'-'4~~ (ellpires) (phone no.) 7'17-u7i''!!..7 .<..IS ':?- /=<'9:2 I NO. I/oZ I I FEE , CHARGE NO_ FEE CHARGE NO. FEE I I CHARGE I I Mechanical PLUMBING ELECTRICAL MECHANICAL Duplell (1 hath) each Temporary Construction -z furnoce/ burner to itTU's Applionce vent separate Stotionory evap. cooler Vent fan with single duct Vent system apart fram heotin~ or A.C. Mechonicol ellhovsl hood and duct :5. ",,0 6. DC Each sin!1le fidure Relocated building (new fix. additional) S.F. Residence (1 both) ~.."" 6O,clI'" Residence of 'f- 1q: ft. New circuits, alterations or extensions ~aR'JC~ c:E"" 1::;:- SERVICES Additional bath I Amps. ~ :< S:c.f) I I I I I I I I r I TOTAL CHARGES I WHERE STATE lAW REQUIRES that the Electrical work be done by the Electrical Contractor, the IIlectrical portion of this permit shall nof be valid until ,a label has been signed by an Elech'.ical Contractor and attached t~ the electrical panel. Water service I 4.~1 Sew!!!r 'Wood dove/heater Storm Se.....er FEEDERS Heat Pump Air handler to 10,000 CFM Amps. Air handler over 10,000 CFM o W4(.(.II-~.5 1'-- ",. 3:;.....1 ISSUANCE OF PERMIT 10. .,,,,, #~.""~ TOTAL CHARGES 4'0. C>C> TOTAL CHARGES ~S-0. SO I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that ~II information hereon is true and correct, and I further cortify that any and all work performed shall be done in accordance with the Ordinances af the City of Springfield and the la.....s of the State of Oregon pertaining to the work described herin, and that NO OCCUPANCY 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 fuJl force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted heron, and that only subcontractors and 'employees who are in compliance with ORS 701.055 will be used 0 is project. NAME (pleose print)~A ~ II411Jl C,IGNATURE FOR OFfiCE USE ONLY Basis for Builder's Board exemption: L.-'I Fire Zone N '4 Flaod Plain --80 ~ Type/Const.~--.1 Bedrooms x.J t!l. O;:torie~ J Units 'lccy Load ':Z ~ Occy Group--!3'-2 Sq. Ftg. Moin Sq. Ftg. Access Sq. Ftg. Other /20::;;- x Value II Value II Value TOTAL VALUATION OATE~IJA~~ I -:<s:a='-l I ~S'c:Xo..... I Zone BUILDING PERMIT 1/2. -=> Plan Ck. Comm/lnd Charges and 65%/ Bldq Per Fee Surcharges 'I. y~ Plan Ck. Res 30%/ Bld~ Per Fee PLUMBING PERMIT ~. c...,. Charges and Fence Surcharges .....0 Z. Demo ElECTRICAL PERMIT .;10. cc:> Charges and Sidewalk Surchar!J~s /. t;c A/ C Pavino MECHANICAL PERMIT . 5..". SO Charges and Curb Cut Surcharges ---- --- "2.:0::'::::', , 7:<.8t!:> I Systems Development Charqe (1 .5%) I Total Comb. Permit .2. 79. '2.'1 TOTAL ?S'"~ o~ . c (~) ......... .~. COMBINATION APPLICATION/PERMIT I. Applicant.ja furnish A. Jab Address B. legal Description 1. example-tax lat 100, Lane County Map Reference 17 03 -43 2. example-Lat 1. Black 3, 2nd Addition to Springfield Estates C. Nome, etc. of owner and construction lender D. Energy Sources 1. example-heat/electrical ceiling/or forced air ~os 2. example-water heater/electrical/or solar E. Square footoge or valuation, etc. 1. example-l 250 sq. foot hause, 500 sq. foat garage 2. example-if new project, check new-if addition, check add, etc. F. B~i1ding 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 ovoid design or construction delays, Building Division Staff must be able to contoct appropriate persons regarding design information or job site ccrrections, 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 t~ 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 Cler~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: / - F/ p~ J2.z;-pr. ;:;_~ c.... ";::? ~~ GJ rA cS~ _ Additional Project Information: PLANS REVIEWED BY: 4_-~~ name Lc:>flN<: ~~.:'-(' s~gnaturr ~ ptMIT VALIDATION ""> "-~/-a~ ..Jot... f;::-U/LOJIJC-.. ...- '- . . ClTy"O'F SPRfNGF1ElD .,' COMBINATION APPLICATION/PERMIT INFORMA TlON LINE 726-3753 CT. '- ::..J I:; VI '-1, fJ INSPECTION LINE 726-3769 Address :z_~O N. ,4 "::;7. ENERCY,SOURCES: Sq. FIg. Main l;z.o5 Heat Et..ec::...:r ___ Sq. FIg. Access, Waler He~S:~~'Z..7". Sq. FIg. Other Rance _ __~<r.__ _New.___Add.l{Alter~Rep. Valve of Work: __Fence _ DemoX.Change/Use r":<:.._r:.,J;.....-, 7'5";~' 00 __Other - - Building Permit Info: Describe War!.. (i.e., Build Single Phone 7'1h-SJ./2L Familv RI!~jdencp With 4tttlch,;"d Goro9.!1 ~V.'E.T-f' C:(-z~;:r:"":::o VU,Pt.SX J;; '/"7",,=:-,,/ I=;c/ /i'../"i/c~'~ / ~-=:..;'.:.....::;;,~ .j ..-:,.;0. L~~ =:; ~.~..~~- '--;~~:~"~':? FaRM"!'''?l. 't' I$"2 f /S'! :5". I~''''' 1-"U1<<."'- Job Add,." Q-i'&..</c~E r;-.t:> 10" 7 M-4/,</ "iT- T~ legal Description a.t:J~5'--~;DA/3.r 0.;::- ~..)6C> Own.. .::7PRI/-I"'" FAE.!oP L/vL_' 7'7"' ConHruclion Lender Address P"ont DESIGN TEAM (nome) (addren) (lin. no.) Primary D~<"ltSN Sr'Y~7c~J''-::-; I=?'.a~~)..: ~'1'3S- ':':=:"~;'~;:,,:-.I'/":~ :-:-",.?rOB j (expiresl (phone no.) ~~ -~--(; ?:</~ Struet'Jral Electrical Mechanical CONTRACTORS (nome) (addreu) (lies, no.) (expires) (.,hone no.) General V/l~1(".~/',)A#"'.r:.; .~".~..~,.,.: ?Iumbinq \/Oh'X/~:'$~ r'-.i7'"C~. ~/o5'" /44/'<i ':51~ Electrical U7Y'" (;J~'V/ ~t!::.'f!'/: ~O .!.!"A,:q./.OW ~h 1"":"/ _~=~(.Jc::;..c/-:~:~ "7 '17-0939- r.:;,,,,,:/- /:(-;1:::: -5PRZ? Mechanical PLUMBING ELECTRICAL MECHANICAL Duplox (1 halh) each Temporary Construction -z. furnace/burner fo ~TU's AppliclMce vent separate Stationary evaI'. cooler Vent fon with sin~Je duct Vent sysfem aport from heotinq or A.C. Mechanical exhaust hood and duct CHARGE i I I I '.00 6, &01 I LJ.~I I 1:-10. 1/.2 I I FEE CHARGE NO. FEE CHARGE NO. I FEE Each sinqJe fi}(ture Relocated buiiding (new fi}(, additional) S.F. Residence (1 bOfh) 5:Qc.:" ~,~I:'J Residenco of 'f... ~q: ft. Now circuits, alterations or e}(tensions -;~.:~.:.~'~L""~;;: ,~~""-'< SERVICES Additional bath I , Amps, -:::::...~ =<S-:"'" \-Vater service I Sewer 'Wood stove/healer Storm Sewer FEEDERS Heat Pump Air handler to 10,000 CFM Air hondler over 10,000 CFM \l'M'-'- 1!,e;qT:RS / .-. o. ;:;"I"c::(> _c. Amps. I I I 1 r I TOTAL CHARGES I o ISSUANCE OF PERMIT 10. CoO "-.i/ . ",,_"9<eo ,;:"pce. TOTAL CHARGES '1~ OCl TOTAL CHARGES 1f5'6. SO WHER.E STATE lAW REQUIR.ES that the Elutrical work b'. dona by tho Electrical Contractor, th. electrical pgrtion of this permit sholl not be valid until .0 label has be"n signed by an Electr}cal Contractor and attached to the .lectricol panol. I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that 011 information hereon is true and correct, and I f",rther certify that any and all work performed sholl be done in accordance wah the Ordinances of fhe City of Springfield and the Lows of the State of Oregon pertaining to the work described herin, and that NO OCCUPANCY will be mode of any structure without the perm inion of the Duilding Division. I further certify that my registration with the &uilder's Boord is in full force and effect os required by ORS 701.055, that if exempt the basis for exemption is noted h.ron, and that only lubcontractors and emplpYlul1 who ore in compliance with ORS 701.055 will b. uled 0 his project. NAME (please print) t;; Hrt10 A ~ .MJ17t SIGNATURE Basis for Builder's Boord exemption: ~'..'''-'' Type/Conlt.~f : Bedrooms --.tL /. . O:torie' ! Units I"'ltcy load ~C-s '-'ccy Group 3"-2_ Foa OFFICE USE ONLY .?<./- 0:_. Ftg. M;;Jin _1- ~ Sq. Ftg. Access Sq. Ftg. Other x Volue <s:.~'C'.~ Value OATE~/7A~~ I I I I Zone Fire Zone Flood Plain ~.-,( l;.,..-J x ,It Va/ue_ TOTAL VALUATION ~~Cl.--"C..'\. 0>""" BUilDiNG PERMIT 1/ z. ..."" Plan Ck. Comm/lnd Chargf!S and 65%/ Bldq Per Fee Surcharges G..I ~/S Plan Ck. Res " 30%/ Bldq Per Fee PLUMBING PERMIT ~c=oo Charges and ..... Fence ~. Surcharges ~ "-:'~ Demo ElECTRICAL PERMIT <-'0. Chargel and ,::>c"O> Sidewalk Surchar!J"s " ., " ~~. A/C Pavino MEeHAN ICAl PERMIT ____ ,:,,~~~::'~~5:~.~ Charges and Curb Cut Surcharges '2, :Z0 ?:?S~ Systems Development Char~e (1.5%) Total Comb. Permit 2. 79. "2.'Jl TOTAL ? S-z. a.'f , . . COMBINATION APPLICATION/PERMIT (CAP) ..')..... .~'. I. Applicant-Ja furnish A. Job Address B. legal Description 1. example-tax lot 100, lane Caunty Map Reference 1703 43 2. example.lot 1. Block 3, 2nd Addition to Springfield Est.nlp, C. Name, etc. of owner and construction lender D. Energy Sources 1. example-heat/electrical ceiling/or forced air qas 2. exomDle-woter heater/electrical/or solar E. Square footage or valuation, etc. - 1. exomple-1250 sq. foot house, 500 sq. foot garage 2. example-if new project, check ~-if addition, check add, etc. F. Building permit information: 1. exomple-cnnstruct single family house with an attache 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) af the Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Stoff must be able to contact appropriate persons regardh design ir.iormotion or job site ccrrections, etc. II. Abbreviated Plumbing, Mechanical & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechanical end Electrical Scnedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate item(sl to be installed B. Full Plumbing, Mechanical, and Electrical Schedules ore 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 abb oted schedules you should consult the fuil 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 os 0 worksheet only. Where possible, Building Division Stoff will prepare a typewritten copy and return it t!' the applicant at the time the actual permit is issued for his signature. IV. Fees and Charges Plan check fees are due and payable althe time of the applicc and na plans will be processed until these fees are paid. All other fees and chorges are due end payable when the permit +- is issued. V_ FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . PERMIT VALIDATION , , CITY OF SPRINGFIELD City Hall Springfield, Oregan Department of Public Works OFFICIAL RECEIPT N B ~7"'?O ~ . () f) ~ \ o. :J.),;)! Date V'- L"-1f.-J Rec'd From ~ Address (S:::D W f\ ~+- Received Far: 0(0!\ /1,-, \ \& ~~ _ I'1n 4.. \-( \ro r\~ loC) QJ 4-U;b c0.4-0 \.~... 4c){..n . ~~ \, (nn ~"\&U:\.. n( () ,~ 4V /n r-../), ~c.o ~\iY' k l~oW -\ \..) , '- (" ( ( ( ( .: ( ~ ( Amount ( ~.. n' \.' 2.0'T ~ lfjJ 4UTHOIHZI!:D SIGNATU~1E ...ClTO...TUIl...uU ~..,..TI.S. luau.c, 0" .,.01 ~ (IX .) ..."., \ Permit Cler~ t - ;c;,p<!:, - - .<~~:;.:_z>ra ,....../~~-.L,., c.. ...~..~) ,,~ ~'~ c:..; r /~ c:....~ Additional Project Information: PLANS REVIEWED BY, nam'5 ~ - L~/v.:: .-- L...~::..,;:.1:i! "ignaturpo / ~ /.-.:,-;::7 ,;..-;;:/~-" I____~..........--, ~ ..I'"1tP' -7-</<!S~