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Home My WebLink AboutPermit Building 1983-9-23 lINSPECTION L1I1E. . CITY Uf SPRINGFIElD 726-3769 COMBIIIATION APPLICATION/PERMIT IJ7-r1J ~ l.A A.IL A~ . c., E!lERGY SOURCES: Job Address~. \tf::A. C'<<\~\\.")~ Meat legal Description ~~. \'\D~~,=,&.\\ I-later Heater ",~ ~. ~r,: Range ~IIUVI' Itl un ~\. ~ v'1Ilf HO~ tW'\ .( tJ (u,v"U/, BuilriinQ Vermit Info: Describe Work.(Le.. Family ~esidence With Attached Garaae) . INfORlIATION UN" 726-3753 Sq. Ftg. '.lain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. -Fence Demo Change/Use -Other - - Owner6.JJ.fS Address ~ A Phone Build Single . S~t\,^~\e,^ .~f'\\.'\ Construction lenJer 14V~1 ~~ " Address Ut:.:::dbN II:.Ar., (name) Phone (address) flies. no.) (exoires) &r~'?I? ~~ \ (phone no./ M!RIP343 Primary Structural Electrical Mechanical CONTRACTORS (name I (address) (] ics. no.) (pxnirpc;,) (ohonP no.) Genera 1 NJJ. , - ~1 ~-_. . ~ ~ ; P'llm~;O(1 Electrical ~1echanical ~ ElE~ M~l NO. I I FFF t r.HARGE NO I Hi=' I fl-lllRG.[ NO. I ~rr I fl-l.;RG[ Each single fixture Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) New circuits alts. or extensions \~ (fj Floor furnace and vent S.F. Residence 11 bath) IDuplex (1 bath) each jAdditional bath I ~Iater service I Sewer IStorm Sewer SERVICES Recessed wall ~n~rp hp~tp~ ~nrl vpnt Of COffi~./INO. FEEDERS Install/alter/relocate rlid.rih_ fpprlp.rc; amps. Appliance vent 5E'Oaratf. Stationary evap. rnnl".r Vent fan with sinole rlud, Vent system apart from I heatina or A.C. Mechanical exhaust hood and durt Wood stove/heater Temporary Construction Change in existing rp~ j 1pprr multifamily~ comm. or Inrluc;trial Of amps. I SSUANCE OF PFRtllT TOTAl CHARGES TOTAl CHARGES TOTAl CHARGES WHERE STATE L\l/ REQUIRES that the Electhcal 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 EXAHINED 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 UO OCCUPAIKY 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. IWIE(please print)-?J7P36 J). t:m11H SIGIlATURE ~~ FOr. OFFICE USE DillY Sq. Ftg. 11aino..9..'){) Sq. Ftg. Access Sq. Ftg. Other DATE e; /~/e.~ , . I Zone r. -\..\ Fire Zone \:)1;:a.. Flood Pla;n~~ Type/Const. ~-U Units Bedrooms ~~ Occy load Stories \ lelr1M\l~oCCY Group~\ c.-.,'l- x Value x Value x Va 1 ue TOTAl VAlUATION \n. ("0"). (!}/a BUIlDING PERfllT Charges and Surcharges · "<2. 00 ---~_._----- ?C'O Plan Ck. Comm/Ind 65%/Blda Per Fee Plan Ck. Res 30t/Blde Per Fee Fence ~""CUl InnS? Systems Development Charae O.5~) q. .:l1oR3. I I I PlUI1BING PERMIT Charges and Surcharges O~mo' \ ~. O't> I Sidewalk --------(:6--1 A/C Paving I Curb Cut ------------ I ITotal Comb. Permit ~q. ~'6 eoq. ~<( ElECTRICAl PERIHT Charges and Surcharges MECHANICAl PERMIT Charges and Surcharges I I TOTAl . COMBINATION APPlICATIOII/PERMIT (CAP) 1. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100. Lane County Map'Reference II 63 43 2. ~xample- lot I. Block 3, 2nd Addition to Springtielc;l Estate"s". .l ~ C. Name, etc. of'owner and construction lender O. Energy Sources 1. example- heat/electrical ceiling/or forced air qas 2. example- waterheater/electrical/or solar E. Square footage or valuation, etc. ----- I. example- 1250 sq. foot house, 500 sq. foot garage 2. example- if new'project. check-nfw ~ if addition, check add. etc. F. Building permit information: 1. exam~le - 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 fil1.1n 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. --- 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 signa ture. 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: . '. ... . . PERMIT VALIDATION .r \ , . ..- \.A " <G~ '\\)" \Lt' 19 \ <640 Permit Clerk , , Permit appl i cant exempt from regi strati on with the B'u'il der I S Board 'because: PLANS REVIEWED BY: \) "',,12~~\n":'\ ~\M ';9"'t"'O~(\ 1 \-u'<--\..- .. ...__...~'". '..... ..... _ ____~.._. .'_ ... ~C~ ~~_.. .._..: ..".._..~...'~ ,~. _. _~. _" .._.._.O_~""~';_-"'___._'---__'_ ._........___.....__.~~... - Additional Project Information: I date t().. \?____~ _______~~L__"__".,-_ " . -. INfORl1ATION UN" ,I 726-3753 Sq. Ftg. 1.lain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. -Fence Demo Change/Use Other- - IIIISPECTlOII UIIE. CITY Of SPRINGFIElD 726-3769 CmlBlilATJON APPliCATION/PERMIT !J7-r1J ~ l.A AIL I~ . E!lERGY SOURCES: Job Address ~!. \(Xp_ C'<<\~\\)'S" Heat legal Description A~. \'\D.~~ ':\&.\ \ l'later Heater ~er:r ~~...:. Ranqe ~~,. . If/~ \\..~(..t'Q ~ V--r, of HO~ tW'\ / tJ lu,v,{,{/ BuilriinQ ';ennlt Info: Oeser be Work(Le., Familv nesidence With Attached Garaael Owner6.JJ.t3 Address zJ:.iJAmtI A Phone Build Single :n \ ,." j) 1,,1) 8 1'\& I--)IJ . S\;"t-\t\V'.~'I'.\':'" .0-<='rv''\\.'\ Constru~tion lender ~ ~ ~ FUn~ Address DES I GN TEAll (name) Phone (address) (lies. no.) (exoiresl &r~4.'?I? Wb.~.0I7403 (phone no. ~h3431 Primary Structural Electrical Mechanical CONTRACTORS (namel JJJJ. , - (address) flies. no.) (pxoirpsl (ohnnp nn \ Genera 1 Plumbino Electrical ~1echanical ~ ElE~ M~l NO. ' . FFF . rHfl.p(;l=' NO SQ. FT. furnace/burner to BTU's t'CC 1..c.HARG..E. :<. Each single fixture Residence of ct"t" ru;&G.E, JlO...... Relocated building (new fix. additional) New circuits a1ts. or extensions Storm Sewer Of ICOMH./INO. FEEDERS I Install/alter/relocate rli~trih_ f~~rl~r, Of amp~1 amps.1 \~ro I I I I I I I Floor furnace and vent I Recessed wall ~o~~p np~tp~ ~nrl I vpnt IS.F. Residence (l bath) 10uPlex (1 bath) each IAdditional bath I ~Iater service Sewer SERVICES ITempOrary Construction IChange in existing ~P,5 i df'I1CP , multifamily. comm. or tndlJo;.trial I Appl iance vent ~eoaratp I Stationary evap. cooler I Vent fan with I sinole duct I Vent system apart from I' heatinq or A.C. I Mechanical exhaust I hood and durt I ~lood stove/heater I I I I I I I TOTAl CHARGES WHERE STATE l~H REQUIRES shall not be va1i1 until the I I I t TOTAl CHARGES TOTAl CHARGES that the Electrical work be done by an,'Electrical Contrac or. the electrical portion of this permit label has been signed by an Electrical Supervisor and returned to the Building Division ISSUANCE OF PFRtllT Zone t. _L\ Fire Zone \..\1;:>. Flood Plain '-~ 1 HAVE CAREFULLY EXM1INED 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 Ore!]on pertaining to the work described herein. and that NO OCCUPAHCY will be made of any structure wi,thout the permission of the Building Division. I further certify that my registration with the Builder1s 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 701.055 will be used on this project. IWIE(p1ease print) . ~}f/fl6 I). s-ml1ff SIGIIATURf ~ FOr. OFFICE USE 0I1LY Sq. Ftg. 11aino.?';l() Sq. Ft9. Access Sq. Ftg. Other DATE ~/~t1; Tyoe/Const. "'\-\...\ Units Bedrooms ~~ Occy load Stories \ lei~e()\oCCY Grouo-~-\ 'J (..~'.; x Value x Va 1 ue x Value TOTAl VAlUATION \CJ. Ni'l. OCJ ElECTRICAl PERI~lT Cha rges and Surcharges _ ___ j~c-~~__ ~ __"i1}S?,,-._~c:.___ ~~;~R~~~ ') 08 Plan Ck. 30%/Bldo I Fence I Demo I Sidewalk I AIC Paving I Curb Cut I CommlI nd Ppr Fpp Res Per Fee ~'2,~Cl li-;nS? i I I I I I Isystems Development Charqe (1.51,) Q,jJt?R3 BUIlDING PERNIT Charges anc Surcharges Plur1BING PERMIT Charges and Surcharges Total Comb. Permit roC{. "'~ (Oq.0<:( . MECHANICAl PERMIT Charges and Surcharges I I TOTAl . . ,.. r COMBINATION APPlICATION/PERMIT (CAP) PERMIT VALIDATION l. Applicant to furnish A. Job Address B. legal Description 1. example- Tax lot 100. lane County Map Reference II 03 43 2. exam2le- lot I. Block 3. 2nd Addition to ~pr1ngtield Estates ' C. Name, etc. of owner and construction lender D. Energy Sources 1. exam~le. heat/electrical ceilinq/or forced air Qas 2. exa~le- 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 pennit information: 1. example - construct single family house with an attached garage 2. exam~le - remodel existing garage into family room 3. examole - 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. --- III. Applicant to sign and date . Whenever possible. the initial application will be used as a worksheet onll. Where possible. Building Division Staff will prepare a type written copy and return it to the applicant at the time the actual penmit 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, <t,~ 19 \ '640 ./ V. FOR OFFICE USE ONlY Permit Clerk j . PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: ~ nameD 1\.\1 \D ~ ~m SignaturOlA-( \ 1\ \\:' e...--\..-. date \ ()- \?____~ \