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Home My WebLink AboutPermit Sidewalk 1982-2-25 ,r , . 'CITY UF SPRINGFIElD COMBINATION APPlICATION/PERMIT EilERGY SOURCES: Heat l~ater Heater Range_ ValuE of Hork: , INFORlIATION LJNt 726-3753 Sq. Ftq. 1,lain ~q. Ftg. Access. Sq, Ftq. Other Ilew Add A Iter Rep. -Fence Demo Change/Use -Other- - ~, B. --- 1 INSPECTION liNE 726-3769 Legal Description \()\ \ \ .t\'f\ ). f'\ 1.1::--')~- 3!; -1/_, ~./r 1)2fl. tJf) Job Address Owner\\:17.- ~Q .l:\- - ~ ~o \-\- tli n Pr Address \ l,"") l ( \'(\('\ ~- f'\ st ' Phone .sO~.J <f\ \ ~ 0 -"" Constructidh L~er Address DE' I GN TEAr1 (name) Phone (address) BuilriinQ Permit Info: Descr be Work(i~e., Build Single Familv nesidence With Attached Garaoe) (\~\l\h~~+~ R~QL f- I )..Qf)f'\i^. - !:)/ - \ (ohone no. ) (l ics. no.) (exoires) Primary * Structural Electrical Mechanical CONTRACTORS I name I Genera 1 (\.1l Q ') \\ 0 1L j (address) (lire:_ nn.) lexoire.:;) (ohnpp nQ ) '2!JjVJ-/'7&/J Plumbino Electrical ~1echanical PlUI1B I NG ElECTRICAl MECHANICAl NO. HF rHARr,E NO.&- 'OE.L. J:.IlARG[ NO 'TI_ ..LHAR!iE. . SQ. FT. furnace/burner to BTU's Each single fixture Residence of Relocated building (new fix. additional) INew circu~ts alts. or extenslons ISERVICES I I' Floor furnace and vent Recessed wall Snnrp hp~tpr ~nrl vpnt S.F. Residence (] bath) Duplex (1 bath) each Additional bath Wa ter servi ce ITemporary Construction IChange in existing rpe:jdp.:nrp Imultifamily. comm. or Inrlustrinl 10f amps.1 ICOffi1./IND. FEEDERS IInstall/alter/relocate I die:trih. fppdpre: jOf amps.! I I I I App 1 i ance vent seoa ra te I Stationary evap. cooler I Vent fan with sinale duct I Vent system apart heatinq or A.C. I Mechanical exhaust hood and durt I ~'lood stove/heater I from Sewer Storm Sewer ISSUANCE OF PFR!11T .~ TOTAl CHARGES TOTAl CHARGES 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 vali~ 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 c~rtify 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 r~o OCCUPAHCY 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 bf'Used on this project. Zone Fi re Zone Flood Plain Tvpe/Const. Bedrooms Stories Units Occy load Occy Group SIGrIATURE~~ /1: FO~ OFFICE USE miL Y So. Ftg. 11ain Sq. Ft9. Access Sq. Ftg, Other Rk,,- DA~,1f)2'. IWIE(please pr"int) /,If.'/''"'' 1(, /rot .~ '-' __If! / ;y v Value x Value. x Value TOTAl V AlUA TJ orl . BUIlDING PERflIT Charges ancl Surcharges . Plan Ck. 65%/Bldo Plan Ck. 30%lBl do COIllll!l nd Ppr Fp@ Res Per Fee Systems Development Charoe (I. 5%) . . PlU'1BING PERMIT Charges and Surcha rges Fence ------------1 D~mo I Sidewalk I A/C Paving . .I' I Curb Cut ----i-.'- ----I I I I \,C:l, I oC ) I - I ITotal Comb. Permit I I TOTAl 1~,laJ \ '\ , ElECTRICAl PERliIT Cha rges and Surcha rges MECHANICAl PERMIT Charges and Surcharges l "---. 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 II 03 43 2. example- Lot 1. Block 3, 2nd Addition to sprlngtield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. example- heat/electrical ceilinqjor forced air Qas 2. exa~le- waterheater/electrical/or solar E. Square footage or valuation, etc. ----- I. example- 1250 sq. foot house, 5DO 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. exam9le. 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 TEM1 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 DUT 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 ONLY Permit Clerk ] 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 signature date , . I j . ,.r-' . "IT '."'" 1 INSPECTION LINE 726-3769 , -- . " , Job Address -\()\ \ r\f\ ~ f"\ ~--'. Legal Description Address Ul:~ ll.iN I E.Ar1 lname) Phone (address) (lies. no.l (~xoi res) (ohone no.) Primary Structural Electrical Mechanical CONTRACTORS lnamel General (\.1l ~')\\ 0 1L __ (address) (lies. no.) (~xoirps) {ohonp no. \ tzDJVj-/7&? Plumbino Electrical ~'echanica1 PLUllB ItIG ELECTRICAL MECHANICAL NO. FEE CHARGE Nn FCC rlJAllli[.1JQ.... SQ. F1. furnace/burner to BTU's '.HLJ:liAIlliE., / Each single fixture Residence of Relocated building (new fix. additional) New circuits a1ts. or extensions Floor furnace and vent S.F. Residence Cl bathl Duplex (1 bath) each Additional bath SERVICES Recessed wall Sn~~p hp~tpr ~nrl vpnt Storm Sewer I!emporary Construction IChange in existing rp<;, j dJ"nrp Imultifamily, 'COl111l. or Industrial IOf amps,1 ICO~1./IND. FEEDERS I IInstall/alter/relocate I rlistrih. fppdprs lor amps. I I I I Appliance vent seoarilt~ I Stationary evap. cooler I Vent fan with sinole duct I Vent system apart from I heatinq or A.C. I Mechanical exhaust hond i'lnd durt I ~.Jood stove/heater I I I Water service I Sewer ISSUANCE OF PFRlIIT " TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall" not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division , I HAVE CAREFULLY EXAlllNED the completed application for permit, and do hereby certify that all information hereon is true and correct, and I further c~rtify 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 110 OCCUPAIICY 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 701.055 will be~sed on this project. Zone Fire Zone Flood Plain Tvpe/Const. Bed rooms Stories Units Occy Load Occy Group SI('IIATURE~/~ A: Rk, -- FOR OFFICE USE DriLY Sq. Ftg. f1ain Sq. Ftg. Access Sq. Ftg. Other DA~M~&2 _ IlAI-1E(please pr"int) /'H./I,'/ 1(, k;tlf/;~A/ x Value Value. Value TOTAL VALUATIDrI. , , ELECTRICAL PERI~IT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges .;, Plan Ck. Comm/lnd 65~/Bldo P~r Fep Plan Ck. Res 30%/Blda Per Fee Fence I Demo I S1de~lk I AIC Paving I Curb Cut I Systems Development Charae tl.5~) . BUILDING PERIIIT Charges and Surcharges PLU11B ING PERMIT Charges and Surcharges '" I I I \::J. I oU I I I ITotal I I TOTAL Comb. rermit IQ. LR) \ I. Applicant to furnish A. Job Address B. Legal Description ( I. example- Tax Lot 100. Lane County Map Referen . 11 oj 43 2. example- Lot I. Block 3. 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceiling/or forced ai 2. examDle- waterheater/electrlcal/or solar E. Square footage or valuation, etc. ------ I. example- 1250 sq. foot house. 500 sq. foot ga 2. example- if new project. check new - if addit check add, etc. ' F. Building permit information: 1. example - construct single family house with attached garoge 2. example. remodel existing garage into family ,AI' 3. examole - convert single family residence fnt \ restaurant (change of use) G. Value of work as defined in Section 303 (a) of th Structural Specialty Code .H. DESIGN TEM1 AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriat persons regarding design information or jOb site corrections. etc. II. Abbreviated Plumbing. Mechanical. & Electrical Schedu A: Except where blank spaces occur in the descriptio Portion of the Mechanical and Electrical Schedule / the applicant need fill-in only the No. Boxes adj ~i to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedul are available at the Building Division I 1. To conserve space on the permit form the sche ~s have been abbreviated 2. If the Item(s) to be installed are not covere the abbreviated schedules you should consult fu 11 schedu 1 es C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AN CHARGES ON THE SCHEDULES O. As noted on the CAP, the label must be delivered. l' electrical contractor for signature by his electr ~ BY supervisor. The general contractor is.not author to sign the electrical label. --- Applicant to sign and date Whenever possible. the initial application will be- us. 'S a worksheet only. Where possible, Building Division, . 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. , COMBINATION APPLICATION/PERMIT (CAP) III. V. FOR OFFICE USE ONLY p" . ...... , I , I "'. ( II CITY OF SPRINGFIELD City Hall Springfield. Oregan Department af Public Warks OFFICIAL RECEIPT ( . ( ( Dat&~ b [)S 19 R~' B Rec'd From .~-r7 Pr \\\\ \ \ Address~ \()\\ ~~ 58121c ( ( ,-' \. l.. Received For: ( (\tJ\ t\ ('H1~ ( \~') (oOe ( ( c :( r' \. (Ir-( Received ~( t? n- ....~rl& .ltUTHOAIZ.C SIGN..TUIltI: '''ILTO'''TU''"'ULL ....'"TI.... IUGI".. 0" 17"01 Amount ( """_, (- .c l . ,'. ~ Permi t Cl erk 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 signature J - date ..- .t' i,