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Home My WebLink AboutPermit Plumbing 1980-12-30 1 INSPECTION LINE 726-3769 ," . CITV UF SPRINGFIElD COMBINATION APPlICATION/PERMIT Y I j EilERGY SQUR;.E7;. d .. ~I . Heat .-tjJ, ~I}JJI. Hater Heater ~~ Range u~_. ValuE Of~;r~ BuilriinQ Permit Info: Deser.be Work{i.e.. Build Single Familv nes;dence With Attached Garaoe) n4/i.Jf /J}}(-w ../).h/~j; j.tjI;JAAI1I......-I) /r-~ .' ~ OivJJJP/J/W1/1- ,5-11-80) ~ h{cs. nor-(e:~;;;s-) (ohone no. I . INFORlIATION UNC 726-3753 Sq. Ftg. 1.lain :q. Ftg. Access. Sq. Ftg. Other Ilew Add A 1ter Pep. -Fence Demo Change/Use -Other - - I IOJ o o -A. ()J IQ ......... :-~. Job Address /;26B 'J7Y)/1//YL ( /7- 0..3 -3S~.q I TL Owner ...Jtp/J1JI.J -LirJ7J ~ Address / / fn </ (f)~.1 'r. .AF)Ld _ r0.M8~ coJucUn L~nder V Legal Description _ -=<..cm () Phone 711 ~ ~D.3'f Address Ut~ I (iN fEN1 (name) Phone {address 1 Primary t1echanical CONTRACTORS (name I (address) + (l;cs. no.) (;iixnires) (ahnM nn.) Structural Electrical Genera 1 Plumbina ~/r1'?.Il1 ) Electrical Mechanical PlUllBIIIG ElECTRICAl MECHANICAl ~ 5 Each single fixture I FEE rHARr.F ~ ~oE, .:2'5.03 I I I I I I I I I I ... rHJiR.G..E.. ~m_ ... r"1\RliE. ' Residence of SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) INew circu~ts alts. or extenSlons I SERVICES I ITempOrary Construction IChange in existing rp~ i rtpncp Imultifamily. COITlT1. or TndlJ"trial I Of amps, ICOMH.IIND. FEEDERS I Install/alter/relocate rlic:t.rih_ fpprlprc: IOf amp~1 I I I .1 Floor furnace and vent Recessed wa 11 Sn~rp hp~t.pr ~nrl '1 S.F. Residence (l bath) Duplex (1 bath) each Additional bath vpnt ~Iater service App 1 i ance vent seoarate Stationarv evao. cooler W . Vent fan with sinole duct I Vent system apart from I heatina or A.C. Mechanical exhaust hood ilnd duc:t Sewer Storm Sewer Wood stove/heater I I I SSUANCE OF PFRtIIT TOTAl CHARGES . WHERE STATE lAW. REQUIRES shall not be va1i~ until the ~")Q9 TOTAl CHARGES that tile Electrical work be done by an label has been signed by an Electrical TOTAl CHARGES Electrical Contractor. the electrical portion of this per~it Supervisor and returned to the Building Division I HAVE CAREFULLY EXAt1INED the completed apr1ication 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 Oregon pertaining to the work described herein. and that NO OCCUPAfKY 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 ::r::(::::::t::~:::s as;::~:'SI(W:O ar~~(~::~:ce with :::II::~~:51J~Jn{ R'7]~~Dm /d' 30-8e FOr. OFFICE USE OiIl Y Sq. Ftg". r1ain Sq. FtlJ. Access Sq. Ftg. Other Rl Tyoe/Const. Bedrooms Units Occy load Occy Group x Value Value Value Zone Fi re Zone Flood Pl a i n x Stories x TOTAl VAlUATION 'V'-Io. BUilDING PER~IIT Charges ane Surcharges ......... . Plan Ck. Conm/lnd 65'UBldo Per Fee P1an"Ck. Res 30%/Blda Per Fee I Fence I D~mo I Sidewalk I AIC Paving ~ Curb Cut Systems Development Charae (1.5%) PlUI1BlNG PERMIT Charges and Surcha rges .;)..5.0-2> ----;.-~---- - , ELECTRICAl PERI:IT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges TOTAl .:7,/..- . DO 41d.I~. 0.2 Total Comb. Permit .....~ -... . . . " , COMBINATION APPlICATION/PERfIIT (CAP) I. Appl icant to furnish A. Job Address B. Legal Description 1. ~xamFle. Tax Lot 100. Lane County Map Reference 17 03 43 2. example- lot I. Block 3. 2nd Addition to Springtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. examole- heat/electrical ceilinq/or forced air Gas 2. examole- waterheater/electrlcalfor solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house, 500 sq. foot garage 2. examoJe- if new project. checklruew - if addition, check add. etc. . F. Buildin'] permit information: 1. example - construct sing'le family house with an attached garage 2. examole - remodel existing garage into family room 3. examole - convert single family residence inta restaurant (change of use) G. Value of work as defined in Section 303 (a) of the _ . Structural Specialty Code H. DESIGN TEM~ 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. Abbrev~ated Plumbing, Mechanical, & Electrical Schedules A. Except I'there blank soaces occur in the description portion of the ,~echanical 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 SCHEOUlES 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 rees 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. I V. FOR OFFICE USE ONlY '~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: j ~ . -~>~.-~ . ") PERMIT VALIDATION Permit Clerk .~ 1 1 Permit applicant exempt from registration with the..Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature .....- .-.. date ,j ".../ ... ,. . ..;..... :-.. . .~:'..~.~~!'i\~..~.. ...~:~~;~~~. ...::......, .':..f.....,:,~..:.~l~.-:... ,.;J.,i.,f:..., ;,....,.'U. '-"". ' " .' . -- ~ . :;. (name) CITY UF SPRlllGFIElD INFORllATION LHIE COMBlllATlON APPUCATION/PER.~lT 726-3753 III j E!IERGY SOUR;:): SO. Ftg. 1.lain ~ ./t,?'-..11J J Heat 1J1D I'lll'?--L-!J.. ~q. Ftg. Access. Hater Heater ~CL Sq. Ftg. Other .. tle\'I Add Alter ~ep. Ranqe V1..J ~_~__~ -Fence Demo Change/Use ValuE of ~}~ Other- - BuilciinQ Permit Info: Describe I-Jork(i'.e.. Build Single Phone 741 ~ Far.Jil v Res idence liith A.ttached r,araoe 1 '?LddJ.I()}]f-JV /!.A//m~j? 6.t;Ii/AAI1J......-I) ,/~ . :.ovAN OivJ.,nO/J/;;U 'I- 5-11-80) , (l ics. no;r--- (e:~;;;s) (lJhone no.) II ' OJ o o -A. I()J lie; I INSPECTlOIl L1IIE 726-3769 Job Address /;26 B 'J7Y)/1/M, ( /7- 0..3 -3.S~41 TL _:=V1A/). ,; Owner ..M/!U) ~r?I.IJM..; Address / / fn <I (F) t? O/Wl./U 'r . A F))~. rfJ/U' 8~ J .. co~;{I.uct.bn l~nder C/ Legal Description ~D.3'f Address DES I (iN TEAr-l Phone (address) Primary Structural Electrical !1echani ca 1 CONTRACTORS (name) (arldrF-5." ) (1 ir:" no \ (pxoires) (nhonp no_ General Plumbino ~ I r1'?.Il1 ) ---- Electrical "~ch~ r.i ca 1 PlUllBlIIG ElECTRICAl , . nIAQr.~ NO. MECHAIlICAl ';0. bE cHARG' .5 Each single fixture .... ,09, ':;5?5 I Relocated building . (new fix. additional) S.F. Residence (l bathl Duplex (1 bath) each IAdditiona1 bath I Wa ter servi ce Sewer "0 <<, ~!:'~ rLlAQr.~ i Residence of SQ. FT. furnace/burner to BTU's !New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wa 11 So~rp hp~tpr ~nrl vpnt Storm Sewer ITemporary Construction IChange in existing rpsj~p'nrp Imultifamily, comm. or Tnrlll"trial I Of amps. COffi1./IND. FEEDERS Install/alter/relocate rl;~trih fppnpr" I Appl iance vent "eoaratp I Stationary evap. r:ooler I Vent fan with sinole duct. Vent system apart from heatina or A.C. Mechanical exhaust hood ;tod rlurt. Wood stove/heater Of amps.1 I I I TOTAl CHARGES WHERE STATE lAIi REQUIRES shall not be va1i~ until the I I _")"')O~ TOTAl CHARGES ISSUANCE or PFRllIT TOTAl CHARGES . that tile Electrical work be done by an 'Electrical Contractor. the electrical portion of this pernit label has been signed by an Electrical Supervisor and returned to the BUilding Division Zone -Fire Zone Flood Plain I HAVE CARE FUll Y EXMHNED the camp 1 eted app 1 i ca ti on for ~ermit, and do hereby cert i fy that all in fonna ti on hereon is true and correct. and I further certify that any and all work Derformed shall be done in accordance with the Ordinances of the City of Soringfield and the laws of the State of Ore~lOn pertaining to the work described herein. and that NO OCCUPAIKY will be made of any structure without the permission of the l3uilding Division. I further certify that my registration ",lith 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 ::r::(:~::::t::~:::s a~;::~:S/IW:O ar~~I::~:ce with :~:II::~~:51~~Jn( i//b;R1 om /~. 30-8c. FO~ OFFICe" USE Q;ll Y - Sq. Ftg'. f1ain Sq. Ft[l. Access Sq. Ftg. Other Rl Tyoe/Const. Bedrooms Stories Units x Value Value Value Occy load Occ'y Group x x TOTAl VAlUATION v~jo.. BUilDING PERfllT Charges an':: Surcharges Plan Ck. Comm/Ind 65%/Rldo Per Fpp -- -- - -- -- - - - P'fan Ck. Res 30%/B1do Per Fee ~5. O~ I Fence __n;._~____1 Demo ~ I Sidewalk ------------ I A/C Paving I Curb Cut I Total r.omb. rermit ~i....C>D 41 d. 1.0. _~5'. . .......... Isyste~s _Development Charoe (1.5%) PlU!lBING PERMIT Charges and Surcharges ElECTRICAl PERI~IT Charges and Surcharges rlECHANICAl PERMIT Charges and SU!C~~~g~l ...... I TOTAL . . ,~. .. . . . .~~~. .' COMBINATION APPlICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Description 1. examole- Tax Lot 100. Lane County Ma II 03 43 2. examole- lot 1. Block 3, 2nd AdditiOl or' )pringtield Estates C. Name, etc. of owner and construction lent D. Energy Sources 1. examole- heat/electrical ceilinQ/or f ~ 2. examole- waterheater/eleC1:rlca(/or so \. E. Square footage or valuation, etc. - I. examole- 1250 sq. foot house, 500 sq. 2. example- if new project. checknew _: ,,,~ check add. ete. ; F. Build;n'] pennit fnformation: 1. examole - construct single family hous attached garage 2. examole - remodel existing garage into ~;1 3. examole - convert single family resider restaurant (change of use) G. Value of work as defined in Section 303 (a) . Structural Specialty Code C H. DESIGN TEAN ArlO COIITRACTORS To avoid design or construction delays, Sui Division Staff must be able to contact apprt [e- persons regd,ding design infornlation or jab ~ corrections. etc. Abbreviated Plumbing, Mechanical. & Electrical S A. Exceot where blank scaces occur in the descr portion of the Mechanical and Electrical 5ch ~~! the aop1 icant need fill-in only the No. Saxe: to tne a.Dpropriate .item(s) to be installed. B. Full Plumbing, Mechanical, and Electrical 5c~ ~~ are available at the Building Division C 1. To conserve space on the permit form the have been abbreviated 2. If the item(s) to be installed are not co the abbreviated schedules you should consl (tt- full schedules C. BUIlDIiiG DIVISION STAFF WIll FIll OUT All FEE~ CHARGES ON THE SCHEDUlES D. As noted on the CAP, the label must be deliver Ita , Amount electrical contractor for signature by his ele supervisor. The general contractor is .not aut. to sign the electrical label. Applicant to sign and date ( Whenever possible. the initial application will be ~ a worksheet only. Where possible. Building Divisic will prepare a type written copy and return it to t applicant at the time the actual permit is issued f ~!~ signature. 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 PFPMTT \I"' ,~"--_.. OF SPRINGFIELD City Hall Springfield. Oregon Department of Public Work. OFFICIAL RECN~~ B 55482 ( r ". , ( . , . i Date J ::J....- ::<.0 19 M /-, '. . O. .1210 J -.LialtJlil... ~( Rec'd From. /V? . , v1J Address Jib 1- _~fLr - ~ . ( " I- I: , Received For: ( . -. II. .p~J~ --1 t7J r> a~. o.! .c ./. ()~ ( ( ( (r-' '(. j/o C_ C~_.__. Receiv~,j_ ~~~" CD ~~ SIGI\IATUIIl[ l ~., .1-' ,~- AUTI4011l'1IlD ..0' ...".. IlUGIl"t:. 011.' ."IlLTO...TU"...ULL .."'14111".. III. (I IV. .. V.' FOR OFFICE USE ONlY Permit Cl erk ~. , PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: ~ i ., Additional Project Information: PLANS REVIEWED BY: name signature date .:>-> -. ...' t' :..