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Home My WebLink AboutPermit Plumbing 1980-5-14 _4_ __ . Address Ut:::llliN TE.Ar~ (name) Phone (address) INFDRlIATION UNC 726-3753 EnERGY SctlR~~, t, Vlll\ ~o. ~tg. l'lain Heat \ ~ \J \\ \ I/;[L&!.! \L.(3. ,tg. Access. Hater Heater Sq. Ftg. Other Uel<l Add A Iter Rep. Ran~e -Fence Demo Change/Use ValuE ot!\orjA -Other- - ..c:::: Builtino PerViit Info: Describe l-Iork{Le., Build Single r~ Familv nesid~nce With Attachpd Garaop) ~ l\ 0 D\ f',Q (\ 0 . \ Ii f'(\ t'1 ~ \...J - () Y\~ (1 \ ~ ~ ~Q. J\O ('rrv~ ""4 \..'~\ \l [), 1 n'\ ,.... - , ,- lliCS.~) (exolresl lohone no.) ." .'. 1 INSPECTION UNE 726-3769 CITV Uf SPRINGFIELD COIIBI;IATION APPUCATION/PERMrT Job Address \~\)~ ~ " \\ S ) I.egal Oe5Cripti~n .31D O. .- IID~ 3'041 owner~~ \ 'f. '~N t LJOJL., . Address \\ \ rA- V......l\ \ l N\ \1\(\ ) Phone const::;~~r" J\ l\) ~. ~ 5f{1~ Primary /1echanical CONTRACTORS (name) (address) (lics. no.) J ~~ (exoiresf~ (Ghooe 00. \ . ; Structural Electrical Genera 1 PlumbinO'<. ~K"- f'.l,,/;.<":i~ \ . ~ Electrical ~ ~~ .~" (\ '-~ - . - ~lechani ca 1 PlUllBlIlG ElECTRICAl MECHANICAl NO. I FEE CHARGE jJn I Residence of fff r~ARG..E. Nn_ I ~n I r~AR.G..E. -3 Each single fixture .~ ~(;(l SQ. FT. furnace/burner to BTU's I Relocated building (new fix. additional) [ S. F. Res i dence (1 bath) louPlex (1 bath) each [Additional bath IHater service I Sewer /fstorm Sewer I. fu~--tJ..\ \) IrFr\.'4-t'\ ~(\ t J ~Y' t ,\(,i\.o \[\ & lir I I. I I New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall So~rp hp~tpr ~nrl vpnt I I [ [ I I I I I I k~.OO TOTAl CHARGES that the Electrical work be done by an. label has been signed by an Electrical ITemporary Construction [Change in existing rp<;.i dp..nr~ [multifamily, comm. or Tnnuc;tritll [Of [COI~'1. IIND. FEEDERS [Install/alter/relocate [ rl;c;trHL fppnprc; IOf iimps.1 Appl iance vent seoa ra te Stationary evap. cooler Vent fan wi th sinole duct Vent system apart heatino or A.C. Mechanical exhaust hood and dud. from ~ Hood stove/heater amps. ISSUANCE OF PFRIIlT TOTAl CHARGES WHERE STATE l~l-I REQUIRES shall not be valiJ until the I I HAVE CAREFUlLY/EXN1INED 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 110 OCCUPAUCY 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 for~~~ effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that ::I~:(:~::::t::::::~iIIl;~)S J3re 74~~~' with :::11::~~:55 JR;;; OjjS P4:q~)Dm\~H~?C. FOr OFF I CE USE mil Y \ "\ Sq. Ftg. f1ain x Value Sq. FtlJ. Access x Value Sq. Ft9. Other x Value TOTAl CHARGES Electrical Contractor, the electrical portion of this per~it Supervisor and returned to the Building Oivision Zone Tyoe/Const. Bedrooms Stories Units Occy load Occ'y Groun Fi re Zone Flood Plain TOTAl VAlUATION BUILDING PER:-HT Charges and Surcharges . Plan Ck. Comm/Ind ____________ 65%/BldCl Ppr F="ee Plan Ck. Res 30%/BldG Per Fee ^ --~8D---[ ::::e _Lb.~?_O I Sidewalk . lJl 0 [ A/C Paving ___.._______J~urb Cut ISystems Development CharGe (1.5%) [ I [ PlU!iB ING PERMI r., Charges and Surcharges ElECTRICAl PERI~IT Cha rges and Surcharges Total Comb. rermit MECHANICAl PERMIT Ch.u'Des :Ind ! TOTI\i. 31\ . '2.() d .. ' .'. COMBINATION APPlICATION/PERMIT (CAP) . 1. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- lot 1. Block 3. 2nd Addition to ~pringtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceiling/or forced air qas 2. examole- waterheater/electrical/or solar E. Square footage or valuation. etc. - 1. examole- 1250 sq. foot house, 500 sq. foot garage 2. examole- 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. examole - remodel existing garage into family room 3. examole - convert s;ngle"family residence into restaurant (change of use) G. Value of work as defined in Section 303 (a) of the Structural Specialty Code H. DESIGN TEk~ 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 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. V. FOR OFFICE USE ONlY. PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . PERMIT VALIDATION Permit Cl erk .; ] Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature ;. .. date .~ "." .' .,.~."'-- ,-"".~-..,..........~~.._....,_.....-.,.....-...,._..-........_~' IIIFORIIATlO,~ 726-3753 .1. EilERG; sd(m"E~<d 17 Yl fl \ ;0. Ftg. 1.lain Heat. ~ \1 \\ \ \ I ill J.! v... 0. Ftg. Access. I. !.Ia ter P~eater (. So. Ftg. Other fleh' Add Alter Reo. Ra.nC'je -Fence Demo Change/Use I r- Val~E Of(\o"jA Other- - If Builf:ino Penilit Info: Describe Hor~(i .e., Build Single B Far.lilv nesidence I'lith Attached t1araqe) ~ 00\ n, 00 . \ \\~ m h V - (\\ y\~ r~ \ ~ ~~ Ct Q . J\ 0 rrro pc: c::4- \. '~f\\ 1-\ (), 1 n~) iJ \- (1iC5.(00..) (exnires) ~ >"'":"'[<c" . ~.'.' -:;~.-\":-",' ~.~W;: ,;~ . ~~, 1 .~ .' '.-..~, . I I"SPECTIOII LIIIE 726-3769 Job Address \~\)D Legal De~cription CITY OF SPRliiGFIELD COIIBI,IATlON APPUCATlOiI/PERMIT . c::...+ \\"-[\) \ \\ ,,-' -~ ) owner0~ \. 'R '~\CJ ~ ~~~ . Address \" \ rA- ( U\ \ \ \r>{\ 0\.0 .J Phone , "-~()~~, \ \\! "So;. 'tYVi 5til~ Construction \.enc(r) J Address DES IGil TEAn (name) Phone {address} Primary Structural Electrical !1echanical COilTRACTORS (address) (lic~_ no.) (name) Genera 1 Plumbinct-. 8flo'!iL'~__~~\ \ . -". Electrical _ L); ("\\'... C\ ~ ~'~echanical PlUllBIIlG ElECTRICAl ilO. F,F Cf<^RGE 'In FFF I rHARr,F NO. ~3 Residence of ,~ Each single fixture oex) SQ. FT. Relocated building (new fix. additional) I New circuits a1ts_ or extensions ISERVICES S.F. Residence II bath) Duplex (1 bath) each Additional bath Temporary Construction Change in existing rec; i dence muitifamily, comm. or Industrial ~!ater service Sewer /' Storm SeYler Of amps. ~ (.fu':\'<Il:.\... 'J '\ tin '-\-\\ ~\C\ '( J \' \.'\('\\<: \:,\ ~-:.\ f1 ( ) \ j '1 I COI11'1./lND. FEEDERS Install/alter/relocate dic:.trih. fppdpr" IOf I I I amps. I . (ohane no. (exoires) (0honp no.) MECHA.N I CAl FFF rHARt;F furnace/burner to BTlI's Floor fu rnace and vent Recessed wall Snnrp hPntpr nod vpnt I I I I 1 I I I I Appl iance vent seoa ra te Stationarv evap. cooler Y 1 Vent fan with sinale duct 1 Vent system apart heatina or A.C Mechanical exhaust hood nnd durt. Wood stove/heater from TOTAl CHA.RGES WHERE STATE l~W REQUIRES shall not be va1i1 until the kC>\OO TOTAl CHARGES ISSUANCF OF PFRIIIT I TOTAl CHARGES Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Division I HAVE CAREFULLY EXAtlINED the completed aprUicatian 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 \....ork described herein. and that no OCCl!PAlICY \'Ii11 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 ~d effect as requlred by ORS 701.055. that if exempt the basis for exemption is noted hereon, and that only subcontractors an~mOlo~ees wh~re i/;ro~Oliance. with OP.S 7nl.055 will be used on this project. IIA:IE(please printljj/!/J.!(J VJ /-/1J-clv01J! ,Ir,;I.~TURE ,ff!/t~ jj i/t;t/.{'p~ )DATE~\\\U \L\?\ FO~ nrFIC, USE O'llY Sq. Ftg. liain Sq. Ft!]. Access S~. Ftg. Other that tile Electrical \'Iork be done by an label has been signed by an Electrical Zone Fi re Zone Flood Plain Type/Const. Bedrooms Units Occy load Occ,Y Group Stories BUIlDIllG PERI.IIT Charges an~ Surcharges Plan Ck. Comm/Ind ____________ 65%/Bld{1 Ppr Fpp Plan Ck. Res 30%/Bldo Per Fee __JbGD---1 ::::e _L.b.~'?_O___ Sidewalk . LJ.! 0 1 A/C Pavin9 I ! Curb cut PlUl1BIrlG PERMll, Cna rges and . Surcharges ElECTRIC~.l PERI:n' Charges and Surcharges liECHA:IIC~.l PERI'1lT CI-: '; ;.-'~ ~ ':,1 '\ \ x Value Value Value x x TOTAl VAlUATlOlI SysteQs Development Charoe (1.5";) ITotal Comb. Permit I ,,3\.Q...0 Applicant to furnish A. Job Address 8. legal Description 1. exalimle- Tax Lot 100. Lane County Hap Reference .~4--1 T Y II 03 43 .. .. 2. examole- lot I. Block 3, 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilina/or forced air QdS 2. exa~J]e- waterheater/electrlcal/or solar E. Square footage or valuation, etc. ------ 1. examole- 1250 sq. foot house, 500 sq. foot garage 2. examole- if new project, check new - if addition, check add, etc. F. Building permit information: 1. examole - construct single family house \'lith an attached .garage 2. examole - 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 (al of the Structural Specialty Code H. DESIGN TEM: MID 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. Abbreviated Plumbing, Mechanical. & Electrical Schedules A. Except where blank spaces occur in the description por~ion of the Nechanical and Electrical Schedules. the applicant need fill-in only the No. Boxes adjacent to the aopropriate 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. BUIlDlilG DI'IlSION STAFF WIll FIll OUT All FEES AND CHA.<GES Oil THE SCHEDUlES D. As noted on the CAP, the label must electrical contractor for signature suoervisor. The general contractor to sign the electrical label. 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. 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. ~, .. 'or CONBIIIATIO:: APPUCATIDrl/PERHIT (CAP) I. II. be delivered to the by his electrical is not authorized I I I. IV. V. FOR OFFICE USE ONlY . PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: I I I I I I . PERMIT VALIDATION OF SPRINGFIELD (. City Hall Springfield. Oregan Department of Public Works OFFICIAL RECEIPT No. B 5 3 4 8 6 n ;\ t'N\\ \~.\4~9~) i From ~f'\'~ '. \\n t.:.::--f.! \\ . resS \\\c-4- ,~QJ-K\I\ p~ ~ CD \ C\I - ived For: ell ~ i.V \'-?Y\~~~, \Y'..po . << l f'y' . () - . I 1\ _\! G\.f'J I I \ . I)U ~- , . :, nO ( !J.!.=/h ( unt n.()/'\ l\ ~'( Recelved.,_":::21. uu ~- -- -.ueb~~ _J ( ...nl0...TU"".Uu. ~"'''ll''S . fUr-tNt O. .~.O' ...".. '". ( (. Permit Clerk I Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: , ,- PLANS REVIEWED BY: .. . . ~ ".., "'~" ... ,., n. " ......... " .. . ..... _I. '..11... ......... ~ ........... .... . ,", "" . ~. ....... .. ..,. " name signature date