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Home My WebLink AboutPermit Building 1981-1-19 INSPECTION LINE 726-3769 'EJi-UJ::~C?r.O-b- I~ . CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT I ENERGY SOURCES: Heat V\ j ("IJ I Water 'Heater ,,\In Range' ~~ I va~ ~O~~-" Sq. FIg. Main Sq. FIg. Access. Sq. Ftg. Other _New~Add_Alter_Rep. _Fence_Demo_Change/ Use. ~ther . INFORMATION LINE 726.-3753 Jab Add".. r'i).O~ mAID logaIO..,,;pHan I 7-()..Q,-,.'<,C::;-4/ ';o..){ iD r <-=<"q{)() Own" <::~.;t. PI' \:: \-Ie,.., 11 C. 0 e )"" \ 1't"1 Address "'"'T'Eof- Phono _'4-7-'Xl'\---'Y Building Permit Info: Describe W~rk (i-.e., Build Single Fomil" ~~~;...f"..~" w;lh ~ttMhftd Goro'i!' IJ;;'-;'j~uh~;, huo /YJU.tJ --.. ,. I /'H'Mdof../..}-(V <..h,,~~ Construtlion lender Address Phone DESIGN TEAM (lies. no.) (expires) (phone no.) (name) (address) Primary - O\JV'N> Q ~ Structvral _.i::lec:ricol Mechanical COt-lTRACTORS (name) (address) (expires) (phono r:.o.) (lies. no.) General n u,.l "'-P 0 Plumbinq Electrical Mechanical PLUMBING ElECTRICAL MEOIANIC.A.l No.1 I 'CHARGE NO.' I I 1 1 1 Amps. . CHARGE NO. I FEE FEE Residence of furnace/burner to Il.TU's Appliance yent separate Stationory_ evap. cooler .- Vent fan with sin!:!lo duct Vllnt system apart from heatinq or A.C. Mochanical exhaust hood and duct .~: ft. Each sin!:!le fixture Rebcated building (new fix. additional) S.F. Residenco (1 both) New circuits, alterations or extensions SERVICES Duplex (1 bath) each Temporary Construction Additional both Wator service Sewer Wood stoye/heater Storm Sewer FEEDERS Heat PumD Air handler to 10.000 CFM Air handler over 10,000 CFM Amp,. ISSUANCE OF PERMIT TOTAL CHARGES o TOTAL CHARGES o TOTAL CHARGES r ()) () () -D. 10> 10 '0- , ! I i , ~ , I , FEE 'CHARGE I I .WHERE,SlATE LAW REQUIRES that the Electrical work be done by. the Electrical (ontr'actor, :the electritol portion' of this permit shall not tIe valid until a label has been signed by on Electrical Contractor and attached to the electrical panel. o I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true' and correct,- and I further certify that any and 011 work performed ,hall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining to the wark described herin, and that NO OCCUPANCY will be mode of any structure without the permission of the Building Division. I further certIfy that my registration with the Builder's Boord is in full form and effect 0 s required by ORS 701.055, that if exempt the basis for exemption is noted "::::::::~,;:::= -. -.-.-. -. - " -'."~"~::.:4;: ~ e?J;-ItI4-.." /-14' FORO~ICEUSEON~ I I I I lone .2.1 Value Value Value Type/Canst...:::! 1-4. ~drooms - lJnits "ccy load ""ccy Group Sq. Ftg. Main Sq. Ftg. Access Sq. Ftg. Other ---- Fire Zone Flood Plain x .2.. Ctori~. x 41'V'1 .Q~ TOTAL VALUATION BUilDING PERMIT 5.0.2 Plan n. Comm/lnd Charges and 65%/ Blda Per Fee Surcharges ,:;to Plan Ck. Res 30%/ BldCl Per Fee PLUMBING PERMIT 0 Charges and Fence Surcharges I Demo ElECTRICAL PERMIT 0 I Charges and Sidewalk Surcharges I AIC Payino , MECHANICAL PERMIT 0 I - Charges and Curb Cut Surcharges --------- I , , i . Systems Development Charao 11.5%1 Tolal Comb. Permit 5.~O TOTAL ..5.:;l..O !......: ./ , ! . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant IQ furnish A. Jab Address B. legal Description 1. examp.le.lax 101 100, lone Caunty Map Reference 17 03 43 2. example-Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example-heat/electrical ceiling/or forced air qas 2. example.water heater/electrical/or solor E. Square footage or valuation, etc. 1. example.1250 sq. foot house, 500 sq. foot garage. 2. example-if new project. check ~-if addition, check add. etc. F. Building permit information: , 1. example-construct single family house with an attached garage . 2. exomple-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 (0) of the Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To avoid design or'construction delays, Building Oiv'ision 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-iri 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. T a conserve 'space on the .permit fa'rm the schedules have been abbreviated 2. If the'item(s} to be installed ore 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 dote Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Division Stoff will prepare a typewritten 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 af"!d 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 VALIDATION " Permit Cler" PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: , J,)'t..61:J-e.d7f~/L &.IJul~n - (I) ,eOu.~-4~ , u v V (]) e::7fA1'o.f AWJ~ Additional Project Information: PLANS REVIEWED BY: nome '^' rU.. ~;;I;;r ~~~ hi C3;. signotur-<> ~~1-~~ ~...\r.~..J.....:".( t.....L,......... rlote 1-(<=1-81 ",' .I Building Permit Info: D;~~;;b; Work-Ci.e.. - Build Single Family Residence With Alloched Goro~__ !)~ /I j /I j h11 '(., J:WO /Y' ! f.1l -' ,. _. . I ~J""/VldI'7U~ '" ".. . CITY OF SPRINGFielD COMBINATION APPLlCATlON/pERMIT I ENERGY SOURCES: Heat VI /~! I Water Heater V\} r, Ranqe 'tl/,rj Va rue of Work: </06,C-'" . I INSPECTION LINE 72~769 Job Address f:d.02 mAID I 7-6~-.~c::.-4/ IO-.)(!.b;r Legol Description .J.,q(J() Owner ~ i-.P\IS:: 1",' h) Address ""TILf._\ WI"\I1<:a I? II ~o."...l-. ~~. ~ho", ,4-7.';..n">.,y Construction lender Addreu phone DESIGN TEAM (namel (addreu) (Iin. no.) Primary O\..V'N Q. .$trucTural rlec:ricol Mechonio:c1 CCNTRACTOllS (address) (Iju. no.) (neme) General n l>.':> "-" 0 Plumbinq Electrical Mechanicol PLUMBING ELECTRICAL NO. CHARGE NO. I I CHARGE I FEE -Tn I I FEE Residence of Each sinale fixture Relrocoted building (new fix. additional) S.f. Residltnce (1 both) $'" ft New circuits. alterations or extensions I I SERVICES Duplex (1 bath) each Temporary Construction Additional both Amps. Water Ulrvice Sewer Storm Sewer FEEDERS Amp.. '.' I I I I I 01 TOTAL CHARGES o TOTAL CHARGES INFORMATIC'N LINE 726-3753' , Sq. fIg. Main Sq. ftg. Access. Sq. ftg. Other New_Add_Alter_Rep. __fence_Dema_Change/ US" ~Iher. ()) C? o .J:;. ()J o ,. (expires) (phone no.) (exClres) (oh?n& :.n,) MEOIANICAL NO. .1 I I .,/ FEE 'CHARGE furnace/burner to R,TU's Appliance vent ,eporate Stationary e.vop. cooler Vent fan with sinClle duct Vent .ystem aport from heatin!:j or A.C. Mechanical eJthou~t hood and duct Wood stove/heater Heat Puma Air handler to 10.000 CFM Air handler over 10,000 CfM ISSUANCE Of PERMIT TOTAL CHARGES o .WHERE. SlATE LAW REQUIRES Ihal the Electrical work b. done by 'the Electrical Contractor, .th. electri(al portion of this permit sholl not tlO valid until a label ha, be_n ,ignod by an Eledrical Contractor and anached to the eledrical ponel. I HAve CAREFULlY EXAMINED 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 ~rformed sholl be done in accordance with the Ordinance.s of the City of Springfield and the laws of the State of Oregon pertaining to th. work described herin, and that NO OCCUPANCY will he mode of any structure without the permission af the Building .Division. I further certify that my registration with the Builder's Boord b in full forco and effect as required by ORS 701.055, that if exempt the basis for exemption is noted heron, and that only 'ubcontroctors and employees who ore in comPliO,n'G"'NWAT'ulhRO' R~S 701.0.~5''(fYWill b. used~on th.I~..prOie. '~I'1/- 7 Basis for Builder's Boord exemption: NAME (pl.... p,;nll DATE ..L=/9~ ' I ' FOR OFFICE USE ONLY 10n" :2 Fire Zone Flood Plain Type/Canst. \J ~\ Bedrooms 11nits 1)((y Load .....ccy Group ---- Sq. Ftg_ Main <:,~. Ftg. Accen Sq. Ftg. Other Ctori~' BUILDING pERMIT Charges and Surcharge. _ .",;J. ...... ~- ~. plan Ck. Comm/lnd 65%/ Bldo Per Fee Plan Ck. Res 30%1 Bldq Per Fee ...... F"") ,<:.-.- PLUMBING PERMIT Charges and Surcharg.s c'"" ~. Fence Demo ELECTRICAL pERMIT Charges and Surchorges .-" '-- Sidewalk A/~ ,ll,:,,,;,,,, MECHANICAL PERMIT Charges and Surcharges ,'1 .~ Curb Cut " ) .. "olue Value Value TOTAL V ALUA liON x 4~("):"."':" Systems Development Chorae (1.5%\ I. Applicant..1Q furnish A. Jab Address B. legal Description 1. example,tax 101 100, lane County Map Reference 17 03 43 2. example.lot 1. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example-heat/electrical ceiling/or forced air ,..__ 2. example-weter heater/electrical/or solar ( E. Square footage or valuation, etc. . 1. example-1250 sq. foot house, 500 sq. foot gal 2. example-if new project, check new-if addition odd, etc. ( F. Building permit information: 1. example-construct single family house with or ;arage C_ o 2. example-remodel existing garage into family -.- 3.. example-convert single family residence into restaurant (change of use) G.. Value of work os defined in Section 303 (0) of Ih. ' Structural Specialty Code H. . DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building [ ~.ic Staff must be able to contact appropriate persons design information or iob site corrections, etc. ., . COMBINA nON APPlICA nON/PE. (CAP) " II. .~bbreviated Plumbing, Mechanical & Electrical Scned ~ A. Except where blank spaces occur in the descriptiol of the Mechanical and Electrical Schedules, the ap need fill.in only the No. Boxes adjacent to the apF <rl item(s) to be installed B. Full Plumbing, Mechanical, and Electrical SchedulE are available at the Building Division 1. To conserve space on the permit form the schec ,s hove been cbbreviated 2. If the item(s) to be installed are not covered on aled schedules you should consulllhe full schec e c. BUilDING DIVISION STAFF Will Fill OUT All FEE: CHARGES ON THE SCHEDUlES III. Applicant to sign and dale Whenever possible. the initial application will be used worksheet only. Where possible, Building Division Staf prepare a typewritten copy and return it to the applic( the time the actual permit is issued for his signature. IV. Fees and Charges Plan check fees ore due and payable at the "time of thE and no plans.will be processed until these fees are poi other fees and charges are due and payable when the is issued. City Hall Springfield, Oregon Department of Public Warks OFFICIAL RECEIPT No,. B 19,'31 CITY OF Dale /-/4 . PERMIT VALIDATION SPRINGFIELD S5631( /.J.uu..LJ.lA...., -yY) ,.if ./L)jd /' /V~f1 1 ~ <"- 0 0 -~ .- ,'dO ~' Amounl Received :$5, ~o C--h..oa c::!~y,,- .J~~ V. FOR OFFICE USE ONLY l-o PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: r ' /":\ d~~-<.{'~+".I'I~./L. e'j.tJJjl.pfj - \~ 1/ ~ 7. Jl,.c.' '" I ( .;2.) c:;:; 1/11/J I -L ') IAA.... t a.vy1L) (r Ifb c{ o//\- Co' Additional Project Information: PLANS REVIEWED BY:. name '~._~..t .. ":~:'-..'. : .' ;......_. -:::.~~; ~:' ~;!.'........; _ signaturo "'t ~. , ... ",;- Rec'd Fram , ,;. x::j.....Tp/,;...:J Address / ,:;; () fj Received Far: 3< Ldo; 1-' J 4 OZi) ( lEI IIY .... ( AUTHORIZl:O SIGNATUIltl: ."UTO"'TU"".U~L ...,..TII:".. IUGI..t:., 0" .,.0' s.."" (,. c I -4'/ltV/IV'..-V,rtp, LI (~-" '. ::;..- \....'l :-"".( ,. -~-~ ".. .-.'.' ..... ".' ..Iatp .1- i(~ ....:.=~: ~ .- ..' ( ( ( ( ( ( ( ,. I. .. .. ( ( ( ( _I J II I I I , I ! I I .t ; I I l