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Home My WebLink AboutPermit Building 1987-11-9 Job Address /67& MA-/h' 5T. Legal Description /7""'~.~.~/0'3~ 'I INSPECTION LINE 726-3769 , . CITY OF SPRINGFIELD Cm1BINATION APPLICATION/PERMIT EilERGY SOURCES: Heat Hater Heater INFORltATION UNt 726-3753 Sq. Ft9. 1.lain ~q. Ftg. Access. Sq. Ftg. Other flew Add Al ter Pep. --Fence Demo Change/Use Other- - ~ ~ Vj l} ) Dwner~..... ~ i'.......w' <.7'z:>JD pA"~~~.;;r- Address u'".... v ~4/.., ...c/~ Phone Ik> ""..... /7.///.NY, ,. . 'U~-~""'i" . ~ 1 ..... I <~/~F/~CP~. 9741.77 Range ValuE of Hark: 9,~ BuiloinQ Permit Info: Describe Work(i~e.. Build Single Familv nesidence With Attached Garaoe) /N~7'1/&,I;> ~~~l'C ~~V6Y/&.r.", :$'~~ Mechanical CONTRACTORS lnaoel General ~7' P-7 /f> (,r:- Plumbino ...:;-.;.hOP;.....,." k~. . , . T Electrical ~.F~/r~ E.--c /'_ II Construction lender Address Ut>IliN ItAII Primary Structural Electrical ~lechanical NO. 2 Each single fixture ~FFf t:HA1K;F NO Residence of .~/~~ I I I i I I I I I I I I I ,t, \.-'" TOTAL CHARGES that tile Electrical work be done by an. label has been signed by an Electrical Iname) PUIllBIIIG Relocated building (new fl.. additional) S. F. Residooce (] batiJ1 Duple. II bath) each Add iti.....l bath \o!a ter servi ce Sewer Storm Sewer TOTAL CHARGES WHERE STAll L.~ REQUIRES shall not be valii until the Phone (address) (lies. no.) (exo; res) (ohone no. ~n. ~3D~i .....;r~ I'~ ,r "';(, --~ (address) (liC':~. no.) (pxoires) (ohnnp no. 1 F(/~6..jn - - -f"/~~ /~)~9'.-V.M& ELECTRICAL ITL .QlARfi[' NO. r" MECHANICAL ... SQ. FT. furnace/burner to BTU's ~'New circuits alts. c.u:-.extens; ons .-< -:>.a ~~e- ~ft Floor furnace and vent SERVICES Recessed wall 'n~C':p hpater nnrl vent Temporary Construction Change in existing rPs j r1J'Pl"P multifamily, camm. or Industrial Appliance vent seoarate Stationary evap. cooler I Vent fan wi th sinole duct I Vent system apart from I heating or A.C. I Mechanical exhaust hood ilnd durt I ~'Jood stove/heater I Of amps.1 COMM./IND. FEEOERS I Install/alter/relocate r1htrih. fpprlprc:. L IOf 2~ amps.1 I I I :?;7..,s, I I I I / /C'" __ TOTAL CHARGES 7'<:;,).. Electrical Contractor, the electrical portion of this pe~;t Supervisor and returned to the Building Division ISSUANCE OF PFRlHT I HAVE CAREfULLV EXAHINED the completed application for permit. and do hereby certify that all information hereon ;s true and correctw and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City of Springfield aJWi the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPArKY will be made of any stru~ture -ntho~t 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 ;s noted hereon, and that only subcontractors and employees who are in compliance with ORS 7nl.055 will be used on this project. IW.IE(please print) rrJ'fX:4.y P Zone C C Fire Zone Flood Plain BUILDING PERI-1IT Charges and "" Surcharges ~ PLUl1BING PERMIT Charges and 5 SurCharges ELECTRICAL PERIIIT Cha rges and U Surcharges -, /1ECHANICAL PERMIT Charges and Surcharges IVDe/Const, ~~ Bedrocns </ "" Plan Ck. 7i~~ <::> ~/Bldn -- -- - --3':73 - ~6~~Bi~~ _____{~_~_ Fence . ;75-1 Oemo _____~<)." -- I Sidewalk '< ..?~ A/C Paving. j Curb Cut I Stories / ~L)d\ SIGNATURE (P;rAI-V P A~.d FO~ OEFICE USE DriLY So. Ftg. S9. Ftg. S9. Ftg. ~.e:>e:>o DATE 1/-9-l 7 t Units Occy load Ocey Group 15--:? riain x Value Access x Value Other~R ~<V.2J7'lalue TOTAL V ALUA TI Or! COIllll/lnd Per Fp€, Res Per Fee Systems Development Charoe (1.51) . L~v ;4 Total Comb. Permit I TOTAL 11../1. "2"3 . , 1 , . , COMBINATION APPLICATION/PERMIT (CAP) : .... .PERMIT VALIDATION . . . .. Ill. I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County' Map Reference II 03 43 2. ~xample- Lot I. Block 3, 2nd Addition to Springtield Estates , " " ' . C. Name.' etc. of owne>r and construction lender '. D. Energy Sources _ 1. examole- heat/electrical ceilinq!or forced air Qas 2. examyle- waterheater/electrical/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 permit information: 1. example. construct single family house with an attached garage 2. examgle - 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 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. --- 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 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 c~arges are due and payable when the permit is issued.... ._ , .,.. I , ". .', " , < .' '. .' , V: FOR OFFICE USE ONLY Permit Clerk I PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Pe~mit applicant exempt from registration with the Builder's Board because: Ad~itional Pro~e~t-Information: .' " PLANS REVIEWED BY: .' !..o??.4&;:tE?;'&;k> signature a;::::~~:;. date /1-7~/ name .. ,( I INSPECTION LINE 726-3769 , . IHFORlIATlON LINL .1 726-3753 Sq, Ftq, flain ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Pep. -Fence Oemo Change/Use -Other- - . CITY UF SPRINGFIELD COMBItIATION APPLICATION/PERMIT ElIERGY SOURCES: Heat I~ater Heater Ranqe ValuE of Hork: 9,~ BuiltiinQ Permit Info: Descr,be Work(i.e.. Build Single Familv Residence With Attached Garaael ,.1'~~o:::.&'FC ~~V&Y""~P Job Address /62& MA-/H 57, Legal Oescription /7'''''''~'~'~/ OO~~ Owner ~/ ~/"M" <rz:::,p ./n;7, y~ ',I!';;r- . - Address /tf:"2 ~ M.t?/.N. ~7'. ?:;;?:l?/~F/EC.Z> ~. Mechanical CONTRACTORS I~I General ~7 P9 ~ ,.r: piumbino .s';"~.....~ kJ$4:. Electrical ~r~/r..c/':) E.---c ...._ Construction lender Address DESIGN TEM Primary Structural Electrical ~1echanic.1!1 NO. (n_1 PLliItIBlllG Phone "'b/.""~,, , .I--.--C: ~e., _-;. 9741// IN ?t'F71/e.,p ~/., -~ Phone (address) flics. no.) (addr~c;.sl flie,,_ nn.) 7?/~6.L/~ - ~ ELECTRICAL Each s;ngle f;xture 1~ I~~ fEL' CHA!ll;F Nn~ SQ. FT. Relocated ba;lding (new fi.. additional) S.F, Res;dence (I bath! 10uplex (1 bath) each IAdditi.....l bat!! IWater sen;ce ISew~r . I Storm S...... i I I I I I ;2 of I h:. .".~l ..\ ., " ..... <<LJ:JiAIlli.E. .Jlll Residence of ~ 'New circuits alts. QJ:....extensions .,.c &>/2 ~A?eo SERVICES ~ft ~ ~ Vj :~ (exoires) I (ahoM no.\ ITemporary Construction /Change in existing rp~ j df'JH':P Imultifamily, comm. or Tnrluo::triitl 1 (pxoirpo:;l (ohnnp nn l f!/~9 ('~')~~-4f/~ , MECHANICAL 1=1=1= ru furnace/burner to BTU's Floor furnace and vent Recessed wall C\n;al"P "Pi'ltiAJO :Inri \lpn" Appliance vent ~eOarittp Stationary evap. cooler Vent fan wi th 5:inole duct Vent system apart from I heatino. or A.C. Mechanical exhaust hnod i'lnd rlUI",t I ~Jood stove/heater I I I I I I I I I I L\.~ that the Electrical work be done by an"Electrical Contractor, the electrical portion of this pemit label has been signed by an Electrical Supervisor and returned to the Building Division TOTAL CHARGB WHERE STATE l~ REQUIRES shall not be yaliJ until the 10f ICO~1./INO. FEEOERS l'Install/alter/relocate rH<:tl"ih. fpprfpl"<: L 10f?~ amps.1 I I I TOTAL CHARGES I I I b::>.s: r I I I ~).'" ..-. ISSUANC, OF .PFRI!IT I TOTAL CHARGES I HAVE CAREfMllf 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 performed shall be done in accordance with the Ordinances of the City of Springfield and tbe Laws of the State of OreC]on pertaining to the work described herein, and that NO OCCUPAUCY will be made of any structu~ ~tbout 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 ORS 7Ql.055 will be used on this project. amps. llAf.lE(please print) rrJ<x4-Y PlfJt.. ld \ SIGIIATURE (iJ;('.(/..v" P A~ DATE //-9-J! ~ Zone C C Fire Zone Flood Plain BUILOING PERMIT Charges an~ Surcharges PLU!~BING PERMIT Charges and Surcharges ELECTRICAL PERr~1T Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges Tyoe/Const, ~ oW Ile<IroOlllS Stori es I FO~ OfFICE Units Occy Load Ocey Group ~- '2 USE DIlLY Sq. Ftg. riain x Value Sq. Fto. Access x Value Sq. Ft~. Other/.N~R ~~71alue , . TOTAL VALUATlOll Plan Ck. 65%/Bldo Plan Ck. 30%/Bldo COIl1l1/1 nd PJ"r Fpp Res Per Fee ___n2~:.~~ 5.7~ /&:.,..". Fence --n_n~7.s1 0_ _____~s:- IS1dewalk ~.. ,,;;>:>'i A/C Paving I Curb Cut I I I I I J "7""'-""0 Systems Development Charoe (1.5~1 ,1# Total Comb. Permit I I TOTAL I'll. '2 '3 . r ( \:,. ,. CITY OF c~~~INGFIE.LD. Sprlng.oId, Oregon Office at Community end Economic Development .W, . OFFICIAL RECEIPT J COMBINATION APPLICATION/PERMIT (CAP) I, Applicant to furnish A, Job Address B, Legal Description 1. example- Tax Lot 100, Lane County.Map Reference 11 03 43 2. exam~le' lot 1. Block 3, 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. example- 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, cneck 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. 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 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 consu,lt .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. --- 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. - .. III. V: FOR OFFICE USE ONLY '. () Dale A1~II. ) ib51 E I ~r o Aec'd From ~,.-,..~ 5 -r=,?=> .?h':,;f,.-li'l-> .,c;;r Address Ih '2~ h1~1II I --- -- l!iDO~..JV ~~ 7q:~ ~ - '/'"$ /'5'.. a-.,. 4 ?$""" '15:"- 7...2S / l..//. :43 19R? o . Received For')A# o 'B~. ~C> o )?'l P.r. .~ Ot:::'R ~ (t - 'l c7?k:- -. (I L4t' /'= Y/9~ (1- Amount Received ItI/. -:< 3 (. .~. c.. - ~~~. "~ull<o"'ZEDsiG"'TuRE /' (. I '" ., _ eUSINESSFOIIMS.INC. 150313U-I1C1 ,:i 151 " Pennit Clerk , PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Pennit applicant exempt from registration with the Builder's Board because: Additional Project Infonnation: . PLANS REVIEWED BY: Lo??~;;Z~~Signature 4~~-, , date /1-7--&-:/ r name