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Home My WebLink AboutPermit Building 1981-6-10 I INSPECTION LINE 726-3769 (lo_ I Job "'dd,..~-:L ~..... \ I Legal Demiption 3-"''' 0 ~-, \\\\ \ ~ ~K~~~i-(W "'dd"" ~ r);:; ,l~_ , Phone e; i ~qf\Q../ . (J \ ". . CITY OF SPIUNGflElD COMBINATION APPllCAflON/PERMIT . INFORMATION LINE 726-.3753 Sq. ftg. Main Sq. Fig. Aceen. Sq. fIg. Other - _New_Add._iite'~ ___Fence_Demo_'th~~ _Olher ~ D ~ , ENERGY SOURCES: Heat Water Healer Ronqe - I Volue of w0500 ,Q) Building Permil I"fol Describe Work (LII., Build Si"91. !:omily p...,;.-l.....(.. Wi I" . Attach..d Garooe} ,. .,.,.... ., - ::;I\1\-~ ,,), 'l. "'" jC'( '.~ ' Zone Fir. Zone Flood Plain 'rypel Const. B.droams . Units "'((y Load "'ccy Group Sq. FIg_ Main Sq; FIg. Acean Sq. Hg. Other ConstrUCTion Lend.r .......'\=ll (to Q "-0)-.,+1 'V'O , \. J (/\, '-\ J.\ II Add,e" Phone CONTRACTORS (nome) (address) Oics. no.) o v;:... ;;e;]?.J" (.ll~irllsi , (ohone noJ J \\""\"", ' I 4{o(';C):<'-~1 I I 1 I MechClnicClI C.nerClI \t ""'^ (\ .. ~ . ~ ""'" 'l:>~- ,,::.:~C 'l:::M~,i: ~ 'O\\...h'\o\P-->~ . ~ ,017 'lJ,,--SL \'7}" f'-< L 'S~:l\ L ~ ~ ~ hZ);- I NO. I I I I I I I I I I I I I I r' I TOTAL CHARGES I WHERE SlATE LAW REQUIRES that the Electrical work b. don. by the E!ertrical Conlrac.tor. the .Iectrical porliofl of Ihis permit sholl nol b. valid until Q lab.1 has b..n signed by an Electrical Contractor and attached 10 ,h. electrical panel. DESIGN TEAM . (oddreu) (lies. no.)' " ~'1,: MECHANICAL FEE 'CH....GE j (namei Primary Structural Electrical PlumbinG Electrical Mechanical PLUMBING ELECTRICAL furnace/ burner to D.TU's Appliance yen' separate $..h,1 fE~ I CHARGE NO. I FEE . CHARGE NO. , /().4{) I I J A<;'GI::l Stationary e'l'op. cooler Vent fan with sinC1l. duct Vent system aport from heatinq _or A.C. Mechanical ~xhaust hood and duct ~."o Residence of Eacn sinqlct fixture R"locar.d building (new fix. additional) S.f. Residen~. (1 bath) Sq: ft. Wood stove/heater Heat Puma Air handler to lO.Don CFM Air handler over 10.000 CFM ISSUANCE "OF ~peRMIT /0.00 I Ne..... circuits. alterations or e.o;tensions TOTAL CHARGES //".""" SERVICES Duolu (1 both) each Temporary COftstruction I HAVE CAREfULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon i. true and correct, and I further certify that any and 011 .....ork ~rform.d .hall be done in accordance with the Ordinances of the City of Springfield and the laws of the Stat. of Oregan pertaining to the work described herin. and that NO OCCUPANCY will b. mode of any structure without the perm inion of tho Building Oi'l'i.ion. I further cerHfy that my ,e-gjlrrotion with the Builder's Boord is in full force and eoffect as required by ORS 701.035, that if ...~mpt th. bOli. for exemption is noted.. heron. and that only subcantroctors and employees who are- in comPliasn'~N"'T'uhRORS 701.~~2 ~ "~~ o~n thir-..,. p,.,raiect. ~... '~~ ~', ~ '" Basi. for B...i1d.r's Board exemption: "'-....... .,.... . ~ \ NAME (pl,o.. p,;nt) ~t"\"" \ I2EQ.\,==>r Q \ . fOR OFFICE USE ONLY \ \ Additional both "'mp.. '2/:)0 Water ..rwice So!&Z. (!~~~~.e- Sewer Star,m Sewer FEEDERS Amps. TOTAL CHARGES '~~ "'-ri.r BUILDING PERMIT ,~~ Plan Ck. Comm/lnd Charges and 6S~:'/ BldQ Per Fe. S...rcharges ,~() Plan Ck. Rei 30%/B/dQ Per Fee PLUM81NG PERMIT Cha'ges and Fence Surcharge. Oemo ELECTRICAL PERMIT 3~ tJO Chorg.. and Side.....alk S...,chorge. /, <;Jf.) A.le PO'l'ino MECHANICAL PERMIT , Charge. and _____jJ,..!.OO C...rb Cui S...,chorges ,{.Jf x x x Value Vol.... Value TOTAL VALUATION Systems Oe'l'elopment Char"o (1..5~\ Total Comb. P~rmit $8'. ;J. y' TOTAL ~ sr. ~tf " ..': ..~ _..,--.;-;..~...~.......................... 2 COMBINA nON APPlICA nON /PEtT (CAP) , I: 'Applica~ ta furnish A. Jab Address B. legal Description 1. examole.tax lot 100. lane County Map Reference 17 03 43 2. exampie.lor 1. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender . D. Energy Sources 1. examole-heat/electrical ceiling/or forced oir gas 2. examole-water heater: electrical/or solar E. Square footage or valuation, etc. 1. examale.1250 sq. faot hause. 500 sq. fao! garoge 2. exomole-if new project. check -,;e;,-if addition, check odd. elc. F. Building permit inFormation: 1. exam ole-construct single family house with an ottached garage 2. examole-remodel existing garagE: into family room 3. examp,e-convert single family residence into restaurant (change of use) G. Value or 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 Stoff mus' be cble 10 contact appropriate persons regarding design informorian or job site corrections, etc. II. Abbrevialed Plumbing, Mechanical & Electrical Sched~les A. Excepl where blcnk spaces occur in the de~criplion portion of Ihe Mechanical and Electrical Schedules, the applicant need fill-in only Ihe No. Boxes adjacent to the appropriate item(s} 10 be instolled B. Full Plumbing, Mechanical, and Electrical Schedules ' ore available allne Building Division . 1. To conserve space on Ihe permit form the schedules have been abbreviated 2. If Ihe item(s) 10 be installed are not covered on the abbrevi. oled schedules you should consult the full schedules C. BUILDING DIVISION STAFF WilL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES III. Applicant ta sign and date Whenever possible, the iniTiol application will be used as a worksheet only. Where possible, Building Division Staff will prepare a Iypewritten copy and return it to the applicant at the lime the actual permit is issued for his signaturE. IV. Fees and Charges Pion 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 ore due and payable ,:^,hen the permit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ~ Additional Project Informalion: PLANS REV!EWED BY, A~ nam'" ";gnoture -... .~.- . Permit Cler~ PERMIT V AlrDA nON -.... .' , /;. :, < I I Ij ~ot~ & -/C1 ~ ~/ .'~_. ~......,....~-- . "---.. ':''S>, ~- \,~ 1&'\ 1\ I(\AA. Own.. '\ \ ~ ~ Q 0;f\ If' \ \.\~\) ~-(Ycr , , Add.... -- 9-, tJ?A V, f(\ I f:n. 71 DQ n9:_../n ConHructiot'l Lend., (:) \t ""'^- ~ " "Q; '\" ~J::>'\I'o. ~\:- ~ ~C ~~\( I/><-.-..'l O\\..hv8~ ~,uC 'l-A-...sL \7~~L S~\L~ '(:) INSPECTION 1I.~~ 726-3769 'i Job Add..... \~~-;::L ~'\~\ LIt';)ol OItIC.iption Add,." DESIGN TEAM {nom,,; Primo,.,. Structural Electricol MechCl"icol CONTRACTOll:$ ("0"'.\ Gf'n.rol Plumbi,..q Electrical Mechonicul PLUMBINC NO. I Fe: 1 CHA.RGE Eoc;, .inqle filetur. R.lo(or.d building (nltw Ii... oddirio"oll S.F. a..id.n~. 11 balh) Duol..: (1 bothl each Additionol barh Wal., nrviclt Se"",.' Sto,_m Sew., r I TOTAL CHARGES I . . INFORMA nON LINE 726-3753 CITY OF SPRINGfielD COM81NAJlCH APPlICArlON/pERM1T I ENERGY SOURCES: Heal I Wal., Heat., lI:onqe _ j Sq. fl,g. Main I Sq. fig. Acelt". Sq. ftg. Other ~ _New_Add -4t.,~~ _._Fence_Oemo_Ch~;u-r;'" _OtMer ~I DI ,~i I I Volu. of woSOO d) Phon. Building Permit Info: Describe Work (i.c., Build Sj"gle Familv Relidence W;Ih Altached Caracll~j ,. '\~~~ ,Q W.)--..-H.......O ,?-l ~ C\ C J (addreu) (Iics. no.). (phone no.l (ex:piresl . ... (address) (fics. no.) \ J . (I')hone no.) , ""\"" l /J .r :. ' . -ru>\..,oO~1 (ex:pires) ~vrt- o ~.::2~' 2.Jn " ELECTRICAL MECHANICAL NO. FEE CHARGE FEE !CHARGE NO. I I II Residence of furnace/burner to ll.,TU's Ap~liance vent separote Stotionary evap. cooler Vent fan with slnqle duct Vent system opClrt from . heatinq or A.C. M.chonicClI e.xhaust hood and duct ~."o I I I ...:ft. / New circuits. alterations or e.x:tenlions /().&i) 3<<> SERVICES Temporary Construction / Amp.. '2J:>0 ~. Cs:j.~.H~.I!!" I I FEEDERS I Amps. I I dSCO Wood stove/heater Heat Puma Air handler to 10,000 CFM Air handler o'ter 10.000 CFM TOTAL CHARGES ISSlJANCE .OFflPERMIT .~~I TOTAL CHARGES /0.00 I /1' ".:..rIn! WHEilE STATE LAW REQUIRES .ho. th. Electrical war. b. done by Ih. E!ertricol Conlroctor, Ihe electrical portior! of this permit shall no. b. valid until a lab.l has b..n signed by an Electrical Contractor and attached to 1M electrical panel. I HAVE CAREFULLY EXAMINED the completed opplication for permit, Clnd do hereby certify that all information h.reon is true and correct. and I further certify that any and all work performed sholl be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining to the work delCrio.d herin. and that NO OCCUPANCY will b. made of any structure without the permission of the Building Oi'tilion. I further CIIIttify that my regislTation witb the Builder's Board is in full force and effect as required by ORS 701.055, Ihat if ex_empt the basis for e.xemption is noted'. ~:::::?d~:= ;,~;;..;' -~;~~~:^:.: ~\~~I FOR OFFICE USE ONLY '" \ Ion. Fire Zone Flood Plain TYPfd Coni'. :..edrCloms ""otief BUILDING PERMIT Charges ond SUfchorg.s ,'i.' l'JC? ,40 PLUMBING PERMIT Charge. and Surcharges I I 3~ool /, <.to I _____lY..!..oo .~st , ElECTRICAL PEaMIT Chorges and S...,c;,orges MECHANICAL PERMIT Charge. ond S",rc;,argu Unih "cl:Y Load -I"'\ccy Group Sq. Ftg. Main Sq; Ftg. Access Sq. Ftg. Olh.r . "'olue Value Vol...e TOTAL VALUATION . plan CK. Comm/lnd 65%1 Blda Pl"r Fen Plan CIt. Res 30~:'1 alda Per Fee Syllems De'telopment C:har",e 11.5~1 Fence D.mo Total Comb. Permit S8'. ;1. sf Sid......alk Ale Pavin", C\,Irb Cut ;y S8'. ~'I TOTAL .......-..-- ~~""-I~..... .......;...~__.<~ III. Applicanl to .ign and date Whenever possible. the initial application will be used as worksheet only. Where possible, Building Division Staff... ( prepare a typewrirten copy and return it to the applicant the time the actual permit is issued for his signaturE. 4- IV. Fee. and Charge. Plan check fee. are due and payable at the time of the application, and no pions will be processed until these fees are paid. All other fees and charges ore due and payable ~hen the permit is issued. . A~ , . COMBINATION APPLICATION/PERMIT (CAP) I. Applica~ to furnish A. Jab Address B. legal Description 1. examole-tox 10. lOa, lone County Map Referenc 2. examole.lo' 1. Block 3. 2nd'Additian to Spring!ie C. Name. etc. of owner and construction lender D. Energy Sources 1. examole-heot/electrical ceilinq/or forced oir gas 2. cxamole-wo'er heoter; electrical/or solar E. Square footage or valuation. etc. 1. examole.1250 '''1. foot hou.e, 500 '''1. foot go rag. 2. exarnole.if new project. check r;e;,-if addition. ch acid. etc. F. Building permit information: 1. examole.construct single family house with an at: garage 2. examole.remodel existing gorag& into faniily roo J. example-convert single family residence into restaurant (change of use) G. Value ai work a. defined in Section 303 (a) of the Structural Specialty Code ... H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Divi: Staff mus. be oble to contact appropriate persons re~ design informcrion or job site corrections. etc. II. Abbr'evioted Plumbing. Mechanical & Electrical Sched~le A. Except where blonk spaces occur in the description pc of the Mechanical and Electrical Schedules, the oppli< need fill-in only rhe No. Boxes adjacent to the approf item(s) to be insrolled B. Full Plumbing. Mechanical. and Electrical Schedules are available at the Building Division 1. To conserve space on the permit form the schedulE have been abbreviated 2. If the item(s) to be insralled are not covered on thE ored scheaules you should consult the full sc"edult C. BUILDING DIVISION STAFF WilL FILL OUT ALL FEES AI CHARGES ON THE SCHEDULES V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: .' PLANS REVIEWED BY, name signature . (" f OJ PERMIT vtLiDATION CITY OF'S'PRINGFIELD , , . :~,Clty Hall '. .:..: , Spr!;,gfle.!d, Oregon Depart""mt af Public Warks ,:' OFFICIAL 'RECEIPT., (- '. fS, ( Dat~ ~\\~~\', \\") ~9 ~ ~O'"'B' Rec'~;\" .~~ \~Q ~'t: . Address n?-fl ~r1, Y1 t" S6696r \ . I < (1e, \, ! Received. F"~ ~1...r\\ .~ .00 '( \--'. "\ \ ~ ,~) " , ~.~~~ '/'-1/ o~()Uc Lj-l-f () I . It U \"<\ ~W ,\L \ \ In .CO \ " - ~/o - f ld1 <- ( ( ( ( < / ( ( S~.~ -. ~\,6~.,/u.. CL ( ~.b, Amount Received (' "' -TI '"ILTO"'~U"".U~~ "II..,.", . luG..... Oil ".0' ...".. ( '. c :, Permit CierI- r , .1 I date ~ -/cJ ~ tf"'/ :..--~ ~-'--'.