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Home My WebLink AboutPermit Building 1981-11-3 .... ~. . CITY Uf SPRINGFIELD COIIBIIIATlDN APPLICATION/PERMIT EilERGY SOURCES: Heat Hater Heater . INFORlIATlON kJNt I 726-37S3 Sq. Ftg. 1'1a i n ~q. Ftg. Access. Sq. Ftg. Other Ilew Add A Her Rep. --Fence Demo Change/Use Other- - j INSPECTION LINE 1726-3769 Job Address 14.'-, 4- U.'-~ ~ ~..cl J'# legal Description J7-{),~ ~.31 1).. .3~ Owner ~b [;). (:;I,.. '"".,si ~ .., Address . I .'f"ll )./14,vel...", 8,..i:lp t.-VA Y SP.c'...J. Build Single ~ "" \) " "J f' Ranqe ValUE of Work: 1St) t) e Bul1dinQ Permit Info: DescrIbe Work(i.e" Phon~,...aJ~ 7 Famil y nes idence Hith ft,ttached Garaqe) I?~ Pnn; Construction Lender Address DESIGN TEAr~ (name) Phone (address) (lies. no. \ (exoires) {ohane no. J Primary A wI- .hI' . " I, ", " !. il Structural Electrical f1echanical CONTRACTORS (name) (address) f1 ies. no. \ (exoi res) ! I (rhOi~ l!1!...L- , Genera 1 Plumbina ()W.I!J'6"R ~ /' PLUllB I NG ,I I! 1 , Electrical .--'--.. , " 'I .Jl~rlical NO: .:..FFF'.... f:HARr,F Nn ~-~- ELECTRICA:- ~~-- n~~=-~__~~_~~~_~ _~~~:~N~;~-l~' -J -=--- '" ~~~- Fi:i~ -Nn- - "'" ~.:o= --. - _-=oo:=_~__~ J=~L -'HARllf~ I Residence of furnace/burner to I SQ. FT. BTU's! Newc;rcu;tsalts. Floor furnace 'I or extensions and vent Each single fixture Relocated building (new fix. additional) S.F. Residence (] bath) Duplex (1 bath) each Additional bath SERVICES Recessed wall Soace heater and. vent; , II ~ Storm Sewer Of amps. Appliance vent o;.poaratp Stationary evap. cooler . Vent fan with sinole duct Vent syste~ apart from heatinq or A.C. Mechanical exhaust hood and duC':t Wood stove/heater Sewer Temporary Construction Change in existing reo; i qenn. multifamily, camm. or Industrial ~Iater servi ce CO~~./IND. FEEDERS Install/alter/relocate n;"tr;h_ fppnpro; Of amps. .- I SSUANCf OF PFRIIIT ~'- : ; TOTAL CHARGES WHERE STATE LAW REQUIRES shall not be valij until the TOTAL CHARGES TOTAL CHARGES 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 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 rm OCCUPAIKY 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 only subcontractors and employees who are in compliance with OP.S 7Ql.055 will be used on this project. that the Electrical work be done by an-Electrical Contractor, the electrical portion of this permit r label has been signed by an Electrical Supervjsor and returned to the Building Divisi~n i i. I HAME(please print) S IGtlATURE FO~ OFFICE USE orlLY Zone Tyoe/Const. Units Sq. Ftg. t1ain Fire Zone Bedrooms Occy Load Sq. Ft~. Access Flood Plain Stories Occy Group 13. ~ Sq. Ftg. Other DATE x Value Y Value x Va 1 ue TOTAL VALUATIOtLISOOs;l BUILDING PERflIT Charges and Surcharges Plan Ck. Comm/Ind _______L.$.!.OI2 65%/Rlrlo PJ'r Fee Plan Ck. Res ,flit) 3D%/Bl do Per Fee Fence er Systems Development Char~e 0:5%) , PLU!1BING PERMIT Charges and . Surcha rges 0_ ELECTRICAL PERI~IT Charges and Surcharges MECMANICAL PERMIT Charges and Surcharges Sidewalk A/C Paving Total Comb. Permit TOTAL ~s. 6,0 \ Curb Cut " , I " ( ,~, ('\ ( . . ~ .--: COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100. Lane County Map Reference II U3 43 2. examp]e- Lot I. Block 3, 2nd Addition to Sprlngtield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceilinQ/or forced air Qas 2. examyle- waterheater/electrical/or ~ E. Square footage or valuation, etc. 1. example- 1250 sq. foot house, 500 sq. foot garage 2. examyle- if new project. check-new - if addition, checl< add, etc. F. Building pennit information: 1. example - construct single family house with an attached garage 2. example - 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. OESIGN TEA/l 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,;n 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 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. --- Ill. 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 signa ture. 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. .~ 1 ~ V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: ;p!1 .. name signature date 1/-.')-2"'/ ...--~-:~", <-'''<:'~r'...-~_~''.r~ " . ,-,P . CiTY UF SPRINGFIELD . COIIBIilATION APPLICATION/PERMIT ,E!IER5Y SOURCES: \. Heat " Hater Heater -I IrISPECTION L1I1E 726-3769 Job Address /Io"~ ~ }L,hL. ~ ~"'OJ'N' Legal Description J7,:"D,~-~-3/ "fL. 3!.oo ~ 1 Nf(lRllA YibN1:'rnr 726-3753 Sq. Ftq. 1,Iain ~q. ~tg. Access. Sq:, Ftq. Other lIew Add Alter Rep, , Fence_Demo~Change/Use Other "0(' ....... '0 '-.J .'-1 ~ Owner Te..ro 0 .Q,...Y"YI~1. ~ 'f Address 1/, I . I .'!"'d nt4Yd,D", $rt<:J? uJJJ. Y SP~rJ. Ranqe _,_._._ ~,_ Valu, of Work: IStJ" a. , . BuikinQ Permit Info: Descr,be'\~orkl;.,e.. Phon<7Y7...aJ~ rFamilv P-esidence Hith ,ll..ttached Garaael ' /?,: Pon~ ' '-~-~---~,- -. ElECTRICA~ ~~-~"~J"~'----:;;~~~;-~~~'- --- FFF CH^RhF ~In _____.=-~.a.".~~._.- ~~F""tCH8.RG..E. -=~Jr)~----"'-= --..."-=-=----=--=,- H~ Residence of furnace/burner to SQ. FT. BTU's Construction Lender Address Ul:.::dliU Il:.A!.' (name) Phone (address) Primary Structura 1 Electrical t1echanical COIITRACTDRS lname}. (address) , Genera 1 Plumbina ()WHER --$ , Electrical ~lechanical l:l..;;.:"~_-.- PlUllBIrIG r;o:~' Each single fixture Relocated building (new fix. additional) IS.F. Residence II bath! -----IDuPlex (1 bath) each IAdditional bath IWater service ISe'Wer I Storm Sewer New circuits alts. or extensions I SERVICES -----I !Temporary Construction IChange in existing rp~ j d",PJ1I"P Imultifamily. comm. or Tnrllldrii'll 10f ICO~~./IND. FEEDERS I Install/alter/relocate ,dic>trih_ fppdpr" IOf I amps.1 1 amps. TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be valiJ until the TOTAL CHARGES Build Sin9le {lies. no.} __ {exoires 1 (ohane no.l (lies. nn. [i I; Ii I, I I, ; t {Phnr.,. .D!hl.- } .1: ,~ J (pxo;rp"l r"ARili'~ I I I I I 1 I 1 I I I Floor furnace and vent _____I ~~~~:s~~~~=~l~nd vpnt. I I I 1 Appliance vent -I Si='oarat~ 1 Stationary evap.. 1 cooler . 1 Vent fan with I, ~inClle dur:t I'vent system apart from I I heatino or A.C. I Mechanical exhaust I' I hood and durt I ~100d stove/heater I.. I I I i I 1 I I I I i I n :; l ISSUANCf OF PFR!1lT TOTAL CHARGES that the Electrical work be done by an, Electrical Contractor, the electrical portion of this permit label has been signed by an Electrical Supervjsor and returned to the Building Divis;~n 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 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 NO OCCUPAUCV 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 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 701.055 will be used on this project. 14Ar.IE(please print) S Ir.rlATURE . "n FO~ OFFICE USE Q;II.Y Zone Tvpe/Const. Units Sq. Ftg. r-tain Fire Zone Bedrooms Occy load Sq. Ftg. Access Flood Plain Stories Occy Group 13 - .:t. Sq. Ftg. Other DATE BUilDING PERIIIT Charges an~ Surcharges ~ Plan Ck. Comm/Ind ---____L_~t2a. 65%/BldQ Per &:'010 Plan Ck. Res I f4() 30%/B1 do Per Fee r Fence ~, Plur~BING PERMIT Charges and Surcharges I Demo ____________1 S,idewalk I A/C Paving ELECTRICAL PERI~IT Cha rges and Surcharges MECHANICAL PERHIT Charges and Surcharges Curb Cut x x X Value Value Value TOTAL V AlUA TI 011 1500 !3:l " Systems Development Charoe (1.5%) I I I ~.6A. tOO \ " ITotal Comb. Permit I I TOTAL " . COMBINATIO~ APPLICATION/PERMIT (CAP) , I. Applicant to furnish A. Job Address B. legal Description 1. examDle- Tax lot 100. lane County Map RefeJ" II 03 43 2. examDle- lot 1. Block 3, 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceiling/or forced 2. examyle- waterheater/electrlcal/or solar E. Square footage or valuation. etc. - I. examole- 1250 sq. foot house, 500 sq. foot 2. exampJe- if new project. check-new - if ad, check add. etc. F. Building permit information: 1. example - construct single family house wii attached garage 2. example - remodel existing garage into fam" 3. examole - convert single family residence' restaurant (Change of use) 'G: Value of work as defined in Section 303 (a) of Structural Specialty Code H. OESIGN TE~1 ANO CONTRACTORS To avoid design or construction delays, Buildi, Division Staff must be able to contact appropr" persons regarding design information or job si1 corrections. etc. II. Abbreviated Plumbing, Mechanical, & Electrical 5cht A. Except where blank spaces Occur in the descripl portion of the Mechanical and Electrical Schedl the applicant need fill-in only the No. Boxes ( to the appropriate item(s) to be installed 8. Full Plumbing. Mechanical, and Electrical Sche( are available at the Building Division 1. To conserve space on the permit form the s( h~ve been abbreviated 2. If the item(s) to be installed are not COVI the abbreviated schedules you should consu' full schedules C. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES CHARGES ON THE SCHEOULES O. As noted on the CAP, the label must be deliver, electrical contractor for signature by his elee supervisor. The general contractor is .not aut' to sign the electrical label. --- III. Applicant to sign and date Whenever possible, the initial application will be a worksheet only. Where possibl~, Building Divisi( will prepare a type written copy and return it to 1 applicant at the time the actual permit is issued 1 signature. IV, Fees and Charges Plan check fees are due and payable at the time of application. and no plans will be processed until t fees are paid. All other fees and charges are due~ payable when the permit is issued. V. FOR OFFICE USE ONLY <I 57568<) . PERMIT VALIDATION . { CITY S'PRINGFI ELD OF c City Hall Springfield. Oregon Department of Public Works OFFICIAL RECEIPT No. B 19 <;( / ( Rec'd Fr~m4;~O )1,1, I":~AJ.A'" , / / . "'1-'" . d Address ./::"'1 /-: /U//'/A'.~---: (;; //-~- Date ; Received For: B , () ~' d. '110 77 tJ /6...... 0;7 # ,,(;c.) >1' · y,-s; cJ) 9..' (s (0 c <:. Amount Received ~ --fl- , /t14,40~ c.. BY . --c., ..,..., ( . ...... "UTHO'UZID-"'SIGN...TURI ( Pennit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: 'L Pennit applicant exempt from registration with the Builder's Board because: Additional Project Infonnation: PLANS REVIEWED BY: name signature ;r!1 date 1/-.1-%/ .'" '.. lJ li' -II II II <I <I (J -(J ... - --.-- (J CI .