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Home My WebLink AboutPermit Building 1986-12-16 " . , IIrrSPECTIOII LIIIE 726-3769 ' c, CITY OF SPRIIIGFIELO CotlBlIlATlON APPLICATION/PERMIT E!IERGY SOURCES: Heat Hater Heater Ranqe , Job Address 1(" {.. k /1< 4, "'- I.egal oe'cr;Pt;on/7-o~_7~_.3{. O~c-o Owner ~/1(ld f~ ~A// Address 4'5 '1)-'" I ;~ ~/ Jhone I r./ (j Construction lender Address OES I Grl TEAll (name) Primary Structura 1 Electrical Phone (address) ! .II!; lfA1/k.J!cIllV Plumbino Electrical f.lechanical PLUI1BIrIG 1r0.' , Fff 'rHARr,f lEaCh single fixture IRelocated building (new fix. additional) I S.F. Residence (1 bath! IDuplex (1 bath) each Additional bath Hater service Sewer Storm Sewer NO , I Residence of SQ. fT. !New circu~ts alts. or extenslons ISERVICES I (address) .~ . INFORt1ATlO~l l1,'it 726-3753 Sq. Ftq. I.iain ~q. ~tg. Access. So. ftq. Dlher r~e\~ Add Alter P.eo. --Fence Demo Change/Use Other - - ~ ,D I~ ~ V:/'JY'JIJ BUil(jino Pennit Info: Describe \~ork(i..e.. Build Single Far:1ilv nesidence I-lith ^_ttached f1araae) (~tJd~ 5Ji. /1 hiT tJa.fI/ j' I' (1 ics. no.) (pxniresl (ohane no. ~ ,~n... o~f ,,--- (1 ies-. no.) (pxoi fP<;-' (ohnnp-no~)------ ELECTRICAL MECHANICAL I !:'n' I rl-!LHU~~ NO. I I ~~~ I rI-lAQr.~." furnace/burner to BTlI's Floor furnace and vent Recessed wall ~n~rp hp~tpr ~nrl vpnt amps I Apol iance vent "en;j ra te I Stationary evap. cnnl€'r I Vent fan with sinole duct I Vent system apart heatino or A.C. II\leChanical exhaust hood and rlurt Wood stove/heater from Temporary Construction Change in existing rps; rlJ'.nrp multifamily, comm. or Inrlu"trial Of CO~~./IND. FEEDERS Install/alter/relocate rl;<;trih fpprlpr~ Of amps. ISSUANCE Of PFR!IIT TOTAL CHARGES TOTAL CHARGES ,IHERE STATE L.\I~ REQUIRES that the Electr;cal work be done by an shall not be vali1 until the label has been signed by an Electrical I HAVE CAREFULLY EXM1INED 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 Soringfield and the Laws of the State of Ore90n pertaining to the work described herein, and that rw OCCUPAIKY will be made of any structure without the permission of the Ouilding 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 exemntion is noted hereon. and that only subcontractors and employees who are in comoliance with OP.S 701.055 will be used on this nroJect. liA!IE(please print) '2&~., f-l.oLlJ:-I\lBEe.IL-' SIr,lIATURE .:>-~ ~ (" /C? ""7 ~ P Dm1l.:l/,.,-\((,.., FO~ OFfICE USE miL Y Sq. Ftg. r1ain Sa. FttJ. Access Sq. ft9. Other Zone r:. " Fi re Zone <=-N Flood Plain Type/Canst. Bedrooms Stories BUILDING PERfllT Charges an~ Surcharges _____~7:/~Q /, r 1:' PLU'1BING PERMIT Charges and Surcha rges .,ELECTRICP,L PER!~IT Cha rqes and Surcha rges Units Occy Load Occy Group 'R-2 Plan Ck. Comm/Ind 65%/Bldo P~r ~ep Plan Ck. Res 30%/B1 do Per Fee I Fence D~R1O Sidewalk ------------ I A/C Paving ____________, Curb Cut I !lECHANICAL PERMIT Charges. and Surcharges TOTAL CHARGES Electrical Contractor. the electrical portion of this permit Supervisor and returned to the Building Division 'WI ~ Value Value Value~~b TOTAL VALUATION x x x Systems Development Charoe (1.5%) Total Comb. Permit I TOTAL ~ 3D. (0 f' ~ --~~ . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Oescription 1. examole- Tax lot 100, lane County Map Reference 1/ 03 43 2. example- lot 1. Block 3, 2nd Addition to Sprlngfield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. examole- heat/electrical ceiling/or forced air qas 2. example- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house, 500 sq. foot garage 2. examDle- if new project. check-new - if addition, check add. etc. F. Bu; 1 d i n9 pennit ; nforma t ion"; 1. example - construct single family house with an attached garage 2. example - remadel 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 (a) of the Structural Specialty Code H. DESIGN TEAN ANO 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 fu 11 schedu 1 es 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: , fI ~. " . , i PERMIT VALIDATION 90 {S ~ 3 (2-/0 ~fb I Cc Permit Clerk Permit applicant exempt from registration with the Builder's Board because: .Additional Project Information: ~ PLANS REVIEWED BY: name signature I J date 'I . . ; 1115 P<:l; T 1011 L HiE ~ 1726-3769 . . Ranqe , tIlFORJ'~T:. 'I L.I...t. ~' 725-375: So. Ftq. /.iain ~q. :=tl). Access. So. Ftg. Other fle\., Add ft., ter P.eo. --Fence Demo Change/Use Other - - t IU.G.. , /JI "i I'," LITY UF SPRIiIGFIELD COIlBlilATlON APPLlCATlON/PERMrT E!IERGY SOURCES: Heat !'Ia ter Hea ter ~JLI I Residence of sq. FT. INew circu~ts alts. or extenSlons Job Address Legal oe'criPtionJ7-o~_7~_'3/. O~c-o / ;J J' 'I! Owner -q/l t r! /\J1.?m4)'"o" f/ Address 4'5 ~fd.c-/t JB1.i4b/ Jhone / U (J Construction lender ..\Jdrcss UES I GII TEAll (name) Phone (address) ,/ Primary Structural Electrical :1echani ca 1 I! CONTRACTORS / i (name) ;; ;' II: General ~ ~ j!A/'.he.i::/;-I~v Plumbino (address) Electrical I.lechanical PLUIIB IrIG 1.0'1 Each s;ngle f;xture IRelocated building (new fix. additional) l's.F. Residence ,11 bath) Ouplex (1 bath) each I I=F:~ I nlARr,1=' SERVICES Additional bath ~ D I~' '~ I. Vr ;Y"JV (luil(;ino Pennit Info: Descnbe l'Jork(l.e., Build Single Far.lilv Residence lIith I\ttached (;araoe) (tim OdJJf t9i [; n-n:f"' tdm j! j' " (l ics. no. ) (exnires) (ohone no. I ~ ~ (l lc". no. ) (exolrp<:.l (I)hnnp no \ ELECTRICAL MECHAN I CAL ~F~ 'rl-l1lli.G.E.l..l!Q I =~:...- J:..l::iAR.G..[ I furnace/burner to BTU's Floor furnace and vent Recessed wa 11 '\l1;\rP hPiltp.. ilnti \IPnt amps, I~ II'" \'" I --I I ! I Apol iance vent C;POi'lratl'" Stationarv evao. r.ooler ~ , Vent fan with sinolp nllct: Vent sySteM apart from 'I heating or A C rlechanica 1 exhaust hood i'lnd nllrt ~!ater servi ce Temporary Construction Change in existing rpc:.inpnrp ImultifamilY, comm. or Tnrlllc;t,r;ill Of COI~I-1./IND. FEEOERS Install/alter/relocate rli<:.t..ih fppnprc; I HAVE CAREFULLY EXAm NED the comp 1 eted ap['ll i cat i on for ,rJermit, and do hereb.v cert ify tha tall in forma t i on 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 Sori ngfi e 1 d and the Laws of'- the Sta te of Oref)on pe rta i n i ng to the work descri bed herei n, and tha t tlC OCCUPAIKY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Goard is in full force and effect as required by Or-S 701.055, that if exempt the basis for exemntion is noted hereon. and that only subcontractors and employees who are 1n comoliance with OP.S 701.055 w111 be used on th1S oroJect. IIAIIE(please pnnt) t'R lC.. NOLlE.I\JB EC.I~' SIr.IIATURE 5=-"-<" R C;? <::: .R _ _DATElL:lh-Y(r"J FOr. OfFICE USE miL Y Sq. Ftg. t1ain SQ. Ftg. Access Sq. FIg. Other Sewer Storm Sewer Of TOTAL CHARGES TOTAL CHARGES HHERE STATE L,'I-I REqUIRES lhat the Electr;cal work be done by an shall not be valiJ until the label has been signed by an Electrical Zone ~ ,..~ Fire Zone v-N Units Occy load Occy Groupfi-2 Tyoe/Const.. Bedrooms Stories Flood Plain BUILDING PERI-1IT ~c; ~() Plan Ck. Charges an~ ""\. _______.1:..___ 65VBldo Surcharges"::;- / (0 Plan Ck. , ~ 30%/Bldn PLUMBING PERMIT I Fence Charges and -----_______ Surcharges O~mo Corrvn/Ind PPl'" Fpp Res Per FF':f" . ELECTRICP,L PERr:IT Cha rges and Surcharges r1ECHAN I CAL PERMIT Charges and Surcharl]es Sidewalk A/e Paving Curb Cut Wood stove/heater amps.1 ISSUANCF OF PFR'IIT I TOTAL CHARGES Electrical Contractor, the electrical portion of this Supervisor and returned to the BUilding Division perr.lit x Value Value Value ~_b x x <1fR7 -r~ I I TOTAL VALUATION Systems Development Charoe (1.5') Total (omb. rermit I 30~fo f' -1 I TOTAL . ... COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Description 1. example- Tax Lot 100. lane County Map Reference II 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. examole- heat/electrical ceilinq/or forced air QdS 2. examole- waterheater/electrical/or solar E. Square footage or valuation. etc. - 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project. check new - if addition, check add. etc. F. . Building pennit information"; 1. examole - construct single family house with an a ttached garage 2. examole - remodel existing garage into family room 3. examole - convert single famlly residence into restaurant (change of use) G. Value of work as defined in Section 303 (a) of the Structural Specialty Code H. OESIGN TEAI'I 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 OIVISION 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 sionature by his electrical supervisor. The general contractor is ~ 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 ~ , " ~{3~3 cZ-j0.-f0 q ! I '. ~ (( I [ , I Permit Clerk Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: !, PLANS REVIEWED BY: name signature date ~