HomeMy WebLinkAboutPermit Building 1981-8-24
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I'
l~ INSPECTION LINE
726--3769
Job Add,,,, k27t? ~~k sfJ,
L,gol 0"'';.';00 J7'''~2~ 'II /7:<.,
Lt:>,. ? ~R7'hI4~~C.
Ow",,>n,.~ ff~h- c/-
Add"" )~7~ p.",,~/('
I ::1.bL;-P /J. m~ 97'-/7--'
I 70
Cnn\trucfJon lender
I ~~drell
I DESIGN TEAM
Phone
(nome;
(oddrQu)
(lies. rio,)
(expires)
(phone no.)
Primary
Structural
Electrical
Mechanical
CONTJ:ACTORS
(nome)
(address)
(lies, no.)
(expires,
(phone no.)
General
Plumbinq
flectricol
Mechanical
PLUMBING
ELECTRICAL
MECHANICAL
NO.1
. I p:J: I CHARGE NO.
FEE I CHARGE NO.
FEE ! CHARGF
Eocn sinqte fjxlure
R~lo(orlld building
(new fix. additional)
S.f. ~~"dl!n~.
(I boTh)
Sq: ft.
New circuits. olteratiolls
or extensions
furnace/burner to
~TU',
Appliance vent
separate
Stational)' ovap.
cooler
Vent fOil with
single dud
Vent .system aport from
heating or A.C.
Mechanical e:llhaust
hood and duct
Residence of
SERVICES
Ouolu (I balhl each
Tomparary Construction
Addilional barh
Amps.
Water service
Sewer
Wood slo...e/healer
Star.m Se......r
feEDERS
Heat Pump
Air handl.r to
TO.OOI) CFM
Ajr handle, 0....'
10,000 CFM
Amps.
ISSUANCE OF PERMIT
TOT AL CHARGES
TOTAL CHARGES
TOTAL CHARGES
WHERE STATE lAW REQUIRES that Ih. Electrical wo,k be done by the EJe...,ical ContraCTor, the .lec~rical portion of Ihil p.rmit .hall nol b. valid unlil a
lab.1 has be.n signod by an Electrical Canlractor and attach.d to the .Iectrical panel.
I HAVE CI\.REFUllY EXAMINED Ihe completed application for permit, and do hereby cerlify that 011 information hereon is true and t:orrect, and I further
certify thai any and all work perfarmod sholl be done in at:cordcrnce wilh Ihe Ordinont:el of the City of Springfield and Ihe lows of the State of Oregon
pertaining to the work dest:riDed herin, and that NO OCCUPANCY will b. made of any structure without Ih. perm inion of the Building Di...i,ion. I furth.r
certify thai my registration with the 8uilder's Soard is in full fort:e and effect os reguired by ORS 701.055, that if uempt the basis for uemplion is noted
heron, and that only $ubcanffactors and employees whQ ore in compliance wilh ORS 701.0.55 will be used on this proj.ct.
Basis for Builder's Boord e,lll.emption:
NAME (pleaslI print)~~
E~~
u
SIGNATURE -D...~- Yl1 . ~~.ti DATE 8--'tJI-..P
FOR OFFICE USE ONLY ~
Zone ....&..-I
Fire Zone
Flood Plein
Typel Canst. 5" AI
Bedroom,
"Iorier
llnih
l"'It:cy load .
Occy Group...M::/
Sq. FIg. Mtlin
Sq. Fig. Act:"u -.!:LJjfIC:::>
Sq. ftg. Other
:II Valua
x /a C;;.5o""' Value ...!f6e:::;c>. ~
K Value
TOTAL VALUATION
r.lxe:c. COO I
BUilDING PERMIT
Charges and
Surcharges
'"3 <? -eo
/. ':?8
Plcn Clt. Comm/lnd
65%1 Bldo Pcr Fee
Plan C!t. Res
30%/ Bldq Per Fee
Systems De...elopmant
Charele f 1.S~:'\
"7. ~C>
PLUM81NG PERMIT
Chorglll and
Surchorges
Fence
Demo
TQlal Comb. Permit
'3.,. , B
ElEGRICAL PERMIT
Chorges and
Surt:hargll1
Sidewalk
Ale Pav;no
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL
11 l./2. .~
Curb Cut
.
COMBINATION A~PlICATlON/PERMIT (CAP)
I. ApplicanJ, 10 furnish
A. Job Address
B. legal Description
1. example-lox 101 100, lone County Mop Reference 17 03 43
2. example-lot 1. Block 3, 2nd Addition 10 Springfield Eslates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceiling/or forced air qas
2. exam ole-water heater/electrical/or solar
E. Square footage, or valuation, etc.
1. exomple,1250 sq. fool house, 500 sq. foot garage
2. example-if new project. check new-if addition, check
add, etc.
F. Building permit information:
1. exam ole-construct single family house with an ottoched
garage
2. example-remodel existing garagE:: into faniily room
3. example-convert single family residence into
restaurant (change of use)
G, Value of work os defined in Section 303 {a} of the
Structural Speci91ty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Division
Staff must be able to contact appropriate persons regarding
design inf~rmation or job site corrections, etc.
II. Abbreviated Plumb;ng, Mechanical & Electrical Sched~les
A: Except where.bl~nk 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 Schedule. .
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 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. Applicanlto sign and dole
Whenever possible. the iniiial application will be used os 0
worksheet only. Where possible, Building Division Slaff will
prepare 0 typewritten copy and return it to the applicant at
the time the actual permit is issued for his signaturE.
IV. Fee. and Charges
Pion check fees are due and payable at the time of the application,
and no plans will be processed until these fees ore paid. All
other fees and charges are due and payable when the permit
is issued.
.
V. FOR OFFICE USE ONLY
Permit Clerl~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,
Additional Project Information:
PLANS REVIEWED BY,
name.Le~~?l~~s;gnature ~- I~""
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PERMIT VALIDATION
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1 ~ 5 P E C T I 0 " 5 -
lNS?:Ci!C:i It-:IE
726-ji'59
1::S?EU:~:; ??OCEOURE FOR THE CITY OF SPR!r:GFIELD
BUILDI::G DI'IISle:1 346 MAW ST!;EET
I::FOR~ATIQ:I L!:IE
726-3753
YCU~ CIlY C:51G;,';TED JC3 i:LI'13ER 15: 8/11> 92.
The follO'.,dng indicJted inspections are required for your construction at 12 ~., ~t:. Y ~~c. ~",.....
It 1S the responsibility of the pennit holder to see tMt ol11 insaections are made'd! tne prop!!!'" time. tnell edcn d(](jress IS
readable frc~ the street, and that the permit card is located at the frant of the property.
D FOOTI::G ; FOU::O~TIO:I: To be
mdue ar~er trencnes dre excavated
and (oms are erected. but prior to
pouring concrete
D lJ,':DERFLCOR PLU:'i3I:;G ,~ ~!ECHANlc.:.l:
To De r.:a..e prtor ..0 lnSta llatlon of
floor inspiation or decking
D -POST & e:~~: To be made prior ~o
lnstd I lallan of floor insulation
or deckir,~
D ROUGH ?l!':~~3U:G. El~Cj~rC""L & ~~ECH-
;":11 C;'l : :.0 we rl( 1 S ~o oe cove reO
untIl t~!!:se ins;lectiens have been
made and approved
D FIREPLACE: Prior to placing fac-
In; ;.IJ,tl:rials and before frar.1ii1g
inspection
[Xl FR..:.....lI,'iG I~:SPECTtON: Must be re-
questec d~ter approval of rough
plumbing, electrical & mechanical.
All roofing, bracing & chimneys, etc.
must be cc:npleted. No work is to be 0
concealed until this inspection has I
been made and aooroveQ. _ .
D Fr::~L PLU:'~BING D FINAL ELECTRICAL
BUILDli:G H:SPECilIT:S:
D SITE l:lSPECTlO:I: To be made
arter excavatlon, but prior to set-
up of forms
n U::DERSl.;S PLU~SI:IG. ELECTRICAL &
~l~(:;;":; (~_':;L: To oe mdue oerore dny
work. 1 s covered
o
IrlSlILATlO:l/VAPOR BARR I ER lNSPEC-
n\J:l: fo oe mewe cHter all lnsula-
tlon and required vapor barriers are
in place but before any lath, gypsum
board or wall covering is JPplied.
and before any insulation is con-
ceal ed
o
WODDSTOVES:
completed
After installation is
o
DRY1,.iALL r~SP~CTiO:l;
after 41 I drywail is
pri or to any tapi ng
To be made
in place, but
SPEC I AL IrlSPECTlQ:!S: When re-
qUlreo by DU110lng Code. speCial
inspector to be present when work
is in progress. ^ copy of the
special testing report to be ..
furnished to the Building Division
D
D
D
Structural Concrete:
3000 P.S.I..
In ex~ess of
o
H.~SO:lRY: S tee 1 1 oca t i on. bond
beams. grouting or verticals in ac-
cordance with U.S.C. Section 2415
Structural Welds:
the job
Performed on
o
D
o
D
FIRE & SEP~RATIO:I WALL: Located
& constructec' accorotng to plans
ATTIC DR~FT STOPS:
ROOF SHEATHmG ';;10 r:AIL!NG:
to lnstalling any rooTlng
Prior
Glu-lam Beams: Inscectioo certi fica
(by approved agency) supplied to Bui
ing Division befo~e beams are placec
SIDEw~lK & DRIVE:-IAY: Required for
al I concrete pavIng within street
risht-of-\'/JY, to be r.;ade after all
excavating complete & fcrm'work &
sub-base material in place
D
Fire Retardant Roofing:
1ation
Before lost
o
CURS AND ~PP!;OACH APRON: After
toms are erectea out prior to
;ng concrete '
POUI'-
'OTHER lIISPECTlO:IS: May be
in accorcance with Building
be indicated in plans or by
fro~ Building Inspector
required
Code. to
not ice
SEWER. WATER & ORAWAGE LINES:
IJrlor t.n Tllllna 1n trencnes
o
o
FWAL FIRE OEPARTMElf
FINAL MECHANICAL
SIGI5-Your Job # is:
D
o
o
o
Site/Location
Footing or Method of Attachment
Electdcal
<:)Rou9h <:)Final
Final - After Installation is com-
pleted
All project conditions. such as the installation of street trees, completion of the requlred landscaping. etc..
must be satisfied before the BUIlOIilG FINAL can be requested.
D Co~struction projects that required approval by the City's Site Plan Review Board shall be inspected by the Review Board
before requesting a final building inspection. Requests for inspection by the Site Plan Review Board must be made 2 days
in advance of the date you wish inspection.
~ FWAl BUIlOHiG: The Final Building Inspection must be requested after the Final Plumbing, Electrical: and Mechanical'
Inspections have been made and approved.
No occu~ancy of the premises can be made until the Final Building Inspection has been made and approved. and a
CERTIFICATE OF OCCUP~:ICY HAS BWI ISSUED BY THE BUILD!1:G DIVISION AND POSTED ON THE PREIHSES.
Signatur~: 04.1A _ 'YY'I, l!:~ Phone: 7~~ - .5.:$ 71 Date: 8 -.;l4l- f? I
t1JBlLE H(1.ES-Your Job # is:
c==J B10Cking~Setup
c==J Plumbing conn~ctions
Sewer and Water
c==J Electrical Connection
From Service to Mobile Home
~ Electrical se~vice
Pedistal
~ Accessory Building - May require
Inspection as Buildings - See Build-
ina. Insoections Above .
~ Final - After Porches, Skirting. Decks,
etc. are completed
:)lgncHure
Date
SlgnJ",ure
Ddte
OTHER-Your Job' is:
o
o
Fence ~ When Completed
Demolition - When Complete
-I
S\gn<3ture
Date
BU:!..Dr::~ aIVIS!C:; :'PP~TJED PL':':IS SH:'Ll R~}l';I:: 0:/ THE BUIl:;!::u SITE AT :'LL TI:1ES. A:/O ALL WORK NUST BE CO:.1PLETEO IN
ACC:;\iJ':','iC! ',./ITH THOSE ~PPRO\'EO PlA,'jS.
NOTE: All ~anholes and cleanouts are to be adjusted at no cost to the City.
P?OC~~::::(': FC~ I~;SPECTTO;I R~CU::Sj - Call 725-3759 (reccrcer) state your City designated jOb number. jOb address. type
OJ lns~eC:lcn re-:::.o~st~o dOl] Ivoeo you will be redcy for ;nspeCi,ion. Contrdctors or (hwners ndme and phone nUr.lbers.
Requests received =efore 7:00 a.m. ~;11 be ~ade tr.e Sdme cay, requests ~dde after 7:00 a.m. will be made the next
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816S3~
CITY OF SPRINGFIELD--BUILDING DIVISION
346 MAIN ST. 726-3753 (BUSINESS) 726-3769 (INSPECTIONS)
APPLICATION FOR ELECTRICAL LABEL(S) BY A BUILDING OWNER
The Electrical Safety Law of the State of Oregon does not require a person to obtain
a license as an electrician and/or electrical contractor to make an electrician in-
stallation on property which is owned by himself or a member of his immediate family
which is not intended for sale, lease, or rent.
(PLEASE PRINT)
APPLICANT'S NAHE ~ ~ \:.... f n G L \ ~ ~
ADDRESS \ 8 "l{ . (~l ~ P If' ) PHONE
ADDRESS FOR PROPOSED WORK \j ~l mo.
r'JU (0-551 {
BUILDING OWNER (IF OTHER THAN APPLICANT)
ADDRESS
PHONE
,1-03-;16-'11
I certify that all of the above information is true and correct, and that no portion/~~~
of any wiring system requiring a label as applied for herein and intended to be con-
'. . cealed by any permanent portion of the building or structure shall be concealed until
inspected and approved. When the installation of the system is complete, an additional
and final inspection shall be made.
Inspections are generally required for at least the following conditions and or stages
of construction:
1- Temporary Service 4'. Rough Electric 7. Mobile Home
2. Underground Service 5. Cable Heat Connections
3. Service 6. New Circuits or 8. Signs
Extensions 9. Swimming Pools
I further certify that I will notify the Building Division when any of the above ELEC-
TRICAL INSPECTIONS are ready, that all work will be done in accordance with the Electri-
cal Safety Law of the State of Oregon, and that if not the building owner,. I am a member
of his or her immediate family.
,s~~nature~ /n. ~~
Date Jt/~ Jb ~ g/
INSPECTION REQUESTS SHOULD BE' MADE ON THE
LINE. THE INSPECTION NUMBER IS 726-3769.
FOR 7 A.M. WILL BE MADE ON THE SAME DAY.
BUILDING DIVISION'S 24 HOUR A DAY INSPECTION
INSPECTION REQUESTS WHICH ARE CALLED IN BE-
FOR OFFICE USE ONLY
-----------------~-f-l----------------------------------------------------------------.--
LABEL NUMBERS ()/-V 1\:5 A LABEL ISSUANCE FEE L/ r 60
RECEIVED BY (~ (/)0 ) DAT3 / ()--'- j ! f:1 .. 8/
5, L.{ 5 '2...
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-.., 60
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INSPECTION LINE
72t.-J769
CITY Of SPlllNGflElD
COMBINATION APPLICATION! PERMIT
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lNFORMAJlOH LINE
716-.1153
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Job.dd,... k.:l'7<? .o/f~'~r(...;jJ,
~ )7'()~I'':l((. V I .7:(..
~ ~1~H1'h'4~7C:
I Own,,;>n -X' E~ rf
I '~d,,,, !..::> 7</ be"l7i__,rJ:'(;
1~~.pkJ. ,,1i?r/'c;:fr"-;7
I CO"Irryctiotl lender
I Add,e"
I DESIGN TEAM
I Primo'.,
I StrUClural
I Sq, "g. Mo;n ~8~
Sq, fIg. "((ltn, --'
I Sq. fIg, Other -,
! ){New__Add _Alter_Rep.
I' . ._hnCII_Oemo_ChongeiU1lt
._ t.j f!St!::>c::> 0'" _Olh"
,+01 /1 od~' ' . I
. " _ /~ ..[1-'... Buildinq Permll In{o: De1Cribll War.. ti,l!., Build Sin91e
Ph~~ -,::~."".:')'":7.- F::m,l., Re"dl"nc.. With Attached C~C1.Qlll
, -- , '7~~~r -S7Cfl"'~tE $V.-z>'
IN If~*~ -F #~c:;.>.5'~ 20')1 2<<;'-
('. "/'
-\"-:-i 1rJ---
/2~OC
ENERGY SOURCES:
Heal
Water HeaUH
ROil'll! -
Value or Worlt:
Phone
(nome;
(oddren)
(Bu. no,)
(e,ll;pirlll'
(phone no,)
Electrical
Mecho"icol
f:c I CHARGE NO
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lCHARGF;
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CONT~ACTCRS
(nom~l
(addr~ul
(lies. no.}
(eKpir.,)
/oho"e no.l
Gp"eroi
Plumbi....,
Electrical
Methanicol
?LUM8INC
ELECTRICAL
MECHANICAL
NO. I
,-
FEE CHARGE NO.
furnace I burn.' to
aTU'1
Applionco ...ant
Hporoto
Stationori' ....op.
coole'
Vent fon with
sin~llt duct
Vent system aport from
hlltoti~g or A.C.
Mechanical .:lIheyst
hood and duet
Residence of
Eeen \inq1e l';"tur.
RollocOI.d building
(new fi... odditionoU
S.F. Roe"d."~.
(1 bOlhl
Sq: ft,
New circuits. alr.ratiotls
or eAtllnsions
SERVICES
Storm Se.....r
FEEOERS
Heat Pum,.)
Air handl., to
10.COJ CFM
Air hondl., 0''-''
10.000 CFM
,
1
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01,1010'1( n boln) pach
Temporor>/ Conl'ruetio"
Additionol bOln
Amps.
Waler ,.rvice
Sewe,
Wood sto..../hIlOlet
Amos.
,
I
-,
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I TOTAL CHARGES
I
ISSUANCE OF PERMIT
TOTAL CHARGES
TOTAL CHARGES
WHERE STATE lAW REOUIRES rhat the Electrical work b. don. by tho E'."'ricol Contractor, the electrical porlion o' this pe,mit .ball not b. valid until 0
lab.1 hot been ~ig"ed by. an Eleerrical Conrranor and atta<hed to th. electrical panel.
I HAVE CA;.REFUllY EXAMINED Ihe completed application for permit, and do he,.by certify that all information h.reon it Ir"e and corr.ct, and I furthe'
c~rtify lhal any and all work pe,farmed sholl b.. don. in accordance wilh Ihe Ordinance. of the City of Sp,ingfield and the la...... of the Stat. of Oregon
p.rtaining 10 th~ work d."rio.Q hel,in, and that NO OCCUPANCY will b. made of any .t,ucture without the pe,miuian of tho Building Divhion. I furlher
alrtify thol my rogist'l"otion with the Builder's Board is in full force and effect 01 required by ORS 701.0.5.5, Ihal if exempt the basi, for eumplion is noted
h.ran, and that only subcontraclars and employ..~ who ore in camplionc:. wilh ORS 701.0.'55 will b. used on Ihis project,
Bosis for Builder', Boord eJl.emptian:
~ SIGN.TURE -04,wolL Y\1
fOR OffiCE USE ONLY
,
I
~<<4AJ?'~ om~~-2i'
pI 1
NAME (please p,in,)
u
CIa,;",
Units
ncey load
.....eey G,oup.JtJ::/
Sq. Fig. M~jn
Sq. FIg. Acce" ~c:>
Sq. Ftg. Oth.,
Volue I
x /0"'- Value ...!tJ:fCJC:>.. ~ ~
x Volue .
TOTAL VAlUATlON~t::f:!).. CloG,
Zone -K:=..'
Fire Zone
Flood Plain
Type/Const, '1Z:'."..A,/
Bedrooms
ElECTinCAl PE;t~IT
Cha,q., and
S...,c;,a,q.s
f.,J ~ r'o...ino
I~. s-~y .8/
I ~.~C>
I
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I SYITerns De.,~lapmenl
Charqe (1.5%\
BUilDING P!:RM1T
Cho''Jes and
SutCho'ges
~ Z 0.60 Plan Ck. Camm/lnd
___~_"____~;,/Bld':tP(lr Fee
Plcn Ck. Res
:!O~:'I Brdq Per F~e
/.,:\,&
PLUMBING peRMIT
Chotge, ond
SutCno'g.,
FenCl!
Demo
TOlal Comb. Permit
~3.<S
I TOTAL
I
I
tJ '1'Z. ..5'8
MECHA.NICAl PERMIT
Cho'a.. and
S..,cna'gltl
I
I
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~-------
I
Sidewoik
Cvtb Cui
Fees and Charges
PIon check fees are d,,:,e and poyable at the time of the OV..ml,.UIIUn, .
and no plans will be processed until these fees ore paid. All
other fees and charges are due and payable when the permit
is issued.
COMBINATION APPLlCATlOJllRMIT (CAP)
I. Applica~ to furnish
A. Job Address
B. legal Description
1. exomole,tax lot 100, lane County Map Refere
2. examole,lot I. Block 3. 2nd Addition to Spring!
C. Name. elc. of owner and construction lender
D. Energy Sources
1. examole-heat/electrical ceiling/or forced air qc
2. exomole.woter heater/ electrical/or ~
E... Square footage, or valuation. etc.
1. examole. ~ sq. foat house. 500 sq. foat gara'
2. example-if new project, check new-if addition, (
add. etc.
F. Building permit.. information:
1. examole-construct single family house with an c
garage
2. exam ole-remodel existing garag~ into family ro
3. example-convert single family residence into
restaurant (change of use)
G, Value af work as defined in Sectian 303 (a) of the
Structural Specialty Cede
H. DESIGN TEAM AND CONTRACTORS
To avoid design:or construction delays, Building Di..-
Stoff must be able to contact appropriate persons rE
design inf~rmotion or job site corrections, etc.
II. Abbreviated Plumbing, Mechanical & Electrical Sched~1
A: Except where.blcnk spaces occur in the description F
of the Mechanical and Electrical Schedules, the appl
need fill-in only the No. Boxes adjacent to the apprc
item(s) to be installed
B. Full Plumoing, Mechanical, and Electrical Schedules
ore available at the Building Division .
1. T a con!:.erve space on the permit form the scnedul
hove been abbreviated
2. If the item(s) to be installed ore not covered on th
oted schedule~ you should consult the fuil schedul
C. 3UllDING DIVISION STAFF Will Fill OUT All FEES />
CHARGES ON THE SCHEDULES
III. Applicant 10 sign and date
Whenever possible. the initial application will be used 0
worksheet only. Where possible, Building Division Stoff .
prepare a typewrirten copy and return it to the applican
the time the octual permit is issued for his signaturE.
IV.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Infarmation:
PLANS REVIEWED BY,
name / ""JT~ ~~~SjgnaIUro
~-
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PERMIT VALIDATION
'oj F
CITY OF SPRINGFIELD'
City Hall
Springfield, Oregan
Department of Public Works
OFFICIAL RECEIPT
N B 1'"711.13
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Date Au::.L-':iI.
Rec'd Fram AtA-
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(!::~C-. F.../ 5/~
Address 1'2'/'7 D, Y'/??l'>/ c.
Sr.
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Received For:
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bE.r;z::. 9-16S-8-2
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Amount Received 7' ..::::> ~
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I ~> - ...UTHOIIll.ED SlGN"'T~[- (
S"~LTO".TU"".uLl ~.I..T~.S . [UQ["[. O. .,.ell 1111l'1 \..
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