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Home My WebLink AboutPermit Building 1984-11-1 I I INSPECTION LINE 726-3769 Job Address .of ) 'f!;() .l0 ~,4 f'<\ (\H'\ , Legal Description \\(}.~?~~ \[)),"l(jlj Owner /')1'\ 1'~, ~f r I e ~ llim AddreSr\J()8')~(t J , m n'( f\Phone cons~ltl;2\ \ '- ,1Jill, ) Cl"L\ \l . CITY U~ SPRINGFIELD. INFORllATION LINt COMBINATION APPLICATION/PERMIT 726-3753 EilERGY SOURCES: Sq. Ftq. 1.lain Heat ~q. ~tg. Access. Water Heater Sq. Ftg. Other New Add Alter Rep. Range Fence_Oemo_Change/Use Va 1 UE of \lor(\[)CJ ,Cf::J _Other Builriina Permit Info: Describe Work(l~e., Build Single Familv nesidence With Attached Garaoe) l 9. f\ \ ()j\_C) 9--- \ \ Q~ . (\. ~. 0 &s/... ~ ::1 ~ Address Dt> I uN TEAI1 (name) Phone (address) (lics.no.l (exniresl (ohane no. I Primary Structural Electrical Heehan; ca 1 CONTRACTORS Inamel General E.m\YI0 \\ \, \til Plumbina raddres, (1ic~. n.o.) (exo;rpd n.O fit> fnQ (m \. '\v'\ ~'\ ) S). 'f\[', . ~U,?\Q'\ 0, \\~_NLf\~ f\ J P. \-4 ' (ohnnp t1.n..l fl4,lty 71~: Electrical M%h~ni,=~l PLUIIBING ELECTRICAL MECHAN I CAL NO. Each single fixture FFF r"ARr.F Nn Residence of SQ. FT. 1 New circuits alts. or extensions SERVICES ~~~ r~~ Nn >>> IJ:IJAIlllE. furnace/burner to BTU's Relocated building (new fix. additional) S.F. Residence (] bath\ -----louPlex (1 bath) each lAdditional bath I Wa ter servi ce Sewer I +- I Floor furnace and vent Recessed wall ~n~~p hp~tpr ~nrl v~nt Storm Sewer Temporary Construction Change in existing rp<;. j dp..m"p Imultifamily. comm. or Tnrluc:.t.rial IOf amps,1 I COMl.1.IIND. FEEDERS [Install/alter/relocate rlic:.t.rih_ fppdprc:. [Of amps.1 Appliance vent <;.poaratp Stationary evap. cooler Vent fan wi th sinale duct Vent system apart from I heatino or A.C. Mechanical exhaust hnod and r1urt. Wood stove/heater , c.ffij f\ Xoo I ISSUANC, OF PFRrllT TOTAL CHARGES TOTAL CHARGES \(')()C> TOTAL CHARGES WHERE STATE L'l~ REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXN1INED 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 rm OCCUPAUCY 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 :::,:(::::::t:::::~s~:~~m~oY~~(~:~~e ~ compliance with :::II:::~:55~~e\\~~::ct~~_ DATE I! ~I ,k~ . . FO~ OFFICE USE OilL Y \. '\. - r \ I ,. \J ') .,'::-:l Zone '" _ '-- Type/Const. - I'\. Units Sq. Ftg. r1ain Bedrooms Occy Load Sq. Ft~. Access Stories Occy Group \.-")V _ Sq. Ftg. Other x Value Value Value Fire Zone x Flood Plain x BUILDING PERflIT Charges and Surcharges . Ie) I'V\ . --- ...:~-- .4( ') Plan Ck. 65%/Bldo Plan Ck. 30%/B1do CorrrnlI nd PM' Fpp Res Per Fee TOTAL VALUATlON \ In( D = Systems Development CharQe (].5~) . PLUr~BING PERMIT Charges and Surcha rges Fence O~mo ELECTRICAL PERI:IT Cha rges and Surcharges _ _lC2t- C'{'\ _ JSidewa 1 k ~(\ I A/C Paving I Curb Cut nuu______1 Total Comb. rermit 11ECHANICAL PERMIT Charges and Surcharges I I TOTAL c9(}'&0 J . '. COMBINATION AP~LICATION/PERMIT (CAP) J. Appl icant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 17 03 43 2. example- Lot 1. 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. examflle- waterheater/electrical/or solar E. Square footage or valuation, etc. - 1. example- 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. exam~le - construct single family house with an attached gar~ge 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. 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 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: . . PERMIT VALIDATION nLY 4- -1 Ii') ,6 lo ~r[q 'S Permi t I Cloc,dxM / ~ Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date . BUIL[lING [IIVISION JOB~ .787 FINAL -A[I[lRESS- -LEGAL- 2050 OLYMPIC ST LOT BLOCI, [IESCRIENLARGE RETAIL AREA 1703253107700 -OWNER- -ENERGY- STU'S LOC"ER RODli HEAT1- 2- 2050 OL YliPIC STREET H20- SPRINGFIEL[I, OREGON 97477 RANGE- -VALUE- 1000 - I1~FO- REPAlli: CDliliERCI AL 5300 851127 841102 / -STATS- BL[lG ZONE CC STORIES FIRE ZONE BE[lRM FLOO[lPLAIN N UNITS VN SQ FEET B2 -[IESIGt~ TEAM- PR 111- ST/E- EL/E- Pl1/E- -CONTRACTORS- GENL-Eli1iANUEL PLliB- ELECT- 11ECH- SEQ-REQUIRE[I PERMITS------FEE---SURCHARGE-[IATE-RECEIPT---PERMIT~------VALUE--- 001-002-BUIL[lING PERMIT 10.00 002-004-ELECTRICAL 10.00 0.40 841101 63795 0.40 841101 63795 1.000 o SEQ-MINIMUM INSPECTIONS + REQUIREMENTS--------------------EXP [IATE---ACT [IATE- 001-042-ROUGH ELECTRIC 002-006-FRM1ING 003-009-INSULATION 004-049-FINAL ELECTRICAL 005-019-FINAL BUIL[lING 841101 SEQ--INSPECTIONS-------COMMENTS--------------------------[IATE----RESULT--INSP--- 001-019-FINAL BUIL[lING PROGRESSIVE FINAL 851127 Cl~I 10 \