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Home My WebLink AboutPermit Building 1980-11-5 I INSPECTION L1IIE . CITY Uf SPRINGFIELD . 726-3769 COMBINATION APPLlCATION/PERMrT Job A.iires;;-"'\ \ ~~ \:'r.d\. 'ilo:1:\.9--- ~~;~GY SDURCES~ Legal Description 7 CJJ, 1'/0'32.7 '7..2- .~ INFDRlIATIDN LINE ~.', 726-3753 Sq. Ftg. /.Iain . ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. Fence_Demo_Change/Use _ J? J I ~JI.1Tb " Owner~(~~ (') \ A.C:C,"\lX D "- Address \ \ n~ ()n ^ Q12,fllL Phone Y] L.J (0 lof'Y)q Valu, of l-Iork:(\JA BUildina Penmit Info: Describe Work(i~e.. Build Single Famil v Res; dence l'ii th .A,ttached Ga raQe) ,-~.NI\ oQ. ri l. f\t\(J-...'J('J .l"l.hu fL --- Construction lender Address Ot~IGlI ItAII (name) Phone (address) '1 ,,'fY><<1fY[ 11 .f)O li!'J.t f'(), Ilics. nolt (exnires) (phone nO.'J Primary Structura 1 Electrical !1echan i ca 1 CDtITRACTORS (name) (address) (1;c<;. no.' (exn;res) (nhonf> no.) Genera 1 Plumbina ~Q....f..- Elect rica 1 --.A o...u nJ2.A-... "~chanical SERVICES Recessed wa 11 So~rp ~p~tpr ~nrl Vl'>rlt l 1.HL..cI!AB.liE I I I I I PLOIIBIrlG ELECTRICAL MECHANICAL ;,'Q. ! lEaCh single fixture I Relocated buildinQ . (new fix. additional) IS.F. Residence (1 bath) IDuPlex (1 bath) each Additional bath FEE CHARGE NO ':J:L.I J1lARG.E. no , SQ. FT. furnace/burner to BTU's Residence of New circuits alts. or extensions Floor furnace and vent - Sewer Temporary Construction Change in existing rpside.nrp multifamily. comm. or Industrial Of amps.1 COI~I'I.II NO. FEEDERS I Install/alter/relocate I distrih. fep.ders I Appl iance vent c;,eoarate I Stationary evap. cooler I Vent fan with sinale duct I Vent system apart heatina or A.C. Mechanical exhaust hnon and duct Wood stove/heater from Hater service Storm Sewer Of amps.1 ISSUANCE OF PFRI11T TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be vali~ until the TOTAL CHARGES TOTAL CHARGES that the Electrical \...ork be done by an Electrical Contractor. the electrical rortion of this permit 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 Ore~on pertaining to the work described herein. and that rlo 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 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 7nl.055 will be used on this project. IWIE(please print) It, OWl Ct 5 R, (A) a I j{fr" Zone Fi re Zone Flood Plain Tyee/Const. Bedrooms Stories Units Occy Load Dccy Group SIGil^TURE~Lat~- J~~/,,}.r." I~.,I FO~ OFFICE USE O;ILY Sq. Ftg. riain x Sq. Ftg. Access x Sq. Ftg. Other x DATE Il~ 5 -fln Value Value Value TOTAL V ALUA TI ON BUILDING PERmT Charges an': Surcharges Plan Ck. Comm/Ind 65X/Blda Ppr Fpp --------------p;an Ck. Res 30%/Blda Per Fee 'Systems Development Charae (1.5%1 11ECHANICAL PERMIT Charges and Surcharges h. 00 ---~~------ ~O _<!;JS'-.c?_CJ___ 'Sidewalk I. c.J U I A/C Paving I Curb Cut I Fence PLUI1BING PERI~IT Charges and Surcharges ELEt'rRICAL PERr:IT I ,Cha rges and P Surcharges Demo ~i.CCAq~ I ~ .Q(') Total Comb. Permit I TOTAL I-~l ,LlO , . .-.-. . .,'-,';' , . ,.". '.i, COMBINATION APPLICATION/PERMIT (CAP) m I. Applicant to furnish A, Job Address B, Legal Description 1. examDle- Tax lot 100,. Lane County Map Reference 17 03 43 2. examole- Lot 1. Block 3, 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinQ/or forced air qas 2. examole- \'Jaterheater/electnca(/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project, ch~ck-new - if addition, check. add. etc. F. Bui ldir.g permit information: 1. example - construct single family house with an attached garage 2. examole - remodel 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, DESIGi~ TEAr-I AND CONTRACTORS To avoid design or-construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or jab site corrections, etc. II. Abbreviated Plumbing, Mechanical, & Electrical Schedules A. :xcept 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 Piumbing, 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, BUILDliiG DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES 011 THE SCHEDULES D. As noted on the CAP, the label must be delivered to the electrical contractor for signature by his electrical suoervisor. 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 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 " .i." PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . I . 1 1 1 i . , . , i ~ PERMIT VALIDATION Permit Clerk 'I . Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date ~ "...... " " " . .;, " \: LeIJa 1 Oescri pt i on . - CITY UF SPRI1IGFIELD C0I1BlilATlON APPLICATION/PERMIT ,,_ EilERGY SOURCES: ........-- \ _ I J.. 1\ CLo 'C\.Sl.--.-- Hea t ~ ."'.'1....,:=.. ~'!ater~, '~r; . .~ ~-_..-~ ~ Valu, of Hor~:i\JA BuilcHna Permit Info: Describe t-Iork(Le.. Build Single Familv nesidence l'lith J1.ttached r.itraae) ,~.rW\ 0<:), ri l. f'\\\r .l'Jr1l1}) Q fL .-/ . INFORlIATlDN LlIlt 726-3753 Sq, Ftq, 1.lain . ~Cl. FtiJ. Access. Sq. Ftg. Other New Add Alter ~ep. Fence_Demo _Change/Use c....::!...)TI;1 _'" ~ \......J tl? 'D I IrISPECTlDII LIIIE 726-376g Job Addi-ess -., \ ~'::::!. Owner\S(-;-~" f':"', \ ...."y..,LXQ Address \ \()~ f:'1n ^ 0 Qjl Q_ r')GJ(o Id'y')q Phone Construction Lender Address Ul:.:iU;iH rl:.N1 (name) Phone (address) 'l ,,'!Y)t0 rn () J:) 0 Ii 11.1 f'l () (lies. nolf (exoires) (ohoneno.l PrimJry Structural Electrical. . ~~echdnica I CC:;TR....Ci'0RS {:lr.~e I (address) (l ics. no. \ (pxoires) (ohnnp nn \ Genera 1 ?l"",oina ~Ol...L)(\Q.A- "ee:riea! ,~Cu...::>n~ "~,:;":!.~ical ?LU::BIr:G ELECTR!ChL 11ECHArllCAL i EdCn singie fixture FEE . CHf.Rr.E ~Jn C'~C' I r~AIU~;: I r:o ! Residence 'of I furnace/burner to SO, FT, BTlI's I C';:r: I rltAOr.;; :?elocateo :uildinQ I (new fix. JCditlonal) I S.F. Residence (] bath I Duplex (1 bath) each New circuits alts. or extensions Floor furnace and vent SERvrCES Recessed wall Snace heatpr and Vl"nt Sewer !Storm Sewpr Of amps. Appl iance vent ,,;poaratp Stationarv evao. cooler ~ . Vent fan with sinole duct Vent system apart from heatino or A.C. Mechanical exhaust hood itnd duct I ~'lood stove/heater Additional bath Temporary Construction Change in existing rf'''; i d\."nc:p multifamily, COITU11. or fnrlu<;triill~ ~!ater serv i ce COf1H,/fIlD. FEEDERS Install/alter/relocate r1istrih_ f~erlers Of amps. TOTAL CHARGES I'HEnE STATE L.\I' REDUIRES shall not be vali~ until the TOTAL CHARGES ISSUANCE OF' PFR'HT TOTAL CHARGES that tile Electrical work be done by an Electrical Contractor, the electrical portion of this permit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXA~IINED the completed aprlication for ~ermit, and do hereby certify that all information hereon is true and correct. and I further certify that any and all work oerforrr.ed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Ore(]on pertaining to the work described herein. and that rlO OCCUPArJCY will be made of any structure without the permission of ~he Building Division. I further certify that my regist~ation with the Builder's Board is in full force and effect as 'required by ORS 701.055, that if exemot the basis for exemption is noted hereon. and that only subcontractors and er:mloyees \...ho are in compliance with O~S 701.055 \'1111 be used on this rroject. NAI.IE (p lease print) -n, cHM ~( 5 R, G):,! KlJ r SH~jj^TURE 7./--- .L/ ,p /~ ),1 l,/oJ DATE //... 5 -~" FO~ OFFICE USE Dill, Zone Type/Canst. Units Sq. Ftg, Hain x Value Fire Zone Bedrooms Occy load Sq. Ftg. Access x Value Flood Plain Stories Occy Group Sq. Ftg, Other x Value TOTAL VALUATlOII BUILDIIlG PERI.IlT Charges an~ Surcharges Plan Ck. Comm/lnd 65!/Blda Ppr Fpp ------------ Plan Ck. Res 30%/Bldo Per Fee ,5 00 'Fence --- ))-()---- Domo _ J:)s.'-C?_c:__~S;dewa I k 1.0 U AIC Paving Isyste~s Development Charae (l.5r,1 I I JLCO=tC\ \-\ i .Qc') PLUI~BING PERI11T Cha rges and Surcharges .- , ELECTRICAL PERI:IT jjCharges and Surcharges IIECHAN I CAL PERM IT Charges and Surcnarges Total Comb. rermit Curb Cut I TOTAL "QlLjO . ..... ~,_ I . , . , .l'~ " . COI:BINATION .~PPLlCATION/PERMIT (CAP) ~ n ~ j j I I. Applicant to furnish A. Job Address B. Legal Description 1. examole- Tax Lot 100. Lane County Map Reference -17 03 43 2. examole- Lot I. Block 3. 2nd Addition to Sprlngtield Estates C. :lame, etc. of owner and construction lender O. Energy Sources 1. exa~Dle- heat/electrical ceilinq/or forced air cas 2. eX~~Dle. waterheater/electrlcal/or solar E. Square t-ootage or valuation, etc. - I. examole- 1250 sq. foot house. 500 sq. foot garage 2. examole- if new project. ch':!ck nel" - if addition, . cneclo:. add. etc. F. Buil.::1ir.g pernit information: 1. exel7:ple - construct single family house with dn a. nJcnea gar~ge 2. eXd~c]e - remodel existing garage into famiiy room 3. eXdffiole - convert single family residence into restaurant (change of use) G. Value of work as defined in Section.3D3 (3) of the Structural Soecialty Code H, DESIG:i TEAi.; AiID CDrITRACTORS To avoid design or.construction delays. Building aivisio~ Staff ~ust be able to contact appropriate persons regarding design information' or job site corrections. etc. II. Abbreviatea Plurr:bing, j'lechanical. & Electrical Schedules A. ~xceDt where blank spaces occur in the descriPtion ::r:ion or tr.e Mechanical and Electrical Schedules. the aoplicant need fill-in only the No. 'Boxes adjacent :0 :ne aODropriate item(s} to be installed B. full Pi~~bing. ~echanical. and Electrical Schedules are available at the Building Division 1. 70 conserve saace on the permit form the schedules have been abbreviated 2. .:f the item(s) to be installed are not covered on :he abbreviated schedules you should consult the full scnedules C. BUILDI;:G DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES 0:1 THE SCHEDULES D. As noted on the CAP. the label must be delivered to the electrical contractor for signature by his electrical suoer~isor. The general contractor is .not authorized to s10n the electrical label. - III. Applicant-to sign and date Whenever possible. the initial application will be used as a worksheet oniy. Where possible, Building Division Staff will preoare a type written copy and return it to the applican~ at the time the actual penmit is issued for his signature. IV. Fees and Charges Plan cneck 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 penmit is issued. I j I v. FOR OFFICE USE ONLY ._ - ,_ .. I .", ".......~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: I 1 PERi.IIT VAll DATION l:ITY OF SPRI NGFI ELD ( City Hall Spr{nglield. Oregon Depa~rl ent 01 Public Work. OFF CIAL RECEIPT No. B \\ -"') 19 (30 /. From m{;rr(} .D \ J...'ti~, () ro h -ess \ \ ~~ r'l ~"1\ Q () DO ( 55099( ( , <' ! ~ ived '- X::1__J\\5C1 \ Wo For: ( ::5.00 ,0)0 ( 1 I 1 ( d)~ '. 0f)pO ~h) 1,00 ( cO OfYf1Q ~:!l () ( (',r -( ( ,.."., (. ( unl Received <..~1 " 4( )- Rv, ft. "'U)Io<O,,'Z(O SIGN"'TU.-E ~ ...ILTO....U.....ULL .......a.... IUGI..I 0" ....0' Pern;it Clerk g ~ " -. ,Permit applicant exempt from registration with the Builder's Board because: " I I Additional Project Information: i,'.I. PLANS REVIEWED BY: name signature I . '>; '~ date