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Home My WebLink AboutPermit Sewer Connection Record 1981-4-8 ~~---., . INSPECTION LINE 726-3769 . - . CITY Of SPRINGFielD COMBINATION APPLICATION/PERMIT INFORMATION LINE 726-3753 ..) ;:b Add,o.. U2:1 cu..;; ~ r1 Il09al Do",'~~_11 () ~ ~4 2 4 I "l'A.....L..D\. '2..01 n _ k' U .h ru 1"'1 r/.. l)('\~'h'v\ 0 ! It "S L\ \J-trl -tY\ PrYYj Ph:~oll.ill.n - n~s;g' . ~ rl 0)0 oSAfri.? ' Conuruction Lender \ ) . I ENERGY SOURCES: )~j. Heat Water Heater Ranqe Value of Work: ! Sq. Ftg. Main; Sq. Ftg. Accin~. Sq. ftg. Other _New._Add_Altor _R~p. __Fence__Domo_Change/ Use __Other, ::xl. ~p UOA -l- r ,F'rY\ ,VI n rA)./TYIJ fn", " c 9; ...r:: I~ I ,/ c:;; "Owner Addren Building Permit Info: Describe Work (i.e.. Build Single Familv Residencp. With Attached Garaoe) Addren Phone DESIGN TEAM (nomel (addren) (lics. no.) (expire,) (phone no.) Primary ", Structural Electrical Mechanical CONTRACTORS (name) (address) ~ 0""01 Qn r"\ \ U AD ho. m fl (rtI~ 1 Plumbing (Iic,. no.) (expires) (phone no.) Electrical Mechanical PLUMBING ELECTRICAL MECHANICAL NO. FEE . CHARGE NO.' FEE 'CHARGE NO. 1 FEE . CHARGE Residence of furnace/burner to "TU's Appliance vent separate Stationary evap. cooler Vent fan with s1n910 duct Vent systom apart from heating or A.C. Mechanical ollhaust hood and duct Each sinqle fixture Relocated building (new fix. additional) S.F. Residence (I both) ..,:ft. Hew circuits, alterations or extensions SERVICES Dual.... (1 both) each Temporary Construction Additional both Amps. Water service Sewer Wood stove/heater Storm Sew!!'r FEEDERS Heat Pump Air handler to 10.000 CFM Air handler over 10.000 CFM Amps. r I TOTAL CHARGES I ISSUANCE OF PERMIT TOT At CHARGES TOT At CHARGES WHERE STATE LAW REQUIRES that the Electrical work be dono by the Electrical Contractor, the electrical portion of Ihis permit ,hall not be valid until a label has been signed by on Electrical Contractor and attached 10 tho .Iectricol panel. I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon i, true and COrrect, and I further certify that any and all worl.: porformod sholl be dano in accordanco with the Ordinances of the City of Springfield and tho laws of the Slate of Orogon pertaining to the work. described horin, and that NO OCCUPANCY will be made of any structure without the permission of tho, Building Division. I furthor certify that my regill'Talion with the Builder's Soard isin full force and effect os required by ORS 701.055. that if exempt tho binis for exemption i,' noted he,an, and tho. only ,ub"'nt'a<l.n a~d employ... Wh;r;1/.n.lJt/-camPliasn,."'O.NWATituhROE RS 701.~055 W~'/l1 be used7n th~;~S pro'. I. Basis for Builder's Soard exemption: J I.. ! NAME (ploa,e p"nll ~ I cH/JI.,O ). _." DATE ..!1l1:,LP'1 FOR OFFICE USE ONLY -- Zone Fire ZOne Flood Plain Type/Canst. Bedrooms C:tarie- Units rlccy load -'Jccy Group Sq. FIg. Main Sq. Ftg. Access Sq. Ftg. Other value. Valuo Value TOTAL VALUATION . x BUILDING PERMIT Charges and Surcharges I I /0. 00 I .40 PIon Ck. Comm/lnd 65%/Bldq Per Fee Plan Ck. Res 30%/ BldCl Per Fee Systems Development Charae /1.5%1 . ~olllon(f\nn Demo Total Comb. Permit } ()O'CX) I I I I &\ 110,YO I PLUMBING PERMIT Charges and Surcharges Fence ElECTRICAL PERMIT Charges and Surcharge, Sidewalk Alc Pavino MECHANICAL PERMIT Charges and Surcharge, Curb Cut I I TOTAL ~~ E\ .:.....__.1... .:.....\.> '. , ~,-~ COMBINATION APPLlCA T10N/PERMlreAP) l 1. Applica~ to furnish A. Jab 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 Springfield Estates C. Name, etc. of owner and construction lender D., Energy Sources 1. example-heat/electricol ceiling/or forced oir Qas 2. cxamole-water heater/electrical/or solar E. Square footage or valuation, etc. 1. example.1250 sq. foot house, 500 sq. foot garage 2. exomple~if new project, check ne;.,-if addition, check add. etc. F. Building permit 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. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regaiding design information or job site corrections, etc. II. Abbreviated Plumbing, Mechanical & Electrical Schedules A. Excp.pt 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 ot 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 abbrevi- ated schedules you should consult the fuil schedules C. BUILDING DIViSION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES 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 typewritten 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 ore 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: Additionol Project Information: PLANS REVIEWED BY, name . signature> "\... "" .RMIT VALIDATION .' Permit Clerk I 1 I I J J ~at... "". . \ INSPECTION LINE 72~7 69 -*:b Addren . , ... . f. CITY OF SPRINGFIELD' . COMBINATION APPLICATION/PERMIT . INFORMATION LINE 726-3753 ,/ c;.; "Owner tl5~i cu.,~ /YY1A1J!6i<l.i/r.~, . If ()~ ~4 2..4 "l'A'<;..U.T\ '2..01 k' ~- h C'l A t'P II"SL\ CU S.~rl . \) Construction lender legal Description I ENERGY SOURCES: I Sq. Ftg. Main H'~~"~::l&~:~.q;&.. Sq. Ftg. Acceu. ,V"."" '_ ...-,;....;. Water Healer ':- _L Sq. Ftg. Other . ~ Range _New._Add_Alter_Rep. I Volve of Work: 1_-Fence__oemO_Change/uslt ( l L _.O,h., ~, (\<--, I V\ ~ , . . , _ j - nil') n2 -riil BUildi;9. Po.'m.;.t Inf.a..;' -D;'~~ribe Work (Le., 8uild Singl. 11 .(\'\ t-~ I Phone' (~n ~ ;jro Fami!,,~,:~;~~"~,: W~ln A"oched~~raoe) " 0)0 0 Cj\A.I. ) c....., J J ? OA ( .f"ry\,V\n rA Lfhv l\ +- fnl' ;.1 ..'.<;' ::xl Addr.u Phone C 9J I...r:: I ~ I n rl. Address DESIGN TEAM (name) (addreul (lies. no.) (upires) (phone no.) Primary Structural Electrical Mechanical CONTRACTORS ~- .rl ... GI!~erol' K J, r'\ (name) (addressl \ l '5, 0 I i r.. YY\ [\ (f'(\(/uAIA ') () I (tics. no.) (expires) (ohane no.) Plumbing Electrical Mechanical PLUMBING ELECTRICAL MECHANICAL I FEE ! CHARGE I I I I / I I I I I NO. FEE CHARGE NO.' FEE j CHARGe NO. Residence of furnacll/ burner to llTU's Applionce vent separate Stationary evop. cooler Vent fon with sinqlo duct Vent system aport from heating or A.C. Mechonical Ollhoust hood and duct Each sinqle fixture Relacafed building (new fix. additional) S.F. Re$idence (1 ba:h) lq: ft. Hew circuits, alterotions or ell tensions SERVICES Dualu (l both) each Temparory Construction A.dditional both Amps. Water service Sewer Wood stove/heator Storm SeWf'r FEEDERS Heat PumD Air handler to 10.000 CFM Air handler over' 10.000 CFM Amps. I I t I TOTAL CHARGES I TOTAL CHARGES ISSUAN~E Of PERMIT I TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be aone by the Electrical Contractor, the electrieal portion of this permit' shall not b. valid until Q label has b..n signed by an Electrical Contractor and a"ached to the .Iutricol panel. I HAVE CAREFUllY EXAMINED the completed opplication far permit. and do hereby certify thot all information hereon is true and correct, and I further certify that any and all worl( performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Or.gon pertaining to the work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I furthor cortrfy that my registration with the Builder's Board is in full force and effect os required by ORS 701.055, that if 8.lIempt the basis for exemption is' noted h..an, and Ihat only '.'><anna<ta" a~d ompla~o.. who a.. ;n ,ampl;an<e wHh ORS 7DI.O>> W~'/II b. ...d an ,hi. p,o~ I. Sasis for Builder's Boord ellemption: NAME (ploa.. pdnl) r I cuAW } IIP)l1/tI- SIONATURE .~ ~~ ~ FOR OFFICE USE ONLY DATE di;hl Zone fire Zone Flood Plain Type/Canst. Bedrooms Ctorio- Units """cy Load accy Group Sq. Ftg. Moin Sq. Ftg. Access Sq. Ffg. Other x "olue, '(alue Value x x TOTAL VALUATION PLUMBING PERMIT Charges and Surcharges If). 00 .40 Fence I Systems Oevelopment Charllilf 11.~%1 hOlllOn{l1nn I } (JO,OC; BUILDIHG PERMIT Charges and Surcharges Plan Ck. Comm/lnd 65%/ Blda Per Fee Plan CIc. Res 30%/SJdq Per Fee Demo I Total Comb. Permit EleORICAl PERMIT Charges and Surcharges I ---------1 \ . I TOTAL I , &\1l0,YO, Sidewalk Ale Pavina MECHANICAL PERMIT .'Charges and Surcharges Curb Cut -- ...... ".:;1.:.-..- l!" . I. Applica~ 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 Springfie!~ Fo:tntes C. Name, etc. of owner and construction lender (C I T Y 0 F S P R I N G FIE L 0 0., Energy Sources 1. example.heat i electrical ceiling/or forced air gas City Hall 2. examoie-woter heater/electrical/or solar Springfield. Oregon E. Square footage. or valuation, etc. - ( Department of Public Works 1. examole.1250 sq. foot hause, 500 sq. foot garag' OFFICIAL RECEIPT 2. examole~if new project, check ;;e;.,-if addition, d' , add. etc. ' F. Building permit information: 1. example-construct single family house with an at garage C.. 2. example.remodel existing garage into family roc 3. example-convert single family residence into restaurant (chonge of use) G. Value of work as defined in Section 303 (a) of the Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction delays, Building Div (1 Staff must be able to contact appropriate persons re .' design inFormction or job site corrections, etc. COMBINATION APPlICATION/PERMI.AP) II. Abbreviated Plumb1ingk, Mechanical & Elehctrdical Schedul ( A. Except where b an spaces occur in t e escription I of the Mechanical and Electrical Schedules, the appl need fill~in only the No. Boxes adjacent to the appn r item(s) to be Installed \, B, Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Division 1. To con~rve space on the permit form the schedu ( have been abbreviated 2. If the it~m(s) to be installed are not covered on t, ated schedules you should consult the full schedl ' C. BUILDING DI'/ISION STAFF WilL FILL OUT ALL FEES. t:..' CHARGES ON THE SCHEDULES III. Applicant to sign and date Whenever possible, the initial application will be used worksheet only. Where possible, Building Division Stafi prepare a typewritten copy and return it to the applicc 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 (p. and no plans will be processed until these fees 'are pai, ~I! other fees and charges are due and payable when the~~rm , is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: PLANS REVIEWED BY, naml""' . ",ignaturl'" ..... ...;.0 .: ,'..a- ttERMIT VALIDATION ( ( c No. B Date LI- R .. 19F1 i Rec'd From R\r-l'\(lxrt l-.. OJ'\\""ib'(1 Q-L( Address J 15 Y ~ ;'1 , r7Ld ~-j-. ,..- ~., . '1 ~'--'r, . -..J'- '""''-I . . ( Received For: ' ql L\' 1 ,( 56250C ( \ \lX\ \ U. -t \, ~. n. c\::'l ~ 1Ji)(Y\.~.fl+ ( , I ) l()~;:). . (y") . . S .Qj \. NJ. r (' AI"\ 1\ ~ Ll.l>-V\. t-n n '\ ( I fV"l. no / ( lom 490 .L/O c ( I . '7i:l.~ .40. (' ~ ( I ----,,- ('\,(n(ii Q J Amount Received (' ~. AUTHO'UZEO SIGNA,TURII!:- ."I~TO"'TUIl".U~L ~"'''T[''S ' l[UGIE..... Oil .7.0, ...".. Coo ( .. -'. - -... ~. -, . r Permit Cler.. I I I I -iatf" ',.. ~ :";~-..w,:",~..,~,",,_v~