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Home My WebLink AboutPermit Building 1980-9-19 . I INSPECTION LINE 726-3769 Job Address t?~ - SfP1Q l~bA\,\ . \-\('V1\ Q... . CITY Of SPRINGFIELD . INFORIIATION UNL Cm1BIiIATION APPLICATION/PERMIT .~ 726-3753 EilERGY SOtrRCES: Sq. Ftg. 1"ain.~7. S- Heat ,c1F(:1lZ/u J.?(~, ~q. Ft9. Access. Water Heater ~/C/ Sq. Ftg. Other r'OA'"n dr Ilew~Add Alter Pep. Raf)ge_ P f-r..A IV/{. -Fence Demo Change/Use Va 1 u€. of Hark: Other - - I.;? CO 00 BuilGino Pennit Info: Descrjbe l~orklLe" Build Single Familv ~esidence With Attached Garaae1 'T"L _ ~!.lY> pgllF1EO ^^.? 4>1>7 ltJ71.C/- I4IAlSi'l)/ Owner i;. JJ. 7J1/){).(0 Address /445 U) /1 ELXIDJF nR,c/i/)/I ) - . Phone ~ '-../ . :>> ~ ,(} Legal Description FB?IJ tuflv 13 -tJ.:;;} - t"J f; ~ /.::J.. Construction lender I;65'C/889 :7/WIJITIOIU' ~ Address DESIGN TEAI~ (name) Phone (address) (1 ics. no.) (expires) (ohane no. J 63:3' --7i8..9 J<;fJ -UOG{ Primary iJ.~TI'1f'd.- 1",'1 J},jIRs\EV u /, Structural . )445 /,J, J;"- R hlJUF: Electrical It. '7 t1echanical CONTRACTORS .[ " (name) (address 1 (lil".<;. no.' (pxn;rp<;) (ohoop no.' Plumbina ow a"V tfJW//)RV OW>>ElV !?wAJG& General Electrical ~1echan;cal PLUI1B I NG ELECTRICAL MECHANICAL Each single fixture FEF CHAR{;F NO '_ Hf:" fHARhf" NO. Residence of furnace/burner to SQ. FT. BTU's ~f"F fHARf.:F NO. Relocated building (new fix. additional) New circuits alts. d\ or extensions /SdJ Floor furnace and vent S.F. Residence (]bathl' Duplex (1 bath) each Additional bath SERVICES Recessed wall ~n~cp hPntpr nnrl vpnt I I I I 3.a,) 1/..7.~1 I I I J. /8.1<1 ;:}!UYJ Temporary Construction Change in existing resJdfi!ncE' Imultifamily, camm. or Indu..trial J/ Appliance vent seoarat.p Stationary evap. cooler Vent fan wi th sinole duct Vent system apart from heatina or A.C. Mechanical exhaust hood and rlurt Wood stove/heater Water service Sewer Storm Sewer Of amps. COMM./INO. FEEDERS Install/alter/relocate d;str;b. feeders Of amps. I SSUANCE OF PFRtIlT lb. a1 TOTAL CHARGES 41247 TOTAL CHARGES lS-t!JO TOTAL CHARGES dlQJ.OCJ I" . WHERE STATE L.'l~ REQUIRES that tile Electrical work be done by an Electrical Contractor, the electrical portion of this per~it shall not be vali~ until the label has been signed by an Electrical. Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED 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 performed 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 IJO OCCUPArKY 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 ORS 701.055 will be used on this project. IWIE(please print) 3~'1lP,I?F.5.C:::0J ( Units Occy Load Occ.Y Group R- ':l, SIGIIATURE ,:'1S" r--'~ Fan OfF I CE USE DilLY , Sq, Ftg. l1ain3'l'f,5" Sq. Ftg. Access Sq. Ftg. Other r~ '--" Zone_I2-1 Fi re Zone Flood Plain_NI') TYDe/Const. :g:.N . - Bedrooms ,. Stories ~ x DlI!.&tJ valueE..;;~H.SO x Va 1 ue x Va 1 ue TOTAL VALUATIOII 1if.::J:;Jf{.5;O om t'J9/I-'O/a'J . j , BUILDING PER~IIT Plan Ck. Comm/Ind ~.LJ~ q () &~s~ste~s Oevelopment Charges and _______L:J...pP_ 65%/Rldo PJ'r Fee -\. C arqe (1.5%) . Plan Ck.. Res v -- I Surcharges ;/.f(g :-).C\() 30%/Bldq Per Fee . PLUMBING PERMIT _ _ _ _ _ _ J)Cl:P.f)_ Fence ~\.\S~ lillgd),Jln~P ,c90 Charges and Surcha rges ,8"ll I Demo 17. 7/J Dd~ It't<!"lo!. DoF /7. 70 ELECTR I CAL PERI:IT 'Sidewalk . I Charges and ___nnl5-~_ SurCharges ,~O A/C Pavi ng ITotal Comb. Permit I~~,/Io 11ECHAN I CAL PERMIT ~--a. 00 I Curb Cut I ~~/ Charges and {::f),OW u.--- Surcharges __nn ~n_-I I TOTAL ,-- , ~~....... . "~'~I1'-"'t .....-=......~,.\,;.....~~~ - ,,/ ,..- L': I COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax lot 100. Lane County Map Reference 11 03 43 2, example- Lot I. Block 3, 2nd Addition to Springfield Estates C. Name, etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinqjor forced air qas 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. ------ I. examole- 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. examole - construct single family house with an attached garage 2. examole - remodel existing garage into family room 3. exa~le - 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 TEM1 AND CONTRACTORS To avoid design or construction delays, Building Oivision 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 Oivision 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 Permit Clerk ~JECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: tJJ1IM.J'-1.iO d..u~ AO. j . , I Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature Aa~-:.~ date 9-/7- ~tI J - - 'I IrISPECTION LItlE 726-3769 Job Address hPI? Fr=RA) It.-if} yI Legal Description 1'5 -():J - I"J ::; _ /.2 _l\I\.P~ /.,7' (a(/~ ~1J>I.~I'I).j Owner ,-r. ~ 77//"XJ.C.J Address /44:5 1./) /1 l3L4c7uE CI?E/i()/i) Construction lender Address UE>!(;Il ILAlI (name) J1~~lf!:::; _..:J.t.,,=Z 9 IpSO --'i\\\ \'\\'"\(\'\ Q .>' CITY OF SPRI:I(;FIELD CorIBIIIATION APPLI CATION/ PERMIT EnERGY SOURCES:. Heat F/~ril.i0 J':(/;!. ~ater Heater ~~i'~(C/ Rance 17.P-17V/(. ValuE of I~ork:' ) IdOO 0( Builr:ina Permit Info: Describe Hork(Le., Far.lily l1esidence IHth /l.ttached ~araQe) ~ iL_ ~~a"1 Phone t&!3 r9i-'i.99 .7I1OJJ ITI CIU/ -.> Phone (address) (lics. no.l Primary IT;:? Tflff:f - Arj ,&FF:)<;;E)f Structura 1 I( 'I ~I #45 /.J J;"'- R!;FJUE: Electrical " f1echanica 1 cornRACToRS Genera 1 Plumbino Electrical t.1echanical rJO " (name) OWIU-V () W/i-'FlU Ow JJDO I/I/I/A.-'a, PLUIIBHlG Each single fixture FFf" CHAR(;f: 1m Relocated building (new fix. additional) S.F. Residence (j bath I Duplex (1 bath) each (":'_. Additional bath ~Iater ser....ice Sewer Storm Sewer 1 /J.k) I rCt.tC;"] I I I " (address I (lies. no.) ELECTRICAL ~~~ rHARh~ NO_ Residence of SQ. FL New circuits alts. or extensions ,<5:0) SERVICES l!emporary Construction IChange in existing rF',?ld~n("... multifamily, corrrn. or Industria 1 Of COMM./IND, FEEDERS Install/alter/relocate distrib. feeders amps. IOf I I I amps. TOTAL CHARGES ~-?d,<l TOTAL CHARGES WHERE STATE L\I~ REQUIRES that tile Electrical work be done by an shall not be ....alij until the label has been signed by an Electrical INFORI1ATIOi'! LJl'it 726-3753 Sq. Ftg. Haio ~11. S- ~q. Ftg. Access. Sq. Ftg. Other Hew~_Add Alter ~ep, --Fence Demo Change/Use Other- - (exnires) ()J R J (' 0\ Build Single ~ ()l (ohone no.l 683 '9!Z:1.9 Jq5 -uoq (exo;rps) (ohoM no_) MECHANICAL I='I='~ rHARh~ furnace/burner to BTU's Floor furnace and ....ent Recessed wall Soacp hpatpr ~nrl vpot Appliance ....ent s.eoa ra tp Stationary evao. cooler ~ . 1-ll V~nt fan wi th . slnole duct 1 Vent system apart heatinq or A.C. Mechanical exhaust hood and duct Wood sto....e/heater ?..aJ ..~..,.~") from ISSUANCE OF PFR!llT /ClJ}') ~ i7.CC this pemit /;:;6:7 TOTAL CHARGES Electrical Contractor. the electrical portion of Super....isor and returned to the Building Division . I HAVE CAREFULLY EXNlINED the completed application for !)ermit, and do hereby certify that all infonnation hereon is true and correct. and I further certify that any and all work performed 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 rw OCCUPArKY will be made of any structure without the permission of the Building Oivision. 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 O~S 701.055 will be used on this project. NAr.IE(please print) 33/! //11(6<:;0/ Zone t?-,. Fi re Zone Flood Pl ai n ///) BUILDING PERfIlT Charges and Surcharges PLU'1BING PERMIT Charges and Surcha rges ELECTRICAL PERI:IT Cha rges and Surcharges ~. 11ECHANICAL PERMIT Charges and Surcharges Type/Cons t. T-:: ,..j Bedrooms ;; Stories ....:; S IG,IATURE .:i::: C-' FO~ OFFICE USE D:ILY Units . , .!.../&'u -(" Sq. Ftg. Hain . / I~' '"-' Occy Load Sq. Ft!J. Access Occy Group .7_"::. Sq. Ft9. Other :-\ .'-...-/ Dm 09//.D/8") ......( '''''' x r.(.c;. '.t;):./ Value /<.!~:i.-:;,'? ..s~:.J Value Value x x TOTAL VALUATION "':::,-::';::;1(,<;0 q " ,"" Syste. ms Development I . I . ~ -\, n'l Charce (1.5%) U~~O . ~I :J,-\s-:5="( IvDod, ,Y(I/~n Plan Ck. Comm/lnd :' d. .1')0 65%/81 do Ppr Ff'e ------------ Plan Ck. Res ~.?~q~ 30%/Bldo Per Fee rifj.O/J I Fence --------~.~;(I-I Demo 1L;',o() I Sidewalk ___n___~::;-1 A/C Paving ~;;, 00 I Curb Cut __nn __~-:;"_I / t'D 1.;1; r'..:~ Du;: I Irotal Comb. rermit /1, 70 ;?tJ,~ TOTAL ,JU 17. 70 /?~I/;h 10:J00 .,,/ <J ~.J J .1.- / ,~, CJ /.... , _<l .~ ..;..,...:C ~--- .- ... -~. - ~ ; f o::.~:: l'~!! :;......; ::~'. :i COMBWATIO:l ';PPllC';ijO:I/PEK~ii (U.i') I. Appl icant to furnish A. Job ;'doress B. legal Description 1. examole- Tax Lot lOa. lane County ;':dP Reference 1/ OJ 4j 2. examele- Lot 1. Block 3. 2nd Addition to Springtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. exam.ple- heat/electrical ceilinq/or forced air oas 2. 'examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house. 500 sq. foot aaraae 2. p.xamole- if new project. check-new - if addition. check add. etc. F. Building pennit 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 3D3 (a) of the Structural Specialty Code H. DESIGN TEA~ 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. BUILOlliG 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 si9n 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 i~ issued. .' , ~ l' i ~ , " !j I ': " " V. FOR OFFICE USE ONLY .""" " ITV OF SPRINGFIELD ~ City Hall Springfield. Oregon Department of PublIc Works OFFICIAL RECEIPT CI 54810()' No. B (\I'\k I r;-'..... ",,'\ 'r). \ n 19'(-'1) IF;O~~\W /~ \'0\ Iss \ 4-4~ ': t " -.A..<: ~~ , \ \~ I \12-.00 LV:::lI'1 ~ .~'S c5)D 60 LlC]7" , gO '\ t:::. 00 ~J. l\c;n ,LoO \..!) 0 (";(',l (){)?-... ,'2f:) \\,\~'(\ ~ 9)), 00 II' f . . t' - "l f' 'i ~ f.' f - ed For:_\:\\f\\ f'L f\ '.J ~ \ ~\\) , I' \) Q~-r LGf'\ \..J\ ~crL Pii C\ \- i \ \_' Received \ 8~ ,~ L? ~\~ ~~l~ SIGN,.TURE ~"ILTQN'TU"N"ULL ..""..n"s, IUGU.E, 0" 9740' ~R , ") ( \l,lC. (\ f-J _. C ~ c ..."..c. ( Permit C1 erk I J PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ( \ , ) t....._:-(. AA.~_.,_r" -J/~' tf_u~~_ G A ("'~. - "7) - - n_ __.. __. ---.... ---. -.--., Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: , -. PLANS REVIEWED BY: /j )1{~ name signature '! lJ 1~' . _/j . / J.~-;e-?A'~--::;? ~ rjate 0':;;-/7- c/A ...... oU j ~