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Home My WebLink AboutPermit Building 1982-7-12 (3) \IILI ,~ PECTlON LINE 726-3769 . Sq. Ftg. Main IbUb Sq. Ftg. Acceu. -5.5! Sq. fIg. Other----3.3.f\ XXNew _Add _Alter_Rep. ___Fence_Demo_Change I Use 64 967.00 I-Olh" Building Permi' Info: De,cribe Work (i.e., Build Single Family Residence With Attached Goraoe) I---.Sin(llp F~rnily with ~tt~rhed Garage I w/woodstove I ,..~ .,.~. . CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT Job Add".. 4395 Forsythi a l.goIO",dpl;on Lot 27. Ravenwood Subdivision ENERGY SOURCES: H.o.-El",rtrir J::~ Water Heater -El rr.t.ri r: Ranqe _Elertri r I Yolue of Work: Owner .l.e.s..s...-R _ Rr('lnkc:: Address p n Rnv 11~ Snringfield. Orenon Construction Lender O. D. V . A. Address DESIGN TEAM (nome) Primary Structural Electrical Mechaniral CONTRACTORS (nome) G.n"o; Jess R. Brooks 21umbinQ nrl n Mprnpr Electrical n;:tVpc:: I='lprt.rir Mecbanical Marsl'jg,ll s PLUMBING _"..,__u.__~ NO_ ; -fEE x Each sinqle fixture Relocated building (new fix. additional) S.F. Residen!=e (l both) 25.001 I 1 10.001 10.001 10.001 I I I I I Duoln (1 both) each Additional balh Waler service 1 Sewer Stor,m Sewer Phon. 747-~On9 Phone (oddreu) (Iics. no.) (address) INFORMATION LINE 726-3753 (Xl ...... o <.n ...... ...... . (expires) (phone no.) (lics.no.) (expires) (phone no.) 8537 1-5-82 747-5009 Wfllil 6-29-=.82 6S9-4992 ~4 6-10.=.82 lli-,5640 2~I9"(L~_12-21-.aL._. _._~4Z:.l.41L-._,.. "'-TI;~;; I ~;l:;;;;~~:"^'-'"- .d I 1 Appliance vent 3.00 I separate I Stationary evop. cooler 10.001 3 I I I 1 I 1 x Rtsj.dA~e of . ..llll' sq. ft. New circuits. oherations or extensions P.O. Box 116 2J..filLAmi r~ntp PO Box 21 4131l'~' S~~~L ~~:RIC~I~- CHARGE NO. I I I I 10.001 37.501 WHERE STATE LAW REQUIRES that the EI.ctrical work b. done by the Ele..trical Contrador, the .Iectrical portion of this permit shall. not be VAlid until a I label has been signed by an Electrical Contractor and attached to the .lectrical panel. SERVICES Temporary Construction Amps. FEEDERS Amps. Vent fan with single duct Yent system apart from . heating or A.C. Mechanical exhaust hood and d~ct 3.00 g.OO 4.50 5.00 I I Wood 'tolfel heater Heat Puma Air handler to 10.000 CfM Air handler over 10.000 CFM TOTAL CHARGES 55.00 I TOTAL CHARGES ISSUANCE OF PERMIT 35. 00 I TOrAl CHARGES I HA YE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true and correct, cmd I further certify that any and all work performed sholl 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 herin, and that NO OCCUPANCY will b. made of any structur. 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 ex,empt the basis for exemption is naiad ::']' ond ,hot only ,ub~n"o"o"ond .mploy... who 0" In ~mpl;on'" w;,h ORS 701.055 wm b. uad on .h;, p,oi.", l:f(:I.:u,~d::::.~:L-;;~ dB{JCI(r~ SIGNATURE d~ //it~ ' OATE_~/j. -~- FOR OFFICE USE ~- o 1 Type/ Const. ~ N Bedrooms 1 ? Zone Fire Zone Flood Plain '"torilll Units 1 .....ccy Load I')ccy Group Sq. Ftg. Main --160.'5- <q. ftg. Acceu -5.5.? Sq. FIg. Olher-3.3.1=: x <.5 <LVolu.$~6, fi91 RO x 10 00 Volu. 5.520.00 x R ?O Volu. ? 7~~ ?O TOTAL VALUATlON$64; qfi7 00 BUILDING PERMIT $217.00 plan CIt. Comm/lnd Systems Development $ 974.51 Charges and 65%/ BIde! Per Fee Chorae (1.5~':'\ Surcharges Plan Ck. Res 65.10 Pd 8-2 ,-81 #57135 8.68 30%1 Bldq Per Fee PLUMBING PERMIT 55.00 hemo Elec Label f5?,c11 R .20 Charges and Fence Surcharges I 1R2,04 2.20 Demo Total Comb. Permit elECTRICAL PERMIT Charges and 1~.00 Sidewalk SO' 9.60 Surcharges I 1 An Ale Ptllfin~ MECHANICAL PERMIT I Charge1 and ______37.J50 Curb Cut 18' 14.16 Surcharges I TOTAL 1. 50 $ 1,356.75 0< COMBINATION . APPLICATION/PERMIT (CAP) j '-. 'I, Applicant ta 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 Springfield Estotes C. Name, etc. of owner and construction lender D.. Energy Sources 1. example-heat/electrical ceilinq/or forced air gas 2. example-water heater/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 ole-construct single family house with an attached garage 2. example-remodel existing gor09& into family room 3. example-convert single family residence into restaurant (change of use) G. Value of work as defined in Sectien 303 (0) 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., Abbrevigte.d Plumbing, Mechanical & Electrical Sched~les ,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 adiacent to the appropriate item(s) to be ins lolled B, Full Plumbing. Mechanical, and Electrical Schedules are available at the Building Division 1. To conserve space on the permit form the sched'ules have been abbreviated' 2, If the item(s) to be installed are 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, Applicant to sign and date Whenever possible. the initial application will be used as a worksheet only. Where possible,' Building Division Staff will prepare 0 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 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 ore due and payable when the permit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: '-^ , Additional Project Informotian: PLANS REVIEWED BY: . PERMIT VALIDATION ..:... Permit Clerk I \ \ I I I I .;~.,o,.1J\l:\ ~rfu jJJu ,...ilil~~,~\ " ~Q) 0 ' nom'" t\ ' f \. -H'4SPECTION LINE 726-3769 I Job Addr!!_. I Legel Description I I Owner .1p('c: R I Addren I I Construc.tion lender I Address I DESIGN TEAM I Primary . -.J. ~_ . INFORMATION LINE 77~7S3 4395 Forsythia Lot 27, Ravenwood Subdiyision CITY OF SPRINGFiElD COMBINATION APPLICATION/PERMIT I ENERGY SOURCES: Heat ~l prt",i~~ I Water Healer Fl ~(':tr; r. Ronqe ~J Ar.tY" r I Value of ~~rk:' ,. p n Rnv 11 h Sorinofield. Oreoon Phoro!! 747-'i00q u 564.967.00 Building Permit Info: Describe Work (i.e., Build Single Familv Residence With Attached Gorooe) Sq. Fig. Main l"OUO Sq. Fig. Access. -55' Sq. fig. Other----3.3.&:;: XXNew _Add _Alter_Rep. ___Fence_Demo_Chonge I Use _Olher co ~ o <.n ...... ...... RrQf\Itc:. O.D. V.A. Sinolt> F~mi1y w/woodstove with att~chpd r,~r~op Phone (nome) {addren} (lies. no.) . (expires) (phone no.) Structural Electrical Mechonkal CONTRACTORS (nome) (address) (Iies,'no.) (exoiresj (ohonp. no_\ Ge",,"1 Jess R. Brooks Electrical OaJ1j1prnt>r n~vP' Flpct>:.ir P.O, 2l6fl PO Amirantt> Rnx ?1 Box 116 SERVICES fiflq-4qq2 ill-..5.6..4 0 _ -__.l.4?:.L44L.._ j MECHANICJ.l F"-CHAiiGE 'NQT' -'."'--""'-, '-I fEE CH6A.ROGO' I 25.00 I' 1 I J.'5'1f:/d1'f5~~;~" 1 I Appliance vent 3 ./00 I separate I Stationary evap. I cooler 3. 00 9. 00 I I 8537 2lliU.O ~4 25Z!lll~ __11.:..21-S1 1-5-82 fi-2q-fl2 fi-10-fl? 747-5009 ~Iumbinq _~;~arsha 11 s PLUMBING NO. I 4131 ?.'.'...s.tre.g,L_,_-__ I ElECTRICAL CHARGE NO. FEE I I I X I I I, I 1 Duolu (1 both) eoch x 25.001 I 1 10001 10.001 10.00 Rl'ifo~'. of _ ___ Sq: ft. New circuits. alterations or extensions Each sin tile fixture Relocoled building (new fix. additional) S,F. Residen!=e (1 both) Temporary Construction 3 Vent fan with single duct Vent system apart from heotinq or A.C. Mechanical exhaust hood and d~d I I 4.50 I 5.00 I I I Additional bOlh Amps. 10.00 I I 1 I 1 I I I I Wood slave/healer Water service Sewer Stor.m Sewer FEEDERS Heat Pump' ,. Air handler to 10,000 CFM I Air handler over 10.000 CFM Ampl. I I I r I TOTAL CHARGES I I I I I I 55.001 TOTAL CHARGES ISSUANCE OF PERMIT 35.00 I TOrAl CHARGES 10.00\ 37.501 I WHERE SlATE LAW REQUIRES Ihat the Electrical wark b. done by the Elertrical Contractor, tho electrical portion of this permit shall. not be valid until a label has been signed by an Electrical Contractor and attached to the olectricol panel. I HAVE CAREFULLY EXAMINED the completed application fOr permit, and do hereby certify that all information hereon is true and COrrect, ~atld I furthel' certify that any and all work ~rformed shall be done in C1ccordanco :with .the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining to the work described herin. and that NO OCCUPANCY v.:i!l~be.made of any structure without ,he permission of the 8uilding Division. I further ~.tjfy that my registrotion with the Builder's Boord is in full forc4 and effect a s required by ORS 701.055. that if eX,empt the basis for exemption is noted heron. and that only subcontractors and employees who ore in compliance- with ORS 701.055 will be used on this project. i. Basis for Builder's Board exemption: . I CC NAME (please print)~E _~__7 Moolrc, ,? SIGNATURE ~ ~ FOR OFflC' US, 9Nl Y 1 /ir~ " - OAT' _-':"/;J. -'i?1J..- Zone R Fire Zone Flood Plain Type/Const..Jl..:.tJ Bedrooms 1 ? Unih /"'lccy Load "Jccy Group R'1 Sq. Ftg. Main -1.6..0.6 Sq. Ftg. Access~? Sq. FIg. Other--3.3.F: x '1~ '1n Volu.$~h, hq1 Rn x 10 00 Volu. 'i,520.00 x II ?0-Volu. ? 7~~ ?n TOTAL VAlUATlON$fi4; qfi7 00 <:torie" BUilDING PERMIT Plan Ck. Comm/lnd Systems Development Charges and $217 . 00 65%1 Bide Per Fee (ho((:le fl.5%1 $ 974.51 Surcharges Plan Ck. Res 8.68 30%1 Bldq Per Fee 65.10 Pd 8-2 ,-81 #57135 PLUMBING PERMIT I TemD (;:F11 R Charges and 55.00 Fence Elec Label .20 Surcharges I TOlal Comb. Permit ?20 Demo 1R?04 ELECTRICAL PERMIT Charges and ______35.00 Sidewalk 80' q.fiO Surchorgel An AI C Pavino MECHANICAL PERMIT Chorael and ______37~0 Curb Cut 18' 14.16 Surch-arges I TOTAL L50 $ 1 ;356. 75 -ignature \y\ f\ ~ I'm j VItI. date (\ ~ \ Q -9 ~ \ , . &0) ~ I . ~ '_4 ./'. COMBINATION APPLICATION/PERMIT (CAP) I. Applicant ta furnish '.;, ~I..:'.~--=-':"'. A. Jab Address B. legal Description 1. example-tox lot 100, lane County Map Reference 1 2. example-la. 1. Black 3, 2nd Additian to Springfield I C. Nome, etc. of owner and construction lender D. Energy Sources 1. exomole.heat/electrical ceiling/or forced oir qas 2. example-wofer heater/electrical/or solar E. 'Square footage or valuation, etc. - 1. examole-1250 sq, foot house. 500 sq, foot garage 2. example.if new project, check new.if addition, check odd, etc. F. Building permit information: 1. exam ole-construct single family house with an cttod garage 2. example-remodel existing garog~ into faniily room 3. example-convert single family residence into r~stourant (change of use) G. Value of work as defined in Sectiun 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 regarc des.ign information or job site corrections, etc. II., Abbrevi<;lted Plumbing, Mechanical & Elect;ical Sched~les A. Except where blank spaces occur in the description partie of the Mechanical and Electricol Schedules, th,\ appiicant need fill.in only the No. Boxes adjacent to the appropria item(s) to be installed B, full Plumbing, Me<:hanicol. and Electrical Schedules ' are available at the Building Division . 1. To conserve space on the permit form the schedules hove been abbreviated 2. If the item(s) to be installed are not covered on the ab ated schedules you should consult tlie full schedules C. BUILDING DIVISION STAFF WilL Fill OUT All FEES AND CHARGES ON THE SCHEDULES 111. 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 appli, 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: .~. . Additional Project Information; PLANS REVIEWED BY, naml'" ~ .....,..,... i . CITY OF SPRINGFIELD City Hall Springfiald, Oragon 'Department of Public Works OFFICIAL RECEIPT \ No. B ( Dat~h~I,\ \0-19<j$Q- ( Rec'd Fro~.\\s) NJ ~ ~ .!l 1 (' Addres& _ P (\) ~CJC \ \\:"\ ~ I Received For. '~\D~\1 ' , \..~6\f\[} 6)\\ 001 (J ~II'" _ ~ ,!..Do ~ 'C' 00 ( \'"'\'-.\ ) -"'; - ') , '-\OJr. A),61U -;::2<' c:O ( <-~)...J , f 40 .,' ( ~,_,~r) , ( :So rO~,r'j{n (, C\ '\~ .8)_ (I ~?5_Q,,G :\fCL AUTHORIZED SIGNATURE 'I ( (-.,....:- '....^ ,I r::;o !l'O 8 ~.......... , (f ~', \, ( 'v-~ \:- 0 ~J'i ( v 40n ( \.---.1\'\ ~. t--,,\~ c 4.--Cjf, , [)~ ~ )4 rt' .. , -' - r-r\ r . ( Amount Recei~ (f (i BY / ~, ( "'" (I BRIGGS PRINTERS'l.ITHOGRAPNERS, EUGENE. OREGON , ~- No. B o~4U~( ,",~ITI}'L,,'lL. d (ReC'dFro~ l'JD \.?J\'\~~fuu1 () Add;e" k1._)~ ill;~ If t' ( ~ $)'S\l ( - G~ Received For. ~' t- (} ( Cl~ ~ ~ Q $ r I ~'-'\ '\ ,.;J( ~' c <L "" ([ ( ,. " c- , (~ (l~: ( t""""""''''' c{ 0 _IT). G C-' , ~ 0 BY " - AUTHORIZED SIGNATURE to.;- \,' (' BRIGGS PRINTERS/LITHOGRAPHERS, EUGENI:, OREGON -'- :1::: 'i1 ri ;.... ~ :;, ..,.', I ;.~~ L,