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HomeMy WebLinkAboutPermit Building 1981-8-12 (2) <--. INSPECTION LINE 72~J769 ! .. . . INFORMATION LINE 726.3753 co 8 <€ CITY Of SPRINGFielD COMBINATION APPLlCATION/PUMIT Job Addren " D~ \ <"\; O~l An ~ (\) . -. . , ~ - '-' Sq. ftg. Main Sq. FIg- Accon. Sq. fIg. Other _New _Add _Alter _Rep. _n _feMe _Demo_Change j U se _Olher Legal Description I ~:::GY S~?X Waler Heater Ronqe - Value of Work: 'r/ Own" [$t 1..1J)l'L- '- J.. )&:t~~y Add''''~~~~~ r \('),a,~~\.l)_Q,) IS ~~~7;~gR:,~~:~t,~n;;'th ~::~:~:d::':~~;' 'uad Singl. Conwu";on l.~d.~ . I).... ') I (\C-yp ) t I-J\.dJ:J. J '('\\ \?\.. Address Phone Mechonicol CONTRACTORS (name) (address) I G.n.,al ~(\ I\oJLd. \1\...(\, (JO '- ~M.o t\ J I P1umb;"a LnLL.""l'(\,\J--- I BecHicol ~ Jr--...c_>- DESIGN TEAM (nome) Primary Structural Electrical Mechanical PLUMBINC NO. I i ! Eoeh sinqle f;;Jtlvre 'I' R~locorlld building (new fix. additional) I S.f. Residen!=l! 11 both) I I 1 1 ! Ouolell; 11 balh) eacn Additional ba,h Waler service Sewer I Slor.m Sewer I I I I I \. \'\\.1\ I TOTAL CHARGES -, I I (oddreul (lies. ~o.) (u;pirei) (phone no.) (l;cs. nc.) I j I I .~,-l ! CHARGF I I I I I I I I I I (expire$) (phone no.) ELECTRICAL MECHANICAL .---~~--rFEE furnace/ burner to lITU's Applionce'vent separate Stationar:,' ovop. cooler Vent fon with sinqie duct Vent .sY$tem oport from heatinq or A.C. Mechanical exhaust hood ond duct f::J: CHARGE NO. FEE CHARGE I NO. Residence of SQ:ft. New circuits. alteratiolls or extensions SERVICES I ! I I I I , ! I I I \~,cj>-l I I I Temporary Construction Amps. Wood stove/heater FEEOERS Heot Puma Air handler to 10.000 CFM Air handler o....r 10,000 CFM Amp$. \ -.1\\1:-\ \Dca ISSUANCE OF PERMIT . TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES Ihat the Electrical work be done by the Ele.-tricol ContraCTor, the electrical portion of this permit shall not be valid until a label ha~ be.n signed by on Electrical Contrortar and a"oched to th. electrical panel. I HAVE CA.,REFUlLY EXAMINED the completed applkation for permit, and do her.by certHy thai 011 information hereon is true and (orrect, and I further certify that any and 011 work. performed sholl be done in accordance with the Ordinances of the City of Springfield and the lows of the State- of Oregan .pertaining to the work described herin, and that NO OCCUPANCY will be mode of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Beard is in full force and effect as required by ORS 701.055, that if exempt tho basis for exemption is noted heron, and that only svbcontroctors and employees who are in camplionce with ORS 701.0~S will be uad on this project. Basis for Builder'~ Boord e:JI.emption' NAME (pleose print) Lo....lA.J("Q... Zon- Fire Zone Flood Plain BUILDING PERMIT Charges and Surcharges PLUMBING PERMIT Charges and Surcnarges ELECTRICAL PERMIT Charges and Surcharges MECHANICAL PERMIT Charges and Surcharges vJ;\4-'::l.€..Y c:.IGNA TUR~1\...A..J..Jt.J FOR OffiCE USE ONLY . (.I)~ om ~-I;;;l.-t ( -";'- ~ Typel Canst. "'-drooms K.-J J "tori.' <:.~. FIg. Main Sq. Ftg. Accen Sq. Ftg. Other Value Val\,le Value TOTAL VALUATION Units ""cy Load Occy Group x x 2J5?=' Pia" Ck. Commllnd 65':01 Bldo Per Fe" Plan Ck. Res 30%1 Bldq Per Fee Systems De...elopment Charae 11.5~..\ \ ~_ cD LoO \D,CO ,40 ---..QJL . J/l fence Demo Tolol Comb. Permit Sidewalk .14 1<: Pavina Curb Cut 19.\ w TOTAL APPLlCA TI9N/&IT COMBINATION I. Applica~ to furnish (CAP) A. Job Add re55 B, Legal Description 1. example-tax Jot 100, Lane County Map Reference 17 03 43 2. example-Lot 1. Block 3, 2nd Addition to Springfield Estates C. Nome. etc. of owner and construction Jender D.. Energy Sources 1. example-heat/electrical ceiling/or forced o;r gas 2. exomole-water heater/electrical/?, solar E. Square1fo,otoge or valuation, etc. ,'I , I 1. examole-1250 sq. foot house. 500 sq. foat garage 2. example.jf new project, check rJe;,-if addition, check add, etc. F. Building permit information: 1. examo/e-construct single family house with an attached garage 2. example-remodel existing gorag~ into faniily 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 Cade H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction delays, Building Division Stoff must be able to contact appropriate persons regarding design inf~rmation or job site corrections, et~. II. ,Abbreviated P:lumbing, 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 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 hove been abbreviated 2. If the item(s) to be installed ere not covered on the obbrevi. 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 end dote 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 signatur&. 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 fe7~ 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 Infarmation: PLANS REVIEWED BY: name signaturf" . Permit Cler~ .;. \ ~-,. PERMIT VALIDATION , .' , . , J " , ... I " .Jeff" " ...AOI. , 'w, INSPECTION LINE 72t..316f . \~ CO' 8 ce . INFOIl:MATlON LINE 716-37.53 CITY OF SPRINGFIELD COMBINAJlCN APPLlCAflON/PEIlMIT Job "'ddr~u '. D~ \ <}(". O~l ~<~ r0 -, \\ - '-' I ~:::GY S~?X S Waler Healer Ronqe _ Value of Work: i Sq. Fig. Main I Sq. fig. Ac't8n. Sq. Fig. O,h.r I _Ne.... _Add _Alrer _Rep. _.. _Fencl! _Oemo_Chongei U lit _Oth.r Legol Description Own" [ r. 1\ \"\Cl..__ '- J.. J &t ~Q.... Y I Add,." \r;y;; \ f\ ~ f'i ~ \(' ~j,a{..) I S~N. ~T'J(~ ~\_' f\\l\('-QS Ie:., I COIHlruction lende~ I Addren ~ DESIGN TEAM Structural I Electrical' .1 Mechanical I CONT~ACTORS (Mme) (oddress) I G.ne,ai ~(\ I\oJLd. \1\...(\, (J 0 '- ~M.o r:" J I Plumbina, ~'"1<\. \J--- I electricol~)t'...o>- (nome; Primary Mechanical PLUMBINe I <I 1 I 8uilding Permit Info: DetCribe Work (i.e., Build Single Fomil... Re,idOl!l'''~e With Attached Goreu:!!!!l Phone {\l (\('Vp ) t \...J\n.<.LJ '('\\~ (oddren) (lies. no.) (u;pirln) (phone no.) (lies. no.) (expires) bhano na,l ELECTRICAL , I CHARGE I NO. fEE CHARGr:, MECHANICAL FEE NO. I F::1O CHARGE I NO. WHERE SlATE lAW REQUIRES thai the EI.drical work be done by the Ele.-tricol ContracTor. the electrical portion of Ihi. permit shall not b. yalid until a 10b.1 ho,. been signed by an Electrical Contractor and attached to tho elec:tricoJ pan.l. I HAVE CA,REFUllY EXAMINED th. completed application for permit, and do hereby certify Ihot all information hereon ;s trlJe and correct, and I f""rther certify that any and all work performed ,hall be done in accordance with the Ordinanus of the City of Springfield and the law) of the State of Oregon pertaining to the work descrio..G h.rin, and Ihat NO OCCUPANCY will b. mad. of any s"""ctur. without the perminian of the Building Division. 1 furth.r atrtify that my registration with the Builder's Board is in full force and effect as required by ORS 701.055, thai if oxempl the. basis for exemption is noted. horan, and that only subcontractors and employees who are in compliance with ORS 701.0.5.5 will b. usad on this project. Basis for Build.r's Board .xemption: NAME (please print) Lo...u....ra... i i Eocn ,inl:lle fill.lvre 'I' R~locared bvilding {new ti.ll. additionail I S.F. i1:<!liden~e (1 bath) ! I I I ! , I I I i I , ! I I I \~.cl>-l OuolelC 11 bod,} eoc;, Additional balh Water ,enice Sewer I Stor.m Sewer I I I , \ iN\1\ I TOTAL CHARGES Residence of furnace/ bvrner !o . ~TU's Appliance yent separate Stationarj' iIIvap. cooler Vent fan with singie duct Vent system aport from heati~q or A.e. Mechanical exhausl hood Clnd d~ct l, Sq: ft, New circuits, aheralialls or elCtensiQns SERVICES Temporary Construction Amps. Wood sta..../h.ater FEEDERS Heat PumD Air handler la 10.000 CFM Air handler onr 10.000 CFM Amps. I I \ J\\~ I I I I TOTAL CHARGES \DCD I I I ISSUANCE OF PERMIT I TOTAL CHARGES <IGNA TURcJJf"LVJ'tJr1... fOR OffiCE USE ONLY . \J;\~~e...y lJ)~ Q< OATE ~-I;;l,-tl. Zone Fire Zone Flood Plain Type/ Canst. ~drooms r-:.J J <::tariel BUILDING PERMIT Charges and Surcharg.s ~5~ - PLUMBING PERMIT Charg.s and Surcnargos \~.co loD \D.CO ,40 elECTRICAL PERMIT Chorgos and Surchargos MECHANICAL PERMIT Charges and Surchargos Units ()ccy load ("lccy Group Sq. ftg. Main "q. Ftg. Accon "q. Ftg. Other Value Value Value TOTAL VALUATION . . plan ek. Camm/lnd 65~~/ Blda Per Fen Plan Ck. Res JO%J 8ldq Per Fee Systems O....elapment ChorQl! (1.5~) FenCl! LJDL. J/J Demo Total Comb. Permit Sidewalk Alc Payino Curb Cvt ~\ w TOTAL ( . APPLICATION/_Mil (CAP) COMBINATION I. Applica~ to furnish A. Jab Address B. legal Description 1. eXam ole-tax lot 100, lane County Map Referer 2. example-lot 1. Block 3. 2nd Addition to Springf C. Name, etc. of owner and construction lender D.. Energy Sources 1. example-heat/electrical ceiling/or forced oir go 2. exomole-water heater/electrical/or solar E. Square footoge or valuation, etc. - 1. example- ~ sq. foot house. 500 sq. foot gara! 2. example-if new project, check new.if addition. c add. etc. F. Building permit information: 1. example-construct single family house with an a gorage 2. exomole-remodel existing geragE:: into family rOI 3. exam pie-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 ovoid design or construction delays, Building Div Staff must be able to contact appropriate persons fe design inf~rmation or job site corrections. etc. II. Abbreviated Plumbing, Mechanical & Electrical Schedul, A: 'Except where.blank spaces occur in the description ~ of th.e Mechanical and Electrical Schedules, the appli need fill.in only the No. Boxes adjacent to the appro 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 schedul have been abbreviated 2. If the item(s} to be installed ore not covered on th aled schedules you should consult the lull schedul 'C. BUilDING DIVISION STAFF Will Fill OUT All FEES A CHARGES ON THE SCHEDULES III. Applicant to sign and date Whenever possible, the initial application will be used 0: worksheet only. Where possible, Building Division Staff, prepare 0 typewritten copy and return it to the applieanl the time the actual permit is issued for his 5ignatur~. IV. ( I- 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 US,E ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY, Additional. Project Information: PLANS REVIEWED BY: name signatur.... ~ I . " \ .... PERMIT VALIDATION ( I CITY OF SPRI NGFIELD City Hall Springfield, Oregon Department of Public Work. 'OFFICIAl RECEIPT r I , '( r No. B S 7 0 6 2 Date (\m C'\ \ k 199<) \ - :d:~:om ~\~~_\~ ~ \J \J- -( ( Received Far: ( ( \~,LV r :::, .00 (cO [(;.DO ( .4l\ . {.J{) ( c, ~\N\~ t ,~.Lrf\ \f)~ - J - \ '-171\ ,Mild . ~ . 0 l,L.$ Da~ ( ,. ~t, ( ( .".. Received lQj~~ dq~p- AUTHO"IU:O SIGNATURE ...'[LTO...Tl,J"......LL ~"'''T,[''S. '[uQE'n. 0" 17.0' ~..".. ~ JJ-J I '. Amount ( ~ ( ( :.' '/ .. .. Permit Cler~ , r ! I I I ~at....