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Home My WebLink AboutPermit Building 1980-4-11 ,r' / I INSPECTION LINE . 726-3769 EilERGY SOURCES: L- Heat ~//n,,{J h J /1 II A_ I-later Heater j'1'1A.. Range -P!PI'}/tl-"_ ValUE of Work: CJ '1 q,OO(). 0_ Builti; nq Permit Info: Deser, be Hark ( ; . e. . Familv nesidence With Attached Garaae) /1 JL\ /ti bM -h/J'.L ~\.. -. CITY OF SPRINGFIElD COMBINATION APPlICATION/PERMIT . Job Address .1- -z '5 7 n \ -' j?od^,~ rr. ; legal Description 17- ():3 - 'A 7 - ?. '2.. Owner \')...."r Address '2- 3S7 Tcu.Lot .3zoc k. 2\L ;-nR-. K' ~\ .JJ'7 t:-f- Phone 7U,. &7t Construction lender" l" \ " / n II L6"""" "".... ) t'.""-.... ~ ~ -1" , A:': I "' ~tl". Address Co"< '> IN'< Ii ()r0 C; 74-2,.(, Phone UtSluN ItAM (name) (address) Primary Structural Electrical /1echanical CONTRACTORS Genera 1 Plumb;na I Electrical t-lechanical NO. flies. no.) 21'; 6A-"..,. 4-S<1- t-J. 2/)1- 1),<:",(" ...... (name) (addrpss) f1 ic:s. no.) c.eBA-t... l:::lE<;'1-A1 COo'\ L ~+ I:>I,...~ \":'':j 1::>"'V\.l1 sf"" c:-l-: c J/.. lel'J .f1""Q.v\. c.."r/ 0,..1 ~o""4-, ~U <so.r j PlUllB lNG ElECTRICAl I FEE I r.HI\Rr.E Nn I I ~~~ I rI-lARr.~ NO. I Residence of Each single fixture SQ. FT. I Relocated building (new fix. additional) 'S.F. Residence 11 bath) Duplex (1 bath) each ~dditional bath ~Iater service Sewer Storm Sewer IM:~ I I I I ~ew circuits alts. V Mt;;'~o~ SERVICES /~BJ Temporary Construction Change in existing rPS;dJ'Jlr:p multifamily, comm. or Tnduc;tr;al Of amps. COMM./INO. FEEDERS Install/alter/relocate d;c;tritL fppdprc; Of amps. ItlFORlIATION liNt 726-3753 Sq. Ftg. Main_LlU. z.s-1 ~C]. Ftg. Access. Sq. Ftg. Other Ilew Add Alter Rep. -Fence Demo Change/Use -Other - - ~ () o 01 ..t lut Build Single IJ.ddJJ1I1YL {exoiresl , (ohone no. \ 74-(" '02/') (~xoirps) (ohonp no. ) J/:,-I!a.... g~ ,4-{o-021....!. MECHANICAl II="H" I rJ.-1AQ(::1=" furnace/burner to BTU's Floor furnace and vent Recessed wall SO<'lr:P hpatpr <'Inri vpnt Appl iance vent seoaratp Stationary evap. cooler Vent fan with sinole duct Vent system apart from I heatino or A.C. Mechanical exhaust hood and fillr:t. Wood stove/heater I I ISSUAtlCE OF PFR!HT /Sf51 TOTAl CHARGES Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Division TOTAl CHARGES WHERE STATE L~W REQUIRES shall not be vali~ until the A.f!5Z. TOTAl CHARGES that tile Electrical work be done by an label has been signed by an Electrical I HAVE CAREFULLY EXAt1INED the completed ap[llication for permit, and do nereby 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 rm OCCUPAHCY 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 701.055 will be used on this .project. SIGIIATURE J) fJ 'l ..-R.... FO~ OFFICE USE Olll'Y IWIE(please print) Zone ~-{ ~ Fi re Zone..tU- Flood PlainLJ6 BUIlDING PERI.IIT Charges anc Surcharges PlU!1BING PERMIT Charges and Surcha rges ElECTRICAl PERI:~ Cha rges and Surcharges 11ECHANICAl PERMI Charges and J S'lt'charges E"D..NA..~"" 1.-. ~.I ~ KA--2-"T""" Tyoe/Const.~~ Bedrooms --- Stories c..-- Units Occy Load ..-- Occy Group ~...~ Sq. Ftg. Sq. Ftg. Sq. Ftg. riain Access Other L/f? Plan Ck. _______L'.e~ 65%/Bldn Plan Ck. /,92 30%/Blda Jd ,d" I Fence ------J'-~w-I D~mo ____ __ /..6'A.f7JSidewalk ,(,t) I AIC Paving I . I Curb Cut 1___________1 ConmlInd Ppr Fee Res Per Fee /&/ L/fln[i I I;;:: I DATE 18 AD ,.1 &1J ~ x Value x Va 1 ue x Value TOTAl VAlUATION~~ Systems Development Charae (1.5%) I I Total Comb. Permit I ~ ~7.s:92 I TOTAl ~~ . . 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 17 03 43 2. ~xample- Lot 1. Block 3. 2nd Addition to Springfield Estat~s C. Name. etc. of owner and construction lender D. Energy Sources 1. example- heat/electrical ceiling/or forced air qas 2. examole- waterheater/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 add, etc. F. Building permit information: 1. example - construct single family house with an attached garage 2. exam~le - 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 3D3 (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 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. 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 ;s 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. 0; - +0..., ;711"ll:::t h] JtOA_g -I\P~"'-; S ')\:2.J V. FOR OFFICE USE ONLY" Permi t Cl erk ,; I PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: I name signatureJ1..~~L L ) da te -st-.lV - friJ w. ~.'~ /' . /1 ItISPECTIOII LIIIE . 726-3769 ..!.' . IflFORllATION LHic 1.1 I 726-3753 Sq. Ftg. "laio..Lti/ .:>,~~( ~ ~q. Ftg. Access. 'G Sq. Ftg. Other ' fie" Add Alter Rep. 0 --Fence Demo Change/Use Other- - I ()J Bui Id Single l-t Il'( CITY OF SPRI:IGFIELD COIIBJ;IATlON APPLlCATION/PERMIT EIIERGY SOURCES: Hea t h',}rlf'O 1.1 J /11TJ..._ !'/ater Heater CI/I/L RanC'Je ......-:O.1,1!r )//I/'. Job Address 2-3'57 VeJ'''i Legal Oe5cription i 7- ()3- ,:'(7.- ~_''2. Owner'1:,,,.,-}. k: 2\(,]-\':),L Address 2- '3 <;;7 i: ~~.j ....1...1. /..-, r.-J- ,'c"..i,Let ,-1'.:'"OC J I I Value: of I-lark: 1/-1,000.02 BuHf':ino Permit Info: Describe Hork(Le., Familv ~esidence I-I; th /I.ttached Garaae) (" , /1 LI\ I ri fl.'\-1 .),/1J2~ Phone 7"''-'c - hlt4 I I I /1/1/J fir rTYL Address UE..)lliH 1l:.Afl c,^-'. '> ,v{ II (name) () "--' c; 74-2..1, Construction lender C't;-',,,,,, ""..... l\ K"-.... \... .~ 1- r" 2..,., .tN_ t / I I I I I I 10f r- I I I I I I ,.. 80 I . ~,""~ TOTAL CHARGES /t.'. __ TOTAL CHARGES ,,~ _ TOTAL CHARGES WHERE STATE C\W REQUIRES that the Electr;cal work be done by an Electrical Contractor. the electrical rortion of this pemit shall not be valiJ until the label has been signed by an Electrical Sunervisor and returned to the Building Division I HAVE CAREFULLY EXMlINED the completed apr1;cation 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 110 OCCUPArJCY 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 ons 701.055. that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in comDliance \'Iith ORS ]()1.055 \'1;11 be used on this .project. NNIE(please print) ED.NA,,,-,"> L. r./1"'~,j-"'--T' SIG:rATURE ~/J k.._~'-:;;~. FO~ OFFICE USE ~ ---.> Sq. Ftg. f1a;n x Sq. FtQ. Access x Sq. Ftg. Other x Primary ZIt.-b,.J....~:T D("<:,t" ,^ Structural Electrical 11echanica 1 CONTRACTORS (name) 2::/ E. B.+LT DE <::;,,-#\/ General Plumbina {' 0.' .(.r~ ~.j. vi L. .~. \":'':'':i E-1-t1-lr; ( Electrical '~("\\i\l.i I.lechanical PLUlIBIIIG 110.' FEF . CHARGE Each single fixture IRe10cated building (new fix. additional) S. F. Res i dence (] bath) Duplex (1 bath) each L.- Additional bath /;;!/~') ~!ater service Sewer Storm Sewer Zone .~,/ - ~ ~ I TYDeIConst."-~ '~._./'/ Bedrooms - Fire Zone :;;;~ Flood Plain ...~-;', Stories ......-- BUILDING PER~lIT Charges an~ Surcharges Phone (address) (lies. no.) {exoiresl (ohone no. Ci--c,<i- N. ;>,;J. 74-1.-. 'C? L, ) (address) (l ics. no.) (exoi rpc:,) (ohone no.1 4:- Co;" JrJ2.Vl.c..-r-/r.."'../" <;o~4-\ It.. -I r?" ~O ,41- -02/.,} "nc.J ,,>:>+J ELECTRICAL MECHANICAL NO I I Res i dence of SQ. FT. INew circuits alts. or"/ or, extensions . .: ,'J) ,~ -e. /'..",1 {),~_r<;" i ("ARC' I I I I I ,rr ~!n. ,rr I rI-lARr,~ furnace/burner to BTlI's I I I I I ~(~I I I I Floor furnace and vent I Recessed wa 11 So~rp hp~tpr ~nrl SERVICES vpnt ITempOrary Construction IChange in existing res.i denr:~ I multifamily , comm. or Industrial 10f I C0111-1. II NO. FEEDERS IInstall/a1ter/relocate rlic:.trih_ fpprlprc:. Appliance vent seo!,!rate Stationary evap. cooler I Vent fan wi th sinlJle rluct I Vent system apart heatina or A.C. I rlechanical exhaust hood <lnd dlJr:t. I Hood s tove/hea ter from amps. amps. ISSUAliCf OF P'RI1lT DATE ,8 A~r') S'O Units Occy Load Dcc.y Group - Value Value Value ,;.'~.-::s TOTAL VALUATlOli c;..} .(XXf;Q ~ /J~ rn Plan Ck. Corrun/Ind _______~Q___.....~~ 65%/Bldo Ppr ~pp Plan Ck. Res I...?? ~ I / ~ 30%/B1 do Per Fee --_____@...:qEJ Fence I <!~1 Demo PLU11BING PERI1IT Charges and Surcharges EL[CTRIC~,L PERI~I\ Charoes and - Surcharges . Systems Development Charqe (1.5%) /4' L/J! nd /- I I I I j&h.;-" n., ./ I....}~ 7~ /(" /)() Sidewalk -_____~_...J.'.:.-__ . {"O I AIC Paving I I Curb Cut r-----------, liECHANICAL PERI11T I Charoes and <:: '-'." ~;> ~.,..,= ~ ITotal Comb. rermit ~ I I . '"j I'JTAL '. " '--. . I Cor.IBlHATlON APPLICATiON/PERNlT (CAP) I. Appl icant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100. Lane County I.lap Reference .,'6 11 03 43 2. examole- Lot 1. Slock 3, 2nd Addition to Sprlngtield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. examole- heat/electrical ceilingjor forced air qas 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. example- if new project. check~~ - if addition, check add. etc. F. Building 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 Soecialtv Code H. OES I G;i TEA:.I AilD 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, r'lechanical. & Electrical Schedules A. Except I.there 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. BUILDI;:G DIVISIOiI STAFF ',JILL FILL OUT ALL FEES AND CHARGES Oil THE SCHEDULES O. 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 OiILY~ , PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . PERMIT VALIDATION :ITY OF SPRINGFIELD City Hall Springfield. Oregon Department of Public Works OFFICIAL RECEIPT t\ f\ t40. B 53 3 0 2 ~ ~ ~L\\.vY\ 19 rt) \ d FromiJ:AfJ. tf\J\ \- US-Y ~ Nls{"I\- Iressl\tll\ M\al-- . C'JPHO_ . :9'ived For: 0\ f'\(\ L - (\ LlLfD ~\\\~ \ -- -. l\ L~ ~\O \7\f) ( r,() ! tQ/\ ou qt.> 00 . - nount Received ~J5~2, ~m) (\ K. T AUTHOR1ZEO- SIGNATURE ~.,,,.. (.. '''L~TQ'''TU.''.U~~ ......n.. . LUG[..[ O. <tUO, Permit Clerk f Permit applicant exempt from registration with the Builder's Board because: I Additional Project Information: PLANS REVIEWED BY: I ", /) /' 1,1 /~ ./ signature A' ~/.z....,;.c.""",,_,_7/-'_- name ,'~.~~.." . '.......-..,_..................<"'..-"'~.I'-...~._'"",... .:~. . J da te '':.!'-,;~:I- frO '. ....-......"'--'-. =-..,.'.""'.,.<_~_, ...,_~,__.. ,.,......:..1 .-~._.,,'_""""_,'-._.. ..- ",+,,_~, ......". ".'.'~' .+'..~:';.......:..............-'~._-.;l~........."......._.' , . ..