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HomeMy WebLinkAboutPermit Building 1986-9-9 \oj [ '~~ c., I INSPECTION LINE 726-3769 Job Address l....\ 580' R-STEle-J ~T Legal Description ~ 'APT, ~Dl \... O\/\.\ (.,.-"S Range (' \L.) bOS} \\31.- INFORl1ATION LHH: 726-3753 Sq. Ftg. r.1a i n ~q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. --Fence Demo Change/Use --Other -- -- '~ ~, 0\ ~I CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT ENERGY SOURCES: Heat Hater Heater Cx>~ , Phone ~f\\1-lf-j)\ Val Uf of Holk: <1 <1 '\ ~ '-, Buildino Permit Info: Descrlbe Work(Le., Family Residence With Attached Garaoe) Build Single Owner'!~~'1-00\.l&LA':) Address~lD lo ~. '1 q~ '~\: ~~10&F-\E'~ 41Y'1~ "T8'A-lQ.., W\J:U Df+P Construction Lender Address DES I GN TEAr4 (name) Phone (address) , Primary , Structura 1 Electrical Mechanical CONTRACTORS (name) Genera 1, fCA)€ R.Ax')C\ A \r_ O(p-P- RoO ~ l tI...)&- -+ R.:E le..oO F 0\.05'"1\..) S - Q.O~ \ 1J G- - ~ P).,....'-l s...~T &'LO w. K I (lics. no.) (exoires) (address) (lics. no.) '1. 'IIi (") ,LI ~..l.Ji.A.) RD, [;\ )('..... ~ I ~ 0 ~ Plumbina Electrical ~1echani ca 1 PLur,1B I NG ELECTRICAL NO. FEE CHARGE NO, (ohone no.) (exoires) \\!'4t't-.lo (oholle no. ) ~L\-O'NtD e:... MECHANICAL SQ. FT. FFF rHARGF NO. furnace/burner to BTU's ITempOrary Construction /Change in existing residence Imultifamily, comm. or Industrial 10f ICOMM./IND. FEEDERS I jInstallialter/relocate " distrib. feeders 10f amp~1 I I I I I I I TOTAL CHARGES J TOTAL CHARGES TOTAL CHARGES , WHERE STATE L'\\~ REQUIRES that the Elect'rical work be done by an,Elechical Contractor, the electrical portion of this permit shall not be valid until the label has been signed by, an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXA~1INED 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 oertaining to the work described herein, and that NO OCCUPAr~CY 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. NAI'1E(please print) .:s-\ M ' RD'::> ~ SIGNIITURE ~ 9~ ) FOR OFFICE USE or~L Y ! \ Zone Type/Const. Units Sq. Ftg. ~) x Fire Zone Bedrooms Occy Load Sq. Ftg. Access x Flood Plain Stories Occy Group Sq. Ftg. Other Re;:-8~F x .. TOTAL VALUATION , Each single fixture Residence of Relocated building (new fix. additional) New circuits alts. or extensions ' IS.F. Residence !l bath) I Duplex (1 bath) IAdditional bath I~Iater service I Sewer Istorm Sewer I I I I I I I I I I I I I I I I I I each I SERVICES I amps.1 I I I I I I I I I I I I FFF rHARGF Floor fu rnace and vent I Recessed wall Soace heatf>r ilnd I Vf>nt I I I I I I I I I App 1 i ance vent seoarate I Stationary evap. cooler I Vent fan wi th sinale duct I Vent system apart from I heating or A.C. I Mechanical exhaust hood and duct I Hood stove/heater I I I ISSUANCE OF PFRr1IT DIm q l '1 ~ D (p I Value Value Va lue k "'). 72. BUILDING PER~1IT ___~tZ'_~~_ Plan Ck. Comm/Ind f;-4. SKstems, Development ,C/,,,.tj Charges and 65%/Blda Per Fee C arge 0.51,) , ' Surcharges 3"_2~ Plan Ck. Res 30%/Bl do Per Fee PLUr1BING PERMIT I Fence I I, Charges and ------------ Surcharges I D6mo I I ELECTRICJl,L PERlm I'Sidewal k I I'. Charges and ------------ Surcharges I A/C Paving I ITotal Comb:- Permit MECHANICAL PERMIT I Curb Cu~ . r. .1 TOTAL I Charges and &3.72 Surcharges ------------1 I r" " , . COMBINATION APPLICATION/PERMIT (CAP) I'. Applicant 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 Springfield Estates C. Name, etc. of owner and construction lender D. Energy Sources '1. example- heat/electrical ceilinq/or forced air qas 2. example- waterheater/electrical/or solar E. Square footage or valuation, etc. 1. exampl e- 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. 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 app~opriate 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 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. PERMIT VALIDATION V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: - \ PLANS REVIEWED BY: name LO?f # t!5- 1}:.:. ;j d!:=./'? Signatur~~~ .......~ d~~e 7"'--;; , , /' -, ./ / 8r;;;: ~:;:-~ ,:.: . ~, ' ',.J <1 I INSPECTION LINE 726-3769 CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT E!IERGY SOURCES: Heat \~ater' Hea ter Range INFORtIATION liNt:. 726-3753 Sq. Ftg. I.lain ~q. Ftg: Access. Sq. Ftg. Other New Add Alter Rep. --Fence Demo Change/Use -Other - -- Owner~ \....k,'1-00\.l&L..A ~ Address~lo tJ? ~.1 q~ ~ T. ~R.l D &f=- \ E h.J6 C.o~ , Phone 'f\\1-lf.;:D \ ValuE of HOll: 9 ~ '\ "3 '-l BuilriinQ Permit Info: Describe Work(i.e., Familv nesidence With Attached Garaae) Build Single .\lJ ~ 0\ ~ Job Address Y 5 RC)' "ASTE!e" ~T_ Legal Description ~ 'A PT ~^,)1 \.. n \ ^\ (....- ~ . i .1Y l ~ Address DESIGN TEAr~ (name) Phone (address) lBA-~ W l-n.l DA--P c.xrF- RoO,~ I ~t:r ..... ~ te.oo F 0\0 5"1\..) S - Q.DCCJ0 \ .0 G- - ~ p)..... "1 s-~T ~'L.O u). M. , (lics. no.) (exDires) (Dhone no.) Construction Lender , Primary Structural Electrical ,Mechanical CONTRACTORS (name) , Genera 1 fC-C'& R...Jcx'lC\ ^ If _ (address) Ilics. no.) '1 'jl;;(~,L.l ~1llA.) RD, r:;'\)r...._ ... jC\' 0 ~ (exoin:,~\ \\ !4l "10 (ohone no. ) ~Ll-O')dD ~ Plumbina Electrical ~lechani ca 1 PLUI,IBING ELECTRICAL MECHANICAL NO. FEE CHARGE NO Each single fixture Residence of I FFF rHARr,F~ NO. FFF rHARr,F SQ. FT. furnace/burner to BTU's Relocated building (new fix. additional) New circuits alts: or extensions ' Floor furnace and vent I I ITempOrary Construction I, IChange in existing I residence Imultifamily, comm. or I Industrial IOf amps~ I ICOMM./IND. FEEDERS I I I Install/alter/relocate I I I distrib. ff'eders 10f amps.1 I I I I I I I I I I I I I I I ISSUANCE OF PFRr1IT TOTAL CHARGES J TOTAL CHARGES J TOTAL CHARGES WHERE STATE Li\\~ REQUIRES that the El ectrica 1 work be done by an,El ectri ca 1 Contractor, thee 1 ectri ca 1 portion of thi s permit shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division IS.F. Residence 11 bath) I Duplex (1 bath) IAdditional bath 1~later service I Sewer I Storm Sewer I I each ISERVICES I Recessed wall SDace heatf'r and Vf'nt I I I I I I I App 1 i ance vent seDarate " Stationary evap. cooler I Vent fan with sinole duct ' I Vent system apart from I heating or A.C. I Mechan i ca 1 exhaust hood and rlllct I ~J~od stov~iheater ~ 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 NO OCCUPAfJCY 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 wi,th OP.S 7nl.055 will be used on this project. "ANE(""" ,d"') :.S \ M ~'S ':'., 51'''AT"RE ~VY\IV 9~) FOr. OFFICE USE DrJL Y ( \ Zone Type/Const. Units Sq. Ftg. ~) x Fire Zone Bedrooms Occy Load Sq. Ftg.Access x Flood Plain Stories Occ.v Group Sq. Ftg. Other R€)Z?e:::::c>F x .. TOTAL VALUATION DATE" I 'l \ '6~ Value Value Value R-=f. 72 BUILDING PER~IIT ---~'-'-~~- Plan Ck. Comm!Ind 1;4. shstems Development , /-/, /J Charges and fi5%/Blda Per F~e C arqe (1.5%) , Surcharges "y_2~ Plan Ck. Res , 30%/BldQ Per Fee PLur~BING PERMIT I Fenc~ I I Charges and ------------ Surcharges I Dt]Rlo I I ELECTRICAL PERlm 151 dewa 1 k I I Cha rges and ------------ Surcharges I A/C Pavi ng I ITotal Comb. Permit '11ECHANICAL PERMIT I Curb Cut I" I TOTAL I Charges and ------------ &3. 7"2 Surcharges I I I \." .. "'~' . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant 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 Springfield Estates C. Name, etc. of owner and construction lender ( D. Energy Sources 1. example- heat/electrical ceilinQ/or forced air q. 2. example- waterheater/electrical/or solar E. Square footage or valuation, etc. ( 1., example- 1250 sq. foot house, 500 sq. foot garagl 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. ex amp 1 e - remode 1 ex is t i ng ga rage into family roc Co. 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 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 adjacen' 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 schedule~ 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 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 i~itial 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 ,. \:.' ~ITY OF SPRINGFIELD City Hall Springfield, Oregon Department of Public Works t (' " ., ,(' ".i- "\"e,~'":,,,,?'". ',' OFFICIAL RECEIPT' ,..', . ,: ..... \ I..,,; c .N~.:~ 67039 Date 5:::- r /: "9;, 19 Z?6 Rec'd From 1?~ ~c:::5~P/~~ ~, ' --=< $c!> 7 Y <. ~ tS>CtJ -}t:z>. Address cr '?"'..~#E C c::>>-;p ... Received For: ~/~C5 if'? 8606 3 cf g'- -p f~D /:;'1.>0 5'. :?g kD ~/tr?3 #- 8("6~~- c "B.p, 8o.~ rtj ~C> 3.:?< .... (' - ~ " , ~rA-(' 225:. 66 ( ~ ~#"5/'C;7 Amount Receive:fi?l Z "2:; . ~ ; . ( ,,( 4~--, ~~ ~,r"" I v v AUTHORIZED SIGNAT'tJRE / ~ ( " ( '. , f , . . BUSINESS FORMS, INC. 15031342-8149 63' , ' .. ' Permit C1 erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name L07f/Y~ ~~ .:; ~/'? Signatur~~~ .c-~ da~e 7"'5-8r;;;: - . ,;' ,/' /' '. 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