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Home My WebLink AboutPermit Building 1979-10-1 :-:. .. . :~ ( ;:"..----. .J' , .i 1 i, ( COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION ,City Hall Springfield ,Oregon Department of Public Works, OFF I C I A L R E CE I P T _ , No. B 5 2 71 7 (I Date 2~0 l~O' , Rec'd Frork((:/LJ- L.Qjju~U~(1 Address '704:1 /_ I A )OJ? l~_tJi.!~ ::-,,( ~ , ,__~' lQ~ . /~ ~' Rec~ived F~f=' "f05 I I 0 ~p 7-Ll.OO ~.b'~ .( D .00 ~. <It, 2-6.ob ;.00 ?-5.00 ) . CX:8 2/.06 /Le'l. <6 4 ' --r--f n ,_ Amount Received I 4-0 rc) - (ell? /p/ ...Qv . AUTHORIZED SIGNATURE. SMELTON.TURNBULL PRINTERS' EUGENE. OR 97401 II. Applicant to furnish A. JuiJ Address B. Legal Description' 1. ,examp 1 e-, Tax Lot 100, Lane County Map Refe} . 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. examole- heat/electrical ceilinq/or forced 2. example- waterheater/electricalJor solar E. Square footage'or valu~tion, etc. 1. example- 1250 sq. foot,house, 500 sq. foot ~~' 2. exqmple- if new project, checkJ1ew -: if add c!reck add, etc. ' , F. Building permit information: 1. example - construct single famlly house Wlt ~ attached garage .. " . "'. 2. example - remodel existing garage into fami 3. example - convert single, family residence i restaurant (change of use) G. V~lue of work as defined in Secti~n 303 (a) of Structural Specialty Code H. DES I GN TEAr,l AND CONTRACTORS To avoid design or construction delays, Buildin! (',' Division Staff must be ~ble to contact approprii persons regarding design information or job sitl corrections, etc. Abbreviated Plumbing, Mechanical, & Electrical Scher ts A. Except wher~ blank spaces occur in the descript' \ portion of the Mechahical and Electrical Schedu~ the applicant need, fill-in only the No. Boxes ae to the appropriate item(s) to be installed (.' B. Full Plumbing, Mechan{cal, and Electrical Schedl are available at the Building Division 1. To conserve space on the permit form the sc~ have been abbreviated 2. If the. item(s) to be installed are not cover ~n the abbreviated schedules you should consult full schedules C. BUILDliJG DIVISION STAFF WILL FILL OUT ALL FEES A '/' CHARGES ON THE SCHEDULES \_ D. As noted on the CAP, the,label must be delivered electrical contractor for signature by his elect supervisor. The general contractor is not autho (,_ to siqn the electrical label. Applicant-to sign and date Whenever possible, the initial application will be u: a worksheet only. Where possible, Building Division ( will prepare a type'written copy and return it to thl applicant at the time the actual permit is issued fOI signature.", ' Fees and tharges , Plan check fees are due and payable at the time of U r application, and no plans will' be processed until the,. fees are paid. All other fees and charges are due anr ')- payable ~Ihen the permit is issued. y/' 5B511'6 (. CITY OF S P RI N G F lEt 0 ( ~)f\ '- pp crJ7 4:? 1/-, \3(o1f~ ~7- , i? t3b4Cj L\ <9-11) y>p I H,P HI. BY ~' ! IV.. " 'v. FOR OFFICE USE ONLf Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: I I Additional Project Information: ....., <,/ \\.., ) ,...... PLANS REVI E~JED BY: r 1,~ <( It, ( ... \.../ ....,. na.me signature date " -' (I 1.1 '@ ,~ . ~ t ( ( l, ( I I . -) .. \ \' '\ f ' /O-,/S-77 . ----- ".;, '. .'iI '1 ItISPECTION LINE 726-3769 INFORr!ATlON .LINE' 726-3753 CITY OF SPRIi!GFIELD COMBINATION APPLICATION/PERMIT IEnergy Sources: . Is~;:;>maln & ac~~. bldg.; \\ heat e..\cc.h-".. c', "- , .,.-,if \,]'J fNater heater ~\.e.c.:\y,u:..___ I-'::new _add ~1 Tpr _r~p. N Iranee eJ~._' __-_- rfence _demolition \ - I 1 f k? .' " f}l?D I' Change/use _other ~ lVa ue. 0 war. .ft. ~ ",. r IBuildin~ permit' i'nfo.: describe work (i.e.. build sinale fam. res. with detached aaraae) , . f/.':c-,Z; d I~ nIl! -, r; V?> -_UJ~~'19 J; 4- SO<lSJ "T 6qrtl9t I I Legal Description Job Address h'3/4 6,d , - - , L c) -t::' t i' ')-4- -;,~-t (\_~ ,~~ ') ~ O.! " " 'f'0f\.f\. Pr1 ) Ed' ~e-!"/~SA;r Owner (name/~ddress/phone) V;1J&tl U/EE.r/ ruM /~~ Construction Lender (name/address/phorie) hdc; NI &;~-e., ".V bA-L/E-~~ '\, - Relocated building (new fix. additional) Is.F. Residence (1 bath) {./ Duplex (1 bath) each , DE:;IGN TEAt1 Primary Structural El ectrica,l . Me('h-=~ical CONTRACTORS Genera 1 Plumbinq Electrical ~lechanica 1 no. 1 Each single fixture ~". ...-::~ Additional, bath ,~!ater servi ce Sewer Istorm Sewer c.:J1 I I I I :;(00 I /~j, pt;.' I TOTAL CHARGES Electrical Contractor, the electrical portion of this Supervisor and returned to the Building Division., )"name) <) ~ /;r .; (address) (lies. no.) ~/ / \ (name) (address) 11 ics. no.) PLU/1BING MECHANICAL FEE CHARGE NO. 1 I FFF I rHARGF NO furnace/burner to BTlI's Floor fu rnace and vent I I I I I I ,~D'9- I ;' {)'-',...!.,I I --=-~z () (i.~ I I .~,~ uD I A. - ;::l,co I I:F~O I I I I I ,I I ,5D~C.t I Recessed wall 50ace heatpr and I vpnt I Appl iance vent seoarate I Stationary evap. cooler Vent fan with sinale duct Vent system apart heating or A.C. I Mechan i ca 1 exhaus t hood and duct I Hood stove/heater, -t.::..1 from :;~~ I 1 ISSUANCE OF PERt1IT TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be done by an shall not be val id unti 1 the label has been signed by an Electrical 7(/X:; I TOTAL CHARGES (exoires) (ohone no.) (exoires " (ohone no_ ) ELECTRICAL , FFF 'rHARr.F '"" ", Residence of ;' :r~~ ~~ SQ. FT. _,,~"jO .!:';-,.. !.O ,c:",,-"- "\.~. :../ New circuits alts. or extensions SERVICES I I 1_._, .", .' I I I ". ,~,..., '. '.'./ r: . I I I I I (T empora ry Cons true t i on IChange in existing residence jmultifamily, comm. or Industrial' Of COMM./IND. FEEDERS amps.I, I I I Install/alter/relocate distrih. feeders ' 10f amp~ New circuits, alts. nr pxt.pnc::innc:: 1 I~O~"3:.> I permi t I HAVE CAREFlILL Y EXArHNED the comp 1 eted app 1 i ca t i on for permit, and do hereby cert i fy that all i nforma t i on hereon is true and correct, and I further certify ~ any and all work performed shall be done in accordance with the Ordinances of the City 'of Springfield and the Laws of th~tah of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure Wit~fZrmi (ion of t~~uild~ivision. , ~W1E (please print) c/k~~/r~ / SIGNATURE rd~/.J.JLd h (i'~E /t:J-I-.?9'1 ~ .... t- 1./ -- /, . -,- Zones >:? ~ ,.,-.----.;;. FOR OFFICE USE OnLY F:-!".~' Flood Plain Occy Group -l) ~ Sq Ftg. /~'!.:;-~/ {1 Value Sq Ftg. ~::;'jLj Value /, (). (1 ~~!7 -; ), 7.. /) 3:'7 ;:;.:..(.(, a J l' :.,:.. /.. ; (.oj ~ .~:....') , Occy Load I BUILDING 'PERr'1!T Charges and Surcharges PLur1BING PERMIT Charges and Surcha rges ELECTRICAL PERMIT Cha rges and Surcharges MECHANICAL PERMIT Charges and Surcharges Bdrms :z.. Type Canst. \/ I..) Stories ~~ Units '.::>_ A C C 0 U ~ T SUM MAR Y ..., ,- I Plan Ck. CoinmlInd, c' { !. t)(5 65%/Blda Per Fee ---------;.,-:-{-;I,Plan Ck. Res /; ':,? j 30%/Bl dq Per Fee : ~.. . ~ {o~. f I) ! {). /?;r; ------------ Fence ~). '<'/7 Sprinkler c::.."cr; f "-':,r~~1 Demo. ..~.. <_:.--.......'.w,_j - --Z~C O-~ ~-;-~~IA/C Paving Sys tem ,~ t ,^, C bet ______~-:!::L..::odl., ur u ~/i.../ Side\'/alk. 1~-:/1/ I lir ( .__) '~I_J 'I Storm Se~ler Con nee . Other Other Other I Total Comb. Permit / / "7 ....,., ~- <J';J.~~"" q lJ; :"- , '~ f. c.'t-0 SOC I TOTAL ~i' J L/IJ7 .... 7 'liP/'Vi v If? ~('/ , ....--.,--. l:l'.; ~"'/'.~' COMBINATION APPLICATION/PERMIT (CAP) I. '.'-~:'. . . ,t. Appl icant to furnish _ A. Jub Address B. Legal Description 1. examp 1 e- Tax Lot 100, Lci'ne 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. example- 1250 sq. foot house, 500 sq. foot garage 2. exgmple- if new project, checknew - if'addition, c~ck add, etc. ' F. Building permit information: 1. example - construct single family house'with an a ttached garage 2. example - remodel existing garage into ,family room 3. example - -convert single family residence into restaurant (change of use) G; V31ue of ~ork as ~efined 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. 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 ";':">{;"., . " ,;' , ~~,-,\,J~~ 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 el~ctrical' contractor for signature supervisor. The general contractor to sign the electrical label. 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 anq return it to the applicant at the time the actual permit is issued for his signature. 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 fee~ and charges are due and payable when the permit is issued. II. be delivered to the by his electrical is not authorized I I I. IV. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: .-':' Additional Project Information: - PLANS REVIEWED BY: \~ signature name I!) , ~;' I ..- ..fII"T" , ' " ' PERMIT VALIDATION i,.; Permit Clerk , date ~' -~ ~y '. /04S-77 ..~ ~.~... I INSPECTION LINE 726- 37 69 Job,Address 161/.4 6 34' LDb~ I CITY OF SPRInGFIELD INFORt1ATION LINE I COMBINATION APPLICATION/PERMIT ,726-3753 IEnergy Sources: . 'sq. ft. main & accsy.bldg.i \'\ 5-A.., T;c:-~ heat e..\(:C.~\L, .;l7lG, ~'1'HI vJ n' fiater heater ~\.t,i~,u..._~-,-- ~ew _add ___~1t".. _r~p, N (' .x ~il..QJ.-tri.o.l ranee eJpr.k-" " fence demolition \- - --ITU 'Vv"\ r. '^ ~ ) - , ,fIfI J 11', J 8'll " change/use other ~ I , \.\..AJ \Vl value of worR': ~II p. - . - ~uildin9 permit info.: describe work (i,e., build ;:;/ ~krT~$.A/r sinqle fam. res. with detached qaraqe) ~ d u ra/(y ~ s. f"O~-----r:i -r 1125 ~ ~o r-r .,.. soct sq Fi ~ ff~ -..2A.JCJO ~~ I Legal ,Description Owner (name/address/phone) V1P1l7' U/EJT ruu ~~t'!: , f' ' Construction Lender (name/address/phone) DES I GN TEAt~ Pr'imary ,/name) 5"" G /,:r , / (address) (lics. no.) (exoires) (ohone no.) Electrical /\/ , Structura 1 : Me('ha~ical CONTRACTORS (name) Genera 1 ,t:;;.. rI c:; , Plumbinq .'f! d1 r~~ Electrical" P~~AY" ~1echani ca 1 (address) (lics. no.) (exoires) (ohone no. ) PLUI:1BING MECHANICAL ELECTRICAL NO. FEE CHARGE NO, FFF rHARGF NO 1'1'1' rHAR(;1' Each single fixture furnace/burne~ to BTlI's Residence of c2 ~ SQ. FT. ~ 5o/Jt) Relocated building (new fix. additio~al) S.F. Residence (I bath) ~ Duplex (1 bath) each ~ Additional bath Hater service' Floor furnace and vent New circuits alts. or extensions 5tfll SOd(;' /{J~' ~O~' Recessed wall I Soace heatRr and vRnt I Appl iance vent I '{ seoa ra te Stationary evap. I cooler Ie Vent fan with I;?~ I /.J..OO sinole duct Vent system apart from I heatina or A.C. cQ. Mechanical exhaust 13~ &,00 hood and duct Hood stove/heater I SERVICES Sewer Istorm Sewer' I I I I I I I ' 'Temporary Construction Change in existing residence Imultifamily, comm. or Industrial IOf amps~ ICOMM./IND. FEEDERS I IInstall/alter/relocate I distrio, feeders IOf amps.! INew circu~ts, alts. I or pxtpnslons I I I I I1J4!L -kJ!!C I I I I I I I I I I 1oO~ ISSUANCE OF PER11IT 300 :L/, ()O TOTAL CHARGES , TOTAL CHARGES WHERE STATE LAW REQUIRES' shall not be valid until the J I HAVE CARE FULL Y EXAr~INED the comp 1 eted app 1 i ca ti on for permit, and do hereby cert i fy that a 11 i nforma t i on hereon is true 1 and correct, and I further certify t any and all work performed shall be done in accordance with the Ordinances of the City 1 of Springfield and the Laws of t S te of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made I of any structure witho rmi ion ~the ~uild~ivision. I NAt.1E (please print) ,~--:/ ~4-./ SIGNATURE ~ de.v/-t JL.d ~ ('i'+E /t:>-I- ~l \ , 1 : j7~17 ,TOTAL CHARGES that the Elec :rical work be done by an label has been signed by an Electrical Electrical Contractor, the electrical portion of this permit Supervisor and returned to the Building Division. FOR OFFICE USE ONLY Zones ~A F'Z- :r::tt" Flood Plain Bdrms ~ Type Const. V ,~_ Sq Ftg, :2S-/1o Value t"O} gg 7 ~20 Occy Load Occy Group j:) ,::<.. Stories d. Units 8.. Sq Ftg. So'l Value 3. 1 4 tt . " 0 A C C 0 U N T S U 1'1, MARY f",q,J I.L1J~, 'i'D BUILDIN'G PER~1IT ______;lJl.oo Plan Ck. Comm/Ind Storm Sewer Connec. " Charges and 65%/Blda Per Fee (.. Surcharges <i,hi Plan Ck. Res IoS. I () Other 30%/Bldq Per Fee PLUr~BING PERMIT _______]1J~()Q Fence Other Charges and Surcha rges 2.f(b Sprinkler System Other ELECTRICA~ PERMIT _?'}~~ (pg~~o_ Demo. Total Comb. Permit 4J </ 7, ga. Charges and Surcharges "2.CQ .~ A/C Paving SDC q "'1. U MECHANICAL PERMIT ______dL.Dn Curb Cut ~~LjI71f)7 Charges and TOTAL Surcharges ,rjL/ Sidewalk /so/ In 4(')