HomeMy WebLinkAboutPermit Building 1980-5-6
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f)'i'lSPECTlON LINE
."1726-3769
Job Address lj R, 90' &a;vw 5ff'7e~ ' ~tl
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Legal Description / -; _ O~ -- ~ .,,, L( I
"reA-f /-0-/ 22~,' -, '
Owner' ~~ ~ ~ 11
Address .~ 2:. ~ J4A ~ Phone .~~~
(W6(!)d ~h()\?> ') HClV~ q~ c>b~ 6: ~t~
Construction Lender
CiTY OF SPRINGFiELD
COMBINATION APPLICATION/PERMIT
Address
DESIGN TEAM (name)
Primary M () fL~rl,,fA=;(C;r,\r, 1'\1"\ I
C t
Phone
(address)
D I ~+r--{L+- =#-/ q
EllERGY SOVRC~ l A~
Hea t €:Ie({ ~,~.(J.1 c.w7)
Water Heater~J~ ~
Range r:!!LU~
ValuE of Work:
SOlhi:'!\Ot~~
Buildina Pennlit Info: Describe Work(i,e., Build Single
Family Residence With Attached Garaqe)
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(lies. no.) (exoires)
IN~O ~ATION LiNt
726 3753
So. Ftg. r. in IOSO
~q. Ftg. Access:
Sq.ytg. Other I.J.JI(Go/I,)
~w Add A1 ter Rep.
--Fence Demo Change/Use
" Other -- --
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(ohone no.)
Structural
Electrical
. Mechanical
· CONTRACTORS .
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(name)
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(address) (lics. no.) (exoires)
?O'/fd ~tRermtiA1 R:f. ~.
(ohone no. )
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.General
,~ Plumbino
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PLUf1B ING
ELECTRICAL MECHANICAL
FEE CHARGE NO, I FFF rHAR(.;F NO, FFF rHAR(.;F
Residence of furnace/burner to
V -H)50 SQ. FT. ~.ca / ~lJtln BTlI's ~<<l.
Ne~ circuits alts. Floor furnace
or extensions and vent
tRSbJ SERVICES I Recessed wall
Soace heater and vent
I
IO.a:J I Temporary Construction Ilo.m 'Appliance vent
seoa ra te
Change in existi~g I Stationary evap,
residenc~ cooler
I mu It ifamil y, comm. or I 3 Vent fan with ~ DO
Industrial sinale duct 3."
10f I Vent system apart from
amps. heatino or A.C.
I COMr4 .IIND. FEEDERS I / Mechanical exhaust I,('~
hood and duct
I Install/alter/relocate I '-Wood stove/heater
distrib, feeders
Of amps.
NO.
Each single fixture
Re10cated building
(new fix. additional)
V,S.F; Residence
(1 bath) .
Dup,lex (1 bath) each,
,
Additional bath
Storm Sewer
I SSUANCr OF PFRrm
1D.1Jo
':)9..Sb '
TOTAL CHARGES
~.lt)1 TOTAL CHARGES
35.Q] TOTAL CHARGES
WHERE STATE LAH REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical [1ortion of this pernit
shall not be valiJ until the label has been signed by an Electrical SU[1ervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed apnlication for ~ermit; 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 Soringfield'and the Laws of the State of Oregon oertaining to the work described herein, and that rw OCCUPAfKY will be made
of any structure without the permission of the 8uilding 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 exemot the basis for exemotion is noted hereon, and that
only subcontractors and emr>loyees who are in comoliance with ORS 7n1.055 will be used on this oroject.
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FOr. OFFICE USE Oii0/' ,ij' /' .:.:. - 'J;"
/ So. Ftg. r1ain '''SD x ;Z~1.0 Value
Sq. FtlJ. Access~31 x '1."ID Value
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DATE/2 j!fti,y 1;0
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Zone Ie-I Tyoe/Const.~N
Fi re Zone ..J.LL Bedrooms .3
Flood Plain-1J..{j Stories ,
, ~~V\~~8'lt37
BUILDi'NGPER~1IT I Plan Ck.
Charges and __~___J~!I!f}{) 65%/Blda
Surcharges ~/DJ I Plan Ck.
7'-/~ 30%/Bl do
Units
.:?S; "'/0. rJ/J
~18q.l./C
Occy Load
Occy Group
e-3
Sq. Ftg. Other
x
Value
TOTAL VALUATION ~t.:.s99. ~D
Comm/Ind
Per Fee
Res
Per Fee
Systems. Development
Cha rqe \1. 5%) .
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PLUr1BING PERMIT ______~S.OO Fence
Charges and
5urcha rges I.~o D6RlO Pa..A" .C-II!. ~ 1.2.0
. ELECTRICAL PERrm ______1?DO Sidewal k /r,j, ~S" t,.37
. Cha rges and
Surcha rges I.(J/) A/CPaving Total Comb. Permit c2Sl>. iJ, )
MECHANICAL PERMIT ~'f,:SO I Curb Cut IK' IIJ:O #7JI,,'i/l) I
, Charges and ------ ---- TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
1.
II.
Applicant to furnish
A. Job ,<1,ddress
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to'
Sprlngfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical' ceilin<1!or forced air qas
2. example- 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 - constrtict single family house with an
attached garage
2, example - 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 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, & Eiectrical Schedules
A. Except where blank spaces occu~ 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 schedul es
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. -
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. '
Fees and Cha rges
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.
IV.
V.
FOR OFFI CE USE QNL Y ..
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
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Permi t Clerk
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Permit applicant exempt from registration with the Builder's Board b~cause:
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Additional Project Information:
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PLANS REVIEWED BY:
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name
Signature~~ ~,
date ~-I7- Jrl?
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; 1.725-3763
Job Address /J R 9 ()
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C/'':i.V;:L/
legal Oe'icriPt ion i --; _")_~
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Ow-ner
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(V./',)f'Jd "S\.-.. OD"" :q'j'/'''''' 0"1:-:_, -, ::1
.Adcress
Construction Lender
Add re 5 5
)ESIG:i TEAl' (name)
PrimaryM. /J d/,?~~/c..,/" Vl r,,"
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Ci:-( OF SPRI:iGFI~LO
C::~BI;IATICN APPLlC,\Tl011/PERMIT
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-"-~~y ~C"RCC. - ,
~::c.'" T....' ':-.j'''' r .Ii'~
Heat t:::lrrl.. ~~fr' dH)
~dter :ieater ~ ~~;,_;
'. ~ n ~ e . -:!";.L, - [ C--....-.
?~one ~~~ !l.~' ~
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'P .. 1-E!\./ '(~... .,. VC (~I// ,5,-"t" I'~~ tn11,,~'f
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Structural
Electrical
~1echanical
CONTRACTORS (name)
General d CL '-I
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',j PlumbinQ
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i'f El ectri ca 1 .
._n ~1echa;' i ca 1
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PLUrmING
NO. i
Each single fixture
ELECTRICAL
5 ~lo -&)
. INfORJ1ATlON Uiic
726-3753
So. Ftq. i'lain J 0 5'0
:q. ::-tg. Access:
Sa. Ftg. Other '13r(6M,)
~w Add Alter ~ep.
--Fence Oemo ChangeJUse
--Other -- --
(e.xoi res)
/2;f S/.{jJ.
, ,
(ohQne n(l )
1rr-7- (.8 S-3.
~. ~,:3) d.
rJ--j 01~ .
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MECHANiCAL
I I F~~ I rHARr;F l ::0. I F-~ rHAPI;C
F-- ! CHARGE ~I() . . -,
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Residence of furnace/burner to
V /11,'540 SQ. FT. ;.s.&; / m ;.A~. ,j n,..\ BTU's 0.0':
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,:")5. ff') I TOTAL CHARGES
:hat :!le ~l ectri ca 1 work be done by an
iaDe1 has been signed by an Electrical
Relocated building
(new fix~ additional)
, .-S. F . Residence.
V" (1 ba th)
Duplex (1 bath)
,I ~S,01
each
J
Additional bath
;O,IY)
Iwater
I Sewer
I S to rm
service
Sewer
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TOTAL CHA~GES
..,HEilE 5i~TE L ~:I ~E':Ui:;ES
sha 11 not ~e '{.] Ii j 'Jnt i i :r.e
Zone
e.-I
''I-N
:-l:~!(;nst..
Fire lone 777 :(!'~rc~s
Fiood ?1 J:n A!{) 5:or~es
?'-'..~V\<\.:..<.., Ovd;,.v_.
.r~ -::: .~~'. ;:.~., F~.' J.
3UlLOl:lG ;~:)1i7 i j"'LJ I
C!larjl!s JI1': ~ - - _ _ _ d..J:I]!2.
,Sure!':ar,j/!' j L/ Q; I
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i ~S.OO;
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~urC:',J"11 S
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elld rljes ar.d
5urc:1ar.:;t!~
I1ECHAll! 0:. il[;;~: i
ChcJrges 1M
New cirtuits'aits. . .
or extensions
SERVICES
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Temporary Construction
Change in existing
residE;nc~
multifamily, comm. or
Industrial
IOf
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ICOMM./IND. FEEDERS
I Install/alter/relocate
d is tri b. f""der<;
I Of amps. I
amps.1
Floor furnace
and vent
Recessed wali
SDace heater and vent
ApDliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinale duct
I 'lent system apart
. heating or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
from
3.10 I '1.1J~
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ISSUANCf OF PFRMIT
~~.t}J TOTAL CHARGES
Electrical Contractor, the electrical portion of
Supervisor and returned to the Building Division
'.-I.Systems Develoo.ment
Charqe \1. 5n ~.
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i H~'iE (~;;E;l!LLr ~.(,~"l:,D :~e cOffioietea dpoiication for [Jermit, and do hereby certify that all information hereon is true
and correct. Jnd ~ 'ur:~er (ertify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Soringfield Jnd :~e L~~~ or :he Stdte of Ore~on oertaining to the work described herein, and that NO OCCUPAliCY will be made
of dny st~'Jct'Jre.I::10ut :r:e ::,,~;ssion of. the 3ui1din<] Oivision. I further certify that my registration v/ith the Builder's
Board is in full .~orce JnC el'ec: JS re~uired bv ORS 701.055, that if exemot the basis for exemDtion is noted hereon, and that
only succcntrac:ors Jna ~ioyeeS ~no 3re in como1iance wlth OP.S 7nl.055 will be used on this oroject.
""."("",, ,,,"t; ',J", i ~ L f 1:."2. Si'''AT"'' 9~-1 f ~4'</
'or: :lFFICE IJSE Oi,0/ /.1 i/........ '-'
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Sa. FtC). ,'1a i n I (}StJ
So. Ft<]. Access ~/3!
I Ct;JnQ
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L_____&.OpJ Sidewalk l;;3,/':'C
I' .. /, CJf) ! AIC PJvin~ '
~~--~_d~~RI Curb Cut Iff'
/'t;/'!
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(!c: :'
Load
':c ::1 (;rouD
9_::;'
1;,_. ~
Ftg. Other
Sq.
~!~n
~~ i; .
:.:rrrn/ ~ nd
;)o~ :O~
~ 5 ~,.' ~ j ~-::
?\In (f..
~es
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ITotal 'Comb.
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thi s permit
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x .;z4/,1..0 Value
'1.'}lJ Value
Value
TOTAL VALUATION dY..5'99. ijl)
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Permi t' I J.StJ. '" )
$7/~ltfD
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5. l~.1 Ol'scr,~;ion
1. e~4m~le- .ax Lot ICO. L3ne County Map Refer
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Z. e.amo~e- Lot 1. 3lock 3, 2nd Addition to'
Sprlngrield Estates
C. ~arr.e, etc. of owner and cons tructi on 1 ender .
D. Energy Sources , , _ .
1. examole- heat/electrical cel1lnqlor rorced P....,
2. examole- water~eater/electrical/or solar
E. Square footage or valuation, etc.
1. examole- 1250'sq. foot house, 500 sq. foot
2. exar.101e- if new project, check new - if ad, ,......
check add, etc.. \
F. Building pennit information: ,
1. examole - construct single family house wi
at:ached garage .
2. examole - remodel existing garage into fam (r'
3. examole - convert single family residence
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of ~
Structural Specialty Code
H. DES I GN iEA11 AND CONTRACTORS
To avoid design or construction delays, Buildi
Division Staff must be able to contact appropr ~
persons regarding design information or job si \,
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Set
A. Except where blank spaces occur i~ the descri~ ~...
portion of the Mechanical and Electrical Sche( \<
the applicant need fill-in only the No. Boxes
to the aopropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Sch! ~.~
are available at the Building Division \.
1. To conserve space on the permit form the:
,have been abbreviated
2. If the item(s) to be installed are not co j!<J
the abbreviated schedules you should cons \~,
fu 11 schedu 1 es
C. BUILDING OI~ISION .STAFF WILL FILL OUT ALL FEE
CHARGES ON THE SCHEDULES
D. As noted on the CAP,. the label must
electrical contractor for signature
supervisor. The general contractor
to sign the electrical label.
Applicant to sign and date
Whenever posslble. the initial application will t
a worksheet only. Where possible, Building Divis
wi 11 prepa re a type wri tten copy and return it tc tf!.'
applicant at the time the actual permit is issuec ~
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 fees an~ charges are due and
payable when the permit is issued.
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SPRINGFIELD
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CITY
PERt~IT VALIDATION
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City Hall,
Springfield. Oregon
Department of Public Wo~ks
OFFICIAL RECEIPT
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Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit. applicant exempt from registration with the Builder's Board because:
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Additional Project Information:
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PLANS REVIEWED BY:
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date L/-/7- ,.>5r)
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