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Home My WebLink AboutPermit Building 1982-2-12 ,/ ." ~ , . ~pi :-i '.... -' fI NSP-E'CT IClN'L I NE ~ 726-3769 "c,~. ".I~_.. .. , CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT ErlERGY SOURCES: He~.f Pa/lhjO Heat tvftllaley(tvetL)SOtlV( ~ \'Jater'Heater .cIur .c/ecl- I NFORt1ATION 'll ~t 726-3753 Sq. F tg. r,la i n :q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. --Fence Demo Change/Use --Other -- -- , Job Address :2.2.:3 2 JSe/ler~l/ s6..J SffJld. Legal Description 17- 0 3- Z. 7- Z - z- TJL S:200 ValUE of Hor$!2,&V003 Built;inq Permit'Info: Describe Hork(i'.e., Build Single Family Residence With Attached Garaqe) 7") I' -7JJ"/ 12e{){ac~ 3 Wih.~~c.vSI fCdeho(k 'Qed (1'1 Cfl ,v~"" h e~{.t'r:J ol-UJ 7TIO SJ.sf.€Vl-l / /Yew W.lj,{ rPov h-ekl-ti7t( s'f,dl-eu.) hal/fl/ lY.ew e.etl4'V1j, !Y-tw kdd,..' g}k'<-. / l' lY.ew I-cWlJ! /r-ew .f!YOh.{-~l4.h'ahC<e..ctoO(/S Phone /l/'.e. tv ,i::-, -e. c.l-yt' CC<..R...- S>-C'rvt'c-(", ~ pr::U'2 ~ ,. (address) (lics, no,)' (exoires) (phone no.) 1=:111'.5oVl b> PIt/I? (!fl'hJh-:Co :<3 C7t2kU4o//Jlttllt~ Joslf 3/11-62--- rJ Owner!ht./;Urs. Iler.6, Woods , Address 1..2 ~ 2 lS.everLl{ sl-y<t~& ..J ,-- S;Pr/n c; A'-€.(&.J;Jre. . : Constructi8n Lende~ Address , DESIGN TEN1 (name) , Primary ./ , Structura 1 Range Phone . ~.:.'9>l .b/'tttp'U{ tJtwetl: . r;"'~,<m ;..01 -{!ItJr/-fi,s 1)rit!tl14It fuUlfJ JeW/CL 336 So3r8- SIf2rf-e& It) 2~ ,CONTRACTORS (name) .. (address) ) (lics. no,) General ELL ISO VI. {p Pla!J {J(}YiJlruchoiA Go ;. '3 ()aul/ICltj (flail, tll.{;-SOJCf : Plumbinq gQ(ja~,p 10uJ--~, (p 8' 3 !hck/h/~l1sl-, t~51 fCfiRo((:, ; Electrical .sCaf'dd k7 e~I--H'c '3 7f.? t//,j)~1 ~:2.()-/c.. ~1echanica1 CV-OWt< jJ,eal( hr /~ts :fYI/In} I'2J kUj' 30Y I D PLurm I NG NO. ~/(I-g J (exoires) 3/'31-&2.. lo/!7~ g 2.. tRlsO-3 Z 111/7-gL ELECTRICAL MECHANICAL ex! 9-.) , () p ~: '3 l(J:'Y JY} 7f(~-It,sg (ohone no. ) JlfS-l(JY7 3ifS-/2V/ ~ofp~g&dL G [fC;, ?f7t :5 Each single fixture FEE I CHARGE NO, I FFF fHARGF NO, Res i dence of furnace/ burner to SQ. FT. BTlI' s FFF I fHARGF Relocated building (new fix. additional) IS.F. Residence (1 bath) / Duplex (1 bath) IAdditional bath IHater service Sewer -- each Storm Sewer I I I I I I Zone Fire Zone Type/Const. Bedrooms Stori es Flood Plain New circuits a1ts. , or extensions Floor furnace and vent I Reces sed wa 11 Soace heater and vent I /SERVICES I I Tempo~ary ,Construction /Change in existing residence Imu1tifami1y, comm. or Industrial 10f ICOMM./IND. FEEDERS /Install/alter/relocate I distrib, feeders 10f amp~1 I I I I -I I I -I I ---J I App 1 i ance vent seoa rate I Stationary evap. cooler I Vent fan with I sinale duct I Vent system apa rt from I heating or A.C. I Mechanical exhaust I hood and duct I \'Jood stove/heater I I I I amps, ISSUANCE OF PFRMIT TOTAL VALUATION I Plan Ck. 65%/Blda ------------PTan Ck: 30%/B1dq -----______..:..1 Fence I D@mo ISidewal k I A/C Paving I I I I I I I I I , TOTAL CHARGES J TOTAL CHARGES TOTAL CHARGES WHERE STATE L~W REQUIRES that the Elect'rica1 work be done by an. Electrical Contractor, the electrical portion of this pemit ;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 ~ereby certify that all information hereon is true land 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 OCCUPAr~CY will be made of any structure without the pe~mission of the 8uilding Division. I further certify that my registration with the Builder's 80ard 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 comDliance with ORS 701.055 will be used on this project. ""'IE (p 'm, pc' "t) /:J/ (isp,,! {lt1:?Uttct,t<_{1;_ SIGllATURE _ . _ ._ ~~ -' FOR OFFICE USE O~'==---- --)i Units So. FtC]. 11ain x Occy Load Sq. Ftg. Access x Occy Group Sq. Ftg. Other x , , " """'!; ~~""'-' -"""- . -;;,~~""~'_"';";".. r-..,.-.: ~ ;....' ~'.'. ~'W'" ..,..... '" i: ,~..~ ',.-~' ,'....r~._.,....,....._:~y.:\.<:.-......t",.,.. ..."~...." BUILDING PER~1IT Charges and Surcharges PLUt~BING PERMIT Charges and Surcha rges ELECTRICf1,L PERtHT Cha rges and Surcharges MECHANICAL PERMIT Cha rges and I Surcharges 'I CommlInd Per Fee Res Per Fee ISystems Development Charge (1.5%) , /'1-9:0 ~-/S..!r~ =# SF! {)'1S- "fa(. I I Curb Cut I I I ! ,-~ -".;. '. .. ITotal Comb. Permit I I TOTAL I . .....v~...:::~:-~,'.a;:.;<...:::..""....., :~~""''" .. 'w DATE %.1 L Value Value Value ~. _1 ." , , " " , '. ~ \... . . 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. example- Lot 1. Block 3, 2nd Addition to Springfield Estates C. 'Name, etc. of owner a~d construction lender D. Energy Sources , 1. example- heat/electrical ceiling/or forced air 'gas 2. example- waterheater/electricalior solar E. Square footage or valuation, etc. 1. example- 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) ~f 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 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. - 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. ~ , ~ i .. .. i ,j ~ ~ ~ ] ~ , ~ ~ ~ .. .. ~ j ~ I, ! ~ 'I l '" V. FOR OFFI CE USE ONLY ~ Permit Cl erk ~ ~ . ;1..1~1.". 1.,..110..1 1ll1,.;.lal. .flOoi.:LII!IIi.".....~IlI_'~.,.,.._',ioaI.IUciJl.ili,.llIIl 1I1111U.....I,..~ IL".~~ .1.t.111i"',WiI I ;;ulolll"'.II.ioI.I.~:.tJIII.....1 lllililli. . ",1I . PROJECT CONOITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: 1 I 3 1 l ! ~ j /I ~ ~ , Additional Project Information: 1 i J i ~ ~ i .. 7M..J. ~ I.W I~ II. JI"",,,..,",,,,..~.,L... ....~I.d._.II..I. .a;l"..aL..u.....11iI .1.1..11 11,"lII.j,I...J.~!Ii..;ojI. I .~-III~......JL~..ltt,,~,.ia 1!i;o,I..i ... 1~1i_.,.I,llk!.,~.ti.l,IIiII~ "J.D..., .li.1..I.h.. ,llu_ _",,,,", IlOJliiio.l.....,i I.. .11,~IIlIIII~IL.,I. .~i. ....,.',' . . 1 "..1,1 ~ PLANS REVIEWED BY: name signature date '.-"-"7'.::,-:-_-,..,.,~.,^ ...."J,~.;"'1" "'r:'::-:-~:~r:.l""~.~". ,...-.,_-,--.'.--7_....;.." ~ :-..-,.~~.:.:.~.,..,. ..~ ',' '. , '-',>". "';,":--..r.-<.,~~-". ,.; .'-/.;;..'".:.:....-<; ..,.'.~ -i.;'-';'"' .:. ';;;::..... '-lO-;"' .::.....,,:r;:~~~; .;'';-~;';;.:, :,--~"-.:;-::,,,~ ~"f"~.;~;'f., '~-..';;'''.~-i'~'.L':<'; ;.",'~~.(>":r~~;j;~.-;k:: .,