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Home My WebLink AboutPermit Building 1980-4-8 '] INSPECTION , 726-3769 , Job Address . LINE Range ValuE of ~Iork: INFORllATION Lime: 726-3753 So. Ftg. I.lain :q. Ftg. Access. Sq. Ftg. Other New Add Alter Rep. --Fence Demo Change/Use Other -- -- & o 0' lo- is- r Legal Description ~. CITY OF SPRINGFIELD, COMBINATION APPLICATION/PERMIT ErlERGY SOURCES: Heat \~ater Heater ~/I gEI/E/CL Y .. Owner' <9rEI/C;;- Addres? /;2.;;(// 4~LE/\J 8~J/FRL yPhone Buildinq Penlit Info: Describe Work(i,e.. Build Single Family ~esi~ence With Attached Garaoe) Co.ns}ructi on Lender /l,J /2/ '0h~ Address , DESIGN TEAI'1 (name) Phone (address) (lics. no.) (exoires) (ohone no. )' Pri ma ry Structural Electrical : Mechanical CONTRACTORS (name) (address) (1 i cs. no.) (exoires) (ohone no, ) General Plumbinq Electrical ~1echani ca 1 ,~I') 1/ IRoN Mre-I:::J.:r Q~OL PLUt1B I NG J ~7.5r;;;'f}.NG j:AI<HRJJ~ I/g J ~ ~~AN IC~L ~-:3J8~ ELECTRICAL NO.1 \ Each Reloc~ted building (new fix. additional) single fixture FEE CHARGE ,sex:J NO, Residence of FFF I rHARGF NO. furna~burner to 7,'-=5 ...6JcPO BTlI' s ; H'!!, r!--1A R(; I' aO ,0, I SQ. FT. .';'-'..'; .......,....\.... New circuits alts. or extensions F100r furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each Additional bath ISERVICES I ITemporary Construction IChange in existing residenc~ ,/multifamily, comm. or Industrial Recessed wall , Soace henter nnd vent ~Jater seryi ce I App 1 i ance vent seoa ra te I Stationary evap, cooler Vent fan with sinale duct Vent system apart from heating or A.C. Mechanical exhaust hood and duct Wood stove/heater Sewer Storm Sewer, Of amps.1 I COMr4./IND. FEEDERS I , I Install/alter/relocate I dlstrlb, feeders Of amps.! ~ ., I I I l..: I, I I TOTAL CHARGES ~~ J TOTAL CHARGES WHERE STATE Ul~ REQUI RES tha t the El ectri ca 1 work be done by an shall not be valiJ until the label has been signed by an Electrical I - ISSUANCE OF PFRr1IT rl ).OU TOTAL CHARGES '\ ~ 0, DC) , Contractor, the electrical portion of this permit and returned to the Building Division Electrical Supervi sor rm,1E( please 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 Soringfie1dand the Laws of the State of Ore<]on Dertaining to the work described her'ein, and that rw OCCUPArKY will be made of any structure without the permission of the Building Division. I further certify that my registration vlith the Builder's Board is in full force and effect as required by ORS 701.055" that if exempt the basis for exemDtion is noted hereon, and that only subcontractors and employees who are in comDliance with ORS 701.055, will be used on this project. .~DATE~~ / / .// (....00"'" /' / print)-f2RtW~JCJ~ 1:1. PE~~IGNI\Tl~ FO~ OFFICE USE OiiL y '> ~ al Zone Fire Zone TYDe/Cons t. Bedrooms Units Occy load Occy Group BUILDING PER~1IT Charges and Surcharges I Pl an Ck. ____________ 65%/Brda I Plan Ck. , ' 30%/Bldq ~ --.d,...~?-y~J Fence . e"U D6R10 Comm/Ind Per Fee Res Per Fee Sa. Ftg. /1a i n x Value Sq. FtlJ. Access x Value Sq. Ftg. Other x Value TOTI\L VALUATION Shster.1S Development C a rqe O. 5%) Flood Plain Stori es PlU/~BING PERMIT Charges and Surcha rges - ELECTRICt,L PERI~IT Charges and Surcharges 'Sidewal k A/C Paving I , , I ITotal' Comb. Permit ,) TOTAL R$4 ~' '" MECHANICAL PERMIT Charges and --. .l,~ 10' <}~- _I Curb Cut {C! , ~ ' COMBINATION APPLICATION/PERMIT (CAP) 'v ? "'ll ." ~, ,...~1 I. Applicant to furnish A. Job ,o.dd res s 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/electricalJor solar E.'Square rootage 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 ~ouse with a~ attached garage 2. example -,remodel existing garage into family room '3. example - convert singl~ 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 appropri~te persons rega~ding design information or job'site corrections, etc. II. Abbreviated Plumbing'. Mechanical, & Electrical Schedules A. ~~cepfwh~re bla~k spaces occur in the descriptio~ 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 wi,ll 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"'-' ~ ~ ! ~ ~ ~ ] . , : , ~ ~, " ~ ~ ~ ! V. FOR OFFICE USE ONLY" 1 1 ~ I ~ ,- l ~""::o P~MIT VALIDATION -:.- ~'-- + - '. . .. ~ ~ ~ , '1 .1 ~ ~ J ;j :l ! J .J ) ~ i J j ! J U Ii J ~ ~ . ~ ~ 1 . 'I . ~ .1' '3 d 1 ; , Permit Cl erk ) J i J . ~ 1 . ~ROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ] j 1 ' J .~ J ~ i ~ ~ ~ . ~ 5 . 1 ~ . ~. r . ~ Permit app 1 i.canfexemp~ .from reg is trat i on with the Builder I s. Boa rd because: ~ Additional Project Information: PLANS REVIEWED BY: ., ~ 1 name, signature date ! ".<=.A .,-....u..... .~-_...~....__~L;. ......./:_..,......."...._...,~,..._...'''..:.~--....,!'lLL._. _. .....~....~_...........~~-....~.."...L-..........-..lJ....,....",...:a~....~..Il "'.............. ...-......_ .~"'--"""........_......,...oI....."_ ~, -. . ....... ~;.....-....'.. .... .- ...~..~. .--- -L-L ......~-----------...- ECTION LINE 3769 Address ~ I'~ . ~ ;..( CiTY OF SPRINGFIELD COMBINATION APPLICATIO~/~ERMIT E!lERGY SOURCES: Hea t I,~a ter Heater,";"" I NFORl1A TI ON LJ i'H: 726-3753 Sa. Ftq. i'lain ~q. Ftg. Access. Sq. Ftg. O,ther Hew Add Alter Rep. --Fence Demo Change/Use --Other-- -- gEI/~/?LY ~" . :::i ,1 Description Ranqe ValuE. of ~jork: ir' /5' rEuC . d--d.. 1/ 4~L-E/\J /it:; J/ FR L yt'hone Buildina Permit Inro: Describe \~ork(i.e., Build Sing.le Familv Residence With Attached Garaae) :ess ;truction lender fiJ 0/ 0a~ :ess ,GN TEAll (name) lary Ictura 1 :trical lani ca 1 'RACTORS (name) Ira 1 IbinQ :tri ca 1 Phone (address) (1 i cs. no.) (exoires) (ohone no, J (address) (1 i cs, no.) (expires) (phone no, ) !ani ca 1 I _p:--JlJ 1/ i RON MEN! OAJ7KOL S7501+Ht=. h1j(I1.e(J~~g J . '\.. ./ PLUr1BING ELECTRICAL ," ME HANICAL ~ --35'8'~ I I I I 1 I [;-~:,-v'1 'I L CHARGES ~~ I TOTAL CHARGES iHERE STATE Ut~ REQUIRES that tile Electrical work be done by an I not be valij until the label has been signed by an Electrical Each single fixture ,i~^," Relocated building (new fix. additional) , S.F. Residence (1 bath) Duplex (1 bath) each IAdditional bath I ~/a ter servi ce \ Sewer Storm Sewer NO, I Residence of I FE" I CHARliFl NO. I FFF I r1-'ARGF Od) O. : HAVE CAREFULLY EXAMINED the comoleted apnlication for oermit, and do hereby certify that all information hereon is true :orrect, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City lringfield and the Laws of the State of Oregon oertaining to the work described herein, and that NO OCCUPAfiCY will be made ly'structure without the permission of the Guilding Division. I further 'certify that my registration with the Builder's i is in full force and effect as required by ORS 701.055, that if exemot the basis for exemotion is noted hereon, and that subcontractors and employees who are in comoliance with ORS 701.055 will be used on this oroject. ,1"" 'd"t)~t=i?a/,gR)CI<' 1-/, j:5E~l",^T"~ ___~ DATE5:&' FOr! OFFICE USE OiilY -- - '/ / / / ~ / / Tyoe/Const. Units So, Ftc). Ilain x Value Zone Bedrooms OccyLoad Sq. FtlJ, Access x Val ue Plain Stories Occ,Y Group Sq. Ftg. Other x Value TOTJ\L VALUATIml _0 ING PER~1IT "ges anG :harges ~BING PERMIT -ges and :ha rges L"-6J)%-ul .1 , ~ ~ I :TRIC;.L PERr~IT -ges and' :ha rges WI I C.o,L PERM [T ;:-. ~ ,,~ ''': '. '. SQ. FT. furn~burner to 7'?_cYcPO BTlI' s r New circuits alts. or extensions Floor furnace and vent ISERVICES I Recessed wall Soace heater and vent Temporary Construction Change in existing residence; multifamily, comm. or Industrial Apoliance'lent separate Stationary evao. cooler - . Vent fan with sinale duct Vent system apart from heatina or A.C. Mechanical ,exhaust hood and duct Wood stove/heater Of I ,I I amps. COMM./IND. FEEDERS Install/alter/relocate distrib, feeders IOf I I I - 1_ ISSUANCF OF PFR'1IT rl }OU TOTAL CHARGES '\ ~ 0,0 () . Contractor, the electrical rortion of this permit and returned to the Building Division amps.! I Electrical Supervi sor Plan Ck. Comm/lnd 65%/Bldo Per Fee Plan -Ck~-Res 30~/BldQ Per Fee Fence ISystems Dev;lopment Cha rqe (1. 5.,) I D@ffiO Sidewalk I I !Total Comb. Permit I I r:- A/C Paving ;.....,....., _,,~./1 !i',#~~ : ~. ,." .... .: .~~...~;:~..',;,:.~; . L'::" .tl ~~ :~ j i I ~ COMBINATION APPLICATION/PERMIT (CAP) 1. Applicant to furnish A.Job ,~ddress B. Lega] Description 1. example-Tax Lot 100, Lane County Map Reference 17 03 43 l. ' examole- Lot 1. Slack 3, 2nd Addition to' Springfield Estates C. Name, etc. of owner and construction lender ,D. Energy Sources ' 1. examole- heat/electrical ceilinq/or forced air qas 2. examole- waterheater/electrical/or solar E. Square rootage 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. 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. DES i G:-l TE:AM 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"Mechanfcal, & 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 aoprooriate 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 fu 11 schedu 1 es C. BUILDING DI'IISION 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 supervi sor. The ge'nera 1 contractor is not. authori zed 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 aoplicant at the time the actual permit is issued for his s i ana ture. 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 OFFI CE USE ONLY v PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPMJCY: , ;. PERr~IT VALIDATION I T Y 0 F S P RI N Gfl E L 0 City Hall ' . Springfield, Oregon Department of Public Works OFFICIAL RECEIPT ~m~~~;' ~ss,~ l5 a(\!0f\o 'led For: '~ ,( .-\?m~) "-- ::s PO e{) ( ( J f\Q~~t\ ri () ,ei:) ~-~ 104, ( 1\ ~?) c Jnt Received r\)'T:--V lj. cCM4 I o Jf:!J ( 'f . AUTHORIZED SIGNATURE ( SHELTON-TURNBULL PRINTERS. EUGENE. OR 97401 ...". ,- <I Perm; t C1 erk /1, ..... Permit applicant exempt from reg,i.stration with the Builder's Board because: I J Additional Project Information: PLANS REVIEWED BY: ~~'I"Lt~;-:,-",-~",~""""",'.J..'M~IlIlU...~I~"loQlAIi.~llliJ~""~~ .' name, signature date '""':....... "'~'.".."~''''&''''I .j~ij.L;;l...IUoII.~...LlI_."f.'~"'L....,.JI~_...J ...."....,..Joo.I.J."",_-J.l..'...............L...J...J......U~,'L....wrl]l'1.<........... ...._..""' _ ~'--"""'___"""~'_~.~~~ ~ ..~ ~ . _"",,,~.'"'''''''''''' .,'-- ,-"'~ .........""".:-. '~.........".,,'~ -- .......-.,..- - ".....,"'~~