HomeMy WebLinkAboutPermit Building 1980-2-11 (2)
.,"';" " II
.
.
I HISPECTIOtl LitlE
726-3769
CITY Of SPRIiiGFIELO
COflBIllATION APPLICATION/PERMIT
EllERGY SOURCES:
Heat
Hater Heater
Job Address
d <;{'}
N A " ~:;f,.{!" 'b
Legal Description '2.-700
INFORllATIOii llllt I
726-3753
Sq. Ftg. 1.lain
~C]. ~tg. Access.
Sq. Ftg. Other
rtel'" Add Alter ~ep..
--Fence Demo Change/Use
Other - -
Build Single
1<6
G
c
G'
{.j -1-, /, '';'"
, .J
5'1.,,,..'f
Ranqe
I
. ValuE. of Hor~:
ROAgd I~:;>, (')()()'~!:..
-Buil{\ino Permit Info: Describe \~ork(i-.e..
Phone 'Jife"'fI~ '1 Far.Jil v nesid"ence \-lith Attached Garaqe)
17()3'3S 57_
Owner 5' O!2I"J(rF'JEd)
Address ~ 2>""0 N.;4"
~ DKIJiJ,<,f'trt b. OP"t:;"{1"J
AU Ll!r,d
-I"
Construction Lender
In<:.'&:' 1/ Nee,:
Address
OESIGr< IEAtl
Phone
(address)
CI...V}1/).,1. f-:.,:;V-
(1 ics. no.)
(name)
Primary
\
"
Structural
Electrical
!1echanical
CONTRACTOR5
(name)
(address)
(1 ics. no.)
'1'70 N. d,1<;~ ${ S'..af1d ;:;'(,75"'7 3-)-'i;;>C>
?~., -S"/OI. q
General C. L~_~. ("nndrc.c..-trai0
P1umbinc
.' ;"1 {. ~ (
Electrical ,-..:\('. Y'j -t!~ ~.~i-~ . ~<../7q:)
Ilechanlc'ale hn's.-tv: I,) Rl?o~h..J s
f:r("~l_' 1::11;
.3~?67(,(-?
PlUf1BI1IG
ELECTRICAL
/iO
FEf r.HARGE Nn
~~~ rHARr,~ NO.
Each single fixture
Residence of
SQ. FT.
Relocated building
(new fix. additional)
~ New circuits alts.
or extens ions
"7.. ,"-,,_oQ ^1.p,e~
1 SERVICES
1
'_oM
).
I
l
I
I
S. F. P.es idence
II bath I
Duplex (1 bath) each
Additional bath
I~!ater service
I Sewer
IStorm Sel'o'er
Temporary Construction
Channe in existinq
rpsirlpniP ~
multifamily, comm. or
Inrlu<:tri.11
Of
amps.1
C0I11.I./I ND. FEEDERS
Install/alter/relocate
.rli<:trih" fpprlpr<:
.--/ Of '~.JJ;-;'.Jf^, i~amps.
/.:P-
<,.J/~)/j.p r...Vpl,1 I"'; ha~'F I
d<<ll/l<o: / c'" 1/~'63 -rev
-{expires}
(phone no.)
(expi n~s)
(phonp no. )
'-/-1-3'0
'7..<,<; - ? G '1 'I
7;:U,-o';+'-/ c,.
MECHANICAL
furnace/burner to
-,-' ~ BTU'
""'. 7"-"'-"-- s
~F~ rHARr;r
/ --
"",
Floor furnace
and vent
Recessed wall
Soaep hp~tpr ~nrl vpnt
I Apol iance vent
seoaratF!
I Stationary evap.
cooler
I Vent fan wi th
sinole duct
Vent system apart from
heatinq or A.C-
Mechanical exhaust
hood ~nd rluet
Wood stove/heater
ISSUANCE OF RFRt11T
/.rl "'"
'-'.
((0,'-
this permit
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L\iJ REQUIRES that the Electr;cal work be done 'by an
shall not be vali] until the label has been signed by an Electrical
---
"4 S. TOTAL CHARGES
Electrical Contractor. the electrical portion of
Supervisor and returned to the Building Division
I HAVE CAREFUllY EXArlINEO the completed apfl1ication for permit, 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 Springfield and the laws of the State of Oregon pertaining to the work described herein, .and that rw OCCUPArlCY will be made
of any structure without the permission of the Building Division. I further certify that my registration '.'Iith the' Builder1s
Board is in full force and effect as required by DRS 701~055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
r- ~/J...
SIGiV\TU~/OJl}LU{ _f/,/:!",iSJ..'u-:"L//
FO~ OfFICE USE DriLY v ./
Sq. Ftg. r1ain x
Sq. Ft~. Access x
Sq. Ftg. Other x
NAI.IE(please print) '-;;;ry A. A~i::.~r"~J(-
Zone .:::.: -'3
Fi re Zone _Z::
Flood Plain
Tyoe/Const. :!r./ JFR
Bedrooms
Stari es
Units
Occy load
Occy Group
O~TE;:) -1/ -:?O
Value
Value
Value
BUILDII~G PERt.IIT .-, <.I, co. Plan Ck.
C!,l ~ --, 65%/81 do
larges an", ------------"""""PTan Ck.
5urcharges f.<t":.?:> . % 30%IBldQ
PLUI1BING PERI1IT
Charges and
Surcharges
CarrmlI nd
Ppr FF!P
Res
Per Fee
TOTAL VALUATION
?-I"~O
Z;;l I-D C . q,';iystems Oev~lopment AI A
''0 -::>2.k, ,liharQe (J.5,,) /1, F;,
i~ / Fence
--7)'.-/1-,----1 Domo
____~~_~":.J Sidewalk
~ A/C Pavi ng
ELECTRIU.L PERt~IT
Charges and
Surcharges r 17, ~
IIECHMIJ CAL PERM IT
Charges and
Surcharges
/,
((;" ..<>
------------
~<{
Curb Cut
Total Comb. Permit
I
I TOTAL
$ G 7.~:_J
.
COMBINATION APPLICATION/PEffi1IT (CAP)
~
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lot 100, Lane County Map Ref,
II 03 43
2. examole- Lot 1. Block 3, 2nd Addition to
spflngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examDle- heat/electrical ceilinq/or force
2. examDle- waterheater/electrlca (tor solar C-
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, 500 sq. faD
2. example- \f new project. cneck-new - if a
check add. etc. (
F. Building permit information:
1. example - construct single family house w
attached garage
2. examole - remodel existing garage inta fa G
3. examole - convert single family residencE
restaurant (change of use)
G. Value of work as defined in Section 303 (a) C
Structural Specialty Code ('
'-H. DES I GN TEAi-l AND COilTRACTORS
To avoid design or construction delays, Buile
Division Staff must be able to contact appro~
persons regarding design information or job ~ (
corrections, etc.
Abbrev~ated Plumbing, r'1echanical, & Electrical Sc
A. Except where blank spaces occur in the descrj
portion of the Mechanical and Electrical SchE €'s
the applicant need fill-in only the No. Boxel
to the appropriate itern(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Sct
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 cc
the abbreviated schedules you should con: (1
full schedules
C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEI
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must
electrical contractor for signature
supervisor. The general contractor
to siQn the electrical label.
Applicant~to sign and date
Whenever possible, the initial application will
a worksheet only. Where possible, Building Div;
will prepare a type written copy and return it t
a~plicant at the time the actual permit is issue I"
s1gnature.
Fees and Charges ~
Plan check fees are due and payable at the time of' tne
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.
II.
be dellv,
by hi 5 e
is not a
I I I.
IV.
V. FOR OFFICE USE o;:LY
.
oil ... ...
OJ'
.
PERMIT VALIDATION
,
,
CITY
Cl
OF
SPRINGfiELD
City Hall
Springfield, Oregan
Department of Public Works
OFFICIAL RECEIPT
( t
r. No. B 52 7 5 3
DOleL -Il 19~O
Rec'd From.5 p-tpcl (ftiJ rh 1 M~
Address 2edJIJ, A "6-6
Received For:
nP
24,00
LYlr-> q b
I O(ot-J2;;
40)0
(
y'P
'Z.-r::J .en
),00
)b.60
. to 4--
HP
Cj-O/1)
(, Amounl~ceived lti1~L2_rP~- --(
()AQ
c~.
(
- ...i/THO"'ZEO SIGNATURE
"Muro".rUA..eui. ~I""T~"S. EUOU.E 0.. er..o,
..,,,.. c..
(
"
Permit C1 erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE DCCUPArlCY:
I
Permit ,applicant exempt from registration with the Builder's Board because:
Additional Project Information:
I
,
J
PLANS REVIEWED BY:
name
/pRN<:S ~c::<::.c.;;:- signature
~:?.-,;~_~~ date
::z~//. oS=-
~,-,-