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Home My WebLink AboutPermit Building 1982-7-8 ..<(\.. .--.... . . "'lltISPECTIOI/ Ciiii, 726-3769 Job Address /,()-;L A/. Legal Description C;~Y Of SPRIIIGFIELD C0/1BUIATION APPLICATION/PERMIT A-./I E1lERGY SOURCES: Heat Ha ter Hea ter Ranqe _ Va 1 UE of Hark: . t! 54.??=- Phone _ Buildinq Permit Info: Descr be Hork( Le.. 747~lf; 'i Family Residence I.lith J\ttached Garaqe) lNFORf1ATION UNto II 726-3753 Sq. Ftg. f'lain :q. Ftg. Access. Sq, Ftg, Other ~je\'I'-3dd _Alter -,Q.ep. _Fence_Demo_Change/Use _Other I O - , ~ .P wner ,<;; ./.R/,uA(A-vA.A/ --, -, ..'7""'" Address 70 ~ /I/, Ndk"r.A" A .u-- Build Single ~ ~ o 10(> I\P ," I .I Address UESIGrl rtAr1 {name} Phone laddress J ~f~~&.Uc ke:r.A'.d ~ tv--?M C'''''~L .....-ur--CA::C~..L- '7 z.o W M v d6EAA. /f ~~ ' I. - (lies. no.)" (exnires) (ohone no.1 ~ Construction lender Primary Structural Electrical I~echani ca 1 COI/TRACTORS (namel (addrp.ssJ (1 ice;. no.) P1umbina ;z E7? 74- ,<' /fQlt/ )( IJ ;;l/6-ell/t: / 9'o~ (pxpirpsl /CJ):$Jn. (ohnn~ no. ) General AI!:'!! /fCOPIA/r,:... lAIc' "34'''''0..2. b Y' Electrical t.lecha n i ca 1 PLUllBltlG " ELECTRICAL MECHANICAL NO,I I Each single fixture IRelocated building (new fix. additional) Is.F. Residence (l bath) IDuplex (1 bath) each IAdditional bath I~!ater service I Sewer I Storm Sewer I FEE I CHARr,F NO I r:FF I fHARr.r: NO. I Ir:r:r: 1 fHARr.f Residence of So' FT. furnace/burner to BTU's New circuits alts. or extensions Floor furnace and vent SERVICES Recessed wall Sn~c@ hp~tpr ~nrl vpnt jTemporary Construction IChange in existing res.i denc4=! Imultifamily. comm. or Tndl1<;tri~l Of amps. I Appl iance vent 5:eD.aratp Stationary evap. cooler Vent fan with sinole duct Vent system apart from I heatino or A.C. Mechanical exhaust hood and rlllrt li.sood stove/heater I I I cor~~,/IND, FEEDERS Install/alter/relocate rli<:trih fpprjprc:. IOf I I I amps. ISSUANCF OF PFRllIT TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be valiJ until the TOTAL CHARGES TOTAL CHARGES that the Electrical work be done by an "Electrical Contrac or, the electrical portion of this pernit label has been signed by an Electrical Supervisor and returned to the Building Division ------ I HAVE CAR:E"FiJU':Y- EXMlr"tfEO the completecf"aprlication 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 OCCUPAHCY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Board is in full force and effect as required by ons 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. IIAI'IE(Please'print)llt'k/01-c'LA'OV A'O/= SIGI1ATU~;--6-",/ /..,,-.c-.......~ FOr!. OFFrr.t: IlSF m~LV .. .... D~T~k2 Zone Fi re Zone Flood Plain Type/Canst. Bedrooms Stories Units Occy load Occy Group Sq. Ftg. r1ain Sq. Ft!J. Access Sq, Ftg, Other x Value x Value x Value TOTAL VALUATI0r1 .s YS7.!!!2. BUILDlIIG PERI,\IT Charges and Surcharges Plan Ck. Comm{Ind ______3C,.a-, 65%/Blda Per ,pp , / Plan Ck, Res / I -, t/ 3n'VRl dn Ppr r:pp ,. ~ 1-- - Fence ------------1 Demo _ _ __ _ _ ___ ___r-~idewalk I A/C Pav,ng -. - ... I Cur~ c-:t - - - - - - -.=.~==[ Syste~s Development CharQe (1.5%) PLU'1BING PERMIT Charges and Surcharges ELECTRICP,L PERI~IT Charges and Surcharges 11ECHANICAL PERMIT Charges and Surcharges ITotal Comb. rermit - TOTAL 37.LfY ,j . ~ COMBINATION APPLICATION/PERMIT (CAP) Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100. Lane County Map R Fel 17 03 43 2. example- Lot 1. Block 3, 2nd Addition tl ~prlngtield Estates C. Name. etc. of owner and construction lender ( D. Energy Sources 1. examole- heat/electrical ceilinG/or fore 2. examole- waterheater/etectrlcal/or solar E. Square footage or valuation, etc. ----- c- I, examole- 1250 sq, foot house, SOO sq, fo ' 2. example- ~ew project. check:new - if chee k add. ete. F. Building permit information: ' ( 1. example - construct single family house 1 . a ttached garage 2. examole - remodel existing garage into fi 3. examole - convert single family residenc! 1"-.... restaurant (change of use) \ G. Value of work as defined in Section 303 (a) ( Structural Specialty Code H, DESIGN TEAM AND CONTRACTORS To avoid design or construction delays. Build ( Division Staff must be able to contact approp persons regarding design information or job s corrections. etc. II. Abbreviated Plumbing, Mechanical. & Electrical Sc, <;If A. Except where blank spaces occur in the descril portion of-the Mechanical and Electrical Schel the applicant need fill.in only the No. Boxes (,_' to the appropriate item(s) to be installed B. Full Plumbing. Mechanical. and Electrical Sche are available at the Building Division 1. To conserve space on the permit form the s have been abbreviated 2. If the item(s) to be installed are not cov the abbreviated schedules you should consu full schedules C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES 0 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 possible. the initial application will be a worksheet only. Where possible. Building Divisio ~a' will prepare a type written copy and return it to t applicant at the time the actual permit is issued f signature. Fees and Charges Plan check fees are due and payable at the time of application. and no plans will be processed until tl,,,,..oot. fees are paid. All other fees and charges are due and payable when the permit is issued. I. be del ivert by his ele( is not auU II I. IV, V, FOR OFFICE USE ONLY . ~ PERMIT VALIDATION . --,- CITY OF SPRINGFIELD City Hall Springfield. Oregon Department of Public Works OFFICIAL RECEIPT B 59?9? No. -J '-( Date "1-~ - 19~ 2...... Rec'd From 12.o~ ,1== ~/c. Address:J~(!J74 n'lo(iJ~/)/ ( , ( {i.'ft LI% 'l{,AJo 13'2... X',~~ Received For: :.SOSP~dof) 'lO~ ~ =r^~S?;;l"<(~ t/ R. 'P. ~% ,;es,..po 1.'1 f/ .-J -?Jt.Lflj ~l)lI\/ (?e Amount ReCje~ _ !L. I - . - ---;;:urHORlZEOSIGNATURE \, ( . BRIOGS t'RINTERS/LITHOGRAt'HERII. IEUGENE. OREGON I, Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: A!1 .._,.__;...--,.~:.~;:.r'.::'-:'::;~;::-:-;:::'::::;.'::":':...._ ......._":':'::"'__.__.r....'~.....;c.........~,<.--"-'-.,.~.:;';. Additional Project Information: PLANS REVIEWED BY: name signature ':-:;;,:::-.-:-:::-:::r..=:::::;7".'7.::=:::'"--;;':,~.-::7.= ~:_-:: .-.--:--..:=....::....:..-=.::..-:-~~::.=~ .:-:.-:::-:::....-::c::: "'" date 7~f -,?..L.