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HomeMy WebLinkAboutPermit Building 1980-6-2 " _~;'ISPECTIO,N L1iiE /:1726-3769 , CITY OF SPRINGFIELD Cm1BInATION APPLICATION/PERMIT INFORf1ATION lllll: 726-3753 .. Sq. Ftg. r.lain 2O~ tb :q. ~tg. Access. Sq, Ftg. Other Ne\~Add Alter, Pep. --Fence Demo' Change/Use Other-- '-- 'Go 8 --l: 6' ("-. , -... Job Address if:;':::SC,.1-C:(/'f-/.ji;: .l.,)/2 Legal De~cri pt ion ~7 ,,'0/= 2-7 /s:r 4iJ J) I 7--() J.-3'-/- Aj Ol'mer Q4Uilj J .tV'EZ..<;dN Address L/Z?: C-4 S:-r'" 4/J to:' 7);2 ErlERGY SOURCl'S! /' Heat .i 6J1~ll LC:>~ , / ' 3o-Ca.A.-- ~ f:::.7-J(7"}'-. ['Iater HeatereO~(.tLI.~_ . c/-I,,--,/c.,. Y ) 11' . . Range () 0 ~7~. ' :~alu,E: of I-/O,r k: 0-'" ~.~, " ?2S;7;<{), d_~ Bui'ttjinq Permit Info: Describe ~Jork(i.e., Build -Single Phone7f7-3'&/: Famil y nes i den(1e l~iJi:h /lttached Ga raqe) . ~fE-22{i. a./'1,~dprnJ, I a CIdd-LlM-, Construction Lender e/2E /;1/4. Of Icm~r'1.IIND. FEEDERS. I Install/alter/relocate distrib. feeder~ ' 10f I I I I TOTAL CHARGES I TOTAL CHARGES l'IHERE STATE, L'i\~ REQUIRES that the Electrical work be done by an Electrical shall not be val j-j unti 1 the label has been signed by an Electrical Supervisor Address -DESIGrl TEAr1 (name) Primary A2-TG'U /0 Structura 1 'Electrical !1echanical , CONTRACTORS , (name) Genera 1 C) \'\/ V'd )',{ - : P1 umbi nq -'..L} : Electrical' <~!. ~~echani ca 1 PLur18 IrJG ._~~.~ i~O . Each single fixture Relocated building (nel'l fix. additional) ,: S.F. Residence (1 bath) IDuP1ex. (1 bath) IA,dditiona1 bath ~'a ter servi ce I each I I I I I I I /;;1. '. I I I Sewer Storm Sewer I .j '. /,' I 1/ Phone (address) --;-, ........,. , '/-- Z2D /V.. L)!I.. <l I I I I I I I I I I I ISSUANCE OF PFR11tT /5~.~Y) I TOTAL CHARGES ' Contractor, the electrical portion of and returned to the Building Division FFF I rHAR(;F I I I ,Ie- .;, . .... ~,-") I I I I I I I I I I (1 ics . no. ) (lies. no.)' (exlJires) (phone no.) Jc? ~?".........i ":. -~.:r. (address) ELECTRICAL, -~ FEE I CHARGE ! NO Residence of 7</7-~~)~ (expires) Ii ;. !i f; f! i: ~ N I' ,I ,.1 ~ .~ I: }I r" R ... ._~ l: r~AR~i1 d . ~ 1 1 ; ; I i I I SQ. FT. I .1 ., I INew circuits alts. !.../ or extens ions 7"~..:-"\iC) '::.~_ :-:..i () e. J~. ISERVICES I (ohone no. ) . ~ MECHAN.! CAL NO. I FFF ITempOrary Construction IChange in existing residence multifamily, comm. or Industrial amps; ., I I I I I I I I I I amps. furnace/burner to BTlI's Floor furnace 'and vent. 'I Recessed wall , Sn~re hp~tpr ~nrl I ~. ~ ~ ,., ,., . ~ I I I I I' I vpnt. f I 11 , I , . . , , I App 1 i ance vent sepa rate I Stationary evap. cooler 'I Vent fan wi th sina1e duct I Vent system apart , heatina or A.C. Mechanical exhaust hood and duct ,\ from , ft I L n Wood stove/heater /7. ..-" ,/./ ,,/ ~t.! l v ./ ,,/ ;1 : I ~ I this permit .1 HAVE CAREFULLY EXNlINED t~e completed application for permit, and do hereby certify that all information hereon is true and 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 OCCUPAfKY. will be made of any structure without the permission of the Building Division. I further certify that my registration \'lith the Builder's Board is in full force and effect as required by ORS 701.055,' that if exempt the basis for exemlJtion is noted h~reon, and. that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. fW1E(please print) .h'-.1 ~tJ /"' _I f\( FL~' uAJ . !,/, S IGrVlTURE/ FOr! OFFICE USE GilLY Zone' i~:'~- / Type/Const. \T~. ;1.~/ Units i So. Ftg. r1ain ~OX' Fire Zone i7L Bedrooms Occy Load Sq. FtlJ. Access Flood Plain fin- Stories ! r- ~ Sq. Ftg. Other Occy Groupo~~'- "Ji _c" Plan Ck. , ~',").o7 65;0 Bld ------~---- Plan Ck. ), I..J-i.! 30%/Bldq Fee ___________-' Fence ;tIff I D~mo / ~()!:) I Sidewalk - - - - - - ->-'-'- - - - '. r{"u' A/C Paving .1 '/,A ' . I Curb Cut -7!Jfr - - - - -:--:-:-:- f, BUILDING PERNlT Charges and Surcharges PLW1BING PERr~lT Cha rges and Surcha rges ELECTR I CJl.L PERr~lT Cha rges an9 Surcharges 11ECHANICAL PERt1IT Charges and Surcharges I DATE x Va 1 ue ~6'~ ;l.-..? U" c:J6" Value Value x. x TOTAL VALUATION ~"'?.?i O. <29 ;..-' Systems Deve 1 opment ~~l? Charqe (1.5%) /0, g3;:~g.-&) I Jota 1 Comb. Permit . " f2e.{'.l1 'pJ- -,- TOTAL 53b5;?... ~3.C)lL (:t. "1 53.0'1 ...,,:....: 'j'~ ...:..." COMBINATION APPLICATION/PERMIT (CAP) 1. '~, Applicant to furnish A. Job Address B.' Le~al Description , 1. example- Tax Lot 100, Lane County~ap RefE 17 03 43 2. example~Lot 1. Block 3, 2nd Addition'to Springfield Estates C. Name, ~tc. of o~mer and constru'ctionlendel' D. Energy Sources ' 1. . examole- heat/electrical ceilinq/or forcee ,(~ 2. examole- waterheater/electrical/or solar E. Square footage or valuation, etc. 1. examDle- 1250' sq. foot house, 500 sq. foo1 2. example- if new project, checknew'- lf ae (;e check add, etc. F. Building permit'information: J 1: example - cbnstruct sin~le fam"~y house t. attached gar~ge. :" (' 2. examDle - remodel existing garage 'into far 3., examo]e - convert single family residenc~ ~iiurant (change of use); G. Ifalue of work as defined in Section 303 (a) q he SiTllC.tu,"a 1 Spec i a Hy Codei H. DE:..i Gl1 TEAll AND CONTRACTORS To avoid design or construction delays, Build D'vision Staff must. be able to contact approp' ~(> persons regarding desi~n inform~tion or job s CDrre~tions, etc. j Abhreviated Plumbing, Mechanlcal,' & Electrical sci A. Except where blank spaces occur in the descri'\" (r1 portion of the Mechanical and Electrical Sch~ the "ppl.icant neeu fill-in only the No. Boxes to the appr6pria'ceitem(s) to be installed ; B. Fun Plumbing, Mechanical, and Electrical Sch' . (e~ . 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 ~: the abbreviated schedules you should ~ons full schedules ' C. BUILDING DIVISION STAFF WILL FILL OUT ALL FE~ CHARGES ON THE SCHEDU(ES . ( D. As noted on the ,C~P, the label must be delive '+ electrical contractor for signature by his ~l supervisor. The general contractor is not,au to sign the electrical label. 'Applicant to sign and date Whenever possible, the initial application will b a worksheet only. Where possible, Building Divis will prepare a type written copy and return it to ~ appl icant at the time the actual permi:t is issued ~ signature. . r -l- 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 ;~ ~ \ 1 1 ~ I ~ 'II I I 1. IV. V. FOR OFFICE USE ONLY {, , " ( CITY PERMIT VALIDATION OF SPRIN'GFIELD City Hall Springfield. Oregon Department of Public Works OFFICIAL RECEfPT ' No. B ...,--. -:::::> Rp.... Date__~ U vV. _ ;:s, ,,19 (' ) \..J Rec'd From Dn, y/r\ '~, N p (Sfl.\A Address Lf::J?<' 0/\'<::(0 ri~jJ\V', .c::.:....... C2-J I ' Received For:,.q ~f\ 4-t, t.f -- "-.." - l - I ~/~ ~ ,-=<I~. Of! ""--'0 _ - ,~ ,__- ~ Cfc' ;. ~., E/;?c/V'{cb { /~.i:;.OO i:C 1,//03 LjC07_ I /P 0 I (..., t" 4' --? 0 l./ I. Amount Received __ ~ -."), -(':1') f' C/J!... ~/~~~ ~ AUTHORIZED SIGNATURE ('. , SHELTON-TURNBULL PRINTERS, EUGENE. OR 97401 BY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: I Additional Project Information: PLANS REVIEWED BY: Il / i- signa ture A.! /.cz.:--, name J J-cf,/t.- .z ::C/o /' tp -~,~--,60 , date , , ~ .. c~'" .-....-'........~_..., ,. . ".' ... '. i<:2~,"-'''oL'iL..' ....... . ,.......t..... -- _"~_""""__1LJt1."""""~ ""L..Ai. ". -'- 1iI~---o....,' LL""'"'" ~ ..!5!oIIo...;......"-J. "....... "-..........._-..~II..__'~""'"'.~...a.."""""...' --,~'" .,;.':ar-,-",,_ ........ '. (J 53652("1 , . t- ' [i" ((, ( " ~ (f: (r (I ( ,I . , .-( ( ~ .J ,; :1 ,j "j .'. ;'i " ) ............J =: