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HomeMy WebLinkAboutPermit Building 1981-4-15 <(:(::0 87."3 I INSPECTION LINE _,., CITY OF SPRINGfiELD . 7260.3769 COMBINATION APPLICATION/PERMIT I I 1111/\ 1'_-""= I MI A"t"" L~ ENERG~~'2't':,_ LlP Sq, Ftg. Ma;n Jab"'ddren~ OMII .~J U.......-- Heat - pi Sq. ftg. Accan._ I Water Healer Sq. fig. Other L.gal D.",;poan 11I.:l?T ~F_7- (. , ~ <,fc::le>... /",)'()3. 22'Z Range _ _New_Add XAIt,,_Rep. t " jfr'olue of Work: _._Fen(e__Dem~ChOnge/~ i ~ L~1r - ~LteK-RLJrB ~ .5J)()Q 00 (~,;;'/J-~~;p:;:;-."=''''- ., "'" ~'" 11 ~ ,;. J I ,~eo ~AJt. h Buildin4 Permit Info: Describe Work (i.c.. Build 5i"91. I Add",. 4j,.A.J l..UVl\.l I I\. 1 ~r"\ PhanOlmtJ_ '::-D;;;ti tih;;;d ..e')2', $b- n _ , 'I' Can.'M';an L.nd.. r'b'W-.l.p ~ ~~ A~A- ~G>;;;'.4#C::"'" 'I Address Phone 'U I DESIGN TEAM INFORMATION LINE 7'26-3753 ~ ~ (\ l' ~ IV ,- (nomel (address) (lies. no.) (expire1) (phone no,) Primary Mt1 pI:) W ".;4~t; 1tl!l{)').., ~~~/A'2,4!2-1, Struclurol Electrical Mechanical CONTRACTORS (name) G.n..al ~bTflS~. (address) (ljcs. no.) (expires) (!)hone- no.} Ah A~. Plumbinq Mechanicol ~If !0 r.Otift.>RT fl ,OW Electrical NO. I --- . FEE I CHARGE' NO. I Ix I I I ELECTRICAL MECHANICAL PLUMBING FEE I CHARGE NO. i_ FEE CHARGE' I Residence of I 157- furnacel burner to Q,TU's Appliance vent separate Stationary evap. cooler Vent fan with sinqle dUct Vent system aport from heating or A.C. Mechanical exhaust hood and duct ./ Each ,;nqllt fill:ture Relacoled building (new fix, additional) S.F. Ruidcn!=o (1 both) Sq: ft. New circuits, alterations or entensians =<dR:~/f ~ SERVICES Sewer Wood stove/heater I I I I I Oualelt (1 both) e-och Temporary Can,truction Additional both Amps. Water service Star,m Sewor FEEDERS Heat Pump Air handlor to 10,000 CFM Air handler over 10,000 CFM ". AOD S...llC'<:'" D~ c7- b,<>O Amps. TOTAL CHARGES I TOTAL CHARGES ISSUANCE OF PERMIT I.:;P, <>C> 15."'" TOTAL CHARGES 16...."'" WHEKE STATE LAW REQUIRES that the Electrical worle. be done by the eTerlrh:al Contractor, the .Iectrical portion of Ihis permit shall not b. valid unlil 0 label has been signod by on Electrical Conlractor one! attached .10 the eleClricol panel. I HAVE CAREFULLY EXAMINEO the completed application for permit, and do hereby certify thai 011 information hereon is true ond correct, and I further certify that any ond 011 work performed shall be done in accordance .....ith the Ordinances of the City of Springfield and the laws of the Slate of Oregon pertaining to the work described herin, and that NO OCCUPANCY will be mad. of any slructure without the permiuion of the Building Division. I further certify that my reghrration with the Builder's Soard is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted heron, and that only subcontractors and employees who ere in compliance with ORS 701.035 will be used on this project. Basis for Builder's Boord exemption: NAME (please print) ~~ A. 6M r-n4 c:.tGNATURf FOR OFfiCE USE ONLY (\~ Zone C. .. 1./ fire Zone_No ~ Flood Plain No- Type/Can".X::flfl? Bedrooms _AI. ~ ' I Unih -Occy Load _t7 Occy Group-F....2 Sq. Ftg. Main Sq. Ftg. Access Sq. ftg. Other x Value x Value /7~t>T'c..C'A~~c-E Valu. TOTAL VALUATION DAT~ I I ~,torie~ :'.__ -.0 .;: ""-=-- .....". PLUMBING PERMIT Charges and Surcharges /01-4. Fence flo.W~~c:5b3dO 75".- -\-f1m L\-l~)-P51 I BUILDING PERMIT Chargos end Surcharges "='':;? ...- -ffilan Ck. Cammllnd ___.-:?_-=-__ 65%/81da Per Fe. I ':) B Plan Ck. Res .' . 30%1 Sldg Per Fee Demo l Total Comb. Permit ~ .r: 5"'2. ELECTRICAL PERMIT Charges and Surcharges IS", -0 be:> Sidewalk Alc Pavino MECHANICAL PERMIT Charges and Surchorgu ____/~.~ .b~ Curb Cut I TOTAL I '-fe;. '>< COMBINA TlON APPLlCA TlON/PERM~AP) I. Applicant, to furnish A. Job Address B. legal Description 1. example'lax lot 100, lane County Map Referenc~ 2. example.lol 1. Block 3, 2nd Addition to Springfiel Name, etc. of owner and construction lender Energy Sources 1. example-heat/electrical ceiling/or forced oir gas 2. examole-water hearer/electrical/or solar E. Square foologe or valuation, etc. - 1. examole.1250 sq. fool house, 500 sq, foot garage 2. example-if new project, check new-if addition, ChE add. etc. Building permit information: 1. exam ole-construct single family house with an aftl garage 2. example-remodel existing garagt. into family roon 3. example-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. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Divis Stoff must be able to contact appropriate persons reg design information or job site corrections. etc. II. Abbreviated Plumbing. Me~hanical & Electrical Sched~le:s A. Except where blank spaces occur in the description po of the Mechanical and Electrical Schedules, Ihe applic, need fill.in only the No. Boxes adjacent to the approp item(s) 10 be installed B. Full Plumbing, Mechanical, and Electrical Schedule. . are available at the Building Division 1-. To conserve space on the permit form the sched"ule: have been abbreviated 2. If the item(s} to be installed are not ~overed on the ated schedules you should consult the full schedule C; BUilDING DIVISION STAFF Will Fill OUT All FEES M CHARGES ON THE SCHEDULES C. D,. . F. III. Applicant to sign and dale Whenever possible. the initial application will be used as worksheet only. Where possible, Building Division Staff w prepare a typewritten copy and return it to the applicant the time the actual permit is issued for his signatur&. Fees and Charges Plan check fees are due and payable at the time of the aF <- and no plans will be processed until these fees are paid. A- other fees and charges ore due and payable when the permit is issued. . IV. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: ~/C-./^,AL Sz:>c::: we; 1:.!::..!2.:'_~~-: ~L~""'7 ~t: .-. . PER.MIT VALIDATION 17 03 43 CITY SPRINGFIELD OF . r " City Hall Springfield, Oregan Department of Public Work. OFFICIAL RECEIPT . 56354. f; / I No. B -, - ~ 3 19~ I C Rec'd From f)!)J..~ ~A Address P ,0 . t:>O X ~ l\ 3~ '-. -~.~ O~ -- , - Received For: ( Date .. ( ~\j} ( -Dp ( r.. dr fYLD ( SDC- t ('- Received Amount e ~~rl. CD j, :18 J,~,OO .&0 1&. ()Q . (a4 ryS-. CO 4'711 (J 1- 70 (I /(1 (l (I Iqo. ~2. (,k r~ (I ( ~I (I ...UTHORIU;D 5IGN....TURII: ...".. ( , 'H.UO"'TI,"""'U~1. ....'..TIl~. . t:uca.u. 0" ,,..0' . '.- Permit Clerk r~~ , I: I 1...,....45 .:::: p,a .JIj""c::::.;:;;:;' C>A.- ~ArL."'" ~ S~ ",.1:,)~7/~~1"!"(' ~,~c:... ~W ~..:- Co..,,;:;r r' .-/,:.,../. :::);qGc'-L ~?7/V?/"T (b7E:t;t;:::g~ S~::.. CoN ,: G~'j..r- ,~",.r.," PLANS REVIEWED BY, "Qme_~/9--\.""",:: - /~ r!= ~.,,;::,..,. signatur'" - ..late Y-:<:::>-S?/ "'4"'':..l-..~~.....t..""",,,,"o.:.. ~ .. '."