HomeMy WebLinkAboutPermit Building 1981-6-29
INSPECTION LINE
716-3769
fI
Job Addrl!U
,2.4.3 '-5
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h':Jol Demiotion ~ -'2..::;
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k'onA J,~ ('"'fe.lF/rlcL
.2 LI~r-:; D,-..2/l()(}.,
Addreu
ConHructio" lende,
Add,e"
Of SIGN TEAM
(nomei
Primory
SCt:...F
StrucTurol
Electricol
.v..echo"icol
(nome)
CONTR-'.CTORS
G,"".' \ IA."-"< - ;:;:';:;)14-6<1';
5<iFCF
CITY OF SPRINGFielD .
COM81NA nCN APPlICA flON I PERMlf~
INFORMATION LINE
7'26-37SJ
iSq'~~It~ ~.
:;001:' Heater B~~r: I ~:: Ftg: Oth., . - '"
Ronqe _ , _New ~Add .)C:Alt.r _Ritp, ().
I Volu. of Work: 7'1S'2. ~ _._fence_Demo_Chang.iU,. ~
J _45A -,~ _O,h" N
Pho", "-::211/ A(}>7 Buildtng Perm;llnfo: OeiCrib. Work ii.o., Build Single I ....n.
T'f -L.' ") Fomi!.. Re,idl!"c~ With Attl1ched Goro.!!:el "U'
IJop ~~ J\~M. ,"&TN-R~ .yI I
b(~tE ~..t# dE71V~ '~4"l
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ENERGY SOURCES;
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Phon.
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. (addr.,,) (liCI, nO,)
(expir.,) (phon. no,)
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€MJPiL.>V€er:" 0yC. ~/:.":>IE'-t.. c:::.".,.,sr. I ~
(oddrllss) flics, no.)
(..?ir.l) (phOM no,)
Plvmbinq
EleclticClI
L: - ...:..
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Mecnonical
-?cl?':'F .
PLUMalNG
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ELECTRICAL
MECHANICAL
Relider"e of
F:;: CHARGE NO. I FEE !CHARGE
furnoce(burner !o .j
BTU', I
IJ.- Applianc. vent --' - '.;l--'
I.porole
Stationary evap.
~oier
I V.nt fan wilh ~.-.
,ingl. duct
Vent IYlt.m apart from
heatinq ot A,e.
M.chonical exhaust
hood ond duct
Wood stove/heater
Heat Pumo
Air handler to
10000 CFM
Air handl.r o".r
1 0,000 CF M
i
!
ISSUANCE OFl'PfRMIT lIP. Cl:>
-
IS-:- TOTAL CHARQES /3 -
Eocn ,;"qlll filltur.
R.locor.d building
(""W fill, odditio"oll
S.F, ~Illid.nc.
(1 bOlh)
FEE t CHARGE I NO. I
!~-~-
I ..r5
I
,
~~: ft,
New circuih. alterOlionl
or Il)l\tenlions
NO, 1
~I
I
I
i
DueJu (1 bOlhl I'och
Addilio"ol bOTh
Wot.r ,.,,,ic.
I
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r-
Sewer
Sh:lrm Se_.r
SERVICES
Temporary Conltruction
AmOI.
FHCERS
Amel,
TOT AL CHARGES
ItfP. -I TOTAL CHARGES
WHERE STATE LAW REOUIRES that Ih. EI.ctrical work b. clen. by th. Elert,icol Contractor, th. electrical portiofl of this pe,mit thall not b. yalid until a
1ab.1 hat been li9ned by on Electrical Controcto, ond attached to ,h. el.ctricol pan.l,
I HAVE CAREFULLY EXA.....INED the complet.d opplicCltion fCl, permit.. ond do hereby certify that all inFormotion h.reon i, trvtl and correct, and I fur the,
certiFy that any and 011 ","ark performed ,hall be don. in acc.ordance with Ihe OrdinonclU of th. City of Springfi.ld and Ih. law I of the .Stat. of Oregon
pertaining to th. wo,1r: de seriOI'd herin.. ond that NO OCCUPANCY will b. mode of any Itructur. without th. permiuion of th. Building Di.,ilion. I further
certify that my regilrTetlion witn the 8uilder'1 ~Qrd is in full farat and eff.ct 01 required by ORS 701.033, lhat if u.empl'th. balil for ...mption it noted.'
h.ron.. and Ihet! only iubcantracton Gnd emplay..s who ClrI' in complionw with ORS 701,055 will b. used on 1his p,oj.ct.
BOlis for Build.r's Boord e)l\l'mption:
NAME (plea,e print)
~~V\ ~ H r C~ \ \<\-,"
iI<..~1
Type/ Conll._ "1Z:- AI
Bedroom I
'itorie-
Zon.
fire Zone
Flood Plain
I
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'1'1. ..rr>
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1.7~
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/<): dO
.~e.
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BUilDING PERMIT
Chargo, Clnd
Surchargel
PLUMBING PERMIT
Charg'" and
Surcharge I
elECTRICAL Pf~MIT
Charge, o"d
Surcharglll
MECHANICAL PERMIT
Char9.1 ond
Surcnorgel
,.-l
'1GNATUR' ~~(~ \0...~~
FOR OFFICE USE ONLY
'q.Ftg.Mo;"~ .-;Z"'l~./~€~
C:q; ff9'~- et..~ x II:>.
Sq. Ftg. Olh.r .II:
i
. DATE (,.,';;'1-55 \ I
I
~1/2...,si
3':;pCfO.. _0 !
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7~';> .S::> ~
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~alu.
Value
VCllue
Unih
I""Iccyload
Oecy Group _:K!' - :s
, TOTAL VALUATION
Plan Ck, Comm(lnd
6s~:./Bldo: Per Fell
Plan Ck. 1t.1
30~:.1 atdq Per Fee
1"2 ::;>~ 1"-"'~"'7t>
/. ~:P..
~
SYllems De.,.lopment
Choroe /1..5%1
/Y-.
Fence
~s: :zS
Demo
TOlol Comb, P...rmit
Sidewolk
..1\ tin..;"..
"""T' -~ <G>" '-,.iLJ
...-,--'",c.."= ,,' _ -"""U' ~~
TOTAL'1i:.n .,:.,..... .c:; ...~...
~~l '7~Y-
... .
"/a-;;;,i;;./",-
Curb Cut
,.'.;.,-,..........'
. ,. ,v~, _'!'.. ~...,.,., ,.~~;:,,""". <:':~:;~~'i'"..." ~~!c-..::~.:,' '1::......"':~::... .'....~b;~t.~...!\~-
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COMBINATION APPlICATlON,'PERMIT .P)
I. Applicaru. ta furnish
A. Jab Address
B. legal Description
1. examDle.tax lot 100. lane County Map Reference.
2. exam ole-lot I. Block 3, 2nd Additian to Springfiel
C. Na.me, ele. of owner and construction lender
D. Energy Sources
1. examole.heat/electrical ceilinQ/or forced air (Iris
2. cxamole.warer hearer; electrical/or solor
E. Square footage or valuarion, etc.
1. examale.1250 sq. foot house, 500 sq. foot garage
2. examDle-if new project, check ri'eW-if addition, chf
odd. etc.
F. Building permit information:
1. exomolp..construct single family house with on ott.
garage
2. examole.remodel existing gorogl!:- into faniily roar
3. exo:nple.convert single family residence into
rCSlauront (change of use)
C. Value or work as defined in Section 303 (a) of Ihe
Structural Specialty Cede
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construc!ion deleys, Building Divi$.
Stoff musr be able fa contect oppropriate persons reg
. design informcrion or job site c.orrections, etc.
II. Abbreviated Plumbing, Mp.cnanical & Electrical Schedule!
A. Except where blcnk spaces occur in the description pc
of the Mechanical and Electrical Schedules. the opplic
need fill.in only the No, Boxes adiocent to the cpprol=
. item(s) to be installed. ___
., -S.' Full Plumoinq. Mechanical.. end f:i:!,;tr(cal Schedules '
'are available at the Buildinq Div;'ii',JIi
1.. To conserve space on the peru'.it form the schedule
hove been abbreviated
2. If the item(s) to be installed ore not covered on the
ored scheaules you should consult the fuil schedule
C. BUILDING DIVISION STAFF WilL FilL OUT ALL FEES At
CHARGES ON THE SCHEDULES
III.
Applicant to sign ana dole
Whenever possible. the initiol application will be used as
worksheet only, Where possible.. Building Division Staff v.
prepare a typewritten copy and return it to the applicant
the lime the actual permit is issued for his signaturE.
Fees and Charges ~.
Plan check fees are due and payable at the time of the 01 )cl'
.. ~
and no pions will be processed until these fees are paid. ,l-
ather fees and chorges are due and payable when the permit
is issued.
IV.
V. FOR OFFICE USE ONLY
.--
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
PLANS REVIEWED BY,
name
LoR~ ({~~
signature
-......
e.
~MIT VALIDATION
17 03 43
CITY OF
SPRINGFIELD
(
City Hall
. Springfield. Oregon
Department 01 Public Works
OFF I C I A l R E C E I PT
(
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No. B 5 6 8 2 9
'/-1- 19ft
Rec'd From f2.0noJ.ct te~land
Address d. LI.3 '5 (J,0 Y' Nyj",-,
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Dale
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Receiv~d For:
( I-
Y)-'rJ L/L/ 00
Lje, J. 7&
( Ie) , ",..
I)~' 10. Or)
ft~ LjC . i./ i)
'70 I
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( L/C;~I .to 0 (
fYl.A'7 I ~. CO
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Amount Received
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AUTIoIOA1Zl:D SIG~...rUlU:
...CLTO...TU......,LL ~",..T""., ru'n"c. 010 .'_0'
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