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HomeMy WebLinkAboutPermit Building 1981-1-27 ../ INSPECTION LINE 726-3769 , CITY OF SPRINGFiElD COMBINATION APPLICATION/PERMIT , INFORMATION LINE 726.3753 109 ENERGY SOURCES: Sq. fig. Main Heat 'f, . G,_ Sq. fig. Acceu. Water Healer ,". J 'l Sq. FIg. Other Ronae ',' i ...., _Ne....._Add_Alter_Rep. Volve of Work~ /_Fence_oomO_Change/U5lP 7t9t>~ _Olher. Building Permit Info: Describe Work (i.e.. Build Single Familv Residenu Wi,h Alloched GOfCII)1I1 ~ Job Address '5{1t,;,. c.J, NJiWiEvJ l:>-RiIJl::: 1.07/ AI/;./ /7-{)~~,}.?-:>'i DIlGw>OPtlc? PA/2t( n 100 UOiLJ,k/W.r'\'1AM --- t,) ;t.'AHltVl(';W C> C) o cJ -0 Legal Oeicription Owner .Address /,(;'0 ---11,ftlc.rle7~ )L.4 ~ .<"OR 'A-A.C7"'~ '''''''Y(' T b~~ :........:.:.:. .. -:' ._. __, ..1...___..____ Phone DESIGN TEAM ("nme) tf)fIIAI(;1' (addren) (lic5. no.) (....pires) (phone no.) Primary Structural ~=tri..al M..ct'-:l,,;,ol cmn~J.CTOItS ,I G.n.,ol ' Plumbinc:: (r:CITIII) fAoAlt::t? . (address) (lie,. no.) (exDiresj {ohon" no,l Ele('l~if'(11 Mecl'o:,';i':-'JI PLUMBING ELECTRICAL -- MECHANICAL fEE I CHARGE NO, fEE I furnoco/burner to a,TU', I Appliance ven~ separate I I 5Iationory....ap. I, cooler I Vent fon with I si"!=Ile duct I Vent system aport from I heotinq or .A.C. -I Mechanic::!1 .,:h"u~! I hood and d..rct Wood ,.oye/hooter -' rNGT' fEE CHARGE I t-IO. CHARGe I i i I. Each lil:~le fixturt: ReJocaled bu;J"~'19 (nl!!W fix. ad:Htiona!) S.F. Residence (1 bOlh) Residence of _~D: ft -, New,circuits, alterations or extensions I SERVICES I Temporary Construction .--t Amp., I , 1 ! I I I ,- .' Duplex (I both) each ~~!.!.:onal both I Wall.:r le,...;,e I Sewer Storm Sewer FEEDERS Amps. I I I I I I 0 TOTAL CHARGES Heat Purno Ai, handler to 10,000 CfM Air handler over 10.000 CfM I r I TOTAL CHARGES I ISSUANCE Of PERMIT o TOTAL CHARGES <0 WHERE $TATE lAW REQUIRES that the Electrical work be done by the Electrical Contractor, the olectrical portion of this permit .hall not b. valid until a label has b..n signed by an Electrical Contractor and attached to th. electrical panel. I HAVE CA,REfULl Y EXAMINED the completed application for permit, and do hereby certify' that 011 information hereon i. true, and correct, and I furth.r certify that any and 011 work performed shall be Gone in ac~rdonce with the Ordinances of the City of Springfield and the laws of the Stato of Orogon pertaining to the work described herin, and that NO OCCUPANCY will b. mode of any structure without the permission of tho Building Division. I further certify thot my regiSfTotion with the Builder's Soard is in full force and Ill'ffect os required by ORS 701.05.5, that if exempt the bosis for exemption -is noted heron. and that only subcontractors ond employees who ore in compliance. with ORS 70JI.O~55 will be2'.d ~n this project. , Basis for Builder's Boord ellemption: _ Oof.c--....An_ NAME (pl.a,. pdnll DON d.';flQ ",,,^, 'IGNATURE , _ DATE / t ?/~, , fOR OFFICE USE ONLY I r;>b,. Type! Coni'. Bedrooms C,tori.. V l' 'Jnits "'ccy load. ^ccy Group -- Sq. ftg. Main Sq. Ftg. Access Sq. Ftg. Other . ValulI "alulI Zone Fire Zone Flood Plain u x Valu~ TOTAL VALUATION .2ZQO, O~ BUILDING PERMIT Charses and Surcharges 7.00 ----;-.;l,~--- Plan Ck. Comm/lnd 65%1 Blda Per fee Plan Ck. Res 30%1 Sldn Pe, fee PLUMBING PERMIT Charges and Surcharges ._-Q--- Fence I Systems Cevlllcpment CharAe (1.5%\ ..~:lOPD lj'21-~J lu/ EEt,,<l') I Tatol Comb. Permit I I i TOTAL 2..& T. Cema elECTRICAL PERMIT Charges and Surcharge. o Sidewalk .Ir o,....;,,~ MECHANICAL PERMIT Charges and . Su!~~~rges "'__' C) Curb C~t 4l 1: ?B ,.,,': ,~....-~.- , " ~~.:?"'.~~~~~~_::.;~<,:~> : ~..... .....&'~..,U.:;;...'&tii,,~ ,'. . -" ~ . Ill. Appiicant to si'::.ln and oate Whenever possible, the initial application will be USE (s. worksheet only. Where possible. Building Division Stl-- prepare a typewritten copy and return it to the applicant QI . - the time the actual permit is issued for his signature. . "I"'.::.t,. . . .' ."'. . ~ .~' . . COMBINATION APPLICATION/PERf (CAP) I. Applicant IQ furnish A. Jab Address B. legal Description 1. example-tax lot 100. Lane County Mop Reference 2. example-lot 1. Block 3, 2nd Addition to Springfield C. Name, etc. of owner and construction lender D. Energy Sources 1. example-heat/electrical ceilinq/or for'ced air gas 2. examole-water heater/electrical/or solar E.: Square footage or valuation, etc. - 1. example.1250 sq, faat hause, 500 sq, foet garoge 2. exaroole-if new project, check new-if addition, che add, etc. F. Building permit information: 1. example-construct single family house with an aft garage 2. example-remodel existing garage into family roo 3. exampie.convert single family residence into restcuront (change ~f use) G. Value of work as defined in Section 303 (o) of the . Structural Specialty Code H, DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Div Staff must be clbleto contact appropriate persons" design informction or job site corrections, etc. II, 'Abbreviated Plumbing, Mechanical & Electricol'Schedu A. Except where blank spaces occur in the description or the Mechonical and Electrical Schedules, the apF need fill-in only the No. Boxes adjacent to the appl item(s) to be installed B, Full Plumbing, Mechanical. and Electrical Schedule ore available at the Building Division 1. To conserve space on the permit form the sehee nave been abbreviated 2. If :he it~m(s) to be installed are not covered on cted schedules you should consult the full sehe C, BUilDING DIVISION STAFF Will Fill OUT All FEE CHARGES ON THE SCHEDULES --- / <,_.//,./'....1' , PERMIT VALIDATION CITY OF SP'RINGF"ELD Clly Hall Springfield, Oregan Department af Public Work. OFFICIAL-RECEIPT ( o \.O~ (I Date (-5 1931No. B 55755(1 ( Rec'd From ()?YlJ:1:ertlYlQt) . Address ~ 7 to w ,:+(1 J )1, ( l..i.u Jl' !, ( c ( Received For: ( Kf-J -(.00 23 ( ( ( , 4C.J /0 I ~o ( tli< ( C' ( ( " \, 7Z~ Amount Received C_1~ , ~'~... i \ " n ..""T.:u"o.".. ".NATu.. u ,....'n~"". ~UOI"t:, 0.. '1'_0. ,.."., ( ( IV, Fees ond Charges Plan check fees ore due and payable at *e time of the appljcation, . 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. V. FOR OFFICE USE ONLY Permit CierI- PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: '. \ ~.)//'! I ,. '7~i.l ,':.: .I.I.' //;-/ i ,{, . }'.'''! , ,.. : i"J "'/~": ,., J J /; r':/; , L}--, (i ( / /;-, Ii (i I., ,- (..' ! I I .. ,: Id" .' /...'. r /. U PLANS REVIEWED BY: 1',>) , /" \: ~ \ , , I ,y:~':'/:~ (: /'T;~ d . .:.. /; //fY' .YI7':1'/ /::; ".,1.1./ ,. ..:.-.,. ,.A.. '" . ~J ,//" //)/II) ( ~/:i' '/./i.~,/ ,.:.":, /',:j.. /")': ,/)/ name ""t:)"'~ S'n.!I\"'-'Cf"' ""'- signatur'" 1 (' C;:;:> ............,r"k- . ....lr.: I >_ I :-rv-- ~ate .' ...--' .~. " '=I' 1'.- '"t,i!~5..''''' . ~ 1". 1.",:!-_;;,a:C 2~~-1"'''''1 ' ..,",'0' " .. "',,' '. .... .....'. . ....r: , _',.;...... 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