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HomeMy WebLinkAboutPermit Building 1981-8-21 INSPECTION LINE 726-3769 . CITY OF SPRINGFIELD COM8lNArlCN APPlICArlON/PERMIT . INFORMAtiON LINE 726-J7,SJ ltl'Jol De,c,ip,ion w fQ,'rVlel"J s~.Q) ,_I 1-O~-77-3 i , rJ2;.O J Gr-<>l""" ,) Ct,.,nr~l) 0-3'1 t,.j) Fo irv; "'.- ,-' '.c?o 0,) I Cc rf)()~T ENERGY SOURCES: I Sq. Fig. Main I Sq. ftg. ActUI. Sq. Fig. Q,tllltr _New AAdd _A h., _Rep, _n _Fonn_Oemo_Chango i ui. _Dlk., ~, -....:, () V) '\J ....... Job Add,e" Hear Wale' Heater Addren Phon, 74(0'/ a:J.1... Ronqtt _ Value of WOtl: .....!~t-".":' :.:....0 L/iJ (i~' 8uildinq Pet.:nillnfa: Oe~ctibe Wark (i.e., Build Sing I. Famih Rf!lidltnc,", With 4.tta{h"d Gataae. (~a.:r 60(=-1: I O_nflt Canuruclian lltnder Addre" Phane O::SIGN TEAM (name; (oddreul (Iics. no,) (expirel) (phone no.) Primary mun or S,ructural ~Iectrical Mechal'lical (ONT~"CTCi!S (I'lamf'l (addresd (lics. no.) (expires) (pnc.l'le l'laJ ] ] Gl'nerai 1'0~ n Ii/' Plumbinq El,.clricol I" MeChanical ?LUMBING ElECTRICAL MECHANICAl NO. . P:l: CHARGE NO. FEE CHARGE NO. FEE ! CHARGF Residenc. aF iurnaceiburner ta DTU's Appliance vont seporoto Statianar}' oyap. coaler Vent fan with linqio duct Vent system apart from heati~q or A,C. M.chanical exhaust hood and duct cacn ~;nqle fill.lure Rotlacaled building (new ti.. additianal! S,F. i!'!I.den~e {1 balhl U~: ft. New circuits. alteratiaus ar extensions SERVICES Dualeoc II balhl fOOen Temporary Construction Additional bOlh Amps. Wot." len;ce Sewer Wood slove/h.oler I I I I I I \rf" 1),.' ~I TOTAL CHARGES } Slot.m Se.....r FEEDERS Heat Puma Air handl.r to 10,000 CFM Air handler oy.r 10,000 CFM Amps. ISSUANCE OF PERMIT TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES Ihat Ih. El.ctrical Worle b. dene by the Elel'tricol Contranor, the .lectrical portion of thil permit Ihall nol b. valid unlil 0 label ha. b.." ,i9ned by on Electrical Contractor and attached to tho electrical panel. NAME (please print) I HAVE CAREFULLY EXAMINED tne completed application for permit, and do h.reby certify that 011 information h.reon is true and correct, and I further certify that any and all work poe-rformed shall be dan. in accordance with the Ordinanc.s of the City of Springfield and the low. of thll State of Oregon pertaining to the worle delCribed herin, ond Ihat NO OCCUPANCY will b. mad. of any structure without the perminion of tne Building Division. I further certify that my re-gisfl'"otion with the Builder's Boord is in full forCll and effect os required by ORS 701.055, thot if uempt th." bods for uemption is noted heron, and that only ,ubcontrClctars and employees who or. in compliance- with ORS 701.0.55 will bo usod on this projoct. <IGNATURE J:i;.., .P9~<"'~ 2 ~h/Y>D FOR OFFICE USE ONLY (/ (I U Ba.is for Builder', Boord exemption: /) bl'ea .J c'n", ,..,..J) DATE ~;;:j/ Value TOTAL VALUATION ,:1,:-,'0:). =<'--" ~=?~:).~O I I I I I I I I I Floo~ Plain .'i~ Typel Canst, :~~. /1tI' Bedrooms --- <torie' ( I "-..-/ Units n<:cy lood Occy Group I'YI}"/ Sq. Ftg. Main c-q. Fig. Accen Sq. Ftg. Other ,t."7:"~'':.{ 'i~ x Volue ~-.-:~ - , - -; ~ Value i?_ ~. Zone . '" /'!" Fire Zone ....,.....; BUILDING PERMIT Chorges and Surcharge. "--;> ,.0:::" -6- ~,.:-. Plan Ck, Comml/nd 65'l~1 Blda Per Fee Pion Ck. Res :30~ol aldq Per Fee ..., ...:). ,1~"O /':"0 . :!!--::<I'~I Syslems Development ChorQ. (1.5~~1 I. " .~ , ~... PLUMBING PERMIT Charge, and Surcharges Fence Domo Totol Comb. Permit ",:::?"?_/"2. ELECTRICAL PERMIT Chorges ond Surcharges Sidewalk AIC Povino TOTAL I ~~,/:z' 1 MECHANICAL PERMIT Chorges and Surcharge. Clolrb Cut I. Applica~ to furnish A. Job Address B. legal Description 1. examole-'ax lot 100. lane Caunty Map Reference 170343 2. exampie-lot 1. Block 3. 2nd Additian to Springfield Estates C. Nome, etc. of owner and construction lender D. Energy Sources 1. examole~heat/electricol ceiling/or forced air g. 2. exomole-worer heater/electrical/or solar E. Square footage or valuation, etc. 1. examole-1250 sq, foot house. 500 sq. foot gara \, 2. examPle-if new project, check new.if addition, odd. etc. F. Building permit information: 1. examole.construct single family house wit,h an I ~._l garage .2. examole-remodel existing garagE; into family rc 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 Dj' Stoff must be able to contact'appropriate persons " .... design info:rmatian or job site corrections. etc. COMBINATION APPLlCA TIO.ERMIT (CAP) ,- PERMIT VALIDATION CITY OF SPRINGFIELD ( City Hall Springfield, Oregan Department af Public Warks OFFICIAL RECEIPT No. B Dote ?? - 8 I 19 2f Reed From ~((->C1fJn ~ (~~ ( Address ~ 3C\ Y.D. .to. udJl V 11 r:;7'1 ':;8 "',_.... ( Received For: II. Abbreviated Plumbing, Mechanical & Electrical Sched~; ~g.OO A: Except where.blank spaces occur in the description j ,"" -b () ( , of the Mechanical and Electrical Schedules, the appl -' T 49" J. I:J/ need fill.in only the No. Boxes adjacent to the apprl item(s) '0 be inslalled ( B. Full Plumbing, Me<:hanical, and Electrical Schedules ( are available ot the Building Division 1. To conserve. space on the permit form the schedu ( have been abbreviated , 2. If the item{s) to be installed are not covered on t~ \, ' ated schedules you shauld consult the full schedu C. BUilDING DIVISION STAFF Will Fill OUT All FEES J , (. . CHARGES ON THE SCHEDULES III. Applicant to sign and date Whenever possible. the initial applicotion will be used c worksheet only. Where possible. Building Division Staff prepare a typewritten copy and return it to the applican the time the actual permit is issued for his signafUr&. Fees and Charges Plan check fees are due and payable at the time of the c and no pions will be processed until these fees are paid. other fee. and charges are due and payable when the p ~i' is issued. t- . IV. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Addi(ionol Project Information: PLANS REVIEWED BY: / ..... -= ":;:? ,5>.:;:....~:" nam.... t-.-.y-./N~ /" ~ .~/ ) signaturo , " Amount Received cOLLi. l -;:j., ('b l\ Q~ ' ('~dA~ J ~ ( AUTHo"ru:o SIGN"TURI: S"ILTO...Tl,'''''"I,1LL ..100'111.' lUGII..II:. 0" .,_g. ..111.1 (, ( " Permit Cieri. , --/ ,:z::;?" /'? -~....e'.......--;r ~__G="-~__-' -tale g-~<~/