HomeMy WebLinkAboutPermit Building 1980-7-31
IiISPECTIOi"l LWE
726.3769
.
CITY OF SPRii;GFIELD
CQ/1BI,IATION APPLlCATlOCl/PERMlT
/; '\-;11 <'_
.
Job AddressStJSQ hU? \'///1"/1
Legal DescnptlOn AlMh.';c.. _ I,..,{.. '. \
E:iERGY SfURCES: .
Heat rei 1>19 dlcf..,IL
\'later Heater 't fn4-"'f(_
Ranqe t._l" L'/-"'I ;
lUFORllA TI ON
~ 726-3753
So. Ftq. 1,lain '-'I c-I '/ ...,.
~q, ,t9. Access. LlU f('
'..:J
Sa. Ftq, Other
,liJle"_Add-",,1 ter_~ep.
Fence Demo Change/Use
Other- -
I
k
,.
Valuh~ Barf.: ..(\ I
,'\,./ / I [j; V
Bli11Cino Permit Info: Describe \'}ork(i.e., Build Single
Familv l1esidence l'lith ",ttached Claraoe)
~.LJ-ft-mJ 1u A p/1Jdp/Yi/'I )
hl..l' j" H/J/'~',/I)/1rJA/)O/1
,f P
Owner '.-iERR( 'J; b'I'?
Addreso>-..) .. ~ /" ?I}
1'\ / '" CA) //./1_',."'/..-.'1 /{
'-'
Phon~vfil;r;~
Construction lender /Ar hi I~ (' 1
Address
DES I GII TEAll
Primary
7d /:;,.",
. Structural .n /.../117
(name)
Phone
(address)
~
/".Nr/
/,7/11,.--;-
Electrical nA "'.' /~;;.~I
t1echanical
CONTRACTORS (name J
Genera 1 --;I'd b",. "'--U!lJ-T
Plumbina ~.1....__
Electrical /) 'j1..1./~ /1 *,N'
r,lechanical
PlUI1BlflG
110.
.
'."
~
:"
~
.'
:~
F, 121': PL.P<. F,
(lies. no. l
(exni res)
;'
.
, .. . i
(address) (lie<:. nn.)
(~xnirp'i )
(ohonp no_)
I)l.;."./" J'/
k'?~")i~./..t_ 1-%tJ.lD 1-f_1i?,/'J
ELECTRICAL
FEE I CHARGF fin I
IResidence of
X 99;;.. SQ. FT.
INew circu~ts alts.
or extenS1ons'
Each single fixture
Relocated building
(new fix. additional)
S. F, Res i dence
(I bath}
Duplex (I bdth)
I Additional bath
x
~!ater service
1 Sewe r
IStorm Se\'/er
;Zs-.oc
SERVICES
each
j{j..~tJ
,I
Temporary Construction
Change in existing
re<:idenr:e
multifamily, COrr.r.l. or
Induc;trial
Of
I
I
I
I
I
I I
3S,ad TOTAL CHARGES
that tile Electrical Hork be done by an
label has been signed by an Electrical
COW1./! NO, FEEDERS
Install/alter/relocate
distrib. feerlers
[Of
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be valiJ until the
"',(;''<.~/I'C;_,
amps.
MECHANICAL
'"' nIAIU~~ Nn ," :r~ARr.~
furnace/burner to
I;;,t;r) BTlI's
I Floor furnace
and vent
I I Recessed wall
~nar:p hpatpr anrl vpnt
/
I~I I Appl iance vent
separ~te
I I I StationdrY eV,\n.
cnoler
13 I Vent Jan wi th I -:l,,?:J
sinol!? duct ';C"l
I Vent syste~ ~pdrt from I
heatino or J\.C.
I / j.lechan i Cd 1 exhaust 1'/.:,0
hood and duct
Wood stove/heater i
amps.
ISSUANCE OF PFR!lIT
/(J.tJd
..;J,<;'.m
TOTAL CHARGES
~i3,:,o
Electrical Contractor, the electrical rortion of this permit
Su~ervisor and returned to the Building Division
J.
I HAVE CAREFUllY EXMIINED the completed aprlication for permit. and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Orel)an pertaining to the work described herein, and that rm OCCUPAlJCY l.,.i11 be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ORS 701.055. that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with 025 7nl.055 will be used on this project.
IW1E(please print)~ tZi?:/ 11bl:!
Zone 2-1
Fire Zone -
Flood Plain NO
BUII.DWG PERI,lIT
Charges an':
Surcharges
PI.UI.\BING PERMIT
Charges and
Surcharges
EI.ECTRIC~,L PERlilT
Cha rges and
Surcharges
I1ECHANlCAI. PERI'IIT
Charges and
Surcharges
Lw. .0:
DPTE 7/j/ /1<-1
SI(;il/\TL1RE
F02 OFFICE USE Dill/( / ....-
/
Tyoe/Const. Ti.-i/
Bedrooms 3
Stari es /
Occy load
Occy Group.r-?- 3
Sq. Ftg. r1ain 09;.l
Sq. FtQ. Access ~/,-/'3
Sq. Ftg. Other
x .2lf.dO
x tt.cfO
Value /l'/,OOt;" "D
Value'i,E, J ~-, <),0
Value
Units
Plan Ck.
______j~pg_ 65Z/Bldo
d ,,, Plan Ck.
rr. ~ 7 30%/Glda
?S.:!JC I Fence
-------~----
/,<+0 I Demo
I'S~OC_~::,::_, I Sid~~~lk G;;L'
- -.7:i5 --/~ ~~-I A/C Paving
Cl3,SD I Curb Cut 18'
c--------~~;;-I
Cornm/l nd
Per Fee
Res
Per Fee
3n.3J
---1S \..\ \ q L 1
[
x
TOTAL VALUATION ,)'7, :1,:21,1.0')
ISystems Dev~lopment
Charoe (1.5,,)
I
I
Ljd!.~::J
I
I
I
I ;)31'), it) ff
;$ ~40.5D J
b,ao
Total Comb. rermit
II. ',fo
I
I TOTAL
co
"&')'
;j .
4!':";
" :.".
2-
'I
C
"
.
.
PERMIT VALIDATION
,
1
COMBIIlATION APPLlCATION/PERHlT (CAP)
1. Applicant to furnish
A. Job Address '
B. legal Description
1. examole- Tax lot 100. lane County Map'Reference
1103 43
'2. example- Lot 1. Block 3, 2nd Addition to,
Sprlngtield Estates .
C. Name. etc. of owner and construction lendE (
D. Energy Sources
1. examole- heat/electrical ceilinqlor fc
2. examole- waterheater/electrlcal/or sOl
E. Square footage or valuation, etc. - (
1. examole- 1250 sq. foot house, 500 sq.
2. exa~Dle- if'I1ew project. check-new - i
check add. etc.
F. Building permit information: (
. 1. example - construct single family hOU51 ~.~.
attached garage
2. examole - remodel existing garage into
3. examole - convert single family resider ('1.
restaurant (change of use)
G. Value of work as defined in Section 303 (aJ
Structural Specialty Code
H. DES I GN TEAI-t AIIO CONTRACTORS (
To avoid design or construction delays, Bui ~
Division Staff must be able to contact appr
persons regarding design information or job
corrections. etc.
II. Abbrevia~ed Plumbing, Mechanical, & Electrical
A. Exce:lt, ",here blank spaces occur in the descl
por:ion of the Mechanical and Electrical Scl
the applicant need fill.;n only the No. Box~ ('"
to the appropriate item(s) to be installed
B. Full ?Jumbing. l'lechanical, and Electrical Sc
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 c
the abbreviated schedules you should con
full schedules
C. BUILDI1;G DIVISION STAFF WILL FILL OUT ALL FE, G"
CHARGES atl THE SCHEDULES
D. As noted on the CAP. the label must be deliv!
electrical contractor for signature by his e'
suoervisor. The general contractor is _not al ~~i
to' sign the electrical label. -
Appl icant .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 ~t to
applicant at the time the actual permit is issued
signature.
IV. Fees and Charges' (
Plan check fees are due and payable at the time O'
application. and no plans will be processed until
fees are paid. All other fees and charges are dUE
payable when the permit is issued.
I I I.
V, FOR OFFICE USE ONLY
~
CITY
OF
SPRINGFIELD
(
!
I
City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
(
S4209(
c
q 1tO. B
DOle4J -a 19(}U,
Rec'd ;'om \-I}l h ,t ~' )~~~il ' j
Address ~'7l (O(){ f?{ ~(],,~. '_ It
< \2tt.
\2-\ OC)
L\~ 4-
~C) .00
\ . Dc)
'!?JOCI
~(\'"
235, fjU
. CIa
(f) f-b
Lj.cG} ,'i}i--
(o~O ,If) (L
(
(
(
Received_For:
bV
(
L\O \0
L-\,c'l /) -
I 4-''ZJ 4-
401 ()
?(.J
(
Y --,t-)
(
-
uv
(
L}O'V\
~)ICL ,-
c;bt-
(
(s
Amount Received
l
c
('If)
~ AUTI-lOI'lIZED 5IG,.....TUR~
P . ....t:lTO...TU~...U~~ ....'..Ttl"$ . 1lI.I01I:..1. Oil '7.0'
....".,
(
(- .
(I J
~
1-
1. fJerml t Cre'rk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPArKY:
I, Permit applicant exempt from registration with the Builder's Board because:
l
.l
f ~
!~ Additional Project Information: FJ..t)o;? EJ t"!/,t;/7'lnN 7'1' P;E. ::J PEEr- ,i:J.A~rle aves
PLANS REVIEWED BY:
... .. ..-., . . .... ~ - ,.... . u, ... .
name
signature
L)~ ~_ ;~d
date !?-I-~t:J