HomeMy WebLinkAboutPermit Building 1981-5-28
Job Add,... 6:;<,lot Fc:.y:c.,i~f1j0-- 5&e~
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dffG ~ :.:..)7 _ 1~{Jj!S3..JD iL852 IvoIU. of Wo'" C1
Own., !-Y{})I) H(J, r./e.'S ;;;9; SO(). 0_
Add.... ;{ f) M5 ;'./tlvfp, In 0 :St. Phon. '74;, - 909..::S'
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INSPECTION LINE
726-3769
Co",truc:tion lend.r
Addre..
DESIGN TEAM
(nomei
Primory
Structural
Electrical
Mechanical
!-OI.
.
'-
. Sq. FIg. Main
Sq. FIg. Aceu'_
Sq. fIg. Other
_Ne..... _Add_Alter _Rep.
_. _Fence _Cemo_Chang.! U 5.
_Olner
INFORMAJlON LINE
726-.375J
CITY Of SPRINGfiELD
~OMal~lnOtt APPLlCATION/PERMlf
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ENERGY ~OURSES:. /).
Heat g 1~/CIc.'r ~ Yr')
Water Healer p ~(.fi/ti.
Ran'll! eJ,,.-t _,r
Building Permit Info: De,cribe Work (i.o.. Build Si"gle
Fomil"(. Re,idt!l1ce With Alfoched Gorcu:'Iel
_ ,()1171 hi" IJ JI;';o" VJI/ r..hl&... f1 OJ1'\.L
:5Pj-i~r> (21')'1.':'>'2)
Phone
. (addressl
(lies. no.)
(phone no.)
(e.-:pir.,)
G..nera\
CONlR.A.CTORS (namel (address) We,. no.) (upire,)
Awk.'t>Hs 7i::gj.J.ev _<;all'S - 1j-4-0 Fi/O.it!ldlkPJI~d - EL.ct1./A.L
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Plumbing
{I..etricol
'Z
Mechanical
PtUMBING
NO. I
Eoc;.. lingle fillture
R.local.d building
(new fill.. additional)
S.F. ll:,"iden~.
(1 both)
Ouolu, (1 bothl each
Additional balh
,
I
Woler ,er.,ice
!.'-:;;;TU;::,,"1.
Sew!', iC'O F.::.ET
St::lrm Sewer
(phon" no.)
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ELECTRICAL MECHANICAL
f::e: I CHARGE' NO. I FEE CHARGE NO, I FEE I C'HARGE l
I Residence of I furnace/burner 10
.g: ft. "TU's
I New circuits. alterations I Appliance vent '-'
or extensions separato
I I Stationary evop.
SERVICES cooler
I I Vent fan with
Temporary Construction single duc:t
j Vent system aport from
Amps. heating or A.C.
I I I I SI,} ~Pl. Y ~~f"::'> /iY2. /O,~ I Mechanicol exhoust
/A..,r-."_f. :---,;J.!.-:. hood ond d~ct
I/)~i/{).O~II / MDl3rL-f. f--f<)/./:; ;j,~l),o.~ I
G-ONNEC:n.y,! Wood stove/heater
I I I FEEDERS I Heat Pumc
I I I I Air handler to
Amps. 10.000 CFM
I I I I I Air handler au'
10,000 CFM
I I I
i I I I
I I I I I
I I I I I ISSUANCE 'bJi.,PE'RMIT -e.
-Fjr),~~ I TOTAL CHARGES -$ XI),6:- I TOTAL CHARGES -e-
j
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I TOTAL CHARGES
I WHERE STATE LAW REQUIRES Ihol Ihe Electrical work be done by the E!ertricol Controctor. the electrical portio" 0' Ihis permit shall not b. valid unlil t.l
lab.1 ho, b_n ,igned by an fle,"ical Contrador and attached 10 Ihe oledricol panel.
I HAVE CAREFUllY EXAMINED ,he completed application for permit. and do hereby certify that 011 information horeon is true ond correct, and I further
certify thot any and all work performed ,hall be done in accordance with the Ordinances of the City of Springfield and the lows of the State af Oregon
pertaining to Ihe worlt d!'scribed herin, and that NO OCCUPANCY will be mode af any structure without the permiuion of the Building Di't'isian. I furth."
~rtify that my registration with the Builder's Board i, in f\lll force and effect 0$ required by ORS 701.055. that if ex.empt the basi, for exemption is noted
heron, and that only ,vbC'Ontractors and employees who or. in compliance with ORS 701.055 will be u.sod on this project.
Basi, for Build..", Boord e.emptian:
NAME (pleas. print) ~6/'.J r h/1, v-,.,
.).L,. III "":
SIGNATURe- -fjaA//-d/'I.A.
FOR OFfiCE USE ONLY
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DATE
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Zone-J::1~~'i. Type/Cons!.kH (~N""
Fire Zone L_l ~~droom. Ttt2--f"~
flood Plain~f'\~ c;tories_^Nt;:
Units
('lccy load
Occy Group
Sq. Ftg. M~in
c.,. ftg. Access
R'::>'
_Sq. ftg. Olher
i4S&, ijt Volu.
x Value
x Value
, TOTAL VALUATlON;;I4 7_-5Cl~,"~
BUilDING PERMIT 4-0:00 h Pion Ck. Comm/lnd -@- I Systems Oe't'elopment 447., 50 n
Cho~ges ~ P~H~LE- 65~ol Blda Per Felt , Chorc:oe (I.,5~1 -
Sl.--;"u~~'\"ilbE . ~- PIon CIt. Res _ 3--'),O..Q 01 I c..oP'I O.~4;)
5~.T.'jP ,~ 30'%1 Bldc:o Per Fee
PLUMBING PERMIT 1/\ :;>0 31 ')we> ,q
Charges and .' c......,- Fence '.--".-
Surchargu () -'ill "" 1 Tolol Comb. Permit 4f58;:(.ftS
,- Demo '--'
ElECTRICAL PERMIT ;::).)..J.3,>- 17,'3:0 I~ L-a.bt. } I ~
Charges Q"d Sidewalk 17S",,',r
Sl,lrchorges )"<) i ...Q-
r. .......;...- Ale PO't'ino
MECHANICAL PERMIT ....;-:+ /)!..FEf3T I 1(, 20 ,<-
Charges and ----~--- Curb Cut - 5~,(g~
Surcharges I TOTAL
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COMBINA nON APPlICA nON/PE.(CAPl
lit PERMIT VALIDATION
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'I, Applicanl. ta furnish
A. Jab Address.
B. Legal De,criptian
1. examale.tax lat 100, Lane Caunty Map Referenc~ 17 O:l 43 '
2. examaie.la. 1. Black 3, 2nd Additian ta Sprin\ (_ CITY ,0 F S P R I N G FIE L 0
C. Name, etc. of owner and construction lender
City Hall
D.. Energy Sources
1. examale-heat/electrical ceiling/or forced air c Springfield, Oregon
2. exam ole-water heater; electrical/or solor ( Department of Public Works
E, Squore footage ar valua.ion, e'c. 0 F F I C I A L R E C E I P T
1. examole-12S0 'q. foot hau,e, SOO 'q, foat gar. No B
2. examole-if new praject, check n;;;...if addition, (C, , n<7 .
add, e'c. Dote X\\\l. \. CJ (') 196 \
F. Building permit information: f-~ " r\v' \ 1~
1. exomole.~onslructsinglefomilyhousewithan ( Rec'd-From \VX\.5\\'0S\O ! '1"\..)...) . -' . (
garage _(\", r) \ ^l\\'""'\ ~
2, exam ale-remodel existing garagb inta faniily r dd ~lI 0'(<. 1\ \S)~ \ j\
3. example-convert single family residence into A ress" .i~ _) (",,"
restaurant (change of use) i,.
G. Value of work o. defined in Section 303 (0) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction delays, Building D. '4
Stoff must be able to contact appropriate persons
design informcotion or job site corrections. etc.
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S 6 612"
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II. Abbreyiated Plumb;ng, Mechonical & Electrical Sched,
A. Except where blcnk spaces occur in the description
of the Mechanical and Electrical Schedules, the apF
need fill.in only the No. Boxes adjacent to the app:
item(s) to be installed
B. full Plumbing, Mechonicol, and Electrical Schedule,
are available at the Building Division .
1. To conserve space on the permit form the schedl
hove been abbreviated
2. If the item(s) to be installed are not covered on 1
aled ,chedules you should consult the full ,ched,
C. BUilDING DIVISION STAff WILL FILL OUT ALL fEES
CHARGES ON THE SCHEDULES
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Received.J:or:
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4D'
(\ '}) 60
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-?{\~OO (/
80.10
440) 50
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Fees and Charges ','~ /
Plan check fees are due anCf payab'ie at the time of the I'.~I'
and no plans will be processed until these fees are paic-l:-:. n_
other fees and charges are due and payable when the permit
is issued.
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Amount Received', Sy:.,~ 'S
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AUTHORIZED SIGNATURE (
tHllTO"'TUR".Ull..",,..TIII,' IUOI..I, QII .UO' ..,,,., \".
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III. Applicant to ,ign and dale
Whenever possible. the initial application will be used
worksheet only. Where possible, Building Division Stafl
prepare a typewritten copy and return it to the appliea
the time ,he actual permit is issued for his signatur€..
IV.
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V, FOR OFFICE USE ONLY
Permit Cler"
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,
'Additional Project Information:
PLANS REVIEWED BY,
name -r,;I'.o\ ~t1EIP-'?J\',\
(J CD
SignOlured.v-rf\) .).h..Luj~
.Jate..s-~A-lqA\
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