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HomeMy WebLinkAboutPermit Building 1981-7-1 !INSPECTlON LINE 726-3769 I Job Addren I legal Description I I Owner I Addreu I I Com,,",';on Lond.. -t5 JJA'fL,;-IJ;~n::'id' ~/' I Add.... P. tJ, f51UL -'lilt,.:; rf";""N'-z Phono,3-1.;;-!.::133 I DESIGN TEAM - '(nomo) - ~ -,'- . -+?~, I Pdmo'y ~7-t ..' As6:: . I Structural I Electricol I Mechanical I I General . CITY OF SPRINGFIELD COMBINATION APPlICAflON/PERMIT .. INFORMATION LINE 72~7SJ I~ I ..... ~, ..c:, \.II " ~ERGY SOURCES: I Heat Water Heate, Ronqe _ Value of Work: ,/;'/inyifjJ: 0/ Al .k...,M~jfk.dl",:"y: f.- tI - - , ,-,,;::<.5 - 71-J h' v{f: Phono ;9, 1/3/ ao I Building' P~r-;;t-I-"-io;' 'De,-c-;ibe Wo~k-(i.e.. Build Single I Family Residence With Att,:,~h'!1 0aroge} (fa.u-ta:"q -+- .o:;t.4-i4n /UW-UJ .L.'tutr...eL~4 1/ Sq. Ftg. Main Sq. Fig. Aceen. Sq. Ftg. Other _New_Add._Aller _Rep. ___Fence_Demo_Chonglll Us. _Other .!??XL) CJ.CLvL~ 'y?j , l$'DZfl.:>~.I=z._ r.e... LJq"<) (oddre,,) (lies. no.) (expires) (phone no.) CONTRACTORS H.siH4C (name) (address) (lies. no.) (expires) (chane no.) J7AVa.~ Plumbinq Electrical Mechanical PLUM81NG ELECTRICAL MECHANICAL NO. i FEE CHARGE NO, FEE I CHARGE I NO. I I I -I I I I I I FEE CHARGE Residence of furnace/burner to ltTU', Appliance vent ~-- separate Stationary evap. caa/er Vent fan with sinqle dud Vent system aport from . heotinq or A.C. Mechanical e.xhaust hood and duct Each sinqle fixture Relocated building (new fix. odditional) S.F. Residence (1 both) Sq: ft. New drcuih. alterations or extensions Sewer Wood stove/heater I I I .1 I I I I I I I I Vg'&>' S'o',m Sowo' ID.~~(,I.r'. ~.-I S12:RM :"Je~ ~ /if)..... I I I SERVICES DuoleIC (1 both) each Temporary Construction Additional bath Amps. Water service FEEDERS Heat PumD Air hand/.r to 10.000 CFM Air handler over 10.000 CFM I Amps. TOTAL CHARGES 30. .., TOTAL CHARGES ISSUANCE OF PERMIT I TOTAL CHARGES WHERE STATE lAW REQUIRES Ihat the Electrical worlc b. done by the Elct~ical ControClor, the electrical portion of this permit shall not be yalid until a lobet has b_n signed by an Elecfrical Contractor and attached 10 Ihe .1.Clricol pan.l. I HAVE CAREfUllY EXAMINED the campleted application for permit, ond do hereby certify thot 011 information hereon is true and correct. and I further certify that any and all work perfor,,",d sholl be done in accordance with the Ordinances of Ihe City of Springfield and the Laws of the Stat. of Oregon pertaining to the work. described herin, and that NO OCCUPANCY will b. made of any strvcture without the permission of the Building Division. I fvrther certify that my registration .....itb the Builder's Board is in full force and effect a' required by QRS 701-.055, that if exempt the basis for exemption is noted heron, Gnd that only subcontroctan. and employee, who are in compliance with ORS 701.055 will be used on this project. FOR OFFICE USE ONLY r-Y~~-e~ \ ' DATE ~/;/P/ Basis for 8uilder's Board exemption: NAME (pleo.o pdnl) _Re hc;e ~ V t 11.1 ,Tnr~ ,b~j;+o.. g <S,GNATURE Zone_~'" . fir. Zone Flood Plain Type/ Const. Bedrooms C,tori.~ Unih ""ccy Load ""ccy Group C... Ftg. Main c". Ftg. Access Sq.Ftg.~ , ~VIN&, . Value Value . x . Value TOTAL VALUATION r9/ q::v i _Do BUILDING PERMIT Charges and SutCha'gn Plan Clt. Comm/lnd 6S~O/ Blda Per Fee Plan Ck. Res 30%/8Jdq Per Fee 5""7. S~ I Systems Development Cha,qe (1.5%1 PLUMBING PERMIT Charges and Surcharges ~.- I. ';Ie> Fence Demo I Totol Comb. Permit 123, <0 AIC PovinD "'72.~ I I I I TOTAL II /83. -..,. ElECTRICAL PERMIT Charges and Surcharges Sidewalk MECHANICAL PERMIT Charges and Surcharges Curb Cut c- , COMBINATION APPlICA TION/pttllT (CAP) 'I, Applica~ to furnish A. Job Address B. Legal Description 1. examole,.ox lot 100, Lane County Map Reference 17 0, 2. example,Lot 1. Block 3, 2nd Additian to Springfield Estat, C. Name, etc. of owner and construction lender D.. Energy Sources 1. example-heat/electrical ceiling/or forced oir gas 2. exomole-water heoterielectrical/or ~ E. Square footage or valuation, etc. 1. exam,ole,1250 sq, foot house. 500 sq, foot garage 2. example.if new project, check new-if addition. check . add, etc. F. Building permit information: 1. exomoJe-construct single family house with an attached go rage 2. example.remodel existing garagE: into faniily room 3. exampie-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 ovoid design or construction delays, Building Division Staff must be able to contact appropriate persons regardinf design informction or job site corrections, etc. II. Abbrevioted Plumbing, Mechanical 8, Electrical Sched~les A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedules ' ___.h_.. are ovoiloble at the Building Division ...' _._-~--"_.__.- 1. To conserve space on the permit form the schedules hove been abbreviated 2. If the item(s) to be installed ore not covered on the abbr. oted schedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL Fill OUT ALL FEES AND CHARGES ON THE SCHEDULES t--, III. Appiicant to sign ond date Whenever possible. the initial application will be used as a worksheet only. Where possible. Building Division Staff will prepare a typewritten copy and return it to the applicant at the time the actual permit is issued for his signatur~. IV. Fees and Charges Plan check fees are due and payable at the time of the application, 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 PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: ~. , Additianal Project Information: PLANS REVIEWED BY: name _signaturp' ( CjY SPRINGFIELD OF City Hall Springfield, Oregan .Department af Public Works OFFICIAL RECEIPT , ... No. B S 6 8 3 : 19 SI Reed Fram ~~ ~ 'f?tVIIV ~ Address ?:CJ. ~ 7o~.s-, C L.f;.e""A' ~ Date Joc.....,. /, ( ( Received Far: ,,- -, 1)t:iB# frlolf3? .. J i:::! <r A-'O/7-&-' 1 c--"??)<4/ r ( li.U;l?~/NG.. .,.S"% /1.<:.. ~Y/nz:::.... rUJrv RoE' v/~ 30.-'" /.::c. ~2.eo 5'9. St:> ( c ( c By.... I \, 1t!5? -~ -~~~- .~-? ,'~-'- V AUTHORIZED SIGNATURE ~ ' SHHTO"'TU"".UH .......T["!I" [UGENE. 0" .'''0' se.".,. \, Amount Received f 'I ,'. Permit CierI- ~=':"":'__"o.-""" dalD