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HomeMy WebLinkAboutPermit Building 1980-5-23 (2) . CITY OF SPRliiGFIELD lNFORIIATlON L1ilt COIIBIiiATlON APPLICATION/PERHIT 726-3753 .~: CclkL ~~;~GY) SJ~~?~:~~, ;~: ~~~: ~~~~Ss,U~ I.enal De,cription /)2 _ :QL/ j"" II 7-0Z-35-:2.3~!ater Heater ", J1 ""L ..srr: Ftg, Other --3.2.~ s; ) L ,'") K' 'J - - ,.,~ --f--- II v'dd Alt 0 , ... - , . : " ......."'...- I Ranqe ,,()n ~ _ eN.L::::f' er ..eD. :.,iXi)l .hlC11i1Cil tr, lrLk'<;-,{:llf!l PIU-/(/ I.t.valu, of I-Iork: ~ --- 6~~~~_Demo_Change/Use [00 Owner OOUQWC, (\1()S'Jl1 . 7-.B'2,L./. 7~o I) Address J (.- r l (11-"J11el'L J ^ n Phone Buil':inQ Permit Info: Describe \'\ork( i.e., Build Single I 'v) AJH r f U';(\ Familv Residence !,~ith Attached (;araoe) H:Jrif1.aP1~ 1.i.7-r{I'"4-__f0ivti\1rr/1YiVVI- rU1.ditfu/?,-- L01~L i , Construction Le r ~:X~/J /1_ ' ' fi'L--- ,--J/ ' Phone (address) I I I I I I I I /;fVY) I TOTAL CHARGES that tile Electrical work be done by an' label has been signed by an Electrical . I I;ISPECTIOII 716.3769 Job Address LIiiE },(, , ~ ) Address Ut:.~IGii TEj\j1 (name) Primary !=.f~ ) Structura 1 I' Electrical \1 t1echanical l' CONTRACTORS (name) Genera 1 (,'Jo..A)<('.~'r-S Plumbino II Electrical " t.lpchaniral 1\ PLUltBIrlG ilO. FEE I rHARr,F I Each single fixture /Relocated building (new fix. additional) IS. F. Res i dence , (l bath) ',jDu.plex (1 bath) each J Additional bath ~!ater service I Sewer I Storm Sewer //)..~') TOTAL CHARGES WHERE STATE LW REQUIRES shall not be valiJ until the . ......'" .'l!: (lies. no. \ (pxOlrpc;. ) (ohon!:' no.) " I' I, (address) (l ice:" no. f"",<oirpc:\ (I)hnnp (In I' '\ i i ELECTRICAL , f~ARr,j:'~ fHAQr,1=' HECHA:llCAL ~ln Residence of I I furnace/burner to BTU's Floor furnace and vent tln. FFF FFF SQ. FT. :r.. INew circuits alts. or extensions ;). {J~: .vlO.eC!. ISERVICES Recessed wa 11 (jl),)rp hPFltp.. ~"rl IIpnt-" /~'S':.G:"J Temporary Construction Change in existing rpS.i q!i'ncp Imultifamily, comm. or Tnrl1Jc:triill Appliance vent 5~oariltp Stationary evap. cooler I Vent fan wi th sinale duct Vent system apart heatina or A.C. Mechanical exhaust hood and durt I Hood stove/heater I from Of amps.] COI.11-1. II ND. FEEDERS Install/alter/relocate rlic:trih fpprlpr<:. IOf amps.1 I I I ./ , --!.' /..1 ,IV ./-- ' I SSUArlCF OF PFR!tIT 1.<;,6C) TOTAL CHARGES Electrical Contrac or, the electrical.portion of this permit Supervisor and returned to the Building Division I HAVE CAREFUllY EXM1WED the completed application for permit, and do tlereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the la\'/S of the State of Oregon pertaining to the work described herein, and that UC OCCUPAfICY \'/111 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 ORS 701.055 will be used on this project. HAlIE(please print)'" Detora..h g, Ma&Jn SIr.;IATURF. \)( ~ J.~ OATEa-Z3-30 FO~ OFFICE USE' DilL Y Zone e.-I Tyoe/Const. .E:-~~{I Units .' So. Ftg. f1ain , Value Fi re Zone .In. Bedrooms Occy Load Sq. Ft/]. Access x Val ue Flood Plain _,A Stories J Occy Group !2~':.) Sq. Ftg. Other 5.;7 S. 7 S' x Value TOTAL VALUATlOtl~ 'if3 ,/, 7'> _______Lt212'O_ Fence ItlC I Demo - ---. -,--' '-,-'-- ----- 1,{;;..::Y.l Sidewalk _______L---".___ 1,0 I AIC Paving ~ Curb Cut ------------ BUILDIIlG PERt.IIT Charges anc Surcharges ___u__':!:Jd2tL 1,'1& PLU'1BIIIG PERHIT Charges and Surcharges ELECTRICA.L PERI:lT Charges and Surcharges :';CHANICAL PERI1iT ~ ,;'r~~<; Jnd . Plan Ck. Comm/Ind 65~/Bldo Ppr ~""F' Plan Ck. Res 30%/Bl de Per F"'''' Syste~s Development Charae (l..5~) '-"0 -:-- ~Z/-f<J ~ 1-:::<. -. I I I I 1>f~/.7h ---l Total Comb. Permit , . - ,- .' . COMBINATION APPLlCAilON/PERNIT (CAP) I. I!. Applicant to furnish A. Job Address B. legal Description 1. examole- Tax lot 100, Lane County Map Re: J/ 03 43 .... 2. examole- Lot I. Block 3. 2nd Addition to l Sprlngfield [states C. Name. etc. of owner and construction lender D. Energy Sources ~ 1. examole- heat/electrical ceiling/or fore 'i 2. exa~Dle- waterheater./electrical/or solar E. Square footage or valuation, etc. - I. examole. 1250 sq. foot house, 500 sq. fa ~ 2. examole- if new project, checknel'Y' - if \it check add, etc. F. Building permit information: 1. examole - construct singie" famlly house (,' . .,attache-d garage 2. examole. remodel existing garage into f 3. examole - convert single family residenc restaurant (change of use) G. Value of "ark as defined in Section 303 (a) G:, Structural Specialty Code H. DES I GN TEMI ArlO COilTRACTDRS To avoid design or construction delays, Bui' Division Staff must be able to contact apprl G1 persons regarding design information or jOb corrections, etc. Abbreviated Plumbing, ~lechanical, & Electrical 1:,'.",., A. Except where blank spaces occu~ in the desc ~ portion of the Mechanical and Electrical Sc the-applicant need fill-in only the No. Box to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and. Electrical S (~u are available at the Building Division 1. To conserve space on the permit form tr have been abbreviated 2. If the item{s) to be installed are not ~er the abbreviated schedules you should cc full schedules C. BUILDUiG DIVISION STAFF WILL FILL OUT ALL f CHARGES ON THE SCHEDULES ( D. As noted on the.'CA~-, the label must electrical contractor for signature supervisor. The general'contractor to sign the electrical label. Applicant to Sign and date Whenever possible, the initial application wil a worksheet only. Where possible, Building Di will prepare a type written copy and return it (~l applicant at the time the actual permit is iss signature. ~ 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. be del' by his is not ( Ill. IV. V. FOR OFFICE USE ONLY, .. . . ". '." . . . _ .~. .. .. ... ,~.. . _.... L.. .., ".... ...... .....".. _OCPMI.T '/:.1 I,~:.li _, I OF SPRIN fI1:10"'----~ City Hall & Springfield, Oregon Department of Public Works OFFICIAL RECEIPT No. B Dote c:=.. --r -.;z... 19~O Rec'd From CiJIJ110 LLJ-10-MYJ'1 Address 4.~5 I'=K~ oiUp 44,00 I.i(n I ()'R8--( JAm' - - -- AU ( J', .~. .--'- ~..-- '-- . ( I CITY Received For: ~p ~6)ln pp 4-&1n yJ-) \ ICfo io A~-15 ---- "'~lt~1~,,,"~ , '1 ~ 53567 fl (". (" ( ( ( ('ttl,/)L C Amount Rece~ved I ( . f h " . (lAP ~ AUTI-IOR'ZEC SIG.....TUR[ \f. S"UTON Tl"~"'UlL ""I"T.:"S lUCl'U 0.. 07"01 ,.,,,'. Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPMICY: Permit applicant exempt from registration with the Builder's Board because: Additional Project. Information: PLANS'REVIEWED BY: ...... ....."." ..II. I .,. h, '.'" "_.",,..,.0.' ,,_ "__,, ....... ._.,... .,,, 0"...1 ... .. ,..", "." ..,,, ....~, '. name ,.... . , signature ,{ Va..., ... ,,''.,, ..-......,,~.. ..",..I~ M..... ''''L,oMoi.,. .0011...,. ,..........,IIJ~~';"".,'_ "~'" ,..... -- j /' ,.cJA..-A-" ;;d~ c ( ( J date 5-~3~~~ '_" .1 -.