HomeMy WebLinkAboutPermit Building 1985-10-16 (2)
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", IrISPECTlON LINE
716-3769
Job Address
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, CITY OF SPRINGFIELD
COHBIIIATlON APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
l~ater Heater
RanQe
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Legal Description 17.(}!I.-Z 7./tf!). t:12t:.e>t!:>
Owner /kkfu, 0iv~ OJ-
Address tf.5tfl 11;p:() ?~~ 7 Phone/f fY
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construction fender
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Address
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(name!
Primary
Phone
(address)
c~~flA#,or
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Structural
Electrical
Mechani ca 1
CONTRACTORS
....lnamel
General
Plumbino
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Electrical
~'echanir:al
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PLUllBI NG
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'9 Each Single fixtu:e
IRelocated building
(new fix. additional)
Is,F. Residence
(] bath 1
IOuPlex (1 bath) each
IAdditional bath
1~~'lWater service
~ Sewer
167'1 Storm Sewer
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ELECTRICAL
I FEF l..QfAR(;F NO I
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Residence of
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INfORllATlON liNt I
726-3753
Sq. Ftg. 1.lain i,{~p ~
~q, Ftg. Access,::;>~Y'a " '
Sq. Ftg. Other
~lew_Add_Alter_Rep. ~
Fence Demo Change/Use ~
ValUE of Hork: Other I( ~
/t>'Z/~~'1.. cc = - - V\
BU11GlnO Permlt rnfo: Oescrlbe Work(l.e.. BUlld Single IQ)'
Familv rlesidence IHth Attached Garaoe) \J
-r~u~K CJ-A~.lJGE -r F
E.xru/?"'/??EN'T -PA/P.Ir .//>/5
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401Yl/
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d 0- ;VI'JC
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SQ. FT.
ITemporary Construction
Cha~ge in existing
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TOTAL CHARGES a5:'.o TOTAL CHARGES ~4 TOTAL CHARGES)Sz.H. /"6E ,~. c:noP
WHERE STATE L,\l~ REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this pernit
shall not be vali1 until th~ label.has .been signed b~ an Electrical. Supervisor and return~d to the Building Divisi?n
New circuits alts.
or extensions
SERVICES
amps
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multifamily. COrTm. or
Indllc:;trjill
IOf ,y~
ICOHl'L/lNO. FEEDERS
l'Install/alter/relocate
rlic:trih. f".".rl,..r<
(ohnnp nn
MECHANICAL
furnace/burner to
BTU's
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200
amps.
Floor fu rnace
and vent
Recessed wall
~n~Piltpr i1nrl vpnt
Appl iance vent
~f10arilt,.
Stationary evap.
cooler
Vent fan wi th
"inole duet
Vent system apart from I
hea t i no or A. C.
I' Mechan i ca 1 exhaust
hood i1nd durt
I Hood stove/heater
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I HAVE CAREFULLY EXAMINED the completed application 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 Oreqon pertaining to the work described herein. and that UD OCCUPAUCY will 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 DnS 701.055. that if exempt the basis for exemption is not d hereon. and that
only subcontractors and employees who are in compliance with OP.$ 701..055 will be used on this project.
rWIE(please print) ~J-IAlIIY~AItI/) FOn or::~~^:~~st~~ ~ OATF)P-./d'-~~J
Zone MM Tyoe/Const34''''~Units ",</.-4. sif. Ftg. r1a;n..,q~ . /~.t:~ Value~~. GO
Fire Zone /'1,/1 Bedrooms N.~. Occy Load~7'<lIT'-'t';Sq. Ftg, Access 7'&:V,,? x_/~.." Value ~/q(:o.CSO
Flood Plainfl4. Stories '1'" :;;"""ME.rJ!ccy GroupJ-/ Sq. Ftg. Other];!? V/~. x_I. ."'P,alue 'f. 5'~<I. -
, = eo, Vi 'Nip 3- QC._ TOm VALUATlOtl!b2 1'3~'I. .,.0
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..9Qa....,.C;C~~ /,)'75: lf6
BUILDING PERflIT 'Z 7""'1. COO Plan Ck, Conm/lnd
Charges and _______L' 65t:/Bldo P.rr Fpp
J.. .,~rSllarQe~ I A ..,.z Plan Ck. Res
"f ~()6. YA<,(.4" V." 30%/B1 dQ Per Fee
PLU'1BING PERMIT It.::>: ~ I Fence
~~~~~:~g:~d ---- -&=:~-I Demo
~~;~~:;C;~/ERmT ____2~.:.~-' Sidewalk I
Surcharges ::l . a.o I A/C Paving ~~.....,
~~~~~~;C;~/ERHIT ____Le.:~1 Curb Cut ". I
Surcharges . C/O I I
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~Als.bU'H1.9'" -t $"">: "70
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5'<.00
ITotal
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Comb. rermit
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grv OF SPRINGFIELD
. City Hall
Sprlngfleld, Oregon
Depertment at Public Work.
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, " OFFICIAL RECEIPT
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, No.8 65470
Datec1)~r /..y: 1;9,<)' ~ :
Rec'dFrom r)O#N b!t;,/e,A,(,/b G~
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~ Received For: r)t775 IT $S' c9 S?y
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V. FOR OFFICE USE ONLY
Permit
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PROJECT CONDITIONS TO BE SATISFI ED BEFORE ..eCI>I:JP AtI6'('. F~,..,i?\ ,I.:> :>c.JA-NC &; I
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Permit applicant exempt from registration with the Builder's Board because:
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': ,Additional Project Information: ,2> ~,., ,_'_~, :...-;.,...,,___ ",__'~
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PL#~ 76 .#;.e-p<./ c.. f',,, 7"': '
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PLANS REVIEWED BY:
hame f "J?~E"' r>~ Sig~ature~,r'"';-~ 't.,';',,:>
da te /e1-I'T .a.::r