Loading...
HomeMy WebLinkAboutPermit Building 1981-8-31 legal De1Cfiption I OJ:ha~pn MH5-_,,- INSPECTION LINE n~3769 Job Addr"n ~. . INFORMATION LINE I" 716-3753 CITY Of SPRINGfiELD ,COMBINATION APPLICATION/PERMIT I aS1 Loehaven I ENERGY SOURCES: Heat NA I Water Healer Range _ Valve of War..: 00 ...... O' lJ1 '" 00 i 5q, Fig, Main I Sq, fIg, Accen, I Sq. ftg, Other I _New __Add _Alter _Rep, _.. _fence._ Demo_Change i U' 5e _Other R1k ~ lot? Owner Brown Add",. 881 lochaven CanHrvclion lender Addreu DESIGN TEAM Primar., ~ Slructural Electrical M~chanical I CONT~ACTO~S G..mHol I plumbina I EIf~ctrical l Mechanical I I I I I I I I I I I I I r I TOTAL CHARGES I NO. ~1Qnn. nn Buildinq Permit Info: -DelCribe Work (i,e.. Build Single Fomil.. R,Hid"nce With Attached Goroae) I '1 I 1 Phone Attached carnnrt Phone (nome; (oddren) (lies, no,) {expired (phone no.) .' 688-6~ I j I I I , , R.r:a..uI'r 15425 ?U3/R? W6.h M;nnC'.le"'+~ {nome} (address) (\ics, no,) (phone no.) (expires; PLUMBING ELECTRICAL MECHANICAL I ,-~ ~ CHARGF i 1 ! \_~ f::= CHARGE FE!: . CHARGE NO. FEE NO, Residence of furnace/burner !o Il,TU's Appliance vent separate Stotionor}' evop, cooler Vent fall with singie dud Vent system aport from heati~CI or A,C. Mechanical e;llhavst hood and duct I I Ro!localed builciing {new tix. odciirional) S,f, ~o!uden~e (l both) Stl: ft, New circuits. olteratiolls or eXlensions Eocn ,;nfllt! f;ltlure i , , I I I i I , I N~ I SERVICES Temporary Construction Additional bOlh Duolel!: t1 both) "otn Amps, Water service Sewer Stor.m Sewer Wood stove/ healer fEEDERS Heat Puma Air handler to JO,OOO Cf,l,\ Air handler o.,..r 10,000 CfM Amps, NA >JA WHERE STATE lAW REQUIRES that the Electtital work be don. by the Ele..t~icol Contractor, the label has been signed by an Electrical Contrador and attached to the electrical panel, I TOTAL CHARGES I I I .1.",I'al p."lan af ,hi. p.,ml' .hall n.. b. valid .n,1I a .1 ISSUANCE OF PERMIT' I TOTAL CHARGES I HAVE CJ\,REFUllY EXAMINED the completed application for permit, and do hereby certify that 011 information hereon is true and correct, and I furthor certify that any and all work performed sholl be done in acwrdance with the Ordinanus of the City of Springfield and thllt lows of the Starlit of Oregon pertaining to the war.. cew;ibea herin. and that NO OCCUPANCY will b. made of any structure without the permission of the Building Division. I further certify that my registration wiln the Builder's Soord is in full forca and ~ffect os required by ORS 101.055. thot if exempt the basis for e;llemptian is noted heron, and Ihot only svbco':'tractors and employees who ore in compliance with ORS 701.0" will be usod on this project, Basis for Builder's Board exe~ptiofl. NAME (please printlLA-a.., ~ ~ ZOM --!11-1' Fire Zone Flood Plain BUILDING P!:RMIT Charges and Surcharges PLUMBING PERMIT Charges and Surcharges ElECTRICAL PERMlT Charges and Surchargu MECHANICAL PERMIT Charges and Surcharges <IGN~TURE,o~)c ~ FOR OffiCE USE ONLY , , -"'""""W6_', DATE Type/Const,~ :!,edroams (toriel Voiue Val.. $3900 0(' Sq. Fig. Main Sq, ftg, Acceu -1.B..C' Sq, Ftg, Other Units I"Iccy Load Occy Group M 1 x ? 00 x Valve TOTAl VAlUATION $1Qnn nn Plan ell., Comm/lnd _-,-__J2B....DD-_ ~"/Blda PO' F.. Plan elr., Res 1 _ 1 2 30%/ Bldq Per Fee I Systems Development CharM / 1,5~:'1 ~R 4n Pn R_?t_Ql ~~717n FenCl! Demo Talal Comb, F'-ermit Sidewalk ,,/e: ;>"vino I I TOTAl $29,12 l~______ I . Curb Cut '.... ,~ 'COMBINATION APPLlCATlONiPl1IT (CAP) I. Applica~ to furnish A. Job Address B. Legal.Description 1. examole-tax lot 100, lane County Map Referenc 2. exampie.lot 1. Block 3, 2nd Addition to Springfie C. Name. etc. of owner and construction lender D.. Energy Sources 1. example-heat/electrical ceiling/or forced air gas 2. examcle.water heater/electrical/or solar E. Square footage or valuation, etc. 1, exom"le-1250 sq. foot house. 500 sq. foot garag 2. exompie-if new project, check ~.if addition, d add. elc. F. Building permit information: 1. examole.construct single family house with an oj garage 2. example.remodel existing garag~ into faniily roc 3. example-convert single fomily residence into restaurant (change of use) G. Volue of work as defined in Section 303 (a) of the Structural Specialty Cede H, DESIGN TEAM AND CONTRACTORS To ovoid design or const~uction delays. B0i1ding Div Stoff must be aole to contact appropriate persons re., ,..... design inf~rmotion or job site corrections, etc. \ II. Abbreviated Plumbing, Mechanical & Electrical Sched~1 A: Except where.blank spaces occur in the description, or the Mechanical and Electrical Schedules, the appl need fill-in only the No. Boxes adjacent to the apprc item(s) to be installed B. Full Plumbing, Mechanical. and Electrical Schedules are available at the Building Division . 1. To conserve space on the permit form the schedu hove been abbreviated 2. If the item(s) to be installed ore not covered on H ated schedules you shouid consult the full sched. C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES, CHARGES ON THE SCHEDULES I · PERMIT VALIDATION CITY OF SPRINGFIELD -I -~ .' City Hall Springfield, Oregon Deportment of Public Works OFFICIAL RECEIPT ( '~:'I:' ( , No. B t\lt'\OI19t91 Rec'd Froa\t_ ~() J J J-... , - Addresrf)()l (( I f) ffiJ..n f\Q.~ , 1:;7106 \J ..L. -..J (' Date ( c ( ( ( ( ( C = , , " ! " ( J Received For: \, \:~ctQ_ ._ ~_CU - (l.19Q l. I Z- ( ,(10 ( c -,- - Receive~ (.r0 rhllV'J AUTHOIltI'ZED SlONATUIltE ( IMlLTO...TU''''.Ull ~IIIIMr(JII' lUOItMl. 0111 .'.0' .....'. ~" Amount {'~ III. Applicant to sign and dote ( Whenever possible. the initial application will be used, Q worksheet only. Where possible, Building Division StaH ", prepare a typewritten copy and return it to the applicar,.;_. 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 pIons 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: Additional Project Information: PLANS REVIEWED BY, naml"" ~ignatur"" Permit CierI- , I ) I -late