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HomeMy WebLinkAboutPermit Building 1981-4-17 I INSPECTION LINE 726-3769 I Job Add'en " . INfORMATION LINE 726.3751 cA CITY OF SPRINGFIELD COMBINAlION APPLICATION/PERMIT ~-j..ql./ ~r .3 I f.r;"ir-;....U S';J.O() Sq. ftg. Main Sq. FIg. Aceen. ~ Sq. FIg. Other _Ne..... .)i.Add_Alter _Rep. _ _Fence __Cema_Chongel U,e _Other. WHERE SlArE LAW REQUIRES that th. Elect,itol work be done by .h. Elutricol Contractor. the .Iectrical portion of thi. p.,mi. .hall not b. valid until a I. label hall b..n signed by on Electrical Contractor and attached to the .Iedrical panet. I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify Ihot all information hereon iI true and corred, and I further ,o,rify that ony and all worlt performed shall be done in accordance with the Ordinances of the ~ity of Springfield and Ih. laWI of the State of Oregon pertoining to the work d.'Ctibed herin, ond thot NO OCCUPANCY will be mod. of any strumr. without the permission of the Building Di"i.ion. I further canfty that my r.gistrotion with the Builder'. Boord is in full force and effect as required by ORS 701.055. thot if uempt the basi. for exemption i." noted. heron, and that only subcontractors ond employees who are in compliance with ORS 701.055 will b" used on this project, SIGNATURE ~ ,;(,;/ c~~ I Systems O."elopment ~ 9.~ PrDa4~'I() -~i t:;~ - L_ - I /.fP c= 40 Total Comb. Petrmit , c:;x:). ~ ._\ ~/::x..f Fee. 1::, I I L~R- 23 Legal DelCriptio~_I'!J;} t,(/ it t f1"eLJM Add,...~ r;) 'i;;2 L,A f~' B ,eel 1/--"".".1-,... ~~ Owner a.+I2.Y Building Permit Info: D."ribeo Work (i.... Build Singl. Familv Re,jd.nc. Wilh A"acned Garaq.l tf~rMrrXurJW>' /0) 1-1-CLtY\ Lt.e 1, (J'tOlf\m (lies. no.) 1 I ConlrruClion l.nder I Addre.. I DESIGN TEAM (nom.) /{/'r.k:. Primary I Structur.,1 I El.ctrical M.chanical Pnon" t'.t/Gt:~ (address) (expirel) CONTRACTORS l, (nom.) J~ ,~r,:,~ -, //,/ /?l.::17J1V' iV" Jlffcs. no.) ) J::J.31"ii1 ~.. {address} (expires) I G~n.ral I Plumbinq I Electrical I Mecnanical I I NO, I 12. r>.rrJ:: r"",~"Sj- 7::/'IC 17>'9 e(j:~j;y OJ( .3J~) YY"'.tJ '" . ELECTRICAL PLUMBING MECHANICAL I fEE CHARGE 1 lOPS /(\,02 CHARGE NO. feE NO. Residence of furnace/burner to llTU', Appliance vent separate Stationary e"op. cool.r Vllnt fan witn single duct Vent system apart from. heating or A.C. Mechanical lI,l{noust hood and duct ICl:ft. New circuils, ohert::Itions or extensions / Eacn linql. fixtute Relocoled building (new fix. additional) S.F. R.sidenm (1 botn) SERVICES o-fAN&E ./5.CE /503 ID,c:e /D.09 2t" I Duol.. (I boln) eacn Temporary Construction Addilional both Amps. Wat., ,ervice Sewer Wood "o"./nllater Storm Sew,,"r FEEDERS Heat Pump Air handler to 10.000 CFM Air handl.r over 10,000 CFM Amps. ISSUANce Of PERMIT TOTAL CHARGES .if I D,c>E. TOTAL CHARGES -# 'JC;:OO r..._.- TOTAL CHARGES Basi. for Builder's Boord eXllmprion: NAME (pleasll prinl~ IJ /jFiid/ FOR OfFICE USE ONLY Zone l'!--4 Fir. Zone Flood Ploin ~b T,p./Can.t.~ ~\ :!,edrooms - c;lorie, I t"'\ccy load -. \ C ....'Y Group_P'-;( Sq. Ft9. Main Sq. Ftg. Access Sq. Ftg. O'ner Units Valu. Volue 'alue TOTAL VALUATION . BUilDING PERMIT Charges and Surchorgu ...3~.D.E2 I /,28 I /0.0.5::- I --- Q,"i!: ---I I/~.::.) ( l 05:/ . '-r-8~ ---:- 6,73- ---I I I ~jLC Plqn Ck. Comm/lnd 65~~1 Bldq Per Fe. Plan Clt. RII, 30%1 BldCl Per Fe. PlUMBING PERMIT Charges and Surcharges fence O.mo ELECTRICAL PERMIT Charge. and Surcnarge. Sidewalk I I I I TOTAL A C PCI"in- MI:CHANICAl PERMIT Charg.. and S~.nh.ree. - Curb Cut '.. ,. ~~;,<~..'.:.~. "~._~,;.,""'; <"~..~ ....>,-"".j\;:;.,~-..~.;.... ~ o ~ (':J (pnone no.) (pha"fl no.) hJ'9-.:;J7::>/ FEE ! CHARGE 1 .,~~ 500 5.~-15.0E' I I I I I I I 10,0.2 -II; 8,O'z DA;E{/JYJ7~/ I ~/S-bO,~ COMBINATION APPlICATION/~IT (CAP) I, Applican{ la furnish A, Jab Address B. legal Description 1, examele.lax lal 100, lane Caunty Map Refe' 2, examele,let 1, Black 3, 2nd Addition to Sprin C. Nome. etC. of owner and construction lender D. Energy Sources' . . 1. example.heat,l electrical ceiling/or forced air 2. cxomOle-woter heater/electrical/or solar E. Square footage or valuation, etc. I. exomale-1250 sq. foal house, 500 sa. fool gal 2. examcle-if new project; check new~if additior: odd. elc. F. Building permit information: 1. example-construct single family house with or garage . . 2. example-remodel existing garage into family 3. ~xamoje.convert single family residence into resrouront (change of use) G, Value of werk as defined in Seclian 303 (a) af Ih, Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction delays, Building [ Stoff must be able to contact appropriate persons design informction or job site corrections, etc. II. Aborcvicted Plumbing, Mechanical & Electrical Sehec A. E;a:ccol where biank spoces occur in the descriotio of Ihoe Mechanical and Electrical Schedules, th~ aF n'!ed fill.in only the No. Boxes adjacent to the OPI itemi'sl to be installed 3. Full Plumbing, Meehanical, and Electrical Scheaul, ore available at the Building Division 1 : To conserve space on the permit form the sche! hove been abbreviated 2. If the ilemls) to be installed arc not covered on aled scheduies you should consult the full schet C. BUILDING DIVISION STAFF Will Fill OUT All FEE~ CHARGES ON THE SCHEDULES III. Applicant to sign and dote Whenever possible. the initial application will be usee worksheet oniy. Where possible, Building Division Sto pr~PQre 0 typewritten copy and return it to the applic the lime rhe actual permit is issued for his signature. .CiTYOF SPRIN,GFIELD City Hall SprIngfield, Oregan Departmenl of Public Warks OFFICIAL RECEIPT Dale,q- 1 18ro. B 56326( (0 'ocd "JltJw,QJ::L'r)/\ (11J'l$:;f Address Il~ fl.kQlJJ D V' tv~~ ~\ Received Far: 1 . PERMIT VALIDATION ~'L ( ~.~( ( ( ~. bf/ c.16 Ii) . ~7._ 00 \,'2~ l'O ,CL) .4(.) Zi) .o() f,OO 19J,OC) - ....-,,') ~ 1.-:- c ~fJ 4-v J () (a ( err L-\ c3 L') t- YY\F (~ Ii O)/J C Amaunt Received ~% ,eta C'_~ {YO eil ~' AUTHOIllIZIED SIGNATUIU: ..."., ( l..lUO...TU....U~~ ..",..,,11:"', . luOIHIl. 0"" ".0' IV. Feus and Charges 0 ( Plan check fees are due and payable at the time of th -4'" and no pIons will be processed until these fees are paid. ,..11 other fees and charges ore due and payable when the permit j, issued. V. FOR OFFICE USE ONLY I Permil Cler~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Addirional Project Information: - PLANS REVIEWED BY, I ftQm,,_0rr7VV\ <::'t'1f'Xv-PI'l",- si goo tu r.... ...:t O"Y'\^- ~"-UJ~ ~ 17.el ""ale_ ., ."" o,,~h_.:....:....;.....' o-"::"'~'."_" t-.~.. ~ ( ( ( ( ( ( c ( -( c ~: ( I I I I I I I