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HomeMy WebLinkAboutPermit Building 1983-9-30 'I IrISPECTION LINE . CITY Of SPRINGfIE~D 726-3769 COMBIIIATlON APPLICATlDN/PERMIT /' -----, E!IERGY SOURCES: Job Address T ..) _ '3.\Q.f'> C""="-<"'~. ,='-~ I Heat ~egal Description,'! e:><-. <;\.(~ ':l.f"I ""'''' ~ r Hater Heater I v Range vali"\J!...l-Iork: "t.!)cra Builoina Permit Info: Describe Work(i.e.; Family nesidence With Attached Garaae) Ni,c:.,~ vJnYY1.L/ c' , ~. 'rO . Owner , ^~..... /t _JAt'Ot1S VV/AV''-&:>_ crphlA..o7' Address C~nstru~tion Lender Phone Address Ut~Ju" ltM1 (name) Primary --;H;; 1'fJh'IC/../A<' Structural Electrical Mechanical CONTRACTORS Genera 1 Plumbina Electrical ~1echanical NO.1 Each single fixture Sewer Storm Sewer TOTA~ CHARGES Phone (addressl flies. no.) INfOlUlATlON LINt 726-3753 Sq, Ftg, I,'a;n ~q. Ftg. Access. Sq, Ftg, Other New Add Alter Pep, -Fence Demo Change/Use -Other- - 00 (}l ~ /,-,r,: 4/'Z'GS 3'16/ itJas#/.I'.G: JgAl12. (name) (addr~ss 1 (lies. no.' Build Single - " P~UI1BING E~ECTRICA~ - - {exoiresl (ohone no. ?q.~ I ~ 1.( (pxo;rpc:.l (I)hnnp M. \ MECHANICA~ I FFF I rHARr,F ~I 1....E1='1=' I r...AB.G.E. NO_' Residence of furnace/burner to SQ, FT, BTU's C,'7;:h,/~ CJ I UJ'::..riOU') SIGrlATURE Relocated building (new fix. additional) S.F. Residence II bath) Duplex (1 bath) IAdditional bath ~Iater service I I I I I I '2. 5.OJ I TOTA~ CHARGES WHERE STATE UU REQUIRES that the Electrical work be done by an. 'Electrical Contractor, the electrical portion of shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division \ New circuits alts. or extensions . \tj!> \S,,p 1~r:LI..t.HARG..E.. Floor furnace and vent Recessed wall Sn~rp hp~tpr ~nrl vpnt \ I I I I I I I I\Dq-iV)~ I I' ,- I I each I SERVICES I I App 1 i ance vent seoarate I Stationary evap. rnnlpr I Vent ""fan with sinale duct I Vent system apart from I heatina or A.C. I Mechanical exhaust hood i'l.nd nlJrt I Wood stove/heater ISSUANCE OF PFRt1IT \0.00. this permit I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true ana 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 Oregon pertaining to the work described herein. and that NO 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 ons 701.055. that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 7nl.055 will be used on this project. ~/~../-~~OATE q AdQ J" / Zone CC Tvoe/Const,f-. \.. " Fi re Zone --- Bedrooms ,~ Flood Plain :~or;es f NN1E(please print) BUI~OING PERMIT Charges and Surcharges P~U'~BING PERMIT Charges and Surcharges E~ECTRICA~ PERIHI Charges and Surcharges MECHANICA~ PERMIT Charges and Surcharges \ !TempOrary Construction IChange in existing" rps i qPJlre Imultifamily, corrm. or Industrial 10f ICOMfI./IND, FEEDERS Install/alter/relocate di~trib. fppd~r~ \O~ \[),rP I I amps.1 Of amps.l TOTA~ CHARGES FO~ OFFICE Units -- Occy load -- Occy Group R- ? , USE DilLY Sq, Ftg, Sq, Ftg, Sq. Ftg, r1ain Access Other x Value Value Value / / x x TOTAL VA~UATION n l"\ 00 Plan Ck, __ _:-1.L.,_____ ~/Blda 'J. c..8 Plan Ck, .) , 30%/Bl do Fence COIllllII nd PJ'r Fpe Res Per Fee 'n J ratJ I() -'5 -Kg I U ,=" 00 ~~ ~""I;ystems Development - .11,/\ 'P1.u...LIl,}J5=harQe t1.5~) , Oe:mo '2.~. CO I Sidewalk ------\~DO--I A/C Paving ____\..~...;~~_-' Curb Cut .(DO I Total Comb. Permit I I TOTA~ \~1 :18 I . . , . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION III. I, Applicant to furnish A, Job Address B. Legal Description 1. example- Tax Lot 100, lane County Map Reference 17 03 43 2, example- Lot I, Block 3. 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender D, Energy Sources 1. exam21e- heat/electrical ceilinqjor forced air Qas 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation. etc. - I. examole- 1250 sq, foot house', 500 sq, foot garage 2. exam~le- if new project, check:ruew - if addition. Check add, etc. F. Building permit information: 1. exam~le ~ construct single family house with an attached garage 2. exam~le - remodel existing garage into family foom 3. exam~le M 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 TEN~ AND CONTRACTORS To avoid design or construction delays. Building Division Staff must be able to contact appropriate persons regarding design information or jOb site corrections. etc. II. Abbreviated P1~mbing. Mechanical, & Electrical Schedules 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 are available at the Building Division 1. To conserve space on the permit form the schedules have been abbreviated 2, If the item(s) to be installed are not covered on the abbreviated schedules you should consult the full schedules C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES D, As noted on the CAP, the label must be delivered to the electrical contractor for signature by his electrical supervisor. The general contractor is".not authorized to sign the electrical label. --- Applicant to sign and date Whenever possible. the initial application will be used as a worksheet only. Where possible. Building Division Staff will prepare a type written copy and return it to the applicant at the time the actual permit is issued for his Signature. IV, Fees and Charges Plan check fees are due and payable at the time of the 'app1ication. 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. /-/e~1 #{p6efJa ~ ". V, FOR OFFICE USE ONLY Permit Cler t . I PROJECT CONDITIONS TO BE SAT.ISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: (\(t)()"("0..'\.\" "\Cl."'-te ~\.(\\, \ '>\ ""?f.-:"~~~ '('ci\\.'1\.t"C"NY\e ,t,..'\ '\ , 7x::. "U~ '1.() \n...;:)~ '\ '....'.,:lto,,"---' (',~,. ~\.(...." \. '" ~.........C"Qro'-'... ~ ~ - \. -. PLANS REVIEWED BY: name UW.h~ "":\ \?\M:;\)\ Signatu~~t\~~\ / date \\-\ ~~~ ..