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HomeMy WebLinkAboutPermit Building 1981-3-16 I Value of Work: .~.::. /).., ) 3 G>jS";lS: G.o - -./ _ . Building Permit Info: Describe Work (Le., Build Single Phon_ ?f(Fp-~ I'~ 'Family Residence With Attach.d Garoael .~j Ik~rAf A-u c'4K. 1=1 (>€- ffl-,4C'E I ItJ.CD I ~O 1St::! WHERE STATE LAW REQUIRES that the Electrical work b. done by the Electrical Contractor, the elemical portion of this permit .hall not 1M valid ,,"til.c I ialMl has b"n signed by an Electrical Contractor and attached to the ...~Iricol pOAll1. . . I HAVe CAREFULLY EXAMINED ,h. completed application for permit. and do hereby certify that all information hereon i. trull and correct, and I fu,ther certify tho. any ono 011 work performed sholl b. done in CII:cordo"" with the O,dinonclu of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herin, ond that NO OCCUPANCY will b. mad. of cny structur. without tho permiuian of the Building Division. I furthe' c:e,tffy that my ,egistratian with the Build.r's Boa,d is In full fa,ce and ..Hed 01 ,equir.d by ORS 701.0.55, that if .....mpt the basis fa, exemption is noted heron, and that only lubcont,actDrl and .mploy..s who ar. in compliance ~ith ORS 701.0" will d an this project. Basis fa, Build.,'s Boo,d exemprianl NAME (pleas. print) ~# 1'0.. /7.-.::?J4.-r-- /JA.J/T L . 2J .I ")'"" ",:' CITY.OF SPIINGFIELQ!' COMBINATION APPLICATION/PERMIT . INSPECTION LINE 726-3769 I ENERGY SOURCES: Heat F; 11~C, \l(U. I Wate' Heal.r E:...cC.. Ronq. 1~L...t:'c.... 5f7f )(-J~ AI F HIL. ?Lh. Job Address l..oID.",;.,;o. ,,'';'''PA1 /' /.;. .., UNIT I. BLOt:. p~fttiJ 'ft;; ~7~O Ow." ~ _ ~/ ----k- a~ I Add,... t'/,If p::7" .J1.c..a-":- I I I I I I I I ,:' 'Construction Lender .;::.,~ '... r 4,A~fI Addr." ~.1 DESICN TEA~" .....r~ ^"'e': Phon. .. , ,c::;;- ~*"p- - (addre,,) ~,..-/'7~ (Iics. no.) (namel P,ima,y SlrUCNrol Electrical Mecl,onical (f~ ) Al-.zf-(odd"..1 dCC-tf j~ (lies. no.l CONTRACTORS O.neral.' ~ (name) ~;:';. /.2..~ Plumbinq /'Z~..d--~ rY), d..L ~ Ci:..J/- ..... EI.ctricol Mechanical PLUMBING ELECTRICAL N;I I FEE I CHARCE FEE CHARGE NO. Re,i.dence of . q/~ ~C1:ft. New circuits, olleration, or e...tensions /5. CY'J / Eat'" tinq!e fixtu,. Relocated building (new fix. additiof\al) S.F. R.,ide"J:e (1 both) . ~s..c::. I SERV!CES Dual.. (l bOlhl eoch Temoorary Construction IC.C(J Addilional both AmI". .;l ~{) I I 1 'I' I I I I I I t Waler ,e,,,ico Sewer IM:Q Storm Sewer FHOERS AmI". ,. TOTAl CHARGES . 3.5': oel TOTAL CHARGES ~5.CO INFORMATION LINE 726-3753 Sq. Fig. Main -.::t.I. ~~ Sq. ftg. Acc.~J. !L4I ~ Sq: Fig. Oth.r ANew _Add -A1t.r _Rep. __Fence_Demo_Chonge/ Use _Other m ...... C> I~ I~ I I (expire I) (phone no.) .... -#'1 ;;;.' -~ (pho.. .o.! 7r(t ~ I (Upilll1) MECHANICAL NO. I FEE ICHA"GE i I I I t,.CQ I I I 1<<:5'"01 I I I furnoce/burn.r to ~ A,TU', Applianco v.nt I.porahl Sto lionory evaI'. cool., V.nt fon with ..;t ,ingle du'c. . Vent syslom apart from heatina or A.C. I Mechanical ....haust I hood and dud ~1'Wood ,toy./hflote, / , 3.co Heat Puma Air'handl., to 10.000 CFM Ai, handle, a....r 10.000 CFM ~ ISSUANCE OF PERMIT TOTAL CHARGES J SYllem, O..,.lopmonl Cha":!e (1,5%) ""5",073 3-r7-fl :k-d'hi!...ufi r Tolol Comb. Permit I ~IGNATY..8.C FOR OFFICE USE ONLY 0./') ct-q. Ftg. Main ~ .~ c". Frg. Acau _?:.~W" Sq. Ftg. Other zo.. f:!~ .~L P U D Fir. Zone - Flood Plain A/ 0 Type/Cond. ~~' - IV ~drooms ~ I Units I"\ccy Load . ""lccy Group ^--~ I "'ilori." BUilDING PERMIT Cho,ge, and Surcharge. ~ u e """' I Plo. Ck. Commfl.d ____J.J:..1l.'.:::.f:::L 65,./Bldq Per Fee' ~ q,_1 Plan CIr:. Re, V ~ ~ 30%/ Bldq Pe, Fee Atl'h PlUMBING PERMIT Charge. and S"rcharges .:;5'.001 /.t,tol .?,<;"./iol . 1.;111 _____~O.~~ I . ya I Curb Cut Fence Demo elECTRICAL PERMIT Charge, and Surcha,ge. Sidewalk AIr. PClvina MECHANICAL PERMIT Charg.. and Surcharge. .3-1t:.-yf "ATE I x ';1,:"'. ~Volu. ~:J,/? 3t.,Z. (,{; x q.::;OI':Volu. _--'ijJ -~ .m.. x Valul . TOTAL VALUATION .-:1,{., S.:IS. (~/'\I . S '/7, ,~'f;' ...0 .;2~'1.I..'" I I I TOTAL #735.7;1., .,...,. ~..~. \ . '-:. '" .' .... . ;',,' COMBINATION APPlICATlON/paIT (CAP) I. ApplicarU to furni.h A, Job 'Addre.. B. legal Description 1. examole-tax lot 100, lone County Mop Refe" 2. examole-Lot 1. Black 3, 2nd Addition to Spring C. Name~ etc. of owner and construction lender D. Energy Sources 1. exomole.heat/electricol ceiling/or forced air q 2. exomole-woter heaterlelectricall.or solar E. Square footage or valuation, etc. 1. example-12S0 'q, foot hause, 500 sq, foat gara 2. exam~le.if new project, check new..if addition, , add, etc. F. Building permit information: 1. example-construct single family house with an c garage 2. exomDle.remodel existing garage into family ro 3. example-convert single family residence into restaurant (change or use) G. Value of work as defined in Section 303 (a) of the Structural Specialty Code H, DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Div; Staff must be able to. contact appropriate persons re design informction or job site corrections, etc. (' ., PERMIT VALlDAT/ON CITY OF SPRINGFIELD City Hall Springfield. Oregan ( Department of Public Works OFFICIAL RECEIPT , No. B 56263r Dote (\f\i\. \D 19<6\ \t~' Rec'd Fram~I:L~, _I ~ '\)'U"\_ ~k Address \I)~\'O ro~t\r\\OK- ( - \~~ For:~~~ An ,\Cf2.-'( -r1'("') - 0" f\\ f\\ D - 3s0 \ , Lftt'l \ 4:0 ( ~~ Df'+ A~OO , 4PJ.'J \ DO, ( cO{) '50 .R'LC .10 .~n8~ c. (""- Received ( (- <, II. Abbreviated Plumbing, Mechanical & Electrical SchedulE A. Except where blank spaces occur in the description p. of the Mechanical and Electrical Schedule., the appli. need fill-in only the No. Boxes adjacent to the opprof item(.) 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 schedule hQye been abbreviated 2. If the item(s) to be installed are not covered on the ated scnedule. you should consult the full .chedule, C, BUILDING DIVISION STAFF WILL Fill OUT ALL FEES A" CHARGES ON THE SCHEDULES ( \\\~~~ (l:>r, Amount Rece~.!'_d ~(") t DC) D'P-.\ 0(\L 'l~~.1 \'- CL ( ( (' IV. III. Applicant to sign and date Whenever possible. the initial application will be used as t worksheet only. Where possible. Building Division Staff wi ( prepare a typewritten copy and return it to the applicant c '. the time the actual permit is issued for his signoture. t-_ Fees and Charges Plan check fees ore due and payable at the time of the application, and no plan. will be processed until these fees'are paid. All other fees and charges are due and payable when the permit is issued. ( ~J ''0m) AUTt40-Jt.'l~D S.OHATUIU: ....L'O...TU....ULL ~.,"'...'. .uo.... O. .'''01 ( I .....-. ( CI '.. .. V. FOR OFFICE USE ONLY I I Permit Clerk " PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: , , ,trY! p~lG!:I/, , Additional Project Informallon: ...{ . /7 A -"7 . _ 'J") ;' / '4'. _ " -r~ ,~j!.a~.JJJ4~..A-'<.V --r.~~ -r...1U/AJ....."'",J ~ , " ,U' ,1 '/ () (;/ ~~.' " {./" , name signatur- AiL PLANS REVIEWED BY:, ~ ..Jate 3-:l.<l- go / .. 0 " .. .~, . to. _ ,