HomeMy WebLinkAboutPermit Building 1981-3-16
I Value of Work: .~.::.
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- -./ _ . Building Permit Info: Describe Work (Le., Build Single
Phon_ ?f(Fp-~ I'~ 'Family Residence With Attach.d Garoael
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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--
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CITY.OF SPIINGFIELQ!'
COMBINATION APPLICATION/PERMIT
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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
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AI F HIL.
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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-":-
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'Construction Lender
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4,A~fI
Addr." ~.1
DESICN TEA~"
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^"'e':
Phon.
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,c::;;- ~*"p-
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(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
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rY), d..L ~
Ci:..J/- .....
EI.ctricol
Mechanical
PLUMBING
ELECTRICAL
N;I
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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 ~{)
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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>
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(expire I)
(phone no.)
....
-#'1
;;;.' -~
(pho.. .o.! 7r(t ~ I
(Upilll1)
MECHANICAL
NO.
I FEE
ICHA"GE i
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I t,.CQ I
I I
1<<:5'"01
I
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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
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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..'"
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I TOTAL
#735.7;1.,
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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- (
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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.
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Received
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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
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(l:>r, Amount Rece~.!'_d
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t DC) D'P-.\
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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.
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AUTt40-Jt.'l~D S.OHATUIU:
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V. FOR OFFICE USE ONLY
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Permit Clerk
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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 '/ () (;/
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name
signatur-
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PLANS REVIEWED BY:,
~
..Jate
3-:l.<l- go /
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