HomeMy WebLinkAboutPermit Building 1981-3-16
(JAJ /1 P
.
~'-f7f )(-~ 2J
l...1 Dn,,;.t;.. ,,~AA -1 /" / ; .
I Ii'lII r BI ac., PLFtJlIQ I LOTu (:,
Owner ~_ . ~/ ---<- (;~;: , J....
Add,... t:/~F:?" ~
INSPECTION UNE
726-3769
Job Addreu
Construction lende'
Address ~-_..:
DESIGN TEA~
.;::."" --. "
T-
4J~"'-f
fl/-. -
~0-
Phone
,<;../::.." pl'
(nome)
Primary
Structural
Electrical
Mechanical
CONTRACTORS (nome) W'~
General . ~ /2.:...-___
Plumbina ~4I".A-, .:"
Electrical ~dL- __
Mechanicol cL./../- .........
CITY Of SPRINGFIElD
COMBINATION APPLICATION/PERMIT
.
INFORMATION LINE
726-J1.53
I ENERGY SOURCES: Sq. ftg. Main ';"i', ;....,-
H..t EJ..'::C, '.~/ hi , Sq. Fr.. A".... . 3r;.-......
- '
I Wo~, Heate,~r Sq. ftg. Oth.,
Ranq. _,!:UC ANew_Add_AIt.,_Rep.
I Value of Work: 1__Fence_DemO_Chonge' U..
3';;')~'7S.c'O _Oth.,
/' _ _ ,~Buil~;n9 Permit Info.l D..cribe Work (Le., Build Single
71/'r4 ~ ~ FamIly Retidence WI,h Attoched Garar.._
cuI>>TT Cone
A,PHIL
~ .,'
r',{LI7.
Phone
-.
S,t:: ;>,:::....
-- - - --
':::IEEP Lt:Jc. E.
(oddre,,) ~~~__;"?~~-J (lies. no.)
(/'~ ') AJ.....1>L-r.dd,...) ,,-/CU I"t'-, <,
PLUMBING
N;I
-,
I I
I
I
I I
I I
FEE
CHARGE NO.
Eaon dnQle fbcture
Relocated building
(new fix. additional}
S.F. Residence
(I both) .
.~5',rrj ,
I
I
I I
I Jc.r.ol
I I
I I
I I
I I
I I
I I
I f
, ~s-:L'61
Dual.. (I balh) each
Additional both
Water s.r",ice
Sewer
Storm Sewer
<.
TOTAL CHARGES
I CHARGE NO'1
/.... 1 furnace/burner 10
~J.CY ,---. I!,TU's
I ~ Appliance vent
I separ.:2te
I I
/OdJO I^-
I
Hies. no.)
ElECTRICAL
FEE
Resj,Qence of .
_:~J!;"'l.- sq: ft.
Now circuits, alterations
or extensions"
SERVICES
Temoarory Construction
c:l (;>{)
Amps.
FEEDERS
Amcn.
TOTAL CHARGES
I
I
I
I
I
I
I
:; s. all
, (e.pires)
4<L~
(exoires) ~ _ ~
CD
.......
C>
........
~
CJ
(phone no.)
I
..!
1
1
(Dh... .D.17~t~:
, .
I
j
,
1
I
FEE CHARGe:
,
,,',":'
!"".a? I t,.oo
I
<<5;)
/tJ.nn
:lO.S?J
WHERE STATE LAW REQUIRES that the IHutrical work be done by tho Electrical Contractor. the olemica portion of this pormit shall not bo valid until, a
iabol has b_n signed by an Electrical Contractor and attached to the olectricol panel.
I HAVE CAREFULLY EXAMINED the complet.d application for permit. and do h.r.by certify that all information hereon is truo and correct. and I further
certify tho' any and all work performed shall be done in accordance with the Ordinonces of ,h. City of Sp,ingfi.ld and the low. of the Stato of Oregon
pertaining to rhe work d.scribed herin. and that NO OCCUPANCY will b. mode of any structu'e without the perminion of th. Building Division. I furth.r '
ce,tlfy that my registration with the Build.r's Boord is in full fOh~. and ..fEect os required 'by ORS 701.0jS, that if exempt the basis far exemption i. noted
heron. and that only subco':!tractOrs and employeo. who aro in compliance with ORS 701.0'5 will d on this project.
Bo.is for Build..... Board ex.mptionl
NAME (pl.ose print) ~H tf'J..
17~#A -r-
z... /~--~ I)UI)
Type/Canst
Bedrooms
11\'0,1."
'Q-N
.7.
I
Fir. Zone
FloOd Plain AI,.,
BUILDING PERMIT
Charges and
Surcharg.s
PLUM81NG PERMIT
Charg.s ond
Surcharges
ElECTRICAL PERMIT
Chorgll' ond
Surcharges
MECHANICAL PERMIT
Charges and
Surcha,ges
- ~,...
"nits
'"'ccy load _ ..
""ccy Graup_k"'-~,;o
MECHANICAL
Stationary e...ap.
cool!!r
Vent fan. with,
sino Ie duct
Vent sYSt.m apart from
heatinq or A.C.
Mechanical ..hau.t
/ hood and duct
f';. 'Wood .lo..../h.at.,
Heat PumD
Ai, handler to
10.000 CFM
I Air handler o....r
to.ooo CFM
ISSUANCE OF PERMIT
TOTAL CHARGES
'1GNATYY
FOR OFFICE USE ONLY
~
rJa
( ~
,
CI/"
c,. Ftg. Main I .-.t.
coq. Fig. A.ccen ------B..oii g
Sq. Ftg. Other
Plan Ck. Camm/lnd
'J?J9.m 65%'Bld. P., F..
Plan Ck, Re.
."1,.<;(. 30%IBldD P., Fo.
3S,oct Fence
---------1
I. '10 Dom.
I J.5:0(') I Sid.w.lk
/ , on I Ale Pa...inn
;10.$"0 I Cu,b Cut
------~ '6'~1
I
. ~c <.L 5~7.3
P~/() .';'I7.fI
x "l;;.~o V.I_
x 'i,St') Value
x Value
TOTAL VAlU.4.nON
I
I
J'1 ~ A" ,J
~t1...Pt'u~~1
I Total ~omb. Permit I
I
I
Systems De....lopment
eharQe (1.5~l
TOTAL
DATE
3-/6, -ff
3~3t.9. 40
.5Cc.. .t!:Jo
~~, f,,75. ton
SD5'. J.:;
.;401
~ag.;l::(1
I
I
#733J~J
."
. '..': ~ ....... '; ~,~ ......;.~..... '...,. '
COMBINATION APPlICATlON/.IT (CAP)
I. Applicaru ta-furnish
A. Jab Address
B. legal De.cription
1. example.tax lat 100, lane County Map Refe,,'
2. example. lot 1, Block 3, 2nd Addition to Spring ,-il
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole-heot/electricol ceiling/or forced air q (,
2. examole-water heater/electrical/or solar
E. Square footage or valuation, etc. -
1. example.1250 'q, foot hou.e, ~ sq. foot garc
2. example-if new project, check new-if addition, I!C'"
add. etc.
F. Building permit information:
1. example-construct single family house with an I ~ct
gorage
2. example-remodel existing garage into family rc
3. example-convert single family residence into
restaurant (change oT use)
G, Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H, DESIGN TEAM AND CONTRACTORS
To ovoid design or construction delays, Building Dh
Stoff must be able to. contact appropriate persons n
design information or job site corrections, etc.
II. .Abbreviated Plumbing, Mechanical & Electrical Sched~1
A. Except where blank. spaces occur in the description f
af the Mechanical and Electrical Schedule., the appl ~.t
need fill.jn only the No. Boxes adjacent to the apprc
item{s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedule. (
ore available at the Building Division
1. To conserve space on the permit form the schedul
hove been abbreviated
2. If the item(s) to be installed are not covered on th \b~
oted scnedules you should consult the full schedul
C. BUilDING DIVISION STAFF Will FILL OUT ALL FEES A
CHARGES ON THE SCHEDULES
III. Applicant to sign and dote
Whenever possible. the initial application will be used a:
worksheet only, Where pa..ible, Building Division Staff, (
prepare a typewritten copy and return it to the applican1
the time the actual permit is issued for his signature.
Fees and Charges (
Plan check fees are due and payable at the time of the al!-
and no plans will be processed until these fees are paid. All
other fees ond charges are due and payable when the permit
is issued. .
IV.
V. fOR OFFICE USE ONLY
"
.
PERMIT VALIDATION
('
,
I -
CITY OF SPRINC!FIELD
City Hall
Springfield, Oregon
Department af Public Works
OFFICIAL RECEIPT
No. B 56265,'
Date (\ ~l\, \ () 19 R\ '. . -
Rec'd ;rom lliQ.~ J '+- ~OJ\t SJn t ) (
Address \~\\() ffi()mLt')K-
I - - ~ . -
Received Fa;: h(\~\- \~ cD
\J401r" ~ Sb C
t \1 ft\D~) p~(~~ c
\ ~~ ~fX)
49;" \ 00 (
ffiU\ H rlJD COO
49.0 .~2- C
&1. CW=t ~ /JO .
kYlC'___ ~" f) (
(
(
(
(
(
(
(~--y-; (
Amount
Received ' r~.lo \
."",o",1?~~~'oL" ..".. (.....
(
~CI
(
'"
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,.
>
Additional Project Information:.;;t... ~ ~.f, . iJ-/J
. ,:.<A..t, .AA.,~ ~, j).L&, JI/ A C'-:J-?
~~,'- 4,,'t7~-<G a..urJ ~~
...:[....71- ~ . (.I ,
PLANS REVIEWED BY,
/(()~
naml'"
. signatur-
""-
,-
,'.
~~.Jr> I?~
I
I
date
3-.,2S"- g(
'.,
"'" ..-.... ..'-.-' '. '. .'.
I
I: