HomeMy WebLinkAboutPermit Building 1981-3-16
INSPECTION LINE
726-.3769
Job Adcf,.....
Con,"uClion lend.r
Addr.ss ~, :
DESIGN TEA~
Primary
Structurol
Electricol
CONTRACTORS
Glln.rol ' ~
N:I
-,
J I
I
Eooh linal. fi.tur.
ReloCCJlltd building
(new fix. additional)
S.F. Re,id.nc.
(1 both) .,
Duol.. (1 both) eoch
Additional both
/
I
Water ,er...ic.
Sewer
Storm Sewer
r-
,I TOTAL CHARGES
:~'-f7f
(J AJ II 'Fr'
.
)(-~ 2J
CITY OF SPRINGFIELD
COMBINATION APPLlCAJlON/pERMIT
.'
INFORMATION LINE
726-.3753
(oddress) t%....._~..-J (lin. no.)
. (expired
(phon. no.l
\:0
.......
C)
.....
~
~
J
1
I
(oho,. .o,l 7~1.'51
, .
I FEE
I
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I ~.cl7
.1
I
I
I
I
I
I
I
I
I CHARGE'
I
I
~,oo
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I..;t,'g)
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ISSUANCE OF PERMIT . /tJ.nn
.15: 0111 TOTAL CHARGES :JO,!{'(J
Units
')ccy Load
"'ccy Group
'iIGNATMB,C
FOR OfFICE USE ONLY
I c,. Ftg. Main --.::t/;;Z
Sq. Ftg. Access ~~:of
Sq. Frg. Oth.r
)( ~ ~ ~';'n'~'alue
JC ~/S;) Vol.....
x Valu.
TOTAL VALUATION
..,~ ~t.9. 40
.:l4" . ~o
R- ~;
ac. -i.L 5/d)'T.:;
Plh() .".,'O,fI
I
I
I
I
I
J 1~<n..pC.t6i-z./.4i
I Total bomb. Permit I
I
I
I ENERCY SOURces: I Sq. ftg. Main ~~/:.~
A F H J (, HeatE Lt!C I c/~. Sq. FIg. AccelS. ...:i~Q"
-E1.r .
l.goID."';.t;o. ,.:-,;.4+/.!.~. ., ?!/ 17. I :::: H'~Ldc r l.:;~ Orh:~d_AIr.'_R...
JJ.1ilT A- ~DC., PY-' Ft Ie I l(lT = / I Volu. of Wo,k, 1-_F..<o_D.mo_Cho.../U..
~ ~/ ) I 3';;'.t,'7$.c,O _Oth., .
Own.r ~_ "/1.-- ~ (.,..r~ I,}-J_ "
'7 /' - _1 8uildin'g P.rmit I"fa: O.,cribe Work (i.... Build Sing I.
Addr... d~p:7" ~.:. Phone f/'(~-~ ~JFQmil., ~e'idenclt With A,11...rh..d C;o,o(oe'
I u ~j'''TT ,..::;, ..:>
~ .;::.PIS~ ....H ,...c.,
I ,c;IP/~PfJ.}C-c.
I
I Mechanical
I
I
I PI\,/mb;,1C~ ~,.4~....."
I EI."'kol tf!2z/--L _
I M.chonical C~ ~- ~
I
ra.-,..
.
r
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("am.)~0-.
rt.t:"'"'J~(odd....) dCU .Ig.,_~
(lics. no.)
~Pj
(uDires) 77;"
WHERE STATE LAW REQUIRES that th. Electrical work be done by the Electrical Contractor, th. .Iectrical porlion of Ihis p.rmit shaU not b. valid until.a
iabel has bH" signed by on Electrical Contractor and attached to the .I.ctrical panel.
I HAVE CAREFULLY EXAMINED the compl.ted application for p.rmit. and do h.reby certify thot all information h.r.on ;, true and correct, and I furth.r
certify thot any and 011 worle performed shall bo done in aecotdance with the Ordinances of the City of Springfield and the Laws of the Stat. 0' Or"90n
pertaining to th. work d.scribed herin, and that NO OCCUPANCY will b. mad. of any structure without Ihe permiuion of th. Building Di...ilion. I furth.r
certIfy that my re-gistration with th. Build.r's Board is in full force and effect a. required 'by ORS 701.05.5. that if exempt the basis for exemption i. noted
heron. and thot only ,ubcontracto,. and .mployee. who or. in compliance with ORS 101.0.5S will d an this project.
Basi. for Build.r'. Board exemptior'
NAME (pleas. pr;nt) ~K tf)..
Zone i~-~
l~UO
fire Zone
Flood Ploin....u."
BUILDING PERMIT
Charg.. and
Surchargu
PLUMBING PERMIT
Charge, and
Surcharges
ELECTRICAL PERMIT
Charge. and
Surchorge.
MECHANICAL PERMIT
Chorge. and
Surchorg..
I R.sidence of
_-Z':.L~. _sq~ it
,- -N~',''':~i~c~ifS. alt.ra~ions
or e:d.nslon,
.':'S-.l'~ I
I
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I
/~.cal
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I I I
_ ~S-'tJl') I TOTAL CHARGES
'I " I Plan Ck. Comm/lnd
.-}9Im 65~../Blda Per Fee
I Plan CIc:. Re,
."1,..r;c, 30%/Bldo POI Fe.
3,S,ccl F.."
------I.</~I D.mo
:2.S:tJCJ I Sid.wolk
1100 I Alc Pa...ino
610.$'0 I eu.b Cut
-------; ~~I
(nomel
,;/...... -
.~
Phone
,.....:;.::, t/'
.
/2.-___
PLUMBING
FEE I CHARGE NO.
/7"",.., T-
Type/Canst. ':.\!--/'i
I.droams ~
I
~toriet
I
I
.3~ f..7S, ton I
.,
s~/~I
ELECTRICAL
MECHANICAL
SERVICES
I
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le.a,,1
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I CHARGE NO.
. /6"'&
r-m.-
FEE
I furnac./ burner to
~ 13TU's
I Appliance ....nt
,.parate
I Stalionory e...ap.
cool.r
., Vent fan with
,'^ sinq/. du'ct .
V.nt sysl.m apar' fram
heatinQ or A.C.
I M.chonicQI .xhQust
/ hood and duct
r..1. Wood sto....1 heater
I Heat Pumo
I Air handler to
, 10.000 CFM
Air hondl.r o...er
10,000 CFM
Temoorory Con,truclion
Amps.
c:l.o-O
FEEDERS
Amps.
Systems De....lopment
Charne r1..5~:'1
DATE
.3-~" -IY
~:2g..~~
.~o
I TOTAL
#733J~J
".:.,:.~.;,~._~ '.". u'_ :.,'~'
,.,'
. COMBINATION APPLICATION/PER. (CAP)
I. Applica~,to furnish
A, Job Address
B. legal Description
1. example-tax lot 100, lane County Map Reference
2. example-lot l. Black 3, 2nd Addition to Springfield
C. Name, etc. of owner and construction lender
D. Energy Sources
1. exomole.heat/electricol ceilinq/or forced oir qa!
2. exomole-woter heater/electrical/or solar
E. Square footage or valuation, etc. .
l. example-1250 sq, foot hause, 500 'q, faat garage
2. example-if new project, check new-if addition, chef
odd. etc.
F. Building permit information:
1. example-construct single family house with an atta
garoge
2. example-remodel existing garage into family room
3. example-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 TEAM AND CONTRACTORS
To avoid design or construction delays, Building Oivisi,
Stoff must be able to, contoct appropriate persons reg'
design information or job site corrections, etc.
II. Abbreviated Plumbing, Mechanical & Electrical Sched'ules
A. Except where blank-spaces occur in the description pOt
of the Mechanical and Electrical Schedules, the applicc
need fill.in only the No. Boxes adjacent to the appropr
item(.) 10 be installed
B. Full Plumbing, Mechanical, and Electrical Schedules .
ore available at the Building Division
1. To conserve space on the permit form the schedules
hove been abbreviated
2. If the item(s) to be installed are not covered on the
ated schedule. you should consult the full schedule,
C. BUilDING DIVISION STAFF WilL FILL OUT All FEES AN
CHARGES ON THE SCHEDULES
. PERMIT VALIDATION
~
(
CITy OF SPRINGFIELD
City Hall
Springfield, Oregon
Department of Public Warks
o FFI CI A l RECEI PT
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No. B 56262:"j
19~\ .
- ~ . .
Rec'd From ~€\ ~o\)Q.>
Address \ rz.\~Q. ~'N\Hl'(
Date (\ \)'\. \ t)
.(
r 0 Cl 06'1'"
(
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~$lL> (I
<~5r:D '
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~F1,OO
1\:9,) \ 00
A(),'EiJ
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\.0 (') :~~I (\\0. Cf,. I :in
sr\C'- f~J::{:) \~ --: l
4O!t~
For: D\~, fl\~
t \1\m ,')
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Received _fl_?)~, \0 '\
t1\\f(\ )
- ",'UTHORliiD SlG......TURI:
.H~~TOH.TU"'H.U~~ """HTIl"'. . ~Uo.lHIl, a", .7.0.' ..."..
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III, Applicant to sign and date
Whene~er possible, the initial application will be used as.
worksheet only, Where possible, Building Division Staff wi (,.
- prepare a typewritten copy and return it to the applicant l
th.e time the octual permit is issued for his signature. .J- .
("
ef .,.,
-c
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IV. Fees and Charge.
Plan check fees are due and payable at the time of the application,
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. .
..
V. FOR OFFICE USE ONLY
Permit Clery
,.
PROJECT CONDITIONS. TO BE SATISFIED BEFORE OCCUPANCY:
,
.
:i
,
Additional Project
Information: J . ~!/' . J /, /7.. I/J. r'J
. . ~l-1-l, -;(,tA_,,-'A.-t>_f, A.LA",-,/ A t1J'J~ "...H!!.Ar~n- ~'h::f...A/
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a.u .L-)4.A'~
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':igMatur...
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PLANS REVIEWED BY,
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~ale 3 -.25'"- g<
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