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HomeMy WebLinkAboutPermit Building 1981-10-14 . ,jll." I:' 1Y; ',' ~;,>:(_.'.';Y; " . INFORlIATlON LIt,E ., 726-3753 So, Ftg, l'lain ~q. ~t9. Access. Sq, FIg, Other Ilew Add Alter Rep, --Fence Oemo Change/Use Other- - . '; IllSPECTioll LlIIE 1726-3769 Job Address 6/1 MIf/A/ CITY OF SPRIIIGFIELO COMBJ:IATlON APPLICATlON/PERMIT I E,IERr,y SOURCES: Heat Hater Heater Legal Description Owner l7-o':1-B5-81 D 9;L6-t) C pJ) ,/'/1)( k/A/h- , , )fD, A/V C(/?I( --1~",:-Co/'~Phone Ranqe Address OE> IGIl TEAll (name) Phone (address) i~ Build Single '" <0 .......... !fC'OP", AJI3'/A/)( r/tOA/r rAAJoJJY' ~ .fJ/I1BJP>-(M,()/)/hc ?~;, If!M eLI/lit; ''A "(1'001"._ (lie5. no.) (exoires) (ohone no. Val'J5 of Hork: -ff ~ fj';2 :.3 --- Buildino Permit Info: Describe Work{Le., Familv nesidence l'lith .A.ttached r.araae) Address /P.EA'OI'/ F .t: Y/Sr/A/(c /..-f A- //1/ Construction Lender Primary ~~1f ~~~ V r 1 .1 i Structural Electrical Mechanical CONTRACTORS (name) (address) 11 ieo;,. no_) (exoires) }ohone no.) / t?/:<</~, i 74-4()71Cl ' I ! General AJo,t::: J,70CF/A/C /A/{; ::;J flt!74 {'t!'ClJ(/ A/J cz,1<'EAJe '#/'/0;; Pl umbi no Electrical ~1echanical i ,..,' PLUIIBIIIG ELECTRICAL MECHANICAL ' Each single fixture FEE CHARGE 'Jll ... r"'IRG.E. ..HQ...1 Residence of furnace/burner.to 5Q, FT, BTU's ... r"'llllif. I NO. Relocated building (new fix, addiLional) Storm Sewer amps.l I IInstall/alter/relocate / rli~trih_ f~prlpr~ IOf amps./ I 1 I 1 I 1 I ISSUANCE OF PFRI1lT TOTAL CHARGES I TOTAL CHARGES that the Electrical work be done by an Electrical Contractor, the electrical portion of this pernit label has been signed by an Electrical Supervisor and returned to the Building Division Of I I I I I I I Floor furnace and vent I' Recessed wall , SOi'll':P h~tltp,. orlnd vPl't New circuits alts. or extensions S.F. Residence (I bath) Ouplex (I bath) each I SERV'rCES I COMfl,/INO, FEEOERS I App 1 i ance vent SPDi\l"i'ltP. I S'tat.ionary evap. cooler I Vent fan wi th sinole duct Vent system apart from I heatina or A.C. Mechanical exhaust hood and duct Il100d stove/heater I 1 I I I 1 I I I 1 I 1 Additional bath IWa tel" servi ce I Sewer ITempOrary Construction IChange in existing I"P~jq~f1cP Imultifamily, comm. or Tnnus.tri"l TOTAL CHARGES WHERE STATE L~W REQUIRES shall not be vali1 until the I HAVE CAREFULLY EXNlIlIEO the completed application for permit, and do herehy certify that all infonnation hereon is true and 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 UO OCCUPArKY 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 ORS 701.055. that if exempt the basis for exemption is noted hereon. and that only subcontractors and employees who are in compliance with OP.S 7nl.055 will be used on this project. 1IA1.1E(please print)1l0P A'CI;;e:/,1h;' JA/C. SIGrlATUR~.hI'/ ~~ , - FOr. OfFICEilSE Q;ILY OAT.E h/i<'//B'/ Zone Fi re Zone Flood Plain Tvoe/Const, Bedrooms S tori es Units Occy Load Occ'y Group Sn, Ftg, 11ain Sq. rtg, Access Sq, Ftg, Other x x Value Value Value x TOTAL VALUATION BUILDING PERmT Charges an~ Surcharges ____n_~tQ-L JIb Plan Ck, Comm/Ind 65%/Bld~ p~r Fpp Plan Ck. Res 3Dt/Bldo Per Fe. Systems Development Charoe O.5~) PLU/~BING PERMIT Cha rges and Surcharges Fence ------------1 Demo I Sidewalk ------------ I A/C Paving Curh Cut jrotal Comb. rermit I I TOTAL \ IIdlif 9/) ELECTRICAL PERI~IT Cha rges and Surcharges MECHANICAL PERMIT Cha rges and Surcharges I. Applicant to furnish A. Job Address B. legal Description I, example- Tax Lot 100, Lane County Map Refer, 11 UJ 43 2, exa~le~ Lot I, Block 3, 2nd Addition ~o ~prlngtleld Estates C. Name. etc. of owner and construction lender 0, Energy Sources I. exam~le- heat/electrical ceilinqfor forced, 2. examole- waterheater/electrical/or solar E. Square- footage or valuation, etc. ------ I, examole- 1250 sq, foot house, 500 sq, foot 9 2. example- if new project, c~eck-new - if add; cneck add. etc. F. Building permit information: -i 1. example - construct single family house wit~ attached garage .' 2. examole - remodel existing garage into famil ;00: 3. examole - convert single family residenc~ in restaurant (change of use) ~ G. Value of work as defined in Section 303 (a) of t Structural Specialty Code '1 H, DESIGN TEN~ AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropria persons regarding design information or job site ( corrections, etc. II. Abbreviated Plumbing, Mechanical, & Electrical Sthed A. Except where blank spaces occur in the descripti portion of the Mechanical and Electrical Schedul the applicant need fill-in only the No. Boxes ad to the appropriate item(s) to he installed' B. Full Plumbing, Mechanical, and Electrir.al Schedu are available at the Building Division 1. To conserve space on the permit form the sch I,... have been abbreviated 2, If the item(s) to be installed are not cover the ahbreviated schedules you should consult ~...' full schedules C. BUILDING DIVISION STAFF WILL FILL OU., ALL FEES At- CHARGES ON THE SCHEDULES 0, 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 pennit is issued for his Signature. IV. Fees and Charges 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. . COMBINATION APPLICATION/PERMIT (CAP) 1 . ~ I ".,' ,_.. Ill. V, FOR OFFICE USE ONLY -. . . ... ~t; ~;II. . . -. . - - - Springfield, Oregon _./' ,'- " Deportmant of Public Work. OFFICIAL RECEIPT {. No. B5 7 4 7 5 . /0-19 199;1 . ( Rec'd From ~_ I?~ . Address J.tn4 Cn-l.n') ~L _ f Date (" Received Far: o 11 .Ir1 LI t' i1P Ir ffiU r .:<..1/.., tJO I . 4% .tll . o ~ ( I ( ( ~. ( (. Amount Received -( fl ..2.1-. 9/., ~ /( r' ~)(j !] AUTHOllllillO 51GIoIATUIIIE .""'1 (: ."ILTO".TU"".ULL ~"I"TIl". . IlUOIl"Il. 0" .T.O' ( Pennit Clerk ~ ......,lILla.... ... ........ ._..... ~."" .........." . ..." .. ... ...........,.".., ....... ."~ ."......" I. ..., I""........ . I....... .. '"~ -....01, . . ." . .. ~......... PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: " PLANS REVIEWED BY: name signature . . , "I ...... 0... .. , _... ....1.-...... date .~