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HomeMy WebLinkAboutPermit Building 1982-6-3 Job Address 1:2.5 A.\AlkJ ~T. ~?FL-" Legal Oe<cription 17-d.,.3-!)-(j '2. Toe., I IrISPECTIQ;1 LIIIE, 726-3769 Owner I I INFORflATION LINE ,I 726-3753 50. Ftg, 1'1ain ~q. f'tg. Access. Sq. Ftg. Other New Add Alter ~ep. --Fence Demo Change/Use Other - - CITY OF SPRI1IGFIELD COIIBHIATION APPLICATION/PERMIT EilERGY SOURCES: Heat /1---- t'Jater Heater ~ ~ I~ I\) I AeT t NTH w.....TT€eS '-:loo li- 3" ~ AVt:- ffijlr€1.J/;. De (;. 4'7 C/-D5 Phone'fi~,S'~ . Ranqe ValUE of Hark: ., 1,000 - BuildinQ Permit Info: Farnil y l1es; dence \-lith Describe Work(i~e.. Build Single JI..ttached llaraQe) Address Construction lender Address UDHifl IEAH (name) Primary V~/5;C: ~~ Structural Electrical f1echanical COfITRACTORS (name) lteT W~ Genera 1 Pl umbi nQ -- " . c.v-r ~)(7 'IJ#Oii!.WAY TIt~V MA5ZWeel" WA~ , , Mo.l..Ioe. iiL.Ec:r, CHAloJtrbS Phone (address) (lies. no.) (exoiresl (Dhone no. ~. ~B7.12<3 (address) ~').O 6""~t. t:!' eu~E; (lin. no.) (exoires) (ohnnp nn " IJJ AJ bR.. '-i t:,s.- <;;,t..&'f.. ,J ^,-I< ~ liYAl 0 t.: D <; 5l.8:::re.1 c. 3 '(-,;-71- 91 Electrical f,lechanical PLUllBlIIG NO.1 Each single fixture Relocated building (new fix. additional) S.F. Residence (1 bath) OupIex (1 bath) each IAdditional bath j~later service I Sewer Istorm Sewer TOTAL CHARGES WHEnE STATE L1N REQUIRES shall not be vaIiJ until the ELECTRICAL FFF rHARr,F NO Res i dence of . SQ; FT, y New circuits alts. or ext~sions ':<1 &' , /Y7C7?<!F SERVICES MECHANICAL FF~ r~A~r.F Nn_ FFF rI-lA~rF, / furnace/burner to BrUls /$.'" Floor furnace and vent Recessed wa 11 ~n~rp hp~tpr ~nrl vpnt I!emporary Construction IChange in existing l"posjdp.;nr:p Imultifamily, COI11T1. or Jnnustrial 10f amps.j ICOffi1./IND. FEEOERS I IInsta11/alter/relocate I rl;<;.tl'"iIL fppdpr.. 10f amp,,1 I I I I I I I I I I ISSUANCF OF PFR!IlT TOTAL CHARGES IS: - I TOTAL CHARGES that tile Electrical work. be done by an.'Electrical Contractor. the electrical portion of this permit label has been signed by an Electrical Supervisor and returned to the Building Division Appliance vent seoaratp Stationary evap. cooler Vent fan with sino1e duct I Vent system apart from I heatino or A.C. I Meehan i ca 1 exhaus t hood and durt I Hood stove/heater I I 1 I HAVE CAREFULLY EXN1lfIED the camp leted apfl 1 i cat i on for permit. and do hereby certify that all i nformat i on hereon is true and correct. and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Drel)on pertaining to the work described herein, and that HC OCCUPAUCY 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 ons 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 7~1.055 will be used on this project. 6$17-/)..1.-'3 '~ DATE ~-3~f?2 Uni ts Occy Load Occ.v Group S IGilATURE <;;7}- : , FO~ OFFICE USE Q;IL Y Sq. Ftg. r1ain Sq. Ftc]. Access Sq. Ftg. Other x x x Value Value Value UAf.IE(please print) '"P (F1oJ1V1 S 'F. Cel Le Zone C. . 3 Fire ZonE' Flood Plain Tyoe/Const. Bedrooms Stories j TOTAL VALUATION BUILDING PERI,IIT Charges an~ Surcharges I/> ~D Plan Ck. ~. 65%/Bldo ------------""""PTan Ck, . ~~ 3D%/Bldo 1/ {O pef ~"::;-B~ Systems Development "':..:/ ;t;t.'>"'[I';z"r Charoe (1.5<) I I PLUf1BING PERMIT Charges and Surcharges CorrmlInd Ppr FpE' Res Per Fee Fence ELECTRIU.L PERf~IT Charges and SurCharges I Demo IS"". - I Sidewalk --------,-i.;-I A/C Paving I1ECHANICAL PERMIT Charges and Surcharges '- Curb Cut jTotal Comb. rermit 2~~ ""'" I ,/} -;z f/G, OP I TOTAL , .. b PROJECT CONDITIONS TO BE SATISFIED BEFORE QWJP.~.tIGY: ~,Il~/'" IS:5p~~/~ : A'~~/A.E""'T ~~~ ~cr......:!';)P.T"'" ~~...r #", ~A<FI.vt'~ c. CL..otorE2' A' - "--" ~_ r_L"i' ~.-. .. ..... ~h~ L~<r- ~ ?-?.sn;r~#1G;. ~C"CF"~~~...., from registration with the Builder's Board because: I COMBINATION APPLICATION/PERM]T (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 11 U3 43 2, exam~le- Lot 1. Block 3, 2nd Addition to Sprlngtield Estates C. Name, etc. of owner and construction lender O. Energy Sources . 1. examo 1 e- hea t/ e 1 ectr; ca 1 ceil i nqjer forced air (I, 2. examole- waterheater/electrical/or solar E. Square footage or valuation, etc. ------ 1. examole- 12S0 sq. foot house, SOO sq. foot garag. 2. example- if new project. check new - if addition cneck add, etc. F. Building permit information: 1. example - construct single family house with an a ttached garage 2. examyle - remodel existing garage into family rOI 3. examyle - convert single family residence into restaurant (change of use) G. Value of work as defined in Section 303 (aJ of the Structural Specialty Code H. DESIGN TENI AIID CONTRACTORS To avoid design or construction delays. Building Division S,taff must be able to contact appropriate persons regarding design information or job site corrections. etc. II. Abbreviated Plumbing, Mechanical, & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacel to the appropriate item(s) 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 have been abbreviated 2. If the item(s) to be installed are not covered or the abbreviated schedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANO CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must be delivered to 1 electrical contractor for signature by his electrical supervisor. The general contractor is.not authorizec to sign the electrical label. --- III. Applicant to sign and date Whenever possible. the initial application will be used a a worksheet only. Where possible, Building Division Staf will prepare a type written copy and return it to the applicant at the time the actual permit 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. V. FOR OFFICE USE ONLY j, 1- )?6iC:l..>/Rt9; i-JP k~>>e ~ ~, ~.A7n=A, :~\.V' ~ ~L.'- ~c!=" . ' . 7a::=--~/_~T----S-. Permit applicant exempt (\J1A Q Q m 0 1(\1. 1\ \' '-."f" Additi!,\,al Projec~ Information: e .L T' CITY OF SPRINGFIELD I ( ,-' " City Hall Sprlngflald, Oragon Departmant 01 Public Works OFFICIAL RECEIPT No. B 59263 DatJ "'~l\O. t ~ ~9 ?/2 . Aec'd~rmQ-(\\\\..~~~\:Qf\~O. : Address 4(1\0 l h \ \\-t~ \1 \Y\fJ X RJ(JCOf{) \J ( ( ( Received For: ( ~ ( ( ~)\J'~ ()'\ Q 1 \( J.T ;4\,,) ( \:,0 Go H c \sea 4~ ,(rf) ( ( ( Amount Aecelved ~(() _0 u rx- , A f\.:C; J - AU'ft)bRlZEOSIGNATURE (r ( \l L-" - BY -\, ( BRIGGS PRINTJ:ItS/LlTHOORAI'HI:IUI.I:UG.l:NI:. OREGON - ' Permit Cl erk ~ ,1'I.._t~ . 1\U\Q 2.,~, B8,!:) ~d~ v I PLANS REVIEWED BY: name ~~ ~6:;?lf" Signature~~__~ date (;;.9-~ . , ':r:~~_. ....::.~"::-_':::::-:~~-'::=.:=-;::.~:~._.: ;:..-:_~-:":'-.::..'..,~::::-7:::::'=;.~~:;,:".."':':_:::-""''=:t.:...;:.:.'~-:"'""::-::=-::..-...,'....;::~~'!:~.-:-:,::;:..,. ....._ ~''''''''.'~",,-..-_".-....._~;:.~'h'' I