HomeMy WebLinkAboutPermit Building 1980-12-31
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INFORllATION liNt
726-3753
Sq, Ftg. I'lain &:<t qJ
~q. ~tg. Access.
Sq. Ftg. Other
-1lew ..Add Jo1Ilter _..?ep,
Fence Oemo Change/Use
Other - ,
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I m~m~OIl LIIIE corlBlllm6NO~p~mmM7~ERMIT
Q / E!IERGY SOURCES:
Job Address O;~/ Mc:u~ ;5fYt7f1'f Heat Y\./~
legal Description 1/~f)~-.:<.5--12 Ilater Heater~rl.
t Ranne 'A /I'X
/0...)( t...... () 1 zoO VAlu, of \'/orkbO
Owner N (1/) I ,<)fY/ltI a.. /R..,;-vpy ~h'N~I'~'..:{!> (P, 006. -
Address J J -: -; r Phone ....1/ BulldnQ Permit Info: Describe l~orl<(;..e,"
p) '=<./ 1'/11'> II/I ..:) Jo-l7r.,. 7"'0- Familv ~esidence l'lith A,ttached Garaael
Build Single
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d 07J-( /1!r! rJ 4(? I/)/-f ./) jJ 1/JJ..t...t".i.
(address) (lics. no. \ (exoires),. (ohane no.
2Q402.. U), 7.M.{(j boo <{O07- '* 0tS$-;CJ"Ib__
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Construction Lender
Address
DESIGN TEAl'
Phone
Primary
(name)
C\\~iYr'~ ,
u
J .T?~(1~Q -
Structural
ElectriC:! I
~:eChanical
cmITR;.r.l~lRS (na~e I
. . # .
General ('0/'11.
l/ij/I:'YI ..
(address) (lic.s. no.' (exoires) (ohane nn.)
,.:J,.K<,7 It{dlr};Y!I/JJ.L J./- 2~J(:,- #f-4~l''J/ - -34.::s-Q3J/...
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3305 1:Yl11Mt '-81 .
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-717-79.:J~
PlI11l1~;n0
V\// C\,
DOJ-.~ ~)v f 0, I" Vui.-
'AID-...
Electrical
~~ec~anic~l
?LUila I j.G
ELECTRICAL
MECHANICAL
S.f. ?esidence
(J bdtbJ
Duplex (I bath) each
CHARGE tJO_ I
[Residence of
SQ. FT.
INew circuits alts.
or extensions
ISERVICES
I
FFF
rH,ll,Rr,F tlO.
f.H
rHARr,F \
II" I i FEF
I Eaen single fixture
. Relocdteo builcinq
(new fix. Jdditional)
furnace/burner to
BTU's
.'
Floor furnace
and vent
Recessed wall
Snac~ n@atpr and vpnt
Storm Sewer
Of
amps.
Appl iance vent
Sfloarate
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hood i'lnd fillet
~!a ter serv i ce
jTempOrary Construction
IChange in existing.
res i d~.nce_
multifamily. COrTrn. or"
Induc;tri?ll
Additional bath
Sewer
COI~'1. IIND. FEEDERS
Install/alter/relocate
dic;trib. fp~der"
Of amps.
__ ('C:/~4r~ Sc:rvir:;.t::
l..{t::JClo.J~D .
Wood stove/heater
%'--
ISSUANCE OF PFRmT
TOTAL CHARGES TOTAL CHARGES ~ s: eX> I TOTAL CHARGES
WHERE STATE lo\11 REQUIRES that the Electrical work be done by an Electr;cal Contractor. the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAMINED the completed application for permit. and do hereby certify that all information 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 Ore9on pertaining to the work described herein. and that NO 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 ons 701.055. that i~ exempt the basis for exempt.on is noted hereon. and that
only subcontractors and emnloyees who are in compliance with ORS 7nl.055 will b ecp.on this pr ~ct.
rWIE(please print~c....;/ S-A-.'y(,o,<.J 5 If,;IATV ____~~d.4-&~'
FO~ OfFICE USE dillY
So. Ftg.
Sq. Ft~.
Sq. Ftg,
OATE/2.--"-31-/<.'
Zone C.~
Fire Zone
Tyoe/Const. ~-)\I
Bedrooms
Stori es
Units
Occy load
Occy Group
A-,~
"
f1ain '0 , Value t::.~. 00
Access x Value
Other , Value
Flood Plain
J
, Plan Ck. COlllTllInd
65%/B1do ~pr Fep
Plan Ck. Res
30%/Blda Per Fee
I Fence
I D~Rlo
I Sidewalk
lAIC Pavi ng
I Curb Cut Alf~n:J.l"""
I
:lf55372- '/Z-/2.-f:,V
, "'3 40 'Systems Oevelopment '
-I ,- Charqe (1.5%)
TOTAL VALUATION
,6UIlOWG PWIlT
Charges and
Surcharges
'3~.=
------------
I. If'!
%:,,-
PlU'iBING PERMIT
Charges and
Surcharges
ELECTRICAL PERr~IT
Cha rges and
Surcharges
tlECHAN I CAl PERMIT
Charges and
Surcharges
_ u_ _~.r:...:-:u
J. 'fO
Total Comb. rermit
It!? -:>
TOTAL
'" Yo &Yi
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COMBINATION APPLICATION/PERMIT (CAP)
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I. Appl icant to furnish
A. Job Address
B. Legal Description
1. examole~ Tax lot 100. lane County Map ~r
17 03 4'3
2. examole- lot 1. BlOCK 3. 2nd Addition'
Sprlngtield Estates
'C: Name. etc. of owner and construction lend! (
. O. Energy Sources
1. examDle~ heat/electrical ceilinQ/or f{
2. examoJe- w'aterheater/electncaf/or SOl
E. Square footage or valuation, etc. - (
1. examole- 1250 sq. foot house. 500 sq.
2. examole- if ~ew project. check-new - i
chee K add. ete.
r. Bllildiny permit information: . ,r'
1. exar.mle -. constr,lct s"ingle far.Jily hous .~.
Jtt~cned gardge
2. ex~~~le - remodel e~istirig garage into
3. exa~Dje - convert single family reside (1.
reStdllrant {change (If use) .
G. Value of work as defined in Section 303 (a
Structural Specialty Code
H. DTES I GN TdEAdi'; AIiD CONTRACTOPS . . B <-
o aVOl eSlgn or constructlon delays. u
Division Staff must be able to contact appl
persons rega rd i ng des i gn i nfOrTIlati on or j 01
corrections. etc. <-
II. ,c"bbreviated Ph.::r.bing. riechanical, & Electrical . .
A. ~xceDt where blank spaces occur in the des(
:~rtion of :he Mechanical and Electrical $c
the applicant need fill~in only the No. 80> 18t.
~~ tne appropriate item(s) to be installed \
B. Full Plumbing, ~lechan;cal. and Electrical S
are aVdilable at the Building Division
1. To conserve space on the permit fonn tli ~."
have been abbreviated \
2, If the item(s) to be installed are not
the abbreviated schedules you should co
full schedules I'
C, BUILOlliG OIVISION STAFF WILL FILL OUT ALL F \~:
CHARGES ON THE SCHEDULES
O. As noted on the CAP, the label must be deli
electrical contractor for signature by his
supervisor. The general contractor is not.
to sign the electrical label. -
Applicant to sign and date
Whenever possible. the initial appl ication will (nu,
a worr.sheet only. Where possible, Building Div. ~
will prepare a type written copy and return it 1
applicant at the time the actual permit is iSSUE
signa ture. "
IV, Fees and Charges C
Plan check fees are due and payable at the time
application. and no plans will be processed unti~ 1.:1lt:~e.
fees are paid. All other fees and charges are due and
payable when the permit is. issued.
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V, FOR OFFICE USE ONLY
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PERMIT VALIDATION
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CITY
SPRINGFIELD
OF
City Hall
Springfield, Oregan
Department of Public Work.
OFFICIAL RECEIPT
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No. B 5 5 5 0 6 (
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Dale I"{ - .;::; I 19 t) ,
Rec'd From (11 oJ, ""CYJ.A.()'\) '"
Address 1. ~ '3 J /0 '1 OO_anloito
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Received For:
BP
3{n eX)
40}{J I' .44.>
CC-.~ 55.00
cp'}/) 1, q(')
('!..(~ (} J! l'Q.v i () .60
Sf)C q(:),O(j
.:1.:
'''0'
Amount
Received 0 '2, _ g 't c.l?
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I "UT"O"':r:~D !IIGNATUIltE
S"lLTO".TUOl"'U~~ ~"'''U''. . IP;UGI..t:. 0" 017.01
f,
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Permit Clerk
PROJECT CONDITIONS TO BE SATISFI!:D BEFORE OCCUPANCY:
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V€hY':'''''''.+R
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mOY/~/C>H:S //1~S7'
7;r""'Fr"/C Mv/::5/=.......
.-4/PP'Ro V&'P
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Permit applicant exempt from registration with the Builder's:Board because:
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Additional Project Information:
PLANS REVIEWED BY:
name L.&-Ji?;;,e n e<::; ~ signa ture
date /'Z-;:J/-go
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