HomeMy WebLinkAboutPermit Building 1980-7-3
~l HISPECTIOII LIIIE lL.' CITY UF SPRINGFIELD .
726-3769 . C0/1BHlATION APPLICATION/PERMIT
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Job Address Jr:rTS :T'1ftmatw.no..lV\/rlv ~~~~G.hS~U~~:. c",\\';"'Q
I,} 7 ~ - I . f I Hater Heater e...\e_L. -\-vt'('~'
.e9i};,Description i ~O~"/:::; 1O..'/.r_o tlt;'1
Ii /J.-V- 1m 0 (N I J],,, N ), "';z.. ( (0 v1. I- I' j.-
Ow~er ;../f""'4 -{ if".;" ~ C Si-a 1\ t 1<
Address -:> r. n ~ I J
'^-Id.~ .I:'ovd., '<L
Primary ,J;,CGJh:IOVI {:v7(J./>-f-t'frl;?(p
Structura 1 s,a.V1't-c
Electrical s.~
liechanical SGt'wL-~
CONTRACTORS Inamel
Genera 1 H. ,=.d Y J:",- ~est"",:,O\ 1.;
; Pl umbi no
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Construction lender
Address
UtS I oN TEAll
Electrical
flechani ca 1
.
lNFORIIATION Ll1It
726-3753
Sq. Ftg. 1,lain '-i';'i() ilJ
:q. !=tg. Access. r
Sq. Ftg. Other
~lew...-jrcfd_AI ter,-,~ep,
__Fence_Demo_Change/Use
_Other
Ranqe
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Phon e
---Value. of l'lark:
"P(pO, DOC>. ~
Bull(:~q Permit Info: Describe ('Jork(i-.e..
Family Residence With Attached Garaqe)
Build Single
oR
C; 7 c/. 0 f 3':1~~~7)-
/1/' '
Or1-i t:.rz.- 7 q 7 - ::)..! ( :;( -
.h.."
+"'uc.k ~1}_V-:VICe_
A ciA \,h i,,^
~5--c. \ \ i tu
I
(n"me)
Phone
r address)
(ahane no.)
(l;es. no.)
(exo;rpc;)
? :;Z). 7 D. Y1 ) ) A 'Eu IWI '" P
rs<</I S-'-:2-)C:-
'l-A-S'_ N d-r
~
(address)
(lies. no.
(f'!XO; res)
(ohonp nn.)
'1'-15 ("M{" vA ~-'1_ [;1"'"
<f-0,'I-'1'1"1 c.
PLUIIBIrIG ELECTRICAL MECHANICAL
/lO. FFF rHARGE Nn ccc r\.lllRr.~ 'In I ~j:~ rU^(l~C
'I Each single fixture Residence of furnace/burner to I
$.Q) 2aa:; SQ, FT. BTU's / ,
Relocated building
(new fix. additional)
1,9.001
I I
/D.wl
I I Appliance vent
Temporary Construction spoarate
IChange in existing I I Stationary evap.
rp~idpnr~ cooler .
I multifamily, camm. or II I Vent fan with
Indu<:tri;l1 sinole duct
I Of I I Vent system apart from I
amps. heating or A.C.
I C0I11,I./lND, FEEDERS II I flechanical exhaust I <I.~o
I IdI~stta~lh/alftedr/relocate I I ~'10~d -~'~~ve/heater I
1<; _r,. pp pr<;.
I / Of 2,on amps. l/s.".,1 ::l. C;;~~ ("Jut" U7'!;> I IA.Q:2.
I I I / 11.% (hll,t'bA09UI_13.aJ
I II. I~
I I I I I ISSUANCE OF PFRlIIT
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TOTAL CHARGES c(O. tVI TOTAL CHARGES .as.cd TOTAL CHARGES .:2~
WHERE STATE l,\1/ REQUIRES that tile Electrical work be done by an Electrical Contractor. the electrical portion of this permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division'
I S. F. Res i dence
(j bath)
I Duplex (1 bath)
Additional bath
~!ater service
Sewer
I Storm Sewer
I
I
I
I
I
I
/
New circuits alts.
or extensions
Floor furnace .
and vent
I
each I
I
I
I
I
I
'I
ISERVICES
I
I
I
I
3.ln
I Recessed wall
So~~~ hPntpr nnrl v~nt
/
~E/.OC(:JtC- 56e
I HAVE CAREFULLY EXNlINED the completed application for permit, and do hereby certify that all information hereon ;s true
and correct. and I further certify that any and all work Derformed shall be done in accordance with the Ordinances of the City
of Soringfield and the laws of the State of Ore()on pertaining to the work described herein, and that HO OCCUPAllCY 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 e basis for exemption is noted hereon, and that
only subcontractors and~p.'~O::~~ Wh:-:~c:l.in) CI~~Ol)i~ce with OP.S 7nl,D55 wil be used on (t:~: Dr:::::. ;,1
IiAIIE(please print) fJ P.",,, ~ -t, '-- '\ =r ~ D~.TE 1-4/rD
,
I
Tyoe/Const. 1l- N
Zone (1.-4
Fire Zone.:;zFI:.
Flood Plain A/I)
, .
BUILDING PERfllT
Charges anc
Surcharges
PLUliBING PERMIT
Charges and
Surcharges
ELECTRIC~.L PERIHT
Charges and
Surcharges
11ECHAfllCAL PERMIT
Charges .and
Surcharges
Bedrooms -
Stories
,-- FOP. OFFICE US( OIIL Y r I .
Units Sq. Ftg. 11a;n 1/ x Value
Dccy Load Sq, Ft9, AcceJl~SSO x Value (00.00').<<:)
.
Occ,Y Group H-'I Sq. Ftg. Other x Value
. + I'}' TOTAL VALUATlO~1 t,~nrYl!?i'
'ri'.-Ce.lp. -""'~T>\ \
~, I ~~ 'Systems Development
I ---,'7, - Cha roe (!. 5")
~ I Plan Ck. COfMl!Ind
______l2.0.'1~'f';. 6S%/Bldo Per Fep
ct ,Plan Ck. Res
".Pl8 30%/Bl do Per Fee
_ _ _ _ _ _ _ -<<0.001 Fence
I ~~ O~mo
ql'Y).OO
I
I
_______.65.<<1 Sidewalk .
/, t/{) I A/C Paving
~------~~i Curb Cut
Irotal Comb. Permit
:115. c;<$!
#//~S.8'8
TOTAL
;
I PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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COMBINATION APPLICATION/PERMIT (CAP)
I.
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---........ HI\I Tr'\n.Trf'\M
CITY OF SPRINGfiELD
City Hall
Springfield. Oregan '
Department of Public Works
OFFICIAL RECEIPT
No. B
I
(
\
I'
)
II.
Applicant.to furnish'
A. Job Address
B. legal Description ,
1. example. Tax Lot 100, Lane County Map Refere (
11 03 43
2. examole- lot 1. Block 3, 2nd Addition to
Sprlngtield"Estates
C. . Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceiling/or forced
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
1. examole- 1250 sq. foot house, 500 sq. foot
2.' examole. if new project. check-new - if add
check add, etc.
F. Building permit information:
1. example - construct single family house wit ('1
attached garage '
2. exa~ole - remodel existing garage into fami
3. examole - convert single family residence i (..
restaurant (change of use) .
G. Value of work as defined in Section 303 (a) of
Structural Specialty Code
H. DES I Gii TEAI'I AllD CONTRACTORS (
To avoid design or construction delays, Buildil \.
Division Staff must be able to contact appropr
persons regarding design information or job si
corrections, etc.
Abbreviated Plumbing, ~1echanical, & Electrical Sch \lp'
A. Except where blank spaces occur in the descrip
portion of the Mechanical and Electrical Scher
the applicant need fill-in only the No. Boxes (."'
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Sch€
are available at the Building Division
1. To conserve space on the permit form the ~ C.",
have been abbreviated
2. If the item(s) to be installed are not co'
the abbreviated schedules you should cons
full schedules
C. BUIlOliiG DIVISION STAFF WIll FILL OUT ALL FEE
CHARGES 0:1 THE SCHEDULES
D. As noted on the CAP, the label must be delive
electrical contractor for signature by his el (r',"
supervisor. The general contractor is not aL
to sign the electrical label. -
Applicant to sign and date
Whenever possible. the initial application will t
a worksheet only. Where possible, Building Divi~ (~
will prepare a type written copy and return it tc
applicant at the time the actual permit is issued-I'ur rll.,..
signature.
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.
(
(
54163~
Date
'7- :?',-,
19 C"C
C Rec'd From ~~'('IVV ~--I-n 11(' k
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Address 2qZ~'::; \'" .;."
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Received For: :;:Z, , i' / 1"1" ~ __ ,j) .' / .
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IV.
V. FOR OFFICE USE ONLY
Permi t Cl erk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
&loa PSI' o.OIJCeE-TE.
..-:8 DA\'S,
PLANS REVIEWED BY:
name
SignatureJfG..wt ~Ld..
date Gr50-lrO
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