The URL can be used to link to this page

Home My WebLink AboutPermit Plumbing 1981-04-20INSPECT ION TINE 72G37r,9 CIIY OF SPRINGTTETD COI,IEINAtION APPTICATION I PERf,III INFOR[4AIION IINE 72G3753 Job Legol Description owner 7r{\ {34-,nnm PhoneAddre:s rmil lnfo: Oescribe Work (i.e., Build Single -Add-Alter-Rep. Euilding Fomi Use ENERGY SOURCES: Heot Woler Heqter Rq Volue of Ftg. Moin Sq. Ftg. 5q. Frg. Wirh Attoched Conttru --[lJl )ct\.lN4\!Io r ) Add re ss Phone fa -) 5 (nome)(oddress)(lics. no.)(expi re s)(phone no.)DESIGN TEAM Primor Stru€tu ,t{echonicol CONTRACIORS (nome)(oddress)(lics. no.)(expire s)(phone no.) Plumbing Electricol Mechonicol PLUMBING ETECTRICAT MECHANICAL Np. i FEE I.-CHARGE NO.FEE CHARGE NO FEE CHARGE Eoch fixture )Residence of -sq. ft. furnoce/burner to Relocored building (new {ix. oddilionol) New circuits, sllerolions or extensions Applionce vent seporore 5.f. Residence (I both)SERVICES Stoiionory evop. cooler Duolex (l both) eoch Temporory Conslruclion Vent fon wifh sing le duct Additionol both Amps. Vent system oporf from heotinq or A.C. Woler:ervice Mechonicol exhousl hood ond duct Sewer Wood siove/ heoler Slorm Sewer FEEDERS Heot Pump Ampr. .Air hondler b r0,000 cFM Air hondler over r0,000 crM ISSUANCE OF PERMIT TOTAL CHARGES @ TOTAT CHARGES WHERE STAIE tAW REQUIRES thot ihe Electricol work be done by the Eletlrical ConltcGto?, the electricol portion of this permit choll not ba volid until o lobel hor bean rignad by cn Electricol Contro<lor qnd ottached to the electricol ponel. TOTA,t CHARGES I HAVE CAREFULLY EXAMINED the completed opplicotion for permit, ond do hereby cerlify thot oll informotion hereon is true ond correct, ond I further <ertify thot ony ond oll work performed sholl be done in occordonce with the OrCinonces of the pertoining to lhe work described herin. ond rhot NO OCCUPANCY will be mqde of ony siructure certafy thot my regirtrotion with the Bvilder's Boord is in full {ore qnd eFfect os required by ORS heron, ond thot only subcontroctors ond employees who ore in complione with ORS 70t.055 SIGNATURE DATE Bosis for Builder's Boord exemptionr NAr\{E (pleose pri of Springfield ond the permission lhe Lows of the Slote of Oregon of the Building Division. I further lhe bosis for exemption is' noted FOR OFFICE USE ONTY Zone -Type/Conrt.-Units -5q. Ftg. fiain FloodPlginqtorier-occyGroup-Sq.Ftg.other-x-Vo|ue IOTAT VATUATION Sq, Ffg. Access x Volue x VolueFire Zone-Eedrooms occy Lood Syslems Development Chqrqe t I .5?'.) BUITDING PERMIT Chorges ond Surchorges Plqn Ck. Comm/lnd BI Per Fee Per Fee659'," Plon Ck- Rer Totol Comb. Permit PTUIABING PERMIT Chorges ond Surchorges Fe Demo Chorge: ond Surchorger PERMII c Sidewolk MECHANICAT PERMIT Chorger ond Surchorge r Curb Cul TOTAI.80 z -BTU'S /-*'4 c{,1' ) c,\) I COMBINATION APPLICI l. Applicoru. to furnish A. Job Address B. Legol Description I. exomple-lox lot I00, Lone County 2. exomple-Lot l. Block 3, 2nd Additi, C. Nome, etc. of owner onci construclion D. Energy Sources I. exomple-heot;electricol ceilinqz'or t. exomote-woter heoter eleciricol , o N,'PEI i (CAP)PERMIT VATIDATION Mop Reference i7 03 43 on to Springfield Estotes lender forced oir gos.@- E. Squore footoge or voluotion, etc.I. exomple-lJ$ rs.foot house, 500 sq. fooi goroge2. exEmElE-iT-niw proiecr, checkiEi-ii oddition, Jheckodd, etc. F. Building permif informotion: I. exomple-construct single fomily house with on ottoched goroge 2. exomple-remodel existing gdtoge into fomily room3. @-convert single fomily residence into restouront (chonge of use) G. Volue of work os defined in Secrion 303 (o) of the Structurol Speciolry Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction deloys, Building DivisionStoff must be oble to contqcl oppropriote pu.ron, regor.dingdesiEn informotion or iob site corrections, etc. ll. Abbrevioted Plumbino, Mechonicol & Electricol Scheduies A. Except where blonk spoces occur in ?he description oortionof the Mechonicol ond Eiectrical Schedules, the oppiicont need fill-in only the No" Boxes odiocent lo the oppropriole item(s) to be instolled' B. Full Plumbinq, Mechoniioi, ond Elecfricol Scheciules ore ovoiloble or the Building Divisionl. To conserve spoce on the pe!.mit form the schedules : hove been cbbrevioted 2. lf the irem(s) to be instolled ore not covered on the obbrevi-. oted scheduies you should consult the fuil schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES lll. Appliconf to sign ond dote Whenever possible, rhe initiol opplicotion will be used qs oworksheet only. Where possible, Building Division Sroff willprepore o iypewritten copy oncj return it to the opplicont otthe time the ocruol permit is issued for his signotuie. lV. Fees ond Chorges Plon check fees qre due ond poyoble of the time of the cppricotion,ond no plons will be processed until these fees ore poid. ailother fees ond chorges ore due onci poyoble *hen ihe permit is issued. V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additionol Proiect lnformorion: signoturetnome dote PLANS REVIEWED BY NONTED INSPECIION tINE 726-.3769 CITY OF SPRINGFIETD COIIBTNATION APPTICATTON / PERfiIII INFORMAIION lINE 726-a753 ERGY SOU'gff''Sq. Ftg. Moin 820 Sunset DriveJob Address Heqt Sq. Ftg. Access @HoOO)(rr Woter Heoter Sq. Flg. -New ReP. Yolue of Work: -Fence-Demo-Chonge/ Use 6 ,000. 00 Other Owner Ed Bennett 820 Sunset Drive ing Permit Info: Describe Work (i.e., Build Single Address Phone Fom Lender Remodel Residence Address Phone DESIGN TEAM (nome)(odd (lics. no.)s)(phone Prim Richard Schmitt BB7 Sunset Drive S ftd 25388 Structurol Electrico I nicol RACTORS Generol Richard Schmitt 887 Sunset Drive Snf] d 2E?AA 726-6898 Plumbing No ne Erecrricot SUn I Of d Mechonicol NOne PTUMBING ETECTRICAT MECHANICAT NO.FEE CHARGE NO.FEE CHARGE NO.FEE CHARGE Eoch sinqle fixture Residence of fr. furnoce/burner to -BTU'S Relocoted building (new fix. oddilionol) New circuits, olterqtions or extensions Applionce vent seporo te S.F. Residence (l both)SERVtCES Stolionory evop coo ler Duplex (l both) eoch Temporory Conslruclion Vent fon with single duct Additionql both Amps. Vent syslem oport from heoting or A.C, Woter service Mechonicql exhoust hood ond duct Sewer Wood slove/ heoter Slorm Sewer FEEDERS Heot Pump Ampr, Air hqndler to r0,000 cFM Air hondler over r0,000 cFM ISSUANCE OF PERMIT TOTAT CHARGES TOTAT CHAROES TOTAT CHARGES WHERE STATE fAW REQUIRES lhot lhe Electticol lqbel hos been signed by on Eleclricol Controclor work be done by lhe Electricot Controctor, the elcctticol portion of this permit sholl not bs volid until q qnd qfioched to the eleclricol ponel. HA,VE CARETUTT'Y EXAMINED the completed oll work performed sholl opplicotion for permit,ond do hereby certify lho t oll informotion hereon I irue ond co rrecl,ond further cerlify thot ond be done ln o ccordo nce with rh e Ordi nonce s of the City of Spri ngf ield nd lhe Lqws of the Stat€of OregonnY OCCUPANICY I be de of structure without the permi ssron of the Bui ldins Division.furtherpertoininglotheworkdescribedherin,o nd thqt NO mo ony certlfy lho t regislrolion with the Bui lder's Boord ts tn f ull force ond effect o s required by oRs 701 .055,tho t rf exempl the bo srs for exemption ts notedmy ond employees who tn complio ne irh oRs 701 will used on thisheron,ond thot only subcontroctors ore Bosis {or Builder's Boord exemplion: NA,ME (pleose print)SIGNATURE DATE FOR OTFICE USE ONIY Zone Const,V Ftg. lv{oin x Fire Zone-Bedrooms lood --Sq.Grorp R-3 50. Ftg, Access x -Vqlue Flood Ploin Ftg. Other-x -Volue TOTAT VATUATION BUITDING PERMIT 36. 00--1.4T--Chorges ond Surchorges Plon Ck. Comm/lnd 65%/Blds Per Fee Systems Development Chorqe (1.5olo) Plqn Ck. Res 3ool./Blds Per Fee 10.80 PD 2-2-8 PTUMBING PERMIT Chorges ond Surcho rges Fe nce REC #55721 Demo Totol Comb. Permit 53. 04 ETECTRICAT PERMIT 15.00--:6tr--Chorges ond Surchorges Sidewolk A/C Povinq MECHANICAT PERMIT Chorges ond Surchorges Curb Cut TOTAT 53.04 726-6AqA (nomel (oddress)(lics. no.)(expires)(phone no.) .,]t a coMBtNAT|ON APPLTCATION/PE[*r (CAP) ,Applicont to furnish A. Job Address B. Legol Description PERMIT VATIDATION 55830 c. D. I. exomple-lox lot'l 00, Lone County Mop Reference I7 03 43 2. exomple-Lot I. Block 3,2nd Addition to Springfield Estotes Nome, etc. of owner ond construction lender Energy SourcesI. exomple-heot/electricol ceiling/ 2. exo mFl e -wo te r1r-eo GTdl-ecl ri co I L-t8'8 I 'or forced oir gos'or solor E. Squore footoge or voluolion, etc.l. exomple-l 250 sq. fool house, 500 sq. foot goroge 2. exEmFlE-iT new proiect, check-new-if oddition, check odd, etc. F. Building permil informotion:L exomple-conslrucl single fomily house with on ottoched goroge 2. exomple-remodel existing goroge into fomily room 3. exompG-convert single fomily residence into restouront (chonge of use) G. Volue of work os defined in Section 303 (o) of the Structurol Speciolty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction deloys, Building Division Stoff must be oble lo contoct oppropriote persons regording design informotion or iob site corrections, etc. ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedules A. Except where blonk spoces occur in the description porlion of the Mechonicol ond Electricol Schedules, the opplicont need fill-in only the No. Boxes odiocent to the oppropriote item(s) to be instolled B. Full Plumbing, Mechonicol, ond Electricol Schedules ore ovoiloble ot the Building Division 'I . To conserve spoce on the permit form the schedules hove been obbrevioted 2. lf rhe item(s) to be instolled ore nol covered on the obbrevi- oted sohedules you should consull rhe full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CH,ARGES ON THE SCHEDULES lll. Applicont to sign ond dote Whenever possible, the initiol opplicotion will be used os o worksheet only. Where possible, Building Division Sroff will prepore o typewritten copy ond return it to the opplicont ot the time the octuql permit is issued for his signoture. lV. Fees ond Chorges Plon check fees ore due ond poyoble ot the time of the opplicotion, ond no plons will be processed until these fees ore poid. All other fees ond chorges ore due ond poyoble when lhe permit is issued. V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additionol Proiect lnformotion: nome signoture I PTANS REVIEWED BY INSPEC'.ION IINE 7?(.37r'9 CIIY OT SPRINGfIETD COI,tsINATION APPTICATION / PERIIIT IN'ORAAAIION [INE 72&i753 Owncr 7.{4. $onnn--r, Addre:r Phona . -Add -Alrer-Rop.Uro Bui SingleI lnfo: Dcrcribe WorL (i.e., Bui ENERGY SOURCES: Heot Wohr Heote. Ro Volue of trg. lloin 5q. Ftg. Sq. Flg. cohttrucrion ,.n)", U --n!0l Addre rr Phona (nome)(oddresr)(lics. no.)(expi re s)(phone no.)DESIGN TEAM Primory <ql l,{echonicol CONTRACTORS (nome)(oddrer)(lics. no.)(expires)(phone no.) Grneral ( - Plumbing Ele ctricol Mechonicol P!UA^BING ELECTRICAI.MECHANICAT r.ro. i FEE -CHARGE NO.I FEE CHARGE No. I FEE i CHARGE Eoth ri fixturt )Re:idencc of -rq. ft. furnoce/burner to --8TU'I Relocored building (aew {ix. odditionol) New circuiis. oltcrotionr or exlensionr Applionce vent seporare s.f (r Reridcn<r both)SERVICES Stotionory evop. ooler Ouoler (l both) eoch Temporory Con3lruciion Vent fqn with sing le duct Additionol both Ampr. Vent sytrom oport f.om heorinq or A.C. Woler rcrvica Mechonicol exhoust hood ond duct Scwcr Wood stove/ heoter Slorm Scwer FEEDERS Heot Pump Ampr. Air hqndlcr to 10,000 cfM Air honciler over 10,000 crM ISSUANCE OF PER}AIT IOTAT CH^RGES @ TOTAT CHARGES WHERE SIAIE fAW REOUIRES thsl th. Elcctricol work ba donr by tho Ehctricsl Cott?oclo?, rhc rlcctrical ponion of thi! pcrmi, sholl not bc volid unrit olobrl ho: brn rigard by on Elcctricol Controctor ond ottachcd to lhe clectricol pancl. TOTAT CHARGES I HAVE CAREFULLY EXAMINED lhe completad opplicotion for pcrmit, ond do hereby certify thot oll informotion hcreon is trua ond correct, ond I furthercettify thot ony ond oll work performed rholl bc donc in ocordonce with the OrCinones of the City of hcron, ond lhol only subcontrostorr ond cmployccr who qrc in rcmpliona wiih ORS 701.055 SIGNATURE DATE 4/ Pertoining lo the work dercribcd hcrin, qnd erllfy thor my r"gitnotion with rhc Euilder/: ,hor NO OCCUPANCY will be mode of ony riructurc Boord is in full Iore ond qffcct os reqsircd by ORS Eocis for Euildcr/s Boord cxtmption: NA.[4E (pleosc prinr) tha boris for cxamption ir'notcd SprinEfield ond the Lowr of ihe Stote of Oregon the permisrion of the Building Division. I furlher FOR OIFICE UsE ONIY nilr -Sq. Ftg. I{oin x ----------Voluc Fire Zon:-Ecdrooms occy Lood 5q, Ftg. Acccss floodPlointo'i..occyGroup-Sq.Ftg.othcr-x-Voluc TOTAT VATUATION, x Zonr -frpr/Co.rr. Sysrems Developmcnt Chorqe ( I .5?'o) BUITDING PERMIT Plon Ck. Comm/lnd Fce Plon Ck. Rar 3O"Ll Chorger ond 5 urchorge r Tolol Comb. Pcrmit PLUIAEING PERMIT Chorgcr ond Surchorgcr Dcmo PERMII SidawolkChorger ond Surchorger MECHANICAI PERMIT Chorger ond Surchorgar Curb Cut IOIAT 8'O LcAol Dercription z 5c d d{ ) c-\) Fance - K1) alC Padaa .A,dditionol Proiect lnformotion: signoture dote anome PLANS REVIEWED BY: coMBtNATtON AppLlq_.,,loN/. |_MtT (cAp) l. Appliconr. to {urnish A. Job Address B. Legol DescriplionI. exomple-lox lot 100, Lone County Mop Reference I7 03 432. e-ir-iG'Lor l- Block 3, 2nd Addition to springfierd EsroresC. Nome, etc. of owner ond construction lender D.. Energy Sources ,t PERMIT VATIDATION CITY OF SPRINGFIELD City Holl Sprlngtield, OrcAon Deporlment of public Works OFFICIAT RECEIPT I. 2. E- sq exomple-heot"electricol ceilin 91'exorn e-woter heoier.elEctri-ricot uore footoge or voluoti on, etc. or forced oir oos ., or solor l. exomole-.I 250 sq. foot house, 500 sq. foor gorogez. exo.mote-rt new proiecf, check new-if oddition, checkodd, etc. F. Building permif informotion:l. exomple-construcr single fomily house with on ottochedgoroge 2. exompl_e-r.-ddel existing goi.oge into fomily room3. d;;;G-converr s;ngle fomily residence into rTfroGEnt (chonge of use) G. Volue of work os deiined in Section 303 (o) of the tStru*urol Speciolry Code \ H. DESIGN TE.Alvt AND CONTRACTORS To ovoid design or conslruciion deloys, Building DivisionStoff must be"obte ro conroct oppropriorl-p"rr.l, ..r"rjr" ( design informction or iob site corrections, etc. ll- Abbrevioted Plumbino, Mechonicor & Erectricor schedules ,{. Except where blonk spcces occur in the description oortionof the Mechonicol ond Electricol Schedules, the oppiicont need fill-in only ihe No. Boxes od[ocent ro the oppropriote item(s) to be instollecj 8. Full Plurnbing, Mechonicoi, ond Electricol Schecjules ore ovoiloble or the Buiicjing Divisionl. To conserve spcce on fhe permit form the schedules hove been cbbrevioted 2. lf the item(s) to be instolled ore nor covered on the obb. ored scheduies you should consult rhe fuil schedules C. 3UILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES lll. Applicont to sign ond dole Whenever possible, the initiol opplicotion will be used os oworksheet oniy. Where possible, Builciing Division Stoff will prepore o typewritten copy oncj return it to the opplicont otthe rime the octuol permit is issued for his signolure. lV. Fees cnd Chorges Plon check fees ore due ond poyoble ot the time of the opplicond no plons will be processed until these fees ore poid. ell other fees ond chorges ore cjue onci poyoble when rhe permitrt_ is irsued. V. FOR OFFICE USE ONLY IIo. B 563 l9 d Received For ( BY ( ( ( Amount R ecer AUTHORIZEi 3HaLtOX.TUiiauLL PitxYEt3 O SIGNATURE . EUCa{E Oi graor Permit Clerk PROJECT CONDTTIONS TO BE SATISFIED BEFORE OCCUPANCY: I itffiH#rf, ffi ,rtrfi6=ffiEIiffi "icIiFiED JtB+&i;t -a CITY OF SPRINGFIETD cot BtNArloN aprrtclrtox/prrmtr INFORMATION TINE 72(-3753INSPECIION t.INE 776.3769 820 Sunset DriveJob '8ff'' Ro ENERGY SOU Heo t Wqter Heoler - legol Description -Fence-Demo-Chonge/ U:e - Other ,--- sq. Ftg. Moin Sq. Flg. Accers. -Rep. Sq. Frg. -New.Volue of Work: 6 ,000. 00owner Ed Bennett Describe Work (i.e., Build Singleing Permit lnfo: Fomi GoroPhoneAddress 820 Sunset Remodel Residence @ lJOOgr(rl Addre ss (phone no.)(lics. no.)DESIGN TEAM (nome)(oddress) Richard Schm'itt 887 Sunset Drive S ftd Structurq I l'{echo no 72Richard Schmitt I None Eteciricqt Sunl ord Mechonicol NOng MECHANICATETECTRICATPTUMBING FEE CHARGENO.CHARGE NO.TEEN furnoce/burner loResidence of fr.Eoch ri fixture Applionce ventNew circuits, olterotions or extensions Relocoted building {ix. Stotionory evop. coo lerSERVTCES S.F, Residence I bolh) Vent fon with st ductConstructionTboeo ch Vent syslem oport from or A.C.Additionol both Mechonicol exhousl ond ductWoler service fSewer HeotFEEDERSStorm Sewer Air hondler to Air hondler over CF/t ISSUANCE OT PERMIT TOTAT CHARGESTOTAT CHARGESTOTAL CHARGES WHERE STAIE tAw REQUIRES rhot tha Electticol label hos bcen signed by on Electricol Controctor work be donc by the Elecricol Conlroctor, tha electricol portion of this permit shqll not be volid until o ond ottochcd to tho electricol Ponel. DATESIGNATURE s lrue ond correct, ond I further the Lows of the Stote of Oregon of lhe Building Divirion. I further the bosis for exemption is noted rtY EXAMINED the completed oll work performed sholl ollthot nformo ntio nhereodoondhcotion,ti {or ereby certifyCAREFUVEpermit,HA'OPP ondrhwithOrdinonceslheofoflndoneocordonceCitySpringfieldbeondthotonycertifylhethout35rOnbedeoofsiructurepermilhoNOOCCUPANCYnynddescribedworkherin,thetongpertoini 701oRs thol ifouired.055,exemptondfo rce effeclthewithBooBuilder's t3rd f ull reqtnthotstrolionregrcertlfymy ll onused rhistoneirh701ORSgrewhotntrosubco n oclors comPndndoemployeesthothero n,on ly Bosis for Builder's Boord exemplion: NAME (pleose print) FOR OFTICE USE ONIY 1-Volue x -Volue TOTAT VATUATION xFtg. MoinZoneType/ Consl, Ftg. Access Group LoodFire Zone-Bedrooms Flood Ploin Sq. Flg. Other-.-- Systems DevelopmentPlsn Ck. Comm/lnd Fee 10.80 PD 2-?-8Fee Plon Ck. Re: 36. 00--1:4q--- BUITDING PERMIT Chorger ond Surchorges C 1 53. 04Totql CombDemo PI.UMBING PERMIT Chorges ond Surchorges Sidewqlk15.00---:50--- ELECTRICAL PERMIT Chorges ond S u rcho rge s Curb Cui 53. 04 MECHANICAT PERMIT Chorges ond Surchorger TOTAT Phone F lartrico I FEE CHARGE seporo te A-Pt' IO.OOO CFMAmoc. (t 50/^\ A/C Povino Tffi J, coMBrN{TloN APPUCATTON/PERMTT (CAP) l. Applicont to furnish A. Job Address { B. Legol DescriptionI. exomple-tox lot I00, Lone County Mop Reference-l 2. exomFl;-Lot l. Block 3, 2nd Addition to Springfield t {eC. Nome, etc. of owner ond construction lender D. Energy Sources I. exomple-heot,/electricol ceiling,/or 2. ex oi;ElE-wo te r Te o t"-rTEIEiTr i--co I /r forced oir gos or solor E. Squore footoge or voluotion, etc. I. exomple-1250 sq. foot house, 500 sq. foot goroge 2. eEmilE-iT new prolect, check-new-if oddition, checl odd, etc. F. Building permit informolion: l. exomple-conslrucl single fomily house with on olto( goroge 2. exomple-remodel existing goroge inlo fomily room 3. exompfe-converl single fomily residence inlo 6iEi76'nt (chonge of use) G. Volue of work os defined in Section 303 (o) of the Structurol Speciolty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or conslruction deloys, Building Divisir Stoff must be oble to contocl oppropriote Persons regc design informotion or iob site corrections, elc. ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedules A,. Except where blonk spoces occur in the description por of the Mechonicol ond Electricol Schedules, the opplic< need fill-in only the No. Boxes odiocent to the oppropr item(s) to be instolled B. Full Plumbing, Mechonicol, ond Electricol Schedules ore ovoiloble ot the Building Division l. To conserve spoce on the permit form the schedule: hove been obbrevioted 2. lf lhe item(s) to be instolled ore not covered on the oted schedules you should consult the full schedule C. BUILDING DIVISION STAFF WILL FILL OUT ALt FEES A} CHARGES ON THE SCHEDULES lll. Applicont to sign ond dote Whenever possible, the initiol opplicotion will be used os worksheel only. Where possible, Building Division Stoff Y prepore o typewritten coPy ond relurn it to the oppliconl, the time the octuol permit is issued for his signolure. PERMIT VALIDATION OF SPRINGFIETDC ITY Ciry Hol! Springfield, Oregon Deporlmenl of public Works OFFICIAL RECEIPT ,n B 55850 ( Do Rec'd d ( ( ived For: { 4 ,1 { (l il , 16',tAmount Received (. 8Y (tllD SIGNAfURE . EUGEX€ OR 97aot { Permit Clerk (t lV. Fees ond Chorges Plon check fees ore due ond poyoble ot lhe time of the opplicotion, ond no plons will be processed until these.fees ore poid. All other fees ond chorges ore due ond poyoble when the permit is issued. V. FOR OFFICE USE ONLY PROJECT CONDITTONS IO BE SATISFIED BEFORE OCCUPANCY: Additionol Proiect lnformolion: PTANS REVIEWED BY: TOI'I SHEI RBON 2-4-81 signoturenome dote t, I I t ,l I