HomeMy WebLinkAboutPermit Building 1980-07-23I IIS
726
P liL
COIlB I ON LICATI ERIi,! I T 726-37
Job Address3533 Viroinia Street
Lesal Description 7 7_D,? __ni -U ,?
EIIERGY SOURCES
Hea t
l.later Heater
RanaeTav /-o / StoDD
0wner Bob fvtillus IJ/,t
Val ue of
Ftq. l.iain--
Sq. Ftg. Access._
Sq. Ftq. 0ther__
-llew]ddrAl
ter-PeP.
Fence Demo Chanqe/Usefotter- - -
BuiIeinq Perntit Info: Describe llork(Fanilv Residence Ilith Attached Garaoe
.e., Build SingleAddreiss 3533 Virginia Street Phofld+7 040?-
Yfl n ) nn,O i t Lc-Jut t flrilL\ t
Construction Lender U
iso
&J
o
t,
Addres s Phone
ICS- nO-I]ES I GN TEAT.I name addre s s (exoi res phone no
primary tt]m. Draqt filasonry Ltd. , 1833 ur. 27th pl. Euo.9P,12 AA\ AN'C,
Structura I
E'l ec tri ca I
l''lec ha n i ca l
natTte address (lics. no- )pxni rps )(nhonp nn
General l.tJm. Dragt ndasonry Ltd. , 1833 ru. 2Zth p1. f uo.9,312 m 6P,a Gn)G
Plumbinq
E l ectri ca I
l'lechani cal
PLUIlB I NG ELECTR I CAL MECHAN I CAL
NO FEE CHARGE FFF CHARGF NO FFF THAAGF
Each single fixture Residence of
FTsQ
furnace/burner to
BTLI' s
Relocated building
(new f i x. add i ti ona.l )
New c.i rcui ts al ts
or extens i ons
Floor furnace
and vent
5 . F. Res i dence
( l bath)SERV I CES
Recessed wal I
SDace heater and vpnt
Duplex (1 Uatfr) eacfr
Temporary Constructi on Apol iance vent
sFDarateAdditional bath
rps i dpnrc
Change in existin-o Stationar3r evap.
cool erI,la ter se rv i ce
Tndrrctria I
multifamily, conm. orSewer Vent fan with
sinole duct
Storm Sewer 0f S.
Vent system apart from
heatino or A.C.
COMI'I./IND. FEEDERS
iilechani cal exhaust
hood and duct
Instal 1 /a l terlrel ocate
di stri h fcpdprs l'lood stove/heater
0f
ISSUANCF OF PFRIlIT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
UJHERE STATE Llll REQUIRES that the Electrical work be done by an Electrical Contractor, the electrica'l portion of this perr,rit
shall not be vali'J until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAI1INED the completed apnlication for oerm'it, and do hereb,y certify that all information hereon is true
and all work oerformed shall be done in accordance vrith the 0rdinances of the City
in full force and effect as required by ORS 70i.055, that if exemot the
subcontractors and ernployees who are in comcliance with ORS 701.055 viill
I'lAl.1E(please print) trjm. Draot SIGiTATURE DA'TE ,1,,1 v ?7 /ln
any
of
and correct, and I further certifv thatof Soringfield and the Laws of the State 0re oertaining to the work described herein, and that l,lC 0CCUPAI{CY will be made
ration vrith the Builder'sof any s
Board i s
tructure without the permission of the
gon
Bui l ding Division. I further certi that m.y
1S on is noted hereon, and that
only ect
FFI E 7
Val uex
ir:a:G^
0c
X ValZone P I Tvoe/Con
Value
TOTAL VALUATIO
Flood Plain - Stories Ftg. 0ther
Fire Zon LoadBedrooms !q. Ftg. Access :
st. F /a Units-l*r-0..,
c.Y Group - Sq
Plan Ck. Comm/ind
65"1/B1do Per Fee
tems Deve
rqe (1.5rSvs
cha
opmentBUILDING PERNIT
Charges and
Surcharges
r/: OOJ-\!r -=--- ---q O Plan Ck. Res
30%/81dq Per Fee
FencePLUI4BING PERMIT
Charges and
Su rc ha rges Dgmo
SidewalkELECTRICAL FERI1IT
Charges and
Surcha rges Total Comb. Permit lt),4!A/C Paving
Curb CutI,lECHANICAL PERI'IIT
Charges and
Su rc ha rges TOTAL fl12'7t/o
i t2,, /.
\U I (}R5
coMBINATI0N AppLI CATIoN/PERMiT (CAp)
B
Applicant to furnish
A. Job AddressB. Legal Description
1. glampiq- Tax Lot 100, Lane County Map Referqncot7 03 432. example- Lot 1. Block 3, 2nd Addition toSpringfield EstatesC. Name, etc. of owner and construct.ion lenderD. Energy Sources
l. exqlg!- heat/electrical ceilinq/or forced , oa2. examp'l e- waterireate.-r]elEEtricElTbr soTfi- *
E. SquaiEE6Gge or val uation,-eTc.l. examole- 1250 sq. foot house, 500 sq. foot r2. efimplE JT-new project, cneir-new - if add: dn.check add, etc. \
F. Building permit information:1. example - construct single family house wiil;tEcled garage
?. example - remodel ex.isting garage into famir "-3. examole - convert singie family-residence irrestaurant (change of use)G. Vaiue of work as defined .in Section 303 (a) of t (Structural Specialty CodeH. DESIGN TEAI4 AND CONTRACTORS
To avoid design or construction delays, BuildincDivision Staff must be able to contatt appropriipersons regarding design information or job sitecorrections, etc.
Abbreviated Plumbing, Mechanical, & Eiectrical SchecA. Except vrhere blank spaces occur in the descriptiportion of the Mechanical and Electrical Schedulthe applicant need fill-in only the No. Boxes adto the appropriate item(s)Fuil PIumbing, Mechanical,
PERMIT VALIDATION
CITY OF SPRINGFIETD
City Holl
Springfield, Oregon
Deportment of Public Works
OFFICIAT RECEIPT
No. B 541C3
Dole 7 -,?r te 't l;
Rec'd F
Address ,llt
(
I
(
(
eceived For
(
(qf fi'r'o7i';
II
III
IV
to be installed
and Electrical Schedu Fllrl c / c),a3
I
(
C"
-1
are available at the Building Divisioni. To conserve space on the-permit form the sch
have been abbreviated2. If the item(s) to be installed are not coverthe abbreviated schedules you should consultfull schedulesC. EUILDING DIVISION STAFF I^IILL FILL OUT ALL FEES A
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be deliveredelectrical contractor for signature by his electsupervisor. The general contractor ii not authoto sign the electrical labelApplicant to sign and date
Hhenever possibie, the initial application wil I be ua.worksheet only. Where possibie, Bui lding Divisionwill prepare a type written copy and returi it to th,applicant at the time the actual permit is issued fo.signature.
Fees and Charges
PIan check fees are due and payable at the time of tlapplication, and no plans rvill be processed until thrfees are paid. Al l other fees and charges are due ar.payable yrhen the permit is issued. - 1-
FOR OFFICE USE ONLY
Amounl Received 0 4-0 1N-c/<
,40
(
(
(
(r,
('
(
V
AUTHORIZEO SIGNATURE
3H€LTON.IUEiAULL PRIXlEFS
'UGENE
OR E7'OI
Permi t Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAIICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information :
PLANS REVIEWED BY:
name dateS1gnatu re
(.
(