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HomeMy WebLinkAboutPermit Building 1980-05-20/a.7'*r:l .- *, - -._-i ! .'J ..a_ r.-r;.... Lvu COI1BI iIAii ON APPLICATION/PERMIT TI II I IiS PECT I 7?5-37 69 E 726-3753 l/)I I Job Address f-ega1 Description / Ranqe EIIERGY.SOURCES: \Heat 1>,"1 -lp !r.rc r.gl-itut.@ -ft- //gaD Sq. Ftq. Access -Fence DetTto C -0ther- r_Pep Sq. Ftg. Other l{er^r Add Al hange/ U se Ftq . l.'la i Va I ue of liork :'L,)c, )?,f, o2\l itt'Mer-LnnFMctr 1?. lnlt e., Build Sing)eBujll.inq Pernrit Info: Describe l'lork('-FaniIy llesidence ili th Attqched Garaqe "rtv 7\ Er) i?ahl - iln\f/ADi:iTTt'(4r7{a aL*i Construction Lender rn J C r1.J CC Addres s Phone ohone no.lics. no.exo i res )addressnameDIS IGN TEAI.I Primary ('5 Vi watN Structura I El ectri ca I i-aec ha n i ca I ohone no-lics. no. ) (exoiresaddress )name Genera i C) Vrl r,t ,, i "/ Pl umbi nq El ectri ca l l'lec ha n i ca I MECHAN I CALELE CTR I CALPLUHB I NG FFF NHA RGFFFFCHARG F NOFEECHARGENO furnace/burner to BTU' S Residence of FTSQEach single fixture New circuits alts. or extensions-\.Ur: ,a:r 7,1t 'v .$,,.f,::. Floor furnace and vent Rel ocated bui 1 ding (new fix. additional ) Recessed wal l Soace heater and ventSERV I CESS . F. Res i dence(l bath) Duplex (l bath) each Apo'l 'iance ,rent seoa ra teTemporary Constructi onlo.an "'a:,r'Addi tional bath npq i dpncc Chan_oe in existing Stati onary evap cool erl/ater servi ce !.r,C{:,J Vent fan with sinole ductIndustrial multifamily, comrn. orSewer Vent system apart from heatino or A.C.0fStorm Sewer iilechanica l exhaust hood and duct-col,lr'r./tND. FEEDERS tr'Jood stove/heaterInstal l /al ter/rel ocatedistrib. feeders 0f s. ISSUAIICE OF PFRIIIT /E,CA TOTAL CHARGES / L,, ooTOTAL CHARGESTOTAL CHARGES l,lHERE STATE L1l'J REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be valij unt.il the label has been signed by an Electrical Supervisor and returned to the Building Division apnlication for oermit, and do hereb.y certify that all information hereon is true and all work oerformed shall be done in accordance r+ith the Ordinances of the City 0regon oertaining to the work described herein, and that i,l0 0CCUPA|ICY lvill be made of any structure without the permission of the Building D'ivision. I further cert'ify that my registration vrith the Builder's Board is in full force'and effect as required by ORS 701.055, that if exemot the basis for exemption is noted hereon, and that only subcontractors and ernoloyees who are in comcliance with OPS 701.055 r.rill be used on this nroiect. l,lAl,lE(please pri nt)DATE i HAVE CAREFULLY EXAI1INED the completed and correct, and I further certify that anyof Soringfield and the Laws of the State of 1,fi S IGiIATURE Ftg Ftg Ftg TOTAL VALUATIOtI .?#, *r-=.'P f'1 x Occ.y Gro ,p ,-i:-.9 sq , itS,/.-Y value rle/Const. -:i*; t' Un i tsZone ,2*i Load Sq l'la i n Fire Zone lff Bedrooms Flood PIain ,'.2'r-; Stories Val ue Val ue Acce s s 0ther Svstems Deve charqe ( t.5z o pment 65il/Bldo Per Fee Plan Ck. Comm/IndBUILDING PERi'lIT Charges and Surc ha rges !r*'. Plan Ck. Res 30%/81dq Per Fee 5--L-aii5a.. oo Fen ce VtC d\T:4-\--t>I rLr!)raPLUI4BING PERMIT Charges and Su rc ha rges Dgrno S idewaI k Tota'1 Con:b. Permi t ELECTRICP,L PERIlIT Charges and S urc ha rges - -jS,og- ! !/{'s,3aA/C Paving Curb CutIlECHANICAL PERMIT Charoa s :nd lr-,gg- , b<l T'l-i;'' L F/ /r€,s, 1 Address j q k /v /,* sor./; 'no"')?d-cyJ @,*. (i r.'i. ..j z_ COI'IBINATiON APPLI CATION/PERMiT ( CAP) I. Applicant to furnishA. Job AddressB. Legal Description 1. example- Tax Lot 10C, Lane County itiap Referenc I7-I3-T3?. example- Lot 1. Block 3, 2nd Addition to 5[rr- ngTi e) d EstatesC. Name, etc. of owner and construction lenderD. Energy Sources1. example- heat/electrical ceilinq/or forced air2, exancle- waterheater/e'lectrical/or sojar-E, Square footage or valuation, etc.l. examole- 1250 sq. foot house, 500 sq. foot ga'2. efiffile- if new project, ctreik new - if addit ilec k--add , etc .F. Bui)ding permit information:1. example - construct single family house with attached garage 2. examole - remodel existing garage into famill3. exaffiTe - convert single iaiily-residence inr restauiant (change of use)G. Value of work as defined in Section 303 (a) of tl Structural Speciaity Code H . DES I GN TEAI.I AN D CONTRACTORS To avoid design or construction delays, Building 0ivision Staff must be able to contact appropria persons regarding design information or job site corrections, etc.II. Abbreviated Plumbing, Mechanical, & Electrical ScherA. Except r.rhere blank spaces occur in the descript'portion of the l''lechanical and Electrical Schedu the applicant need fill-in only the i,lo. Boxes a,to the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Sched are available at the Building Divislon1. To conserve space on the permit form the sc have been abbreviated2. If the item(s) to be installed are not cov€ the abbreviated schedules you should consu' ful I schedul esC. BUILDiI{G DIYISION STAFF I^JILL FILL OUT ALL FEES CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be deliverelectrical contractor for signature by his ele supervisor. The general contractor is not autto sign the electrical label.III. Applicant to sign and date Hhenever possible, the injtial application wil1 br a worksheet on1y. [,Jhere possible, Building Divis'will prepare a type written copy and return it to applicant at the time the actuai permit is issued r signature.IV. Fees and Charges Plan check fees are due and payable at the time of the appiication, and no plans r./i l1 be processed until these fees are paid. All other fees and charges are due and payable vrhen the permit is issued. V. FOR OFFICE USE ONLY - PLANS REVIEWED BY: PERMIT VALIDATION CITY OF SPRINGFIEID Ciry Holl _ Springfield, OregonDeportment of publiJ Wo.ksOFFICIAT RECEIP; No. B 13160 ( tl_ F t f For .? oc , Acs BY ( { 6'-d (^ ( (,(.i 00+ ( I/{c'7 7 +?r. 'ba Amount q . "..t".. r, " - "1.: l::.::'.: : 0 olr-rn/<_I I I 3t) SIGNATURE ( EUGENE oP graor 5A5rr.8 or Permit Clerk si gna tu re n da te .f-.?c- i/t PROJECT CONDITiONS TO BE SATISFIED BEFORE OCCUPAI.ICY: Perm'it appljcant exempt from registration with the Builder's Board because: Additional Project Information: name ( <- n- I 7<-,bLl 7 4t-/^ XJ- --