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HomeMy WebLinkAboutPermit Building 1981-6-4 INSPECTION LINE 776-.3769 .. '-',... CITY OF SPRINGFiElD . ,COMBINAflON APPLlCAflON/pERMIT'~7..."~' -'",., --J-,.. ,,. I ~~:~lw~Ktan;~ . INFORMATION LINE 726-.3753 I~' ..--. 0- uJ' U1 Jill' Legal Description ~(~ S/'/~.:L 17~ ;fc; IVCF? ;2,~ .- /4- Sq,,1 dPrJ' /frlc rC c> fr., k'rf c' .~ I Water Heater RanQe _ I Value~Work: // "de? 110 Sq. Ftg. Main ~r7 Sq. Ftg. Accen. Sq. Ftg. Other _New _Add_Alter_Rep. __Fence_Demo_Changel Use _Other Job Addreu .E1l';~ . r:lbf/JV/T/a. YO) L I~d, Owner s. ec-l~e ~ /:!~ Add'e" ..;2 C, ,p, '5- 7[. ~ ()0fI' Phone .74tn- 04K~ Building Permit Info: Describe Work (i.e., Build Single Familv Residenc"" With Attached GaraCle! .(..((J(1 fr)'-()J{jJri mu '17.lkl Q~_ . NY) , DeLilrrml T 54b " . . -.... -- ~--- , Construction Lender OuJ",-,p~- Addre" Phone DESIGN TEAM (name) (address) (lies. no.) (expires) (phone no.) ...." I Primary , Structural I Electrical I Mechanical I CON.fk.".CTORS I Gen"al /:'!..e....0..u .Cr, r /C~- ilJJ/Ir!":~Qll..IJ<)'tA:",. ~.!fSi._ 3S--7SR I .. ;.:"'? <",.",c~ Pur,lrJHl:q ._._..' ___ /?D,6 (N r #. We.'/'ev 3/.5"3.7 &~~ -t/,I1<1.. :5 S.J S,f /;) ';;) '..f./ ,5</.?.;I. V?O (nome) (uJJrl::.l~s) (ljcs. no.) ,,,,"" .~{, /,;2-:;2;2-0'/ . :f'h-Z(/.;>fJ: " I I !:Iecr,ical --.-- I !.I,'..~hanicClI ~_~~:~~-=_,~~_~~~:~~,~-;~'==-:~-'~~~I~' ._"~~~. .___~ ._~l.~".~ICA:' ---.- - ~ ~~,'--~:r--~ J.!O. !i-..-- . il. fer: .1 CHARGE,' NO. Ret:dollCll (.of" . "".'O._-!-.I~-FEt- nlARG': NO. ." Eacn sinqle fbtlure sq: ft. ., . "'1 Relocaled building I ~ . N"v! circuits,.alieratit'ns . __ _. (ne"! fLw:. odditionol) _....._ _ _~ _ ~r eJlltens:ons ___ _ __ _. ~~t)() -.-.-,,:....-..-......- MECHANICAL f...I"f..J~e/bl,;rner to C.TU's '~'-:'-'--rErt ~ -2HAi;,..:!i_l . I /ll.o..o.. _ ;'.:nps. I Applianco vent Kp....ate S'"tirJnarj-' eyap. cool~r 1-/-- -Vent fan with 1ingle duc; I . Vent Sy. stem aporl frf.m heatinq or A.C. A'.e::har.ical exhaust i hc.ood o~ld duC"i" ,/ J SII'O','er 1/f1.~~' -- I I I I -1__- __, Wood slove/heoter I ----13.0;; I I I ,- I- S.F. Ri!~idenc. __.._.J!.lo:"i.,_ SERVICF.S Du:,lex (1 both) each / I Addjtion~1 bo;h ~Wate;ser"'ice Temporcry Co"structlo" Stor,m Sew"r FEEDEk:; Heat Pumc Air handler to 10.000 CFM Air hondler over 10,000 CFM Amp,. I I I TOTAl CHARGES do.od TOTAL CHARGES Ix WHERE STATE LAW REQUIRES that lh. Electrical-wOI. be don. by the Elt!t~iical. Controcto!'" laLel has bean signed by an Eleth'ical Controdor Gna ottached .to Ihe eledrica: panel. . :1 1 --.1 -I -I--L. -_.=-~= =~~_ __u_I:,C~~ l ~ ISSUANC!:: Of PERMIT IO~c'" I / s: Or) I TOTAl U1A'G,S /3.00 the III~ctTh.ol -poltion o~ Ibi. permit shall i10t b. o:did until r.l I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that 011 infonnatlon hereon, is !j'U. and CUrle<t, 0.1.-1 I furth:!" certify thot any and 011 work performed sholl b. don. in accordance with the Ordinances of the. City of Springfield and the lows of the State :.f Orege,;: p01"taining to the work described herin, and Ihat NO OCCUPANCY wjll b. made of ony structure- without th. perr.liuion of the Building Division. I further certIfy that my registration with the Builder's Boord is in full force ond effect 0 s required by ORS 701.0.55, thot if exempt the basis for e,.emption is notefl heron, and that only subcontradors and employees who ore in complionce with ORS 701.05.5 will b. used on this project. Bosis for Builde~s Board exemption: .,GNATURE _12~ )6? u/. ~ DAT~ tt,-~#... NAME (please print) -~"-~--_._.-. ~--_.- fOR. OFfiCE USE ONLY lone Typel Canst Fire lone Bedrooms Flood Plain ---:- _--Storie, I 'nits nccy Lood n..y Group Sq. Ftg. Main <-'l. Ftg. Acces~ Sq. Ftg. Olher ,C)t,.o --'---~--.-'" x j 9. c, (/ Yalue / (, ccr."''' x Val'J. x Vo!..- TOTAL VALUATION ~.. /1,000. - BUILDING PERMIT Charges and Surchorges _____ $(.,.00 ;:J .:4':'/ ,;lO.DO ,'!!D /.5.,co . ('0 _____.8-'ooJ ,S;1.1 Plan Ck. Comm/lnd 65~;,1 Blda Per Ftre Plan Ck. Res 30%/ BJdo Per Fee /97 .00 Systtrms Developm~nt I ChoroQ (1..5%J 5 - 2.2 - )S 1 f Q..{' jJ0::JJ{) PLUMBING PERMIT Charges and Surcharges Fence Demo Total Comb. Permit //)g,/ta ELECTRICAL PERMIT Charges and Surcharges Sidewalk Alc Pa..,inQ I I I T?TAl Z"/iJ~Jb MECHANICAL PERMIT Charges and Surchargtr, Curb Cut ......,......::._.....04..:._,~.,. . '.";':-'"-_.,,,-- I. Applicant to furnish A. Job Address B. Legal Description 1. exomale.tax lot 100. Lane County Mop Referencp 17 03 43 2. example,lot 1. Block 3. 2nd Addition to Spring fie C I T Y C. Name. etc. of owner and construction lender ( 0.. Energy Sources 1. exomole-heat/electrical ceiling/or forced air gas 2. examole.water heater/electrical/or solar E. Square footage or valuation, etc. 1. examale,1250 sq. foot house. 500 sq. foot gorog. 2. example-if new project, check new-if addition, eh ,'- add, etc. I, F. Building permit information: 1. examcle-construct single family house with on at. (.' garage 2. example-remodel existing garag~ into family roo 3. example-convert single family residence into restaurant (change of use) G. Value of work as defined in Section 303 (0) of the Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS ( To avoid design C?r construction delays, Building Divi ~ Stoff must be able to contact appropriate persons re, design information or job site corrections, etc. II. Abbreviated Plumbing, M~chanical & Electrical Sched~le A. Except where blank spaces occur in the description p of the Mechanical and Electrical Schedules. the appli need fill.in only the No. .Boxes adiace~t to the appro item(s) to be installed . B. Full Plumbing, Mechanical. and Electric..1 Schedules are available at the Building Division 1. To conserve space on the permit form the schedul, have been abbreviated .2. If the item{s) to be installed ore not covered on th ated schedules you should consult the full schedul C. BUILDING DIVISION STAFF WilL FILL OUT ALL FEES A CHARGES ON THE SCHEDULES COMBINATlO~ APPLICATION/PER. (~) , ~ ". III. ,Applicant to sign and date Whenever possible. the initial application will be used a . worksheet only. Where possible. Building Division Stoff ' prepare a typewritten copy and return it to the applican the time the actual permit is issued for his signatur(.. IV. Fees and Charges ,"' Plan check fees are due and payable nt the time of jffi, ;-"',.' and no plans will be processed until these fees are poid.J,.,.. other fees and charges are due and payable when the permit is i"ued. V. FOR OFFICE USE ONLY PROJECT CONDITIONS. TO BE SATISFIED BEFORE OCCUPANCY: '" Additional Project Information: ~, , , C;-J--;;o ~/-? /Yu;"",-;~" ~.u.d:re.-L, ~,P~-;e--k - tf6.-.lj.-U?---C' d . /,/ . . "/' / / /l, , . (./ J~~7!"'H, /t.k.'~-,-.u.~... L4-<'p~~ . V .-1,&.&;:,u~ A~A. 4~ ~. _CI. ,~.2.d..{.u_v.. tI ,/~~ () PLANS REVIEWED BY: nam'"" ...ignatur~ -, ~~""'._""<-''''''''' .'PERMIT VALIDATION OF'SPRINGFIElD / { , , City Hall Springfield. Oregon Department of Public Works OFFICIAL RECEIPT r" ( \.. No B 56665 001<>-,(\\ \ \\~ 4- 1 ~ \ . Rec.i~~.m \nC b (l hS (\ ~ D\(1\'(\~. f\. Address 73\ 'S~'"2-., \::MVYf\~P(~ Received For: ~\r\ ~ . . ~i() ,~ . lftr') ~.~ ~\Jl\\D/ ~0{) 00 ~, 4G" Ph \ Q UCl ~ -X-- \ 'S.- nl) 1'fA .'(r{) \,\\O~ N 4LY()C~:~~ I;' ;" ',t,- ( (" <. ..-, \. Amount Received' '-I (J'fJ.11O ~~, , '. ( ( ., / ( I \ $..t:lTO"'.TU"".Ull ".'NTI".. lue ..1:,010 '7"0' ..."." . ....j.'''' e:~y. (" ......~- Permit CierI- , .....----; /~l I~ ~alo '?-/-F/ . ~~ , . ti .... ..........._ .::>-..~.....a..._'_.._ -~.-..~ ~ ,,"