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HomeMy WebLinkAboutPermit Building 1979-10-16 ., INSPEUION LIIIE ~..7:6-3769 NOTIFIED ~IQ-,q4 . INFORMATION L1No.1 ' 726-3753 Sq. Ftg. I.lain (' ,\ /. ~q. Ftg, Access. //3b lfJ Sq. Ftg. Other j lC.New Add Alter Rep. I Range -_ Fence_Demo_Change/Use ~ -~v~u~ of l'/ork, _Other II~ _ _ ~ ~,OOO_OD - '" ul1ciinQ Pennit Info: Describe Work(i.e.. BU11d Single I P ne ;79?7-7~~ amilv Residence With Attached Garaae) . . CITY OF SPRINGFIE.O COMBINATION APP.ICAT[ON/PERMIT ~ 0#'7 ./0 J E!lERGY SOURCES, ..Jrl<-lllA?..--/e Heat r Hater Heater Job Address &, 9 3 S- ~ /Y\ A / ttJ- .egal Oescription C,6,ro /t 02 3636 Owner. R.IIL Ph. L. JE /1/5 crV ~ Address (Qq 8':;-- /Y\ A IN SPR.. r;;,c/e Id {f),eEClOIV "-., -," Construction Lender V ftL9"'j.;-3U Address DESIGN TEAM (name) Primary Structural Electrical P.Uf.1BING NO.1 -----lEach single fixture Relocated building (new fix. additional) S.F. Residence (1 bath) Ouplex (1 bath) each I Additional bath Water service Sewer Storm Sewer TOTA. CHARGES WHERE STATE L\W REQUIRES sha 11 not be va 1 i'J until the <j-(l)UL~ -'~ 0/- w-Jo ~ Phone (address) flies. no.) (exo; res 1 J, ,-JA ~' .P~ (ahone no.) Mechanical CONTRACTORS (namel ~ Genera 1 (' /^2r r1? &-"<>...0--... 1 Plumbina -- Electrical (~aQ..r 'c/:. 9~ ~'echani ca 1 (addrps~1 (1 ir.<:;_ nn_ l (poxoirpc:.l (nhnnfll nn ) {"C/ ?, {" - rn~ (oq.3S: /na-v,-V RECTRICA. FFF rijARr.F Nn ", Nn Res idence of SQ. FT. New circuits alts. 1/5d() E- ar extensions SERVICES I I If) t;!;> ITempOrary Construction I IChange in ex;sti~g r~s j d..eJ1cF' jmultifamily, comm. or Innuc:trial Of amps. CO~~./IND. FEEDERS [nstall/alter/relocate dic;,trih_ fppnprc: / Of #J..r4"..&'..... IN'\. amps. fSco. 1'J<!'l-7.;;l}?':2- ?<I?-?.:2Y2-- MECHANICA. rrr r'::lAB.G.E. furnace/burner to BTU's Floor furnace and vent Recessed wall ~n~cp hp~tp~ ~nn vpnt Appliance vent S~Oari'itp Stationary evap. c:ooler I V.ent fan wi th sinole duct I Vent system apart heatina or A.C. I Mechan; ca 1 exhaus t hood and duC't 1 Wood stove/heater I I I from I'()~ TOTA. CHARGES [SSUANCf nF PFRI1IT 3l>~ TOTA. CHARGES I \~~~ IO-il-lq that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed aprlication for permit, and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Soringfield and the laws of the State of Oregon oertaining to the work described herein, and that NO OCCUPAHCY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 7nl.055 will be used on this project. N,,(l:lE(Please print) 'K A '- P fJ. J~N<'F..n/ S~~ATVRE,~~~ _~-1-'?~~~ V L. DATE (I)c) /& - 7'1 .FOP-'OFFICE USE OllLY . v Zonp Tyoe/Const. 'II-N Uni ts Sq. Ftg. /1ain x Value Fi re Zone J:ZJ::. Bedrooms Occy .oad Sq. Ftg. Access II 'V. x 7.'1 Value 5ll/1Jt.. (,(/7 Flond Plain Stori es Occy Group M-( Sq. Ftg. Other x Value ~I Plan Ck. Comm/[nd '11(.100 651/Rlda Por Fpp ------------PTan Ck. R"es I. q a.. 301lB1 da Per Fee ______jlJ.QO_ Fence .40 I D_ _ ___ __ _~Q,-ogJ .Sidewalk I.;[l) A/C Paving BUI.OING PERmT Charges and Surcharges P.UI~B[NG PERMIT Charges and Surcha rges E.ECTRICA. PERlm Cha rges and Surcharges MECHANICA. PERMIT Charges and Surcharges Curb Cut : TOTAL TOTA. VA.UATlON SysteC'ls. Development Charqe (J.5~) Total Comb. Permit q/..s~ 97 (1;,6:2 - . COMBiNATION APPLiCATiON/PERMIT (CAP) r:. Applicant to furnish A. Job Address B. Legal Oescription 1. examole- Tax lot 100, lane County Map Reference 11 oj 43 2. example- Lot I. Block 3, 2nd Addition to' >pringtield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. examole- heat/electrical ceiling/or forced air oas 2. examole- waterheater/electrlcal!or solar E. Square footage or valuation, etc. - 1. example- 1250 sq. foot house, 500 sq. foot garage 2. exa~le- if new project. check-new - if addition, cneck add, etc. F. Building permit information: 1. example. construct single family house with an attached garage 2. examele - remodel existing garage into family room 3. examjJle - convert single family residence into restaurant (change of use) G. Value of work as defined in Section..303 (a) of the Structural Specialty Code H. OESIGN TEAM ANO CONTRACTORS To avoid design or construction delays. Building Division Staff must be able to contact appropriate persons regarding design information or job site corrections. etc. II. Abbreviated Plumbing, Mechanical, & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Division 1. To conserve space on the permit fonm the schedules have been abbreviated 2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the fu 11 ,chedu I es C. BUILOING DIVISION STAFF WILL FILL OUT ALL FEES ANO CHARGES ON THE SCHEOULES D. As noted on the CAP, the label must be delivered to the electrical contractor for signature by his electrical supervisor. The general contractor is not authorized to sign the electrical label. - Ill. Applicant to sign and date Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Oivision Staff will prepare a type written copy and return it to the applicant at the time the actual permit is issued for his signa ture. IV. 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . , PERMIT VALIDATION l:)l:) . ~g, J,o;z, @)? 4~b tt-P Y!J ,(Sf) ).20 ". ~lD ~-P I D.{;() 47D q() .,. ':------- q I 60 ~D~Zdr-~c c2p Permit Clerk Permit applicant exempt from registration with the Builder's Board because: , - Additional Project Information:L.z, A/..h.LdL ~-"--,,,---7, SignatureL xL.~ y/J~ - O.f" IVA" D~," -~) PLANS REVIEWED BY: name ~~, !J ~A~'J."'1 i;; da te It::? -/9-?? , J