HomeMy WebLinkAboutPermit Fire Damage Report 1982-1-14
'llrlSPECTIOII LIIIE . CITY OF SPRlrlGFIE~D . INFORllATIDN LINt I
726-3769 ' C0I1BIIIATION APPLICATION/PERMIT 726-3753' J~
/1 A fJ",'.v=...., l fV\ ^. I n \,4-, . EIIERGY SOURCES: Sq. Ftg. I.lain
Job Address ~{'-)~..I l\l ~-' ~ Heat ~q. Ftg. Access.
Legal Description Hater Heater Sq. Ftg. Other 3
New Add Alter Rep.
Range ___ -Fence Demo Change/Use
Owneu _~~"\I. _ ~ _ .M 't\oJYi(\ ~GJ\.4~ va13t)o?j()(),t:JO Other- - -----.
Address 1\ AS..~ \; ~ Phone /l ~~~11~np.e~~~~~eIQa~ j1.~~~~h~~eG~~~~~l'.e., Build Single \..J
~ -t 6i (C;J.tCL. ~~:W)- r\fJJx\~~f--,_i\ flD(\ ~ I r
Constructi~ ~)-- .I \J ~-
~
Address
OESIGN TEAl,j
(name)
Phone
(address)
: Electr-ical
!lies. no.) (exoires) {ohane no. J
, -----~-+,. --~--"c_~~:I
, , ~
-- ---- --_._-_.-.:;..;..,~. '_.,_. 'Il
Mct;liailical .. .' .' . i!
CONTRACWRS -- 2namel it; --.,-,.. .~-~j,aOs~>, -,:." ~(l_~f~',L,-~,-iOn~, ~L~',.,:"~":~ ".~5C70,i~~L~r;'r) ;
'-;;-eneral_&~_oSJ \.'~-~-a....w+ J ~ -.J^ . " ' I( :r.t>T7'
I ' - - - J - ',' , ,-. ~ '
~l"mblnO ~ -l.:~h"hf\ -- e.l A' ~-', I ~-- , fJ .
I Electl'ica _ .. ,1_ n,.ll.U..I.\ r(L---L9 ' ..J.;. .lU.,,)1._YC"__ ..,~ - -.r .
i .', -~., I ,'1
""l~_c,hru~_~L~. ,.~,,- .'~, ,.', ..., , ""="T""'"'~-~ ",~'~~"-,'~~"._-~--.--- ._,.".',..~~.."..,.,."'...' ",.,..0~,~~~~".=~___~J~
I' PLUllBIrlG i ' lLECTRIC!\~', . f;ECHAN1CI';, j ,~
""N'dT"'--."""- "'--"1"~FiL"THARGE+iiQ,-T"'"~-'-~._~-~~~'<iF'- .i.tl8"ili: A :"=~"-:~=::::::~1f~f.::..:r.HARiiF~
- E h-~:-l-f' t" .. -. - 11" - Residence of . ~ 'furr.ace/bl.:;"ner "te; I I"' / 1'1
ar. 51119 e 1X ure .il SQ fT.; S"iU'c- I ,;
~. . ... . .1
(I _ '.
Relocateclbuilding--"'--" Newcircuitsalts. ----.-.-- Fl00,fu;:;aC;-----i "l1
(new fix. additionc:.i) ~ or extensions und ve.lt i:
_,. II
S.F. Residence SER ICES Recess<<1 wall ~ Ii
11 bath) V ~OjH':P hp;!tpr ~nd vpn _ _ "j'l
1--.-
Duplex (1 bath) each _,_ _____ J...,,' _.._ .l~
. j Appliance vent
Additional bath Temporary Construction seDar~tp
Change in existing Stationary evap. i
resjd.pJ1ce cnoler - . I
multifamily, CQIlTf1. or Vent fan with
Industrial sinale duct
Of Vent system apart frain I
amps, heating or A.C. ;
Mechanical exhaust
hood ilnd duct
Primary
, Struc~ur'al ___.. _ ___ _. .._
~Iater service
Sewer
I
I
~
I ~ '
· L_--.J
I 1 ~
- ~.~_. - - __ _ _____ -----4- - .-_
I ' II
_ ; n___.U
, ~
..-1._ JSSUANCf~ PFRr~T ~:t:
rom~= lrom~= lrom~_s. l ~,
WHERE STATE L\H REQUIRES that tile Electrical work be done by an, 'Electrical Contractor. the electrical portion Of this pernit I
,shall not be valiJ until the label has been signed by an Elec~rical Supervisor and return~d to the Building Divisi~n t
. .
I HAVE CAREFULLY EXAMINED the completed application 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 Ordinancestof the City
of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAHCY ~il1 be made n
of any structure without the permission of the Building Division. I further certify that my registration ltlith the;Suilder's II
Board is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon, and that :1
only subcontractors and employees who are in comoliance with ORS 7nl,05~,~1 be used ~iS project. . '~
IlAI1E(please print.l~Ll:l1~_1L- GJrnfl ~) _ SIGtlATURE 1~f.-~ 1aJjrVi7lA~_~A!~lI8"1.._:1
___ ,__~_~ __..,..10J. OfFICE USE OiI~Y _,,_._~:__....:._"..j
Zone Type/Canst. Units Sq. Ftg. riain x Value I il"
fire Zone Bedrooms Occy Load Sq. Ftn. Access ,x Value J . tl
. .
Flood Plain Stories Occy Group Sq. Ftg. Other x Value ; II
TOTA~ VALUATlor!=t= ,II
I .-11
'Systems Development' j "il
CharQe (1.5%)' '_ .,,:1
ij
Storm Sewer
COMM./IND. FEEDERS
Install/alter/relocate
di~trih. f~eders
Wood stove/heater
Of
amps.
BUI~DING PER~lIT
Charges an~
Surcharges
, 1 '"\'-1 OC) , Plan Ck. Conm/lnd
_ cl_L:.._ __ 65tJBldo Ppr Fpp
D:. 2)C) Plan Ck, Res
~. 3D%/Bldo Per Fee
__L5-,Q~__ Fence
. f...ou Demo
I Sidewalk
I A/C Paving
I Curb Cut
I
ITotal Comb. rermit
i
r
i
P~uP1BING PERMrT
Charges and
Surcharges
ELECTRICA~ PERI~rT
Cha rges and
Surcharges
MECHANICA~ PERMIT
Charges and
Surcharges
I
I TOT A~
\4l vf),
I . '-....
.
,,-.. ,
i
, COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
IV.
I. Applicant to furnish
A. Job Address
B. Legal Oescription
1. example- Tax Lot 100, Lane County Map Refe! (e.
II UJ 4>
2. examele- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. example~ heat/electrical ceilinq/or forced
2. example- waterheater/electrlcal/or solar
E. Square footage or valuation. etc. - (
1. example- 1250 sq. foot house, 500 sq. foot -.
2. example- if new project, check new - if ad
. Check add. etc. .
F. Building permit information: (.
1. example ~ construct single family house wi ~~
a ttached garage '
2. example - remodel existing garage into farr
3.. examole - convert ,single family residence ~
restaura.l'.It (change of use) I"
G.' Value of work 'as defined in Section 303 (aj of
Structural Specialty Code
H. OESIGN TEAM ANO CONTRACTORS,
To avoid design or construction delays. Build; (
Division Staff must be able to contact appropl
persons regarding design information or jab s:
corrections, etc. '" /
II. 'Abbreviated Plumbing. Mechanical, & ,Electrical Scl "1'
A. Except 'where'blan~ 'spaces occur in the descril
.portion of the Mechanical and Electrical Schel
the applicant need fill-in only the No. Boxes JO<
to the appropriate item(s) to be installed \, ,
B. Full Plumbing, Mechanical, and Electrical Schi
are available at the Building Division
1. To conserve space on the permit form the'
have been abbreviated ("'"
2., If the item(s) to be installed are not co
the abbreviated schedules you should cons
full schedules
C. BUILOING OIVISION STAFF WILL FILL OUT ALL FEE ~O
CHARGES ON THE SCHEOULES
, O. As noted on the CAP, 'the label must be delive
electrical contractor for signature by his el
supervisor. The general contractor is.not au
to sign the electrical label. -
Applicant to sign and date
Whenever possible, the initfal applfcation will t
a worksheet only. Where possible. Building Oivis (S..!!-..
will prepare a type written copy and return it tc
applicant at the time the actual permit is issuec
signature.
Fees and Charges (
Plan check fees are due and payable at the time ( .
application, and no plans will be processed untilJ--..".......
fees are paid. All other fees and charges are due and
payable when the permit is issued.
('
CITY O~ SPRINGFIELD
City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
(J
~ No.8
Dot \\ .. 'A- 19~~
Rec'd F .<'tIC). ~ ~m..
A"re.' ~"l!1l() (.) >s ~ ~1
Received Far:
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57859(,
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t ~ ro,f)
\!l\ po
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\ <..,00
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<r;
, Amount Received
f4llon
') 'f:i~~,!::C~'-
."UTO"'T1,1"".ULLI''''''U''., t:uot:..t:. 0" .uo, ....,..
III.
(
"V. FOR'OFFICE USE ONLY
Permit Clerk
"
.
PROJECT CDNDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~~'''''''
t/
. ". ~ o-'-c ~
~'~,.., V.,
.?/d-U
U
,~
Ci... . iMtn:L
-{/
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
1
PLANS REVIEWED BY:
name
signature
/2
date /-/V-J"~
,I