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HomeMy WebLinkAboutPermit Building 1984-2-6 . . Ranqe INFORl1ATION liNt ~I 726-3753 Sq. Ftg. f.lain ~q. Ftg. Access. Sq. Ftg. Other Uew Add Alter Rep. --Fence Demo Change/Use -Other - - IIISPECTIOII L1I1E 726-3769 Job Address 7'7~o .#At-,'..., , CITY OF SPRIIIGFIELO COtlBHIATION APPLlCATION/PERMIT E!IERr,y SOURCES: Heat ('later Heater .' Owner CPc_; I Address 7'-7 c,/o ~ SA...x c.l...... .s;o,'-{.c ~A. .... ~luE of Hork: ().J /000 , - '. Phone;r,r, oo~ ~~~1~~n~e~~~~~elnf~~ A~i~~h~~eG~~~~~~.e., Build Single ~ 1 ~ Legal De,cription I? - cJ'L - 3 "2.. ~ (.) c:J 7.::>/ Address Ul:.~I(iN ItN1 (name)Cr,::o '-~. I ~- S~'e.-r ~ tU#-V'!!>-~'" <; ~-o/ ~"'- c.-I e...,. ~..J,,--;?' Phone IB~_1 A c......,f'_v./.;.- ~".,.7.,\ '"-;;;.6:0..V ~ (address) ,',*",,,,~ _(lic5."00.) (exoires) (ohane no. Construction lender Primary Mechanical CONTRACTORS (name) ~~F, 'address' (lies. no.) ~ (exofres) (ohnnp nn ) Structural Electrical General Plumbina Electrical ~lechanfcal PLUllBIrIG ELECTRICAL MECHANICAL .....!!Q."I Each single fixture , FFF 'CHARr,F .1'n Residence of ~J:'!:' . fl:iARG.E. Nn SQ, FT. furnace/burner to BTU's '=.J:'J:' ru~ Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent I I I I I I TOTAL CHARGES I TOTAL CHARGES I TOTAL CHARGES WHERE STATE L~W REQUIRES that the Electrical work be done by an, Electrical Contractor. the electrical portion of this permit shall not be valiJ until .the label has been signed by an Electrical Supervisor and returned to the Building Division S.F. Residence (1 bath) Duplex (l bath) IAdditional bath 1~later service I Sewer I Storm Sewer I I I I each I SERV ICES I amps.1 -, I I I I I I Recessed wall 'So~rp hp~t~~ ~nrl vpnt !Temporary Construction Change in existing rPos. i dJ'nrp multifamily, comm. or Tnrluc:.trial IOf ICOffi1./INO. FEEDERS I Install/alter/relocate dic:.t.~ih fpprlprc:. IOf amp~1 Appliance vent seoaratp Stationary evap. cooler Vent fan with sinale duct Vent system apart from I heatino or A.C. " Mechanical exhaust hood and durt I \.Jood stove/heater I I I ISSUANCE OF PFR!llT I HAVE CAREFULLY EXNlINED the completed aprlication for permit, and do hereby certify that all infonnation hereon is true and correct, and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City of Springfield 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 Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemp n is noted hereon. and that only subcontractors and employees who are in, comol;ance with OPOS 7~1.05~d on this ect. IIAI-IE(please pr;ntCeC i (~"')I..Oe..I SIr.IIATL~. ~::. DATut2 -6- "7 Fon OfF! CE USE QiIL Y So. Ftg. rlain Sq. Hg. Access Sq, Ftg. Other Zone Tyoe/Const. Bedrooms Stories Units Occy Load Occ'y Group x Value Value Value Fi re Zone x Flood Plain x TOTAL VALUATION BUILDING PERMIT Charges and Surcharges __L~_~~___I ~~~~B~~~ , LJtt> Plan Ck. . -, 30%/Bldo ConmlI nd Pe>r Fpp Res Per Fee Systems Development Charoe (1.5~) #.4 PLUt1BING PERMIT . Charges and Surcha rges Fence ------------1 Demo I Sidewalk I A/C Pav; n9 I Curb Cut I ITotal Comb. rermit : TOTAL lot/. ~CJ ELECTRICAL PERI:IT Cha rges and Surcha rges 11ECHANICAL PERMIT Charges and Surcharges . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100. Lane County Map ReferencE ( II 03 43 2. example- Lot 1. Block 3, 2nd Addition to Sprlngtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinQ/or forced air 2. examole- waterheater/electrical/or solar E. Square footage or valuation, etc. ------ 1. example- 1250 sq. foot house, 500 sq. foot gara 2. example- if new project, check-n€w - if additio check add, etc. F. Building permit information: , C' 1. examele - construct single family house with an attached garage . 2. examt;lle -. remodel existing garage into family r 3. examDle - 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. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design infonmation or jOb site correct ions, etc. .. 11. Abbreviated Plumbing, Mechanical, & Electrical Schedule: ( A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the appl icant need fi 11-in only the No. Boxes adjacl (, to the appropriate item(s) to be installed 8. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Division 1. To conserve space on the permit form the schedu' CO' have been abbreviated ,2. If the item(s) to be installed are not covered ( the abbreviated schedules you should consult thf full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND ( CHARGES ON THE SCHEDULES , .' 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. ", - Applicant to sign and date Whenever possible, the initial application will b~ used as a worksheet only. Where possible. Building Division Staff will prepare a type written copy and return it to the applicant at the time the actual penmit is issued for his signature. 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 paya~)e when the permit is issued. . , llI. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: (" - -;- "V OF SPRINGFIELD City Hall Sprlngllald, Oregon Department 01 Public Works OFFICIAL RECEIPT , No. B 62366 ~f{ SI-.x4~ ( Date .Fei$. L., 19 Rec'd From C Eel '- Address ~g3';> ~L4-"'-e-,'''' ~. ( Received For. t)~ g 'I"D"'j/ ~~t= ~~:J':; ::;? ~J> ~ . ( 7?P ~~ . If<:> .. ......-. . -, tir/t7. (t9- . /t!:>.etl ( c<<g9~ / t:). ftt-t> '" , Amount Received ~~~~ VP Aulfi RIZEDSIGNATCF!E /- \.. .,noo. ~ftINTl:ft./LlTHOOIllA~Hl:ft.. I:UGI:NI:. OftI:OO" - ~-( "- . .'.. '.. r" Permit Clerk oi Permit applicant exempt from registration with the Builder's Board because': Additional Project Information: PLANS REVIEWED BY: name~~ #~""'~ignature_~~~ ;-...date ;Z,.~';'8'1.' :..,.., -. I ( , . -t '" . ~ , i"!-o ; <:) -, ~ C>-F'.+- ;:;N/~# ?;/,S $A.,).7 ;::;:"rr 57l>?f ~ ~ r~i'f~e:y . ~4".)': ~ c..?J9-~ LesAP ~ ~ f=t-'I?r')' / p-/ , . " " .... ~ . o .., .,. . -' , " /.- '-,.~"" "I ~-o lJ-.';Jc. 1-","'- I \ , '" I., --1'" -d.- /i/--9% " /. ,0, ~ ;1- {L..J'-Pu~ --, J .~....... .' DATE RECOEVED :i?-<::-"8 1-.,-, Joe No,B'1'~/ ZONE CC - \ UNITS _ STCnIES LEGAL. DESCRlPTION OCCUF'ANCY GROUP OCCUPM-=CY UJ.e,O TYPE COt.1ST. _ AD;RESS_'1?&/t::> M#/U.-5T. OWNER ~~~I'C .Zin'ffd!P;p..:--- THE cor.lTE~rr5 Hl:'RE 0.... Hl.VE SEJ:.:N REVIEV.:ED. \fIltH ALTERAT10tJS INO!CA,EO IN COLORED PEI..CIL. CH,\NSES OR ALTER.J:..:-,OflS M..CE A'FT'~R DAT;;: ei:::LCW SHALL BE APPROVED BY THE 8tJILD1N~ OFFICIAL. f: , 'I ! i \ , CITY OF SPRiNGFiELD. OREGON ~~:ROV_ED ,BY #~.__,~:' DATE.~:~~_' " ..' 3 t;" (!; <l1......~ IV /(>/1..- FIOQo(. - ~ A -, ~ -:2' , ~ ~ , '" ,-, I'r . \ - V) GCA.LE: OAT!: t;J..1I be. S... ?'~....., +4!:o''''~.j C c.,A-If./4 -{ <:.L