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Home My WebLink AboutPermit Building 1983-2-25 ~ '1~~?M,,"~N :Jr. I HISPECTIOrl LIIIE. CITY UF SPRlilGFIElD 726-3769 CQrlBIilATlON APPLICATION/PERMIT _ I EIIERGY SOURCES: .... Job Address J:.1.t:.~bJ3le..kJ~/,,",{:zJ!, Heat /Y.A. legal Description /7 _ Doz,. - 3 2- _" 'Z- ~/9'o>~ l'later Heater , Ranqe Owner ~ Address Ca:.H1f!.A u Construction lender Address UlS I (iN TEArI (name) Primary ~ H",< l....). B.a,k:#"'.te b..'" JJF. J hHB4~pv ~.S'4k.. "'''.3'- I "flY / . Structura 1 Electrical . . INFORlIATION lItlE 726-3753 Sq. Ftg. 1.lain ~q. F'tg. Access. Sq. Ftg. Other lie" Add Alter Rep. --Fence Demo Change/Use Other- - ~ ~ I~ "'" Phone Valu, of Hork: ~bO.- Builriina Pernlit Info: Describe'Work(i.e., Familv nesidence IHth .A.ttached Garaae) Bui ld Single L II;. Jo4o T rle6..... t:L J;?, ~ l L.. Ii) U.J e:- ltt.M O. ~ Phone f address 1 (1 ics. no.) (exoires} (ohonp I'lO ... ,- ~ ..~ (address) (lir.!=;. nn.) (exo;rp~)' (ohnnp nn \ '~'JJ~ I ~H~'4-17V. ~SSt:.. '&.1..! -/lY$"9'" " .. , l1echanical CDNTRACTORS (name) General I~,.,A,.< kJ. R.4.1--':}#p , Plumbina Electrical '.lechanical PlUllBING NO. . / Each Single fixture 111.:",."." ~_....~ jRelocated building I' (new fix. additional) Is.F. Residence I (1 bathl IDuplex (1 bath) each I IAdditional bath I 1~/ater service I I Sewer I I Storm Sewer I I I I I I I I I I I I I TOTAL CHARGES WHERE STATE l1H REQUIRES shall not be valij until the ELECTRICAL MECHANICAL FFF . CHARr,E NO eee rHARr,F" NO. eee tI-lAQGF" , ,. Residence of furnace/burner to BlU's s:- I I I I I I I I SQ. FT. New circuits alts. or extensions Floor furnace .and vent SERVICES I Recessed wa 11 Sn~~p hp~tpr ~nrl I ilmps.1 I I Appl iance vent seoaratp I Stationary evap. cooler I Vent fan wi th , sinole duct Temporary Construction Change in existing rp<;, i dJ'flt:P Imultifamily, camm. or Industrial 10f ICO~1./IND. FEEDERS l'Install/alter/relocate rlic:.trih fppf1prc:; . IDf I I I amps. ISSUANCE OF PFR!HT TOTAL CHARGES ,'f':...... TOTAL CHARGES that tile Electrical work be done by an. Electrical Contractor. the electrical portion of this perr.1it label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXN1INED 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 Ordinances of the City of Spri ng fi e 1 d and the laws of the Sta te of Oregon pertai ni ng to the work descri bed herei n, and tha t NO OCCUPA1~CY 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 exemption is noted hereon, and that only subcontractors and employees who are in compliance with OP.S 7~1.055 will be used on this project. 1lAf.IE(please print) 20ne <t!:. C Fi re Zone Flood Plain Tyoe/Const.~N Bed rooms Stories Units Occy load Occy Group S IG;IATURE FO~ OrFICE USE DillY So. Ftg. !lain ;1<:>)''37::; Sq. FtC]. Access b'-"2 Sq. Ftg. Other . x ~ljl6Value ~~.-" x Value x Value TOTAL VAlUATION~~ ~.o Plan Ck. _____t:2'-_____ 65%/Rlda -.&1 Plan Ck. . ~" 30%/BldQ _____~~~__ Fence . -:<1> I D~mo I Sidew~lk I A/C Paving BUILDING PER/lIT Charges and Surcharges PlUt1BING PERMIT Charges and Surcha rges ElECTRIU.l PERI:IT Charges and Surcha rges MECHANICAL PERMIT Ch3rges and Surcharges DATE .... ConmlInd Ppr Fpj:l R-es Per Fee ... <<i'C ~sYstemsDevelopment ..-. Charoe (1.5~) . ifc."r IS ct>O Y8 J' ::ZS.s.,r. I I ~A. 7~. ,7 ~ , (J~D,...".c;..... Curb Cut I Total Comb. rermit I I .1 I TOTAL n I If. If'! 15: "3 Yo I . " \ iTY OF SPRINGFIELD City Hall Springfield, Oregan Dapartment 01 Public Works OFF I C.I A L R EC'E I PT ( No. B 80464 Date F~ ~ 19 ~ "3 Rec'd From 71f6M"f-r w: b -'fA' F/'f ':t:A.A/~ ~o~''*~7J t" Address ';t~_eu ",_t:: . 45')Ie . COMBINATION APPLICATION/PERMIT (CAP) III. I. Applicant to furnish A. Job Address B. legal Description - 1. example.- Tax lot 100, lane County Map Reference ~. 11 03 43 2. example- lot I. Block 3, 2nd Addition to Sprlngt;eld Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. exam~le- heat/electrical ceilinq/or forced air 2. examole- waterheater/efectrical/or solar E. Square footage or valuation. etc. ------ 1. examole- 1250 sq. foot house, 500 sq. foot gara. 2. example- if new project. check--new - if additio: . check add. etc. . . F. Building permit information: 1. example - construct single family house with an attached garage 2. examl?le - remodel existing garage into family rl (.. 3. exa~le - 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 TEN~ AND CONTRACTORS To avoid design or construction delays, Building ~ivision Staff must be able to contact appropriate persons regarding design information or job site corrections. etc. II. Abbreviated Plumbing, Mechanical, & Electrical Schedule! 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 adjacl ( 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 form the schedu~ <: have been abbreviated 2. If the item{s} to be installed are not covered ( the abbreviated schedules you should consult th~ . full schedules J' 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 be 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 permit 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 payable,when the permit is issued. .. ( Received For. JazsIF e31O"tf'~. ( ( . . -PIC. SiP #';10 r. ,.... ~e. 7. ':'e:> 6.- .":l.1f s-: ~- ~ "2. 0 ( .- . .. ( ~,~ IS""'. '3 Y . C~< ~?<..;r-,"') Amount Received />. ~ y BV --~\ y ~$;I _ AUTHORlzEOSIGNAru..... ,- \ .RIGGS PRINTltll:ll/LlTHOORA..HltIUI, ltUOltNIE. OIlIEOON r . - . , , , ~ .. . I , V. FOR OFFICE USE ONLY Permit Clerk PROJECT CONOITIONS TO BE SATISFIEO BEFORE OCCUPANCY: i/~ 7E_P~RA-;t;>.,. (!>,r: hR/c... 7H~o ue:= H ~=<. :)l#7"c.C #e;"cr_ ;2'.....". 13;?e-y:~-~~ ?'c?zi=>(.J.....7f,g:;, Permit applicant exempt from registration with -57'Rc..rc T~A! ~ /f-~~w~;p ~.c..,.. A-- /I?~h'j Ai' c.rs; c/ oS ~. .J.,-r'.J?o V~ .~~(.J /J'c-: hs. M, ~/'r the Builder's Board because: ~'-'~,;; cCr~LY. Additional Project Information: PLANS REVIEWED BY: name LCSRNZ;- ~~ Signature~~~ / , date < .~~--e-:i' , ,.