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HomeMy WebLinkAboutPermit Building 1986-3-28 (2) -----..,-..._,,:.~. ..-' '-'-j- --_._~~:.., .@..- .,' .", " ,'-. - B1SPE'TlON LINE 726-3 69 Job Address .3:3 20 M-AtA' Legal Descriptlon 17-t)z..!/..~J. CITY UF SPRINGFIELD COMBINATION APPLICATION/PERMIT '. I ElIERGY SOURCES: Heat Water Heater Ranoe ,~ ~ \), ....... ~ ~ IHfORJtATJON l.L~l:. " 726-3753 Sq. ftg. Hain !q. ftg. Access. Sq. ftg. Other --11ew__Add~lter-"~ep. Fence Demo Change/Use Other- -- .<;;r. "2~ 'FL.Er.et- ValUE of Wor~ "'0 r 3c;)CO I Bull6ino Penmit Info: Describe Work(i.e.. Fa~ilv nesidence With Attached C,araoe} Build Single Address Owner -.Jf)<:,qtf,' 6UJuA.' Phone Construction lender Address UI:.~H.iN fl:.Ar., Primary Structural Electrical Mechanical CONTRACTORS General ~w A:)bc.. Plumbina Electrical ~1E!chanieal NO. (name) Phone (address\ ~r;.,~P?,r !iM- I1tf/f~.tJ'J';j- hi'F; MIli2:UA-tL: Eb:rrl A:fA<H- : .lJtitM<L I ~At'~" 'l flies. no.l rexnires) (ohone no.) (name) " "WL ~ 1'" "I~lf1irc; !'In..' .. -- {FJhnnp fin 1 (addressl (PYI"';""'c:.' PLUIIBING I cCL J:l:lARG.E ~In ~~~ rl-l MECHANICAL FFF Each Single flxture furnace/burner to BTU's Relocated building (new fix. additional) S.F. Residence II both) Duplex (1 bath) each Additlonal bath Water service Sewer "'0' Storm Sewer ~ I 2.2.! Floor furnace and vent / ~ ~~~~~~a"rt ~~nt "e'!. Temporary Construction Change in existing rp~ i (h~.nrp multifamily. comm. or TJ'lrlnc;;tri;tl Appliance vent c:.pn;t r~tp St.ationary evap. r-""lpr Vent-fan with c:"jnnlp rfll,.1' Vent system apart from heatina or A.C. Mechanical exhaust ~C'(\~ ;tnd rfllr-t Wood stove/heater 3,,0 ! .2LJ~ 1 !J() Of amps. VAMU/J1 I>;f''/(/U?c'. CO~1./IND. FEEDERS Install/alter/relocate rHe1'..;" f".pripre Of 6A~ rJll"l,c!?, ?~ amps. tSSUANCE OF PFRltlT ~7!!!. TOTAL CHARGES 22 S"o TOTAL CHARGES /11/,v , that the Electrical work be done by an 'Electrical Contractor. the electrical portion of this label has been signed by an Electrical Superv~sor and returned to the. Building Division. TOTAL CHARGES !H11.//iNt(M WHERE STATE L~W REQUIRES shall not be valij untl1 the 15"" pemit 1 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 oerformed shall be done in accordance with the Ordinances of the City of Springfield and the Laws'of the State of Ore~on pertaining to the work described herein, and that 110 OCCUPAIlCY 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 ~ereon. and that only subcontractors and employees who are in compliance with ORS 7Ql.055 will b~ used on this project. IWIE(please print) Zone c:: ~ Fire Zone Flood Plain BUILDING PERNIT Charges anC: Surcharges PLur~BING PERMIT Charges and Surcharges ELECTRICAL PERmT Cha rges and Surcharges MECHANICAL PERMIT Charges and Surcharges Tyoe/Const.~~ Bedrooms Storl es / SIGIlATURE FOR OFFICE USE 0111 Y Sq. Ftg. ltain Sq. Ftg; Access So. Ftg. Other .IFn>'?At:f x x DATE I Units Occy Load Occy Group..B-2 Value Value Va 1 ue :s~...?...., <;!Z TOTAL VALUATlON x :3 <2> -s-a Plan Ck. Conm/lnd _______-:;~-_-~/BJ1o P.rr fpp / t;.,... Plan Ck. Res .. 30%/Bldo Per Fee ___~~_~~_~_ Fence /,/0 22. .S-o ------------ .~ t' ____L~~~___ ,bD Systems Development CharQe (1. 5~) , . DC/IllO .Sidewalk AlC pavlng?~~1 I Curb' Cut I I I iJ8. S~ ITota1 Comb. Permit I TOTAL Ill! 6.1'1 . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Oescription 1. examole- Tax lot 100, lane County Map Reference II UJ 4J 2. example- lot I. Block 3. 2nd Addition to ~prlngtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. examole- heat/electrical ceiling/or forced air ad 2. examole- waterheater/electrlcalJor solar' E. Square footage or valuation, etc. ------ 1. examole- 1250 sq. foot house. 500 sq. foot garage 2. examp_l~- if new project, check-new.- if addition, check. add. etc. F. Building pennit information: . 1. example - construct single fa~11y house with an attached garllge - - t.' . iIi. . \:.. 2. examole - remodel existing garage into family rao 3. examole - 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 AND CONTRACTORS To avoid design or construction delays, Building ,~ .. Division Staff must be able to contact appropriatet. 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 appli~ant need fill-in only the No. Boxes adjacen 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 schedule: have been abbreviated 2. If the item(s) to be installed are not covered on the ab~reviated schedules you should consult the full schedules C. BUilDING DIVISION STAFF WIll FILL OUT All FEES ANO CHARGES ON THE SCHEOUlES D. As noted on the CAP, the label must be delivered to tl 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 b~ used a~ a worksheet only. Where possible. Building Division Staf1 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. V. FOR OFFICE USE ONLY t PERMIT VALIDATION /j) &/ to CITY OF SPRINGFIELD City Hall Sprlngftald, Orogon Department 01 Public Works OFFICIAL RECEIPT ( No. B 66180 (Date i ,q - ?1, .- 19~ ( Rec'dFro~~h~ (,.1000.. ~\..LCOQ.y r' \ ( Address ( - .: R~~lv~J'FOr-' x(o'o 1~1 h~~ ~h ~. ( t/i~ (" 4-;t, ( c 'f /D -rYu./'A. ( J/i., ae, fJ,V.kna Ol2f" _ rlotHir/lEm $' / '7 (P. /1 0vrL~ ( Amount Received ( ,. .~ ~, . '>1 l'ermitClerk. AUTHORlZEO SIGNATURE ~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: !2'w~ ;- ~er A1P~r A,c IV ;lQk BtI~llJu A~~ , .~.d n--.c-. ~'X.~ I, '5'1' '!Yl. ~() /10 ~.So ,Cj() 1'5'. ()O ,I/J{) ,'51(,5 () . !Jl1J)O (' ~,. J- /I/1.h{ld~ 11'-<( . UN I tf71l ) /-., t:) ~ .;u"'lJ~t"A7~AJf/P.-':::.;?$ ,,"(.MT AlE c"....4~ /)Mt~ M?E= ~,!,q'1"-'rJ"" ,." ,t=M1.rr 6~.7~ . Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name .#~/~~ signaturep~LJ L. m~ '. 'date 'f /-:2~ flU. / I I