The URL can be used to link to this page

Home My WebLink AboutPermit Building 1983-6-30 ,., .. .:. . . Job Address 3S'c::>!{;"' MAf:/ />I Legal Description 57:' CITY UF SPRINGFIElD CmlBlilATION APPliCATION/PERMIT EilERGY SOURCES: Heat \'later Heater Ranqe Valu€. of Work: / ~ 4Jc:,.. Cr- Builriina Permit Info: Familv Residence Hith INFORllATION liNE .1 726-37S3 Sq. Ftg. "tain ~q. Ftg. Access. Sq. Ftg. Other New Addl(Alter Rep. --Fence cremo Change/Use Other- - ~ \JJ ...... I HISPECTIOII 1I1IE 726-3769 Phone I Describe Work(i.e., Attached Garaoe) \.I \J I........ Address IJ.I/'IC {",O P,,4Y/<5 /I/g, ..5-3'tr..>-~ Build Single Owner Address Ul:.~ltir~ 1l:.A1' (name) Phone (address) Ce>h.$T,Q~ cr rYJ11tS ~ /~"'" 7/vG' r.i!9~/N'" ~N7)-.A&.7er~ C:C~c..'~/.e-r~ C/)I1f~u./ ~ (lies. no.) (exoires) (ohone no.) 7.1-/-,--, '1~ '-I Construction Lender Primary A ~L ,~ Structural Electrical Mechanical CONTRACTORS (name) ,( address) (lire;.. no.) (pxnirpe;.) (nhonp nn_ Genera 1 Plumbina Electrical ~'echanical <€t.F PlUllBIIIG ELECTRICAL FEF rHARr,F jJn 1Of.L1.cJiABliE .l!!l.... Residence of furnace/burner to sq, FT. BTU's MECHANICAL NO, Each Single fixture IOf.L .cJiABliE / , , Relocated building (new fix. additional) )t New circuits alts. ~ e~)'lJ i o~U~Tr"E SERVICES /.5:~ Floor furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each Additional bath I ~Iater servi ce Sewer Recessed wall S~~rp hp~tp~ ~nrl vpnt TOTAL CHARGES WHEnE STATE l1W REQUIRES shall not be vali1 until the I I TOTAL CHARGES 1.5'":-1 TOTAL CHARGES that tile Electrical work be done by an "E1Ektrical Contractor, the electrical portion of this permit label has been signed by an Electrical Supervisor and returned to the Building Division ITemporary Construction IChange in existing rp~idenr.p . Imultifamily, COIml. or Tnrltlc:t.rial IOf amps,l ICO~1./INO. FEEDERS I IInstall/alter/relocate I rli~trin fpprlprc: IOf amp~1 I I I I I I Appliance vent o;.E'Oarilt.p Station~ry evap. coolE'r Vent fan with c:inole duct I' Vent system apart from 1 heatino or A.C. IMechanical exhaust hoor:! and dur.t I Hood stove/heater I I I Storm Sewer ISSUANCE OF PFR!1IT I HAVE CAREFULLY EXAt1INED 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 Or~on pertaining to the work described herein, and that rw OCCUPAr~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 701.055 will be used on this project. IlAlIE(please print) T 11 \- r 4..,--4-A'" ,- .' ~r-... .". SIGIIATURE r - - - -. FQP nFF1GF- '.ISE '.Y Tyoe/Const. .<;'"'-;U Units So. Ftg, Bedrooms Occy Load Sq. Ft9. Stories ~ Occy Groupl'-Y.z?Lsq. Ftg. . /7J /.I OJ ' '/ - 'i h~.;_, !JATE.~ ..,.'}d-lf.i:. Zone ~ ~ Fire Zone Flood Plain f1ain Access Other x x Value Value Value /C>e>C>."". x TOTAL VALUATION BUILDING PERNIT Charges an~ Surcharges /~ ..... Plan Ck, COllll1/1nd / t . 65%/Rl do Ppr Fpp -------~-;;-- Plan Ck. Res . /' 30%/Bldo Per Fee I Fence ------------ I Demo 1.5': c:. '" ISidewa 1 k - --- --6;;;--' A/C Paving I Curb Cut I Systems Development Charqe 0.5%) PLUI1BING PERMIT Charges and Surcharges ELECTRICAL PERr:IT Cha rges and Surcha rges I ITotal Comb. rermit I I TOTAl :::<G. 0.<:> 11ECHANICAL PERMIT Charges and Surcharges . . I COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description I. example- Tax Lot 100, Lane County Map Reference 1/ 03 43 2. exam~le' lot I. Block ~, 2nd Addition to SprIngfield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. exam~le- heat/electrical ceilinqlor forced air c 2. examale- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - I. examole- 1250 sq. foot house, 500 sq. foot garag 2. example~ if new project. check-new - if addition cneck. add. etc. F. Building permit information: 1. example - construct single family house with an a ttached garage 2. examEle - remodel existing garage into family ro 3. examyle - 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. 11. 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 adjace 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 schedul, have been abbreviated 2. If the item(s) to be installed are not covered 01 the abbreviated schedules you should consult the full schedules C. BUILOING OIVISION STAFF WILL FIll OUT ALL FEES ANO 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. --- III. 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. V. FOR OFFICE USE ONLY ~ITY OF SPRINGFIELD . City Hell Springfield, Oregon Department of Public Works OFFICIAL RE'CEIPT N Bt=:1?O- O. ""'.!. _ I ( Dale ,JUN<!!' 3c!!1 19B';' , ( Rec'd From ~'-:D P4V/~ Address III a. ,;sL ~ If ~ 1< ' ( Received For: ( ~1r~31/?J " U~E/'k I A-l ~~t!!'PC"i:.. 13.~ Ib.o-d K':::tt5 . 1ft:!;) e:r, (5"':-6- 1-'-1 ~eJ, . 6&; ( ( ~/ -~ ~. / K#:' t.jo'l6 (, ( Z~. 0-0 '~~r~__~/' ..- ......... ~ AUTHORIZEDS;G"ATUR' '" ~" BRIGGS ..RINTERSILlTHOGR"..HEII:S, EUGENI:, OREGON r Amount Received " ( By.... c~'" ... .'. ': '''- Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: , " J Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: " , name ~JUE~~~ signature ~17 ~~ date 6-..;o..8~