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HomeMy WebLinkAboutPermit Building 1980-11-24 lUFORtlATION LINt 726-3753 So. Ftq. I.'ain cr-O.:L.- ~q. Ftg. Access. So. Ftg. Other l .Uew Add Alter Rep. RanQe '~Fence_Demo_Change/Use Value of I./ork: 11" _Other Owner ~j(,~,,,V 5CHA9,t/~vP' ! 'f?() - . ../.. / / <>~")" 'G~BUir~~nQ Permit tnfo: Oeser be Work{l",e.. Build Single Address IYI~ IfJHr'.!f.NAl4. Phon~:r~,~ Family Residence 1.lith P.ttached r.araae) I I I 1/0.0-:1 I I I /tJ.tJ.'7 I TOTAL CHARGES Contractor. the electrical portion of this and returned to the BUilding Division I HAVE CAREFULLY EXN11NED the completed application for germit. and do hereby certify that all information hereon is true and correct. and I further certify that any and all \lOrk oerformed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Orel]on oertaining to the work described herein, and that llO OCCUPAIKY 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 ons 701.055. that if exempt the basis for exemption is noted hereon. and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. IW\E(please print) &"~'II!V ~Hh..cNf!;[r,II.~TURE~', ./~L FO!!" bFFICE USE O;jL Y ,,- ,. ~ -- Units 'n. Ftg. rlain 503 x Occy Load - Sq. Ft9. Access x Occ'y Group M... I Sq. Ftg. Other x /2-t<,..-""'~~ ISystems Development I Charoe (1.5.,) 5 00 ) J-?4- 'i() fJj},A::t 0B/ t =-Q - r I I CiTY UF SPRINGFIELD COMBIiIATION APPLICATION/PERMIT EllEReY SOURCES: Heat Hater Heater_ , I WSPECTlON LIIIE 726-3769 Job Address /~~ S' (;JKrn A/AlR Legal DmriPtion'.ot"Gq I }/(e <T. U III O:...CHL/ b Construction Lender 1)&7.4 CHe..-D Address DES IGN TEArI Phone {address 1 (lics. no.) (nameJ Primary ";Je'~'7 ~Ah..v~......c/ ~ Struct\..l:'"al Electr:::ai ;~echanic3l CG~HR;.CTG~S Inal!1ei (addrpss) l1ir:~. no.) Genera 1 A ftI AI ~-,e ?lur.:bina , ::lectrlc3l ".~':!-.3.,i::~ 1 ?U;lloUjG ELECTRICAL ."}.! I FE~ CHA.RGF Nn I I Residence of SQ. FT. New circuits alts. or extensions ~t"t" 1 rUAPl~~ WL f I'acn single fixture $." $.00 I~~ioca~ec oUllding (new fix. 3~jitional) S.r. ?esidence (J bathl Duplex (1 bath) each SERVICES Additional bath ITempOrary Construction IChange in existing l'"p~ i q~n('~ multifamily. corron. or Tnduc;trial Water service Sewer Storm Sewer Of i!mps, S.Oo ICOr11".IIND. FEEDERS I Install/alter/relocate nidrih. fpprlpl'"C; .I 10f 4 b /I- amp~ / 7('V -.5, VI/rIj" Di"~I) I I I I TOTAL CHP.RGES //J ,(}rJ I TOTAL CHARGES WHEP.E STATE L.'lj REQUIRES that tile Electrical work be done by an Electrical shall not be valij until the label has been signed by an Electrical Surervisor Zone [!- / Fire Zone .- Flood Plain AIIl .~~d.... " "II-lot Type/Canst. Bedrooms Stories I BUILDING PERI.IIT Charges anc Surcharges ;:,' Plan Ck. dJC).t)O 65\/Bldo ------------ Plan Ck. t 'if {) 30%/Bl do :J{J ,00 I Fence --------:~~-I Demo ______e\tJ, 00 I Sidewalk ,,?O I A/C Paving I Curb Cut ,------------1 CorrrnlInd Ppr Fpp Res Per Fee PLU'1BlNG PERMIT Charges and Surcha rges ELECTRICAL PERr~IT Cha rges and Surcharges I1ECHANICAL PERMIT Charges and SurCharges ?] - - ...D -..\ II S"# <:.]) (exoires) (phone no. (pxoi rps) (ohonp nn. \ MECHANICAL ~!='t" nUIQf,~ furnace/burner to BTU's / Floor furnace and vent Recessed wa 11 Snar:p hpatpr ann vpnt I Appl iance vent 'iPDarate I Stationary evap. cooler Vent fan with sinole duct Vent system apart from I heatina or A.C. Mechanical exhaust hood and duct II-SOOd stove/heater lSSUANCf OF PFPJ1IT permit I om~..a Y-"G' Value Value Value TOTAL VALUATION 1.000 = Total Comb. rermit I I TOTAL >P'taJ., ~ {) it -, COMBINATION APPLICATION/PERMIT (CAP) III. t. Applicant to furnish A. Job Address B. legal Description !. examole- Tax Lot 100, Lane COOl ~a II 03 43 2. examole- Lot I. Block 3, 2nd Ac ~prlngtield Estates C. Name. etc. of owner and constructio ~n, D. Energy Sources 1. examole- heat/electrical ceil in 2. exa~~le- waterheater/electrical E. Square footage or valuation. etc. (' I. examo I e- 1250 sq. foot house, 51 2. example- if new project, check-r cneclI; add. etc. F. Btlilding pemit information: C Rec'd 1. exam~'e'" construct single 'fam; I ~, dt7.C!.cneo garage 2. examole.. remodel existing garag 3. exali1~le - convert single family; restaurant (change of use) G. Value of work as defined in Section: Structural Specialty Code H. DES I GN TEA;.! MID CONTRACTORS r: To avoid design or.construction delay Q. Division Staff must be able to cantac persons regarding design information corrections. etc. ( II. Abbreviated ?lu:r.bing. r'lechanical, & Electl ., A. :xce~t ~here blank soaces occur in thl :~rtion of :r.e Mechanical and Electric :ne a;:lplicant need fill-in only the Nc ,o^- :0 tne a~pro~riate item{s) to be insta ~ B. Full Plumbing. :1echanical, and Electri are available at the Building Division 1. To conserve space an the permit fo tn, have been abbreviated \ 2. If the item(s) to be installed are the abbreviated schedules you shou' full schedules C. BUILDl1iG DIVISION STAFF WILL FILL OUT I (FF CHARGES Oi; TIlE SCHEDULES O. As noted on the CAP. the label must be electrical contractor for signature by suoervisor. The general contractor is. to sian the electrical label. . Applicant-to sian and date Whenever possibie. the initial application \ a worr.sheet only. Where possible. Building will preoare a type written copy and return applicant at the time the actual permit is i signature. IV. Fees and Charges ( Plan check fees are due and payable at the t , application. and no plans will be processed ~~(r tnese fees are paid. All other fees and charges are due and payable when the pennit is. issued. . . PERMIT VALIDATION . , CITY OF SPRINGFIELD r City Hall Springfield. Oregan Department af Public Warks OffiCIAL RECEIPT ( No. B Date 12 ~ 3! l?~() From ~~9Ox,-~?~t:.nt~ Address 14(.)~ u - 'yt- 55504(" ( .' (0'- Received ( Far: .( hP l\~/,,,, j- JOLD C;;.[~) .. .( pp (Jplr-. Iv {tD~ Bn ( ( f,P .qD/"l) r. 2C),OO r 6,0 (' '< \ a. Amount Received ( ~1--_ 4-Q CP-. (i~ 8Y _" -C. \'.~ S (I~"UD ..D.",U", ."l~TO"'TU"..::~~T::~'<T~.. . IlUOI..t:, Oil .'.01 ( I.."'. ( \/- V. FOR OFFICE USE ONLY . Permi t Cl erk J. '". . .... PROJECT CONDITIONS.TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: /~:. ~ ,p.I1' ~ ~LL."Y' ~~ if ~~. ~~_ c,.-/. 7"...1& -:,.7.,:......... M.-7""'u /,.,'.'fi; . ., --,A. u v v ./v-gf,~tJ k M7-K4-/'d' __war. ~'!;'~'. ~ ~ ~, : tJ . ;.v ~ PLANS REVIEWED BY: name signature &, date 11-;;<(,-8"0 ~._....-