HomeMy WebLinkAboutPermit Building 1983-9-14
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IltISPECTIOl1 L1f1E' . CITY OF SPRIfI'GFIElD
726-3769 COIlBlflATlDN APPLICATION/PERMIT
Job Address /920 04 y)I? ~r: I ~ ~fi +'Fl d mAl J ~~;~GY SOURCES:
legal De.cription /7-.CJ!>'~S.31 . 0 ~?ao 'later Heater
, Ranqe
Owner KIi' Al(l-IF'o';IFL! !(?-'~lL ::Mops
AddressLf~ll ,"iVl'T>= ( A')~(ytj ct_
C I)()( {)fr (9 t.A YLj.::;.::l--1
Construction le~der
Address
DESIGN TEAI1. (namel
Primary (CUr\ Icnr,ll)/I, rllln~
Structural ' (
(j /MIl.
Electrical
Value of Hork:
:!<~. _0
Phone BuilGlnQ Pennit Info: Descrlbe \~ork(Le.. Build Single
,.C.IIl:;.-.cb<:_IJ< (:familY nesidence I~ith JI..ttached Garaae'
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Phone
(address)
,
INFORllATlON LWc
726-3753
Sq. Ft~. 1-1ain-L....:?6
~q. HI). Access.
Sq. Ftg. Other
---!lew_AddXAl ter_Rep.
__Fence__Demo__Change/Use
_Other
C()
lJJ
-
...D
IOQ
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flies. no.)
(exoirp.s)
(ohone no.
I
Mechanical
CONTRACTORS (name) {address} l1ic~. no.
General g.IIEhr 5kJEE7". /t>SS" $14 &-":'~,,":>EH ~r:>
Plumbino J1:>u ~;r~W# ~, kvw ~N..v~
Electrical <'..4. ~C~7: (~he-.c.svr')
~Iechanical J?6A;;1 ~~ '
I
each I
I I
/I~ater service 1.tl.~~7s-o'l/a-
I Sewer I I
I Storm Sewer I I
I I I
I I I
I I
I I
I I
I I I I
TOTAL CHARGES ~. c:Il:>i TOTAL CHARGES I S....., TOTAL CHARGES
WHERE STATE L"~ 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
PlUIIBHIG
-1ll' , I
'I Each single fixture
Relocated building
(new fix. additional)
I F~L 1...t.l:i^~H:~
r~o .............
~. oIItW-.
S.F. Residence
(1 bath\
Duplex (1 bath)
Additional bath
ELECTRICAL
"ll..-'
Res idence of
SQ. FT.
1
New circuits alts.
or extensions
::l dR ./V')bR~
I SERVICES
I
(pxni~psl (ohnnp nn )
?~roB"/
. r;EL..CJJAllliJj,n
MECHANICAL
. en'
'ru~
ITempOrary Construction
IChange in existing
rpsictf'llCP
ImUltifamily, COIml. or
IndlJc:.tria.l
IOf
ICO~1./IND. FEEDERS
Install/alter/relocate I
rl;~t~ih fpprlp~~
Of amp~1
amps.1
furnace/burner to
BTU'S
I
,15-
I
I
I
I
I
I
I
I
I
I
Floor furnace
and vent
I Recessed wa 11
Soa.rp hp~tp~ ~nrl ~pnt
I Appl iance vent
, 'ipoar:atp
I Stationary evap.
r.oolpr
I Vent fan with
sinole duct
I Vent system apart from I
hea t i no or A. C.
I Mechanical exhaust
hnod and durt
I Uood stove/heater
I
I
I
ISSUANCf OF PFRrnT
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 Derformed shall be done in accordance with the Ordinances of the City
of Spri n9fi e 1 d and the laws of the S ta te of Ore!}on pertai nf n9 to the work descri bed here; n 1 and tha t rw OCCUPAllCY will be made
of any structure without the permission of the Building Division. I further certify that my r~g.stration with the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exem t on is noted hereon, and that
~:r::(:~::::t:::::~s a\lloYee\?~:l;~~~~~~::~:~ :Z;!f 0 ~/~~ATEgfu/03
- FO~ Or(ICE USE miL Y I I
Sq. Ftg. riain-LY.<~ x Value 3'2_OC4>_o.
S~. Ft~. Access x Va I ue
Sq_ Ftg_ Other ,Value
Zone rMR
Fire Zone
Flood Plain
Tyoe/Const~.IIf.~}>~.Units
.
Bedrooms Occy load
Stories / Occy Group.fi-;Z
Plan Ck. Comm/lnd
65~/Bldo Per Fpp
Plan Ck. Res
3D%/Bldo Per Fee
::;t::'. 4<: Fence
I. <p I Demo
_____/s:-I Sidewalk
.';1> A/C Paving
BUllDHlG PERmT
Charges an~
Surcharges
I -;?J:So -..
____L_______
5".~
PlUl1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERr:1T
Charges and
Surcharges
IIECHAI! I CAl PERMIT
Charges and
Surcharges
TOTAL VALUATION
Syste~s Development
Cha roe tJ. 5~) -
36. ~s-
Curb Cut
I
J./. A.
I
I
I
lrotal Comb. rermit
12>5"./<:'
I
I TOTAL
27/S7
.
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Oescription
I. example- Tax Lot 100, Lane County Map Reference
17 03 43
2. exa~le- Lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. example- heat/electrical ceilinqfor forced air oas
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
I. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project, check new - if addition.
check add. etc.
F. Building penmit information:
1. example - construct single family house with an
attached garage
2. exam~le - remodel existing garage into family room
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. DESIGN TEAM AND 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.
II. 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 adjacent
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 schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the- -.
fu 11 schedu 1 es
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. ---
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.
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V. fOR OffICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
PERMIT VALIDATION
.-
)
CITY OF SPRINGFIELD
City Hall
Sprlngfiald, Dragon
-) ,d! ~7artman' of Public Work.
@ 0/ b8"~FICIAL RECEIPT.
No. B 61
)Date q--r~ 19 ~~ .
) Rec'dFrom e,~d.!" u::t=" _
. Address / 0 ~-S- s: ~!!-:
) RecelvedFor:~-J/:- i3/~j~'~
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t:211/;
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Amount Recelve~ e:z ? 1. 51
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( /" AUTHORlZEO SIGNA T
'",. ~RINTE"./I.ITHOORA~
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Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
.
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name L.t>R/'o!.... ;:wc::::~~ignature~~~.. ;;-
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date 9-/3-.a3
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