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HomeMy WebLinkAboutPermit Building 1983-9-14 e()(l)-tAcJ : ~1_1()'lf-\ .o.,u ,rYlGr1.. ~~.L3- ILlO':) 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' I vg(Y)(lrJ u . (l.DOVYLUV.'~ I (6.llj lrlu7 a I U 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 .J) 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. / 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~'~ )~.P~ I~~~ J.f' f>J A s:. ~ ~ )f?M-. ~p~ -t7~t1)o , .-) ~j} ..n , n .. CA.k., f^/ I)~ J-/- a; 0 )f"&ckr.L-~ _< () vf)-_ h~ - /';J.Q {: f'.~. -- t:211/; -, I Amount Recelve~ e:z ? 1. 51 ~ ( /" AUTHORlZEO SIGNA T '",. ~RINTE"./I.ITHOORA~ (! !!- ) Permit Clerk ,I _,tfN .4~/~......(_ . ;t::'6~ " . S4v~E #..:::a 1#$JZ>~770~ tfJ;;Y~ I~~~ MEc::.HA-#/C:::::A~ k6>RA/ k> ~E kr- :,Qt-~ < (,.J7'~ ~~~__ACAJ"_ '/t~~ W~ ~~AI'/.,.=.:?;>. , ~A?/r . , . Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: . ~ name L.t>R/'o!.... ;:wc::::~~ignature~~~.. ;;- L~_~ I .. ., ~ date 9-/3-.a3 J /