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HomeMy WebLinkAboutPermit Building 1982-9-3 . . I INSPECTION LIIIE. CITY Uf SPRWGfIELD 726-3769 CDrmWATION APPLICATION/PERMIT J b Add '/0 r \" . C -II E!IERGY SOURCES: o ress.,,:)() '-I I) "':1.\'),(, <,\)t,,,~ P!ll~ Heat Legal Description 'I n~ 'd S '=) l (), 17J0 !Iater Heater Ranqe_ ValuE of Hork: I~.- e.-r "ief1~I\+ Address..:\ ()<I'O y€,(I..c.J ~O()ht \4alr <;0[0'1 OI,\",u,C_ SD(I~~{t..\L Phone Construction Lender Address UE5 I uN TENT (name) Phone (address) Primary Structural Electrical 11echan; ca 1 CONTRACTORS , INFORlIATION LINE 726-37S3 Sq. Ftq. 1,Iain ~q. ~tg. Access. So. Ftg. Other New Add Alter Rep. -Fence Demo Change/Use Other- - - I c/) rJ Builolna Pernlit Info: Describe Work{i.e., Build Single Family Residence With Attached Garaae) L -1 j) () ( ~.om ml" 'f ri (1,,1 Kp,m(Jcllf>-, flies. no.) (ohone no.l (exoirf!sl (address) (lies. no.) 10101.\ \lnoo/k ~f.\P"P" ICCl/d ...,,) '''; I~ ELECTRICAL FEF r.HI\Rr.F Nn~ S:'- Residence of SQ. FT. I New circuits alts. or extensions SERVICES (name) 't4o.:t'f'Y A."hbclV'l'\ 6c o-I.;", IJ, 't.-\ec+,(;C +-,'re 5orl\\~\'Y Genera 1 Plumbina Electrica'l f..lechanical \-bl(()f'''-. -\- ~(-ic..p PLUllBlIlG riO, I Each single fixture Relocated building (new fix. additional) S.F. Residence (1 bath) Duplex (1 bath) each Additional bath (~xDir~s) (ohnn~ nn. ;;,JiJg/){"!., 34?'-S"~qo MECHANICAL ~r:L...cH8.R.G.E. NO, r:r:L..tliARG.E.. I furnace/burner to BTU's I~- Floor furnace and vent Recessed wall ~n~rp hp~tpr ~nrl vP~t amps. Appliance vent seoarate Stationary el/ap. cooler Vent fan with sinale duct Vent system apart from I heating or A.C. Mechanical exhaust hood and duct Wood stove/heater Hater service Temporary Construction Change in existing res j deflCe multifamlly, COJrnl. or Industrial Of CO~1,/INO. FEEDERS Install/alter/relocate ni~trih_ fppdpr~ I t: 0.. TOTAL CHARGES I~. - TOTAL CHARGES that the Electrical work be done by an 'Electrical Contractor. the electrical portion of this permit label has been signed by an Electrical Supervisor and returned to the Building Division , I HAVE CAREFULLY EXM11NED 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 Oregon pertaining to the work described herein. and that NO OCCUPAUCY 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,Wiji be used on this project. IWIE(please pr;nt)+bVY(! .It<.kltcvv\, SI(,!lATURE ~ /J-t{.t-uw/' DATE q-:s-!,'d" FO~ OFFICE USE m.LY v Sq, Ftg, flain Sq. Ftg. Access Sq. Ftg. Other Sewer Storm Sewer Of TOTAL CHARGES WHEnE STATE L~W REQUIRES shall not be valiJ until the Zone Type/Canst. Bedrooms Units Occy Load Occy Group Fire Zone Flood Plain Stories BUILDING PWIlT Charges an~ Surcharges /....... 0" Plan Ck, Co","/lnd /"". 65%/81 do PPf Fpp -------.-~~- Plan Ck, lies -,' 30%/Bldo Per Fee _____s;.~____ Fence . ,,:/e> Demo ' PLU',IBING PERMIT Cha rges and Surcharges I I I I I _,L.. ELECTRICAL PERI:IT Charges and Surcharges ----/(;!>. - . .yO Sidewalk A/C Paving 11ECHANICAL PERMIT Charges and SurCharges Curb Cut amps. ISSUANCf OF PFRIIIT Value Value Value TOTAL VALUATION x x x b.St!:> Systems Development Charqe (1.5~) Total Comb. rermit 7(;, . -- TOTAL "3 2. ~o i . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Oescription I. examole- Tax Lot 100, Lane County Map Reference 1/ o.j 43 2. examp'le- Lot I. Block 3, 2nd Addition to springtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. exam21e~ heat/electrical ceilinqlor forced air ( 2. examole- waterheater/eJectrical/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house, 500 sq. foot gara! 2. example- if new project. check new - if additior check add. etc. F. Building permit information: 1. example - construct Single family house with an attached garage 2. exam.ele - remodel existing garage into family rc 3. exam~le - 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 adjacE to the appropriate item(s) to be installed 8. Full P.lumbing, 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 c the abbreviated schedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES O. As noted on the CAP, the label must be delivered to electrical contractor for signature by his electrica supervisor. The general contractor is.not authorize to sign the electrical label. --- Ill. Applicant to sign and date Whenever,possible. the initial application will be used a worksheet only. Where possible, Building Division Sta will prepare a type written copy and return it to the applicant at the time the actual permit is issued for hi 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 J . PERMIT VALIDATION tPiloQ4 (' -1- CITY OF SPRINGFIELD ( CllyHall Sprlngllald. Oregon Department 01 Public Works OFFICIAL RECEIPT , No. B 59694 Dat__~ ri- i. \519 8~ I Rec:d~::;]i~~.ll\l~ C'~ I Address \fJ\. 04 t~.A )-{l 1\ Q .tN ~ I"f )),Q \4 fj ~ ( ( ( ~ Received For: ( ( '- 1~n\l).OO t\ c~( J}') . - 4{) , A )Q~,J) , c:::; '.00 '\, ,Lj% .~() ~, 0 Q..iliM-. I () .-00 .40 (t"l_.sn ( ( ( r' I , 4-0/) ( (\r)~ - \ I) ( .~ 1,1fJ . Sf) ~~~. l~uJ'~~RE Amount Received ( ( .~..., .Rllla. PRINTER8/UTHOaRAPHIER.,IEUaI:NK, OREGON ~ . -'- Permit Clerk~~) PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: i J 01 Permit .applicant exempt from registration with the Builder's Board because: ! Additional Project Information: PLANS REVIEWED BY: name signature , r.=-=-~~--:::::.:..-::::::. -~':'_~==;::-'::'.;:'-:--::-':""'=::':',~-::::':-.-::::.-:':-.~_-:-:::":': ~'::':'.=.::::..:,;::.':';;"==";~=:':::,-':::-":"::.~:::;:':;;:'~'w_-:"~--;:::;=~;::~~_ ._------'_.:..7':.-;::--~~...::-. . "J date '. . ~