HomeMy WebLinkAboutPermit Building 1981-7-13
I INSPECTION LINE
726-3169
I Job Addre~'
I LltgaJ Oescriotion
I
-
2~73 OC.T/YIF'7C.
t..<>r /.~ f.?4-L/-A#<:"
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r~~D.
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Construction lend.r
Add,.n
CESIGN TEAM (name)
Primary B;:?tlLe ~""'''fJkc..~,,~^,.,J./.A
SlructurClI
electrical
CITY OF SPRINGFielD
COMBINATION APPLICATION/PERMIT
I ENERGY SOURCES:
Heat
I Water Heat.r
Ranae
57.
Phone
(oddreu)
7..,
~f'.-V,.=. /7 :.::J ,.;'v.~,.
Mechanical
CONTRACTORS (nome) (address)
Go"'ol rJ3'~/4.:}-)[ p f~--U~
Plumbina .:> M~ -{"-{.,,,n-vt-:-"'''--:l'
Electrical
/~~~.-/
)'0"
2 0/t.--l..L91.
Mechanical
PLUMBINC
NO. i
/
Each sinal. fixture
RelocaTed building
(new fi.... additional)
S.F. Residence
(1 bOlh)
Duol.. (1 balh) each
Additional balh
Water ,.,...ice
Sewer
Storm Sewe,
TOTAL CHARGES
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5:""""'1
ELECTRICAL
Residence of
__.__~o,:ft.
New circuits, alterations
or e.tensions
SERVICES
Temporary Construction
Amps.
FEEDERS
Ampl.
TOTAL CHARGES
.
INFORMATION LINE
726-3753
, I
Sq. ftg. Main
Sq. Ftg. Accen.
Sq. fig. Other
_New _Add _Alter _Rep.
__Fence_Demo_Chonge/ Use
_Other
~
Ii
1
\J
(Iics. no.)
1J>/7;J7~.~~~
. (..pires)
(Iics. no.)
(e.pirel)
,;70 -y P' B
,;1 D~ 3) C
C;/C/o
FEE I CHARGE
I
I/j-:"'~
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I I
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IS 00
G - ..30-;,"l.
b - 3o....J12
!?-/7-Y/
MECHANICAL
NO.
I furnace/burn.r to
'II,TU'I
I Appliance vent
separate
Stationary evap.
cooler
Vent fan with
sin~l. dud
I. V.nt system apart from
hoatinQ or A.C.
I M.chanical exhaus'
hood and duct
I Wood stove/heat.r
I Heat Puma
I Air handler to
10,000 CFM
Air handler over
10.000 CFM
!/Y,4c. P'-''''''T/r'''''~J,.-
I I
I I
(phonll no.)
:;:)9-7S-~:\;
I
(ohone no.1 L
to ,)'7 -./2 ,.y ,
3'13.)-'-011
3 tj.?-.2/43
7-!..b-8'9-.?(
FEe
I CHARGE.
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/6."",.01
I I
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I~ue of Work:
Ow... 8.:Sv./"l/,Iyr'H r??/i-J-,,"U.../N ~~_r 4{.~1 .y'17~/J- ~
J.J-~' ./ ~.J - I Building Permit Info: Describe Work (Le., Build Sing I.
Addreu -.."/ ~ Lt,( '-~UM~..d. Phone ~ -,8...t2/C=; Forni Iv Residence With ~t1ached GorJ:lq~ .
~:ZS'8 I <,-~~.zl.(:...-d 1[,1.'-aJt./k,"f..
I ' '']'7<#/ / "" )' "
-f.J -<''','0---<:.( ,') .4 A-.-<''-'Zh
I ".Y (/
'~jJ' 71- I
l , _'....<~M_..l."'..
,[3 /!-<.L.-M'-../-
I
fEE i ~~:E i NO'1
10'"
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ISSUANCE OF PERMIT
TOTAL CHARGES
--
/tP.""
/{,. ~
WHERE STATE LAW REQUIRES that the Electrical war. b. dona by tho Elet~,ical Contractor, the .lectrical portion of this permit shall not be yalid until 0
lobel hOI be.n signed by an Electrical Controctor and attached 10 tho electricol panal.
I HAVE CAREFULLY EXAMINED th. completed application for permit. and do hereby certify that all information her.on i. true and correct, and I furth.,
certify that arty and 011 work performed sholl be don. in accordance with the Ordinances of tho City of Springfield Gnd the Lows of the State of Orcg!:'n
pertaining to the work described herin, and that NO OCCUPANCY will b. mod. of any structure without the permission of tho Building Divilion. I furthor
certrfy that my r.gistration with the Builder's Boord is in full force Gnd eff.ct os required by ORS 701.055. that if exempt the bOlis for ....mption is noted
heron, and that only subcontracton and employees who are in compliance with ORS 701.055 will b. used on thi. project.
Basis for Builder's Board ...emption:
NAME (plto.. p".') G<.{ l' '< E 'T}, 0 m P,<:'O t1
c--:<
Type/Con.t. :11:- /.11__<
~drooms
Ion.
Fir. Zone
Flood Plain
c"'ri.-
q.
BUilDING PERMIT
Chorges and
Surcharges
/B! """""
7. -;; 'I
5",-""0
~""
PLUMBING PERMIT
Chargel and
Surcharge,
ELECTRICAL PERMIT
Charges and
Surchcrges
/ J-' _0
-~('.?
~
o 'GNAYURE duf OA/~
FOR OFFICE USE ONLY
Units
....'cy Load ~'!~
"ccy Group 1?.. :2
I Plan Ck. Comm/lnd
65%/ Bldc Pet fee
I Plcn Ck. Res
30%/ alda Pet Fee
C--:. Ftg. Main
Sq. Ftg. Acc.n
Sq. Ftg. Other
e "~'~"hOATE7-)3~?1
.
Yalue
Yall.le
.IC "clue
YOYAL VALUAYlON '-117. /$1';>, "'"'"
1//7-c;..,-f3;.-I.2-0 I Sy"om.Oo-;:lopmt.t
/). P_ Charae (1.5,..1
I I
I
Fenc.
Demo
Sidewcdk
MECHANICAL PERMIT
Charges and
Su,chargel
A/C Pavina
;6 ' ~o I Cu,b Cut
..-----.-6'(-1
.
I
'17, ?~8. ---
I 7/~, ,,-=<
I
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1 ~z.S',6S
I
I'
l Total Comb, Permit
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I TOTAL
# CJ ,/(.90
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'I. Applica~ to furnish
A. Job Address
B. legal Description
I. example'lax lot 100, lane County Map Reference 17 03 43
2. example.Lot I. Black 3. 2nd Addition to Springfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole-heat/electrical ceilinQ/or forced air gas
2. examole.~afer heater,' electrical/or solar .
E. Square footage or valuation, etc.
1. examole..I250 sq, foot house. 500 sq. foat 9ara9' {
2. exam pie-if new project, check new.if addition, cr.
add. elc.
F. Building permit information:
1. examole-construct single family house wi"lh an at ;t. Dote
goroge
2. exomole.remodel existing garagE:. into family roc .r Rec'd
3. exampie~converr single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (0) of the
Siructurol Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction dl;"lo)'s, Building Div
Staff must be Cible to contact approF-'ril.lte persons re C'"
design information or job site \;orrec-Hons, etc.
COMBINA nON APPlICA nON/PEA
(CAP)
II. Abbreviated Plumbing. Mechanical & Electrical Sched~1
A. Except where blank spaces occur :n the description,
or the Mechanical and Electrical Schedules, the cppi
need fill-in only the No. Boxes adiC1cent io the Orpj,
item(s} to be installed
B. Full Plumbing, Mechonical. and Electrical ~chedules
ore ovuiloble at the Building Division
1. To conserve spoce on the parmit form the schech
hove been obbrevialed
~. If the item{s} to be instaHed c:r~ not C(\vered or: t
aled schedules you should consult the full sched,
C. BUILDING DIVISION STAFF WILL FILL CUT ALL FEES
CHARGES ON THE SCHEDULES
111. Applicant to sign and dote
Whenever possible. the initial application will be used
worksheet only. Where possible, Building Division Staf
prepare 0 typewritten copy and return it to the opplicc
the time the actual permit is issued for his signaturE.
IV.
Fees and Charges
Pion check fees ore due and payable at the time of thf
and no plans will be processed until these fees are pai ('I.
other fees and charges ere due and payable when the /'"
is issued. 4-- '- ~
v; FOR OFFICE USE ONLY
~-
'.'~........__-_-_..c....._-.'
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
/ - 07'(r,;' Z;:: ;:~/.
...
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PERMIT VALIDATION
CITY OF
SPRINGFIELD
City Hall
Springfield, Oregon
Deportment of Public Works
OFFICIAL RECEIPT
(
No. B
1981
P t:eJI'LI, frY.
('('OnrCf, ~yt- -'S Xj-en<::.
7-cJ~
56950(
from mon':I.~\
.:('
Address LYt) I
\
Received for:
hn
fRIQO
7 -J.L!
SO/:;
,2()
/_J"'. ()j
.t/JO
/['1.00
.loti
7 /0,d, ~
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L/ / ) ~~'::~..=-::~ (
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( J/1(') { .v
AUTHO"IZ[I) SIGNATU"I[ (
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. Amount Received"
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Permij. Clerk
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Additional Project Information:
PLANS REVIEWED BY,
/ c,=>"I-.,J;: ;-"-:~.c cR
name .:..- .,/, , "ignctur....
,
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7 - -:2.0-8 ,
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