Loading...
HomeMy WebLinkAboutPermit Building 1982-3-3 . CITY UF SPRINGFIEI.D CDllBlilATlON APPl.ICATlON/PERMIT ~ 1/5 () L 'f~ PIc:.., ~~~~r,Y ~~~6 . I.egal De5cription -rLiJ 17- '3 -Zt:i y~ 0t- Ilater Heater E!Lr?:c... P"'~c.E"c... '# OI:tO 1 -.if -Z ~:~:: of Hark: ~, rom" Owner ::rf\:(:.l<:. LEE' - RJeI'I-\TEle. \-\-()~f5 II VVV Address \)lI\'V\~ l,..e;e:,Q Phone Builoino Pennit Info: Descr be Workli',e.. Build Single r;.;"~ C"7 \'\o1C;. F- ':;T\ I ~,,<:'"~: Family nesidence tlith Mtached Garaoel F:IAf-'='I\JF . f')~. q 7#f/ O~ P""we. TI TUN W\A\l.e-ttO,^~e. Construction I.ender ~/A I '7- 01> - .:J 0... - t.fL --rL. /;2110 . I WSPECT ION I. WE 726-3769 Job Address Address Ut~ ll.iN I t.Af1 Phone (address) {lies. no.l (name) tJ/lA. Primary , Structural Electrical J&:IiINC:~J'or/NS Hechanical BtS~IYl€K '5H~,,4?~<.. CONTRACTURS (name I (address 1 Gener~JA:flh~ ~~ Mc.~rr\.l. Plumbina (lies. no.\ ,Eh(p; Electrical ~1echanical PI.U1IBING EI.ECTRICAI. -1Jlh FEE CNARGE-liD, FFLI..cI!ARIiE. NO, Residence of Each single fixture SQ, FT, Relocated building (new fix. additional) New circuits alts. ~ or extensions ts.9!' S.F. Residence (] bath) Duplex (1 bath) each Additional bath SERVICES Temporary Construction Change in existing l"'~~ j d_e.nce multifamily, camm. or Industrial Ha tel'" serv; ce Sewer Storm Sewer Of amps. COMH./lND, FEEDERS Install/alter/relocate distrib. f@@d@rs Of amps. INFORllATlON LINL 726-3753 Sq. Ft9, 11ain ~q. Fta. Access. Sq. Ftg, Other 107m flew Ad<lXA Iter Rep, , Fence_lfemo~hange/Use _Other o f{ o ~ (exoir@s) (phon@ no. (~xDir@...l "Ii? S=-/ j <78 (,K<J-500'/- (ohon@ no. ) I:ft/W.~ tS~s 4ff OS"i Loo 7.lf6-~ HECHANICAI. FFF rH'IRGl:. furnace/burner to BTU' 5 I , Floor furnace and vent Recessed wall Soac@ n@atpr and vpnt Appliance vent c;;eoaratp S-tati.onary evap. cooler Vent fan with !i:inale duct Vent system apart from heatina or A.C.. Mechanical exhaust I hood and duct Wood stove/heater I IkI9r R- "'" ;:> I (p.oo I I - ISSUANCE OF PFRllIT /0.00 TOTAl. CNARGES TOTAl. CHARGES IS'eS', TOTAl. CNARGES ItLJ.oo WHERE STATE L"I REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit shall not be val~1 until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFUI.LY 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 oerformed shall be done in accordance with the Ordinances of the City of Springfield and the I.aws of the State of Oregon pertaining to the work described herein, and that 110 OCCUPAflCY 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 f~ce and effect as requir by ons 701.055. that if exempt the basis for exemption is noted hereon. and that only subcontractors ~emP10YeeS who are n comoliance with OP.S 701.055 will be used on this project. \ ~ ~\l'N\~ Cl L8:- ''7 IW'lE(please print) , j'"'( A _ SIGllATURE DATE ,-=<; --3-g- "-' FO~ OFFICE USE OIlLY Sq, Ftg. llain S9, Ftg, Access 13-'). S9, Ftg, Other Zone r!. - f Fire Zone Flood Plain )l'-N-.units Type/Canst. Bedrooms Occy I.oad Occy Group Stories , Value Value Value x x BUILDING PER/lIT Charges an~ Surcharges , L/.' Plan Ck, Conmllnd _______::7_~QQ 65S1BJdo Per Fpp Plan Ck, Res I,") (p 30%lBldo Per Fee #~, to 0 --#515'IOS- "'"""",,,Ill? TOTAl. VAI.UATlOII D<..A.:.A.J "J'systems Development J/ '" II"tX Charqe (!.5~) /y.,.,. Total Comb. rermit PLUl1BING PERMIT Charges and Surcha rges Fence D~mo ~~.et)1 Sidewalk _____n -~&;I A/I. Paving j G, .00 I Curb Cut __n___ -~~il EI.ECTRICAI. PER1IIT Cha rges and Surcharges NECNANICAI. PERHIT Charges and Surcharges TOTAL 7lJ.OO ~ 7t. 00\ J, , . ;, , COMBINATION APPLICATION/PERMIT (CAP) I, Applicant to furnish A. Job Address B. Legal Description I. examole- Tax Lot 100, Lane County Map Refer, II 03 43 2. example- Lot 1. Block 3, 2nd Addition to ~prlngfield Estates C. Name, etc. of owner and construction lender D. Energy Sources ( 1. exame'e- heat/electrical ceilinqlor forced c..... 2. I example- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq. foot house. 500 sq. foot, (11" 2. example.. if new project, checknew _ if add; .... cneck add, etc. F. Building permit information: 1. example.. construct single family house witt: < attached garage 2. examele - remodel existing garage into famil 3. exa~le - convert single family residence 1n restaurant (change of use) G. Value of work as defined in Section 303 (a) of t Structural Specialty Code H, DESIGN TEAt4 AND CONTRACTORS To 'avoid design or construction delays, Building Division Staff must be able to contact appropria persons regarding design information or job site 'corrections, etc. II. Abbreviated Plumbing, Mechanical, & Electrical Sched A. Except where blank spaces OCcur in the descripti! portion of the Mechanical and Electrical.Schedul. the applicant need fill-in only the No. Boxes ad, to the appropriate item(s) to be installed B. Fun Plumbing, Mechanical, and Electrical Schedu' are available at the Building Division 1. To conserve space on the permit form the 5chl . have been abbreviated , 2. If the item(s) to be installed are not cover, ~n the abbreviated schedules you should consult full schedules C. BOILOING DIVISION STAFF WILL FILL OUT ALL FEES AI ('" CHARGES ON THE SCHEDULES D. As noted on the CAP. the label must be delivered electrical contractor for signature by his electr supervisor. The general contractor is.not author to sign the electrical label. - ( Applicant to sign and date Whenever possible, the initial application will be us a worksheet only. Where possible. Building Division will prepare a type written copy and return it to the ~. applicant at the time the actual permit is issued for Signature. ~ Fees and Charges Plan check fees are due and payable at the time of the application. and no plans will be processed until these fe~s are pai~. All other fees and charges are due and payable when the permit is issued. III. IV. V. FOR OFFICE USE ONLY -- -- . ~ I CITY OF I nC'nUTT "'" T nI\TTf'''' SPRINGfiELD 4 ( City Hall Springfield. Oregan Department of Public Works OFFICIAL RECEIPT No. B S 814 54 I 19P,d . Date ,~- ,~ Rec:'d Fro Address '8 ~ -~, ,,'-" o QJ) ( 1'\ ~tl~ u (y', o ( Received For: " \, b-'P ( tJ f) ( f frL() C ,( Lj '-I. co /.70 /~-. f)() .h() /I, , fJO , (,,</ 47D ( L.j '} (} c L/9" ,( (' it' 1 f,OO ~(l/)II . . (0) /1dJ..l .J , AUT"'ORIZI[D SIQ".ATURI[ ( 'MILTOM-TV'''..U.... """JoTIIII'. IUGIMI. 0"' ....01 ...,,_. '" ( <: Amount Received <: Permit Cl erk (J J Al d.u..~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additionail Project Information: PLANS REVIEWED BY: name signature ~~ . ~ UU-. date 3-'3-~:z...