HomeMy WebLinkAboutPermit Building 1982-3-3
. CITY UF SPRINGFIEI.D
CDllBlilATlON APPl.ICATlON/PERMIT
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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
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.
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
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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 ~
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Received For:
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AUT"'ORIZI[D SIQ".ATURI[ (
'MILTOM-TV'''..U.... """JoTIIII'. IUGIMI. 0"' ....01 ...,,_. '"
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Amount Received
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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...