HomeMy WebLinkAboutPermit Building 1980-1-8 (2)
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I INSPECTION LINE CITY UF SPRlIlGFIlLD INfURllATlDN LINE II
720-3769 COMBINATION APPLICATION/PERMIT 726-3753
Job Address 7 -z... 4-9 !1'A/Sd c:>-r. Ener9Y Sourcesi' sq. ft. main & accsy. bld9 ~
7 -"r. oeat ~ilJ f"''''_4"'~ '\nt~ I/" ,t.. 7 ,S1{A. u: ~ ~
... riater hea, ter-~"'''''',''''I''''!'1!.1Ar'" ~new_add dTter:_rep. \.J'
Le~al Oe,criptionA.OT ,f),;}I-{c.!(el1-zip_ #,1/.-< ranoe ~.Iv_~>f ___u fence demolition
f ~4'~ L changelUse, other I 1:>\
J70;l 35.34 TO..:x A.d/"" dlOO ,alue 0 work:!'(.~<:>.(.l!;n L..... - \",J""
_~I A"'---,-DAz:::' Juildin9 permit info.~ describe work (i.e., build I.c-
Owner (name/address/phone) d.,..4/1V /'Ic-- "'H~ iinQle fam. res. with detached oaraael \J
S~ ;/tl/YJ?{ It! ~JJJ.lf.affJ/; I
. /J)./]-JJ /1f1/JflJ;,A r;/lUf/p_ / I,
Construction lender (name/aqdress/phone) (/ tI . ~ I~
, " I
Dt.SHiN fEArl (namel faddress) (lics. no.) (exoires) (ohone no.)
Primary ALfb",.IO ~ 2:2-.9N"r::;jt{ ~ 747 Rtf23
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Structural
Electrical
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Mechanical
CONTRACTORS I name I
:r;;;,;v .,()f t::. Jt#l3
Plumbino "BI'l"SbIl) ~)U\N\'n1 ~~
Electrical B;IIe. /:.\eL.ivl~
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'Iechanica! ~":;tt()A~vt J..\~o.:f.\lAj=
PLUI,IBIIIG
General
NO.
'E,
rl-1ARGE
Each single fixture
Relocated building
(new fix. additional)
,~ S.F. Residence
.,. II bath\
Duplex (I bath)
I !Additional bath
I ~!a ter servi ce
Sewer
I
each I
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I 11}."'0
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Storm Sewer
TOTAL CHARGES
WHERE STATE LAW REOUIRES
shall not be val id until the
(addrp~c; )
) (pxnirp';.)
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no.
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MECHANICAL
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_343-05:z.~
ELECTRICAL
NO.
1.ilL J:JjARGJ:. .lW
I Residence of
V 16,7'.7
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furnace/bu~ner to
BTU' 5
SQ. FT.
:lS""
Floor furnace
and vent
New circuits alts.
or extensions
. Recessed wa"
~n~rp hp~tpr ~nrl vpnt
I SERVICES
I
I Appl iance vent
SPOrlr<ltp
I Stationary evap.
cooler
I Vent fan wi th
3 sinole duct
I Vent system apart from I
heatino or A.C.
Mechanical exhaust
hood and dud
3eo
'1'!9
ITempOrary Construction
IChange in existing
rp~ i dJ'JH.P
multifamily, comm. or
Tnrlll<;;trirll
I
amps.1
Of
ICOMM./IND, FEEOERS
I Install/alter/relocate
ni"trih_ fpprlpr"
I 1,/,,9)
I So ClG
I
Of amps.
New circuits. alts.
"O' ~vt"'n.,;nn'"
I
I
Wood stove/heater
I
I
TOTAL CHARGES
I
/b,onl
~SO I TDTAL CHARGES
Electrical Contractor, the electrical portion of this
Supervisor and returned to the Building Division.
permit
ISSUANCE OF PERf11T
.3S"~
that the Electrical work be done by an
label has been signed by an Electrical
I HAVE CAREFULLY. EXAMINED the completed application for permit. and do hereby certify that all ~nfo.nnation hereon is true
and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinan'ces of the City
of Springfield and the Laws of the State of Oregon pertaining to'the work described herein, and that NO OCCUPANCY will be made
of any structure without the permission of the Building Divis;!?n. . n, YJ 11 .'. 11 _' .
NAI'IE (please print) bD l\~\A c. MeR-d.€... ' SIGNATURE N~ C.11-c~'DATE ?-I~'~O
Flood Plain IV"" Bdrms ~ Type Const., --J/~_ Sq Ftg.
Oeey Group 1fJ-~ Stories l Units' / So FtlL
ACe 0 U N T SUM MAR Y
Plan Ck. Comm/Ind
65%/Blda Ppr Fee
Plan Ck. Res
30%/Blda Per ,ee
Zones R-I
Oeey Load
BUILDING PERflIT
Charges and
Surcharges
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1.'10
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1,</0
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PLUMBING PERMIT
Charges and
Surcharges
ELECTRICAL PERllIT
Cha rges and
S.urcharges
11ECHANICAL PERMIT
Charges and
Surcharges.
FOR DFFICE USE ONLY
1I()'1~.7
S'fr~..:lS'
Value 'iln:i'~..<t~_,,-
Value 1.J3 It...~~
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Fence
~\ <:\~.
I Storm Sewer Connec.
112:9. II Other
I Other
I Other
I Total Comb. Permit
I SDC I.s-%
I
I TOTAL
<Int.. II
L?,9S,l!)()
-#1801.//
Sprinkler System
Demo.
A/C Paving
Curb Cut
/,(1 /
7'1. -M
/1. goo
7.<:JS
Sidewalk
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COMBINATION APPLICATION/PERMIT (CAP)
1.
'.'
Applicant to furnish
A, Job Address
B. Legal Description ...
1. example- Tax.Lot~lOO, ~Lane County Map Reference
'11 63 43
2. example- Lo-t'i. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceiling/or forced air qas
2. exarnyle- w~terheater/electr;cal/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. example. if new project, check-nEw - if addition,
check add, etc.
'.F: . Building permit information:
1. . ex'ample - construct single family hous~e wlth- an'
attached garage
2. exam~le - remodel existing garage into family room
3. examole - 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 TEAl,! 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.
Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules, r :1
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
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must
electrical contractor for signature
supervisor. The general contractor
to sign the electrical label.
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.
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
p~yable when the permit is issued.
-, "! ,~
11.
be delivered to the
by his electrical
is not authorized
11f.
IV.
V.FOR OFFICE USE ONLY
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'PERMIT.VAlIDATION
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Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Additional Project Information: U,.A' .
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P~ANS REVIEWED BY:
't ;;ho~ .
~~.A'~,
name
signature ~"'A' L..;.:rY.
date/-.:l-X'/'?
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747 cf'tf23
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DAJ cf'AE
:ones. .p-/
Deer IJ.1J
BUILDi,'ift .'('::.:11 i
Char'j(!\ Jnd
SurCh,Jrr.es
Plt:~a I:i(j P(;~:~l i
Charges dnd
SUrChJrl;eS
ElECTRIU,l PER':IT
Char.,'!,> dnd
Surchd rges
(address )
2::;2.!:) N.~ -s:
(1 ics. no.)
ConstructIon Lender (name/address/phone)
~rl!'oII"Y
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permi t
J b', 'if ORE FttlLY EU,,r,l!:I[D the camp 1 eted app 1 i Cd t i on for permit. and do hereby cert i fy that all; n fonna t ion hereon is true
\lnd con'~c~. Jnd I further certify th~t any and all work performed shall be done in accordance with the Ordinances of the City
of SprU1<H1Cld Jnd the lJWS of the State of Oregon pertaininCl to the work described herein, and that NO OCCUPAtiO will be made
of 4"1 ',:ruc:ur(! without the permission of the BuildinQ Division. (\ /J II
1lA.~E(ol'J\epnnt) bD""i,Q C. MC'f2,de... ,SIGNATURE N~c:':.1JLckDATE?-IS-qO
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I I I SSUANCE OF PER!IIT / t.:1..~D I
TOTAL (;"'(,ES 55,,:-1 TOTAL CHARGES ,..1!3.50 I TOTAL CHARGES
.~t;r S~~7( l^~ REQUIRES that the Electrical wo~k-be done hy an Electrical Contractor, the electrical portion of this
'.ih411 ~a: ~e VJlid until the label has been signed by an Electrical Supervisor and returned to the Building Division.
p',
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Slruc:unl
[lec~rl C! 1
~~c"'nICJl _ .___.
CC~H5rJ( IMS f name' _ ._ _ _
G<nml biJ;V .(/)1c.m~.
Pl\r-"bIM_?;rtS"if\ '~\ll\t.'\~\ ~3
Elect"Cl! 13: \ i c., I=Jr'c.-t,rl '--
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PlU::SI::G
:00. I FFE. CHARr.F NO_
[,en \ln~le fiKture
R~locJte(J ~~llding
(n... ri.. JQditiondl)
v S. r. "e\ l":enec I .., <' 0:;
(I !':,l~~\ r:.~AJ.
(h..:I1.'1 (1 ~Jth) edch
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,l1~lll tl On.! I b.lth
Y.lter ";~rVlce
IS~..~r
IStor~ Sl,...~r
7t1/-:::Jqft,1
7.:.f7- 4:~9()
(;,67-/8.:51 .
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MECHANICAL
) (exoirps)
/ .-:>..,5 3, '-/
ELECTRICAL
FFF
rHARGF NO, I
" Residence of
V.f,'c'J;'/,,7 SQ. FT.
INew circu~ts alts.
or extenSl0ns
ISERvtCES
I
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wall
So~cP hp~tpr ~nrl vpnt
~
,-'
App 1 i ance vent
<;f"oaratf'
Stationary evap.
coolf"r
Vent fan wi th
sinole duct
I Vent system apart
heatina or A_C.
I Mechanical exhaust
hood t1nd rllJ('t
I Hood stove/heater
ITempOrary Construction
IChange in existing
rps i dJ'~nrp
Imultifamily, corrm. or
Tndll<:tri.11
IOf
ICO~j./IND. FEEOERS
l'Install/alter/relocate
rlic:trih fpprlprc:
IOf
/
3el>
9""'1
I
'J..-01
IS.Dd
I
amps.
INew circu!ts. alts.
"'.. ..v.."'....,'''....,
from
amps.1
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FOR OFFICE USE Olll Y
Flood Pbin //,~i Bdrms 3 Type Const. 1/-/./
tl..:..:y Group (...'_=, Sr.o~/ IJnit:c:' /
. d -,- F rr-IC1J-Y-ue. -I} il t.1- 0: P v
..,.,.> ,,~ Plan ck~Co;m,ilnd . 1"" "
_ _ _ _ _ _ ::;,(J$':';'.:":'-'-. 65~ B 1 d P r F e
1'- Plan Ck. Res
,/).'1'2 30%/Bld Per Fee
~S". OJ I Fence
-------\",;---.-
! . 'I() I Sprink'ier System '"
_ _ _ _ _ _ _~3.~':.!..~z. Demo.
_ Sq Ftg, )1., '1/.,7
Sn FtQ. ~<;"'~-:3.:J.!)
Value f! 'l~ ;"':1:;". 7.~-
---;-:; .' .;. -
Value 4::) }(Q,'/"n
....I-:J,".!"j"..~ ...._
Stonm Sewer Connec.
~C\O \
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\ Q;21 Other
I Other
~
Total Comb.
I SOC / ,...,]/
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Permit
"ECHAlII C;,l PERM IT
Charge,> and
Surch.lrljes
II Vo A/C Paving
(1&.,50 I Curb ~'ut -.. /-Q /
--------/.!~;I Sidewalk 79 _.:'0
tf'2k..ll
I. ~9,,,,""1_
'1? IS'oI.11
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TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
V. FOR OFFICE USE ONLY
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PERMIT VALIDATION
CITY OF SPRINGFIELD
City Hall
Springfield. Oregon
Department of Public Works
OFFICIAL RECEIPT
C I No. B S 2 814 (
Dote '1-- 5 .' 19 ~ 0
(' Rec'd FromrhVl H(~
Address 1:';6 3=3
( - ,- ~i-=' C. .;~'::/ )1'1
Received For:Sv)lCf_ I <1.iS'
~LI~OO
~6 In Q'7
3S,(')()
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In.06
,40
ZE:) ,00
1.00
Z~.SO
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't6 /e
Received /5<01 , /}
8hPY(~L
AUTHORIZED 51 -'TUitE
""nTO"'TU''''.U~L ~""HI"S . 1"".0" .7.0, .1''''.
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I. Applicant to furnish
A. Job Address
B. legal Description
1. examole- Tax lot 100. ,Lane County Map Reference
. 1I oj 43
2. examole- lot 1. Block 3, 2nd Addition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. examole. heat/electrical ceilin~/or force
2. exa~~le- w~terheater/electrlcal/or sorar-
E. Square footage or valuation, etc. - ,r'
I. examole- 1250 sq. foot house. 500 sq. foo ~r
2. example- if new project, check-nfw - if a
check add, etc.
F; Building permit information:
1. example - construct single family house ~
attached garage
2. examole - remodel existing garage into fe
3. examole - convert single family residencE
restaurant (change of use)
G. Value of work as defined in Section 303 (a) (
Structural Specialty Code
~ H. DES I GN TEAl.! AIID CONTRACTORS
To avoid design or construction delays, Buill
Division Staff must be able to contact approl
persons regarding design information or job:
corrections. etc.
II. Abbreviated Plumbing, Nechanical, & Electrical S. (~'!
A. Except where blank spaces occur in the descr
portion of the l~echanical and Electrical Sch'
the appl icant need fill-in only the flo. Boxe (
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Sc
are available at the Building Division
1. To conserve space on the permit form the
have been abbreviated ('
2. If the item(s) to be installed are not c
the abbreviated schedules you should con
full schedules (",
C. BUIlDli'IG DIVISION STAFF WILL FIll OUT ALL FE 0N
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be deliv
electrical contractor for signature by his E
supervisor. The general contractor is not c i?'r
to sign the electrical label. ---
Applicant to sign and date
Whenever possible, the initial application will
a worksheet only. Where possible, Building Div;
will prepare a type written copy and return it 1
appl icant at the time the actual permit is. iSSUE
signa ture.
Fees and Charges , ~
Plan check fees are due and payable at the time ' .
application. and no plans will be processed unto
fees are paid. All other fees and charges are l
p~yable when the permit is issued.
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAtlCY:
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Additional Project Information: ~1~U~~~~~'
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name
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PLANS REVIEWED BY:
signature
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