HomeMy WebLinkAboutPermit Building 1980-11-6 (2)
IIr'SPECTIO;/ LIIIE
725-3769
.
.
CITY OF SPRUIGFIElD
CmIBIilATION APPLICATION/PERMIT
EIIERGY_<;l1URCESr' .
Heat t,-Lecr l.C
Job Address
2026 Donnelly, Springfield
Lochaven Subdivision
Lor33 bUS
& Bernard Hiatt & Robert
INI'ORlIATION Llilt I
726-3753
Sq. Ftg. "lilin
~CJ. Ftg. Access.
Sq. Ftg. Other
Ilel< Add A lter ~ep.
-Fence 0";;;0 Change/Use
Other=- -
-
Hater Heater
Ranfle
ValuE" of Hark:
19,500
BuildinQ Pennlt Info: Oeser be Work(Le., Build Single
Far.1ilv l1esidence I-lith fl.ttached r.araoe)
Mobile home set up with
improvements
eJl~ LU Ul..P ,
(lies. no.) (exoires)
I
I
I
I
I
I
I
I
I
I ISSlIANCE OF PFRlIlT
TOTAL CHARGES I TOTAL CHARGES I TOTAL CHARGES
liHERE STATE L\H REQUIRES that the Electrical work be done by an "Electrical Contractor. the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
Legal De!'icription
Owner
Gene
Address
.., -'
\..JU.....\lJ..~U
CEntennl.aL
74l-Pl<4~0
663 W.
Springfield
Construction Lender
Address
UI::::i1 tilCTl:.f,11
(name)
Phone
(addrp~s )
Primary
Structural
Electrical
~~::-:ha!'li ::::31
; : :~;-:7.':\:7C-.::..s
i:-,i!.;::e!
Genera I
Hiatt Bros.
(address)
Springfield-
f1 i cs. r.n.)
:' : ':~:Ilr;q
~:ect.rical
Penselin Electric
20-48C
Springfield
".:.:-~"':;:~:
?l~!~S!:;G
ELECiRIC.~L
",J.l
j c~c
I
i
I
I
I
I CHARr.F
!:"j:'~
I n111or.~1 r';o
tlO
Residence of
:~ach sinqle fixture
sq, fT.
I'New circu~ts alts.
or extens lOns
'IRelocated building
(new fix. additional)
[S.F. Residence
(l bath)
Ouplex (1 bath) each
SERVICES
Additional bath
Temporary Construction
Change in existing
rpc: i d_pnl"P
multifamily, COlTl!l. or
Tnrlllc;.triill
~Iater service
I Sewer
Storm Sewer
[Of
amps.1
COMM./INO. FEEOERS
Install/alter/relocate
rlic;.trih. fpprlprc;.
Of
amps.
--
I~
I
I
(ohane no. I
(~xrd rp,,)
IChQnp I'lQ. \
741-1420
741-1186
MECH;3:I CAL
I
I furnace/burner to
BrU's
Floor furnace
and vent
1 r.~J:'
I
I
I r~lGor.t"
I
I
Recessed wa 11
'\O;:J,P hp~tpr ,,"d \!,:lnt
I Appliance vent
~poaratp
Stationary evan.
cooler ~ .
Vent fan with
sinole duct
Vent system apart
heatina or A.C.
Mechanical exha~st
hnod and duct.
from
Wood stove/heater
I HAVE CAREFUlLi' EXN1WED the completed appl ication for f1ermit. and do hereby certify that all information hereon is true
and correct, and I further certify that any and all \...ork oerfonned shall be dane in accordance with the Ordin.l.nces af the City
of Saringfield and the Laws of the State of Oregon pertaining to the work described herein. and that HO OCCUPI~rKY will be made
cf a:::, 5t:'"~cture without the permission of the Building Division. I further certify that my registration Ir/ith the Builder's'
Boara is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption ;s noted hereon. and that
only subcontractors and employees who are in com~liance with Or.S 701.055 will be used on this project.
i:;';1E(please print) D<2. Gt "- Lv, 'I) c- "",Ie.
S Ir.iIATURE YtJQ.-
FO~ OFFICnJSE GillY
Sq. Ftg. r1ain
Sq. Fta. Access
Sq, Ftg, Other
, \J/J' /
i/..'/'-<Af/~
DATE//~~ ~f ()
Zone_H I-t ">_TYDe/Const.
Fire Zone Bedrooms
Flood Plain Stories
1,-H-1
Un; ts
Occy Load
Occy Group I<:-"?l
BUIlOlllG PERiHT
Charges an':
Surcharges
40 00 'Plan Ck.
, 6SI/~ldo
------------Pidn Ck,
301/Bl do
l~ 00 Fence
__ _.......d.:..______
en 0 D@mo
__lD"Q9___ Sidel<alk
40 I A/C Paving
COfllll!lnd
Ppr Fpp
Res
Per Fee
PlO'.IBING PERMIT
Churges and
Surcharges
ELECTRICft.l PERI~IT
Cha rges and
Surcharges
r1ECHAN I CAl PERM IT
Charges and
Surchar!)es
Curb Cut
. .
x
x
Value
Value
Value
x
TOTAL VALUATION
Syste~s Development
Cha roe (!, sn
ZQ2.50
Total Comb. rermit
TOTAL
"
I
.
.
I
I
3
~
l
I
I
1
j
I
I
I-
I
!
I
i 1
City Hall '~)
Springfield. Oregan 'j
Department of Public Work.
OFFICIAL RECEIPT
No. B S5103~
Date 11-- /" 19 ?,O ,
r Rec'd Fram . H: Ii l1 J}U; ',,; (t.ltc~
I ~ I, -9.- I u. Ci! aLl "1..lil-l~ )
AddresslL.:'_1O 0 -' - -
, . -~ Ow Oon\'\e..lL~d
RecTJhl',p , l1 H 0( ) .C (/' I. ,(
.
.
. ... ''''~I . .~..
--. .....
.,_.
. "r
J
CITY
COMBINATION APPLICATION/PERMIT (CAP)
I.
PERMIT VALIDATION
III.
Applicant to furnish
A_ Job Address
B_ legal Description
1. examole- Tax Lot 100. Lan~ County Map Reference
17 D3 43
,2. examole- Lot I. Block 3. 2nd Addition to
Spnngtield Estates
C. Name. etc. of owner and construction lend'
D. Energy Sources
1. examole- heat/electrical ceilinqjor f, .....
2. exa~ole- waterheater/electrlcaJ/or so
E. Square footage or valuation, etc. -
I. examole- 1250 sq_ foot house. 500 sq_ (!,
2. exam~le- if new project. check-new - i ~.
cneck add. etc.
.. ~~ndi~:: ~er:;:it information:
;::.l:.=:-:::ie - C~:1struct s;ngie family nous .Jft,
attached garage '\...
_. :....a:-:::ie - re::ooel existing garage into
-=J.=;=l~ - ':~~ye!": single family resi.J.2!
--~:~~~: :~~~n:e ~f US2}
-. .=~:.:: cof ....un e.s ceflnec in Section 303 (a; ~..
Structural Specialty Code
n. CC:5iG;; 1~;"',iAr;D CONTRACTORS
i0 cv~i~ :;5i;n or construction delays. aui ~~
Division Staff must be able to contact appr ~~
~ersor.s regarc;ng design information or job
corrections. etc.
.:=-=~.:~=:=: ~;:.;~.:;ir:;. :~::c~anical. .i Eiectri,:~l: 17,'
..;. ::,::ce:: ~':here :Jank soaces occur in the descl \:i
::~:i:i. :f :~~ ~;c~ar.ical and Electricai Sc:
:::e =;::~;::!::: need 7111.in only the ;ic. SCXE
:~ :he a!:':ro:r1ate item(s) to be installed (
~_ ;~11 Plu:::~in~. t'lechanical. and Electrical Sc \j~1
~:"e ~~aiidDle a: tne Building Division
. 7J ~~r.serve Suace on the permit form the
have been abbreviated
2. If the item{s) to be installed are not Ct ~er
the dbb'"evi a ted schedu 1 es you s hau 1 dean!
full schedules
C. BUILDIi:G DIVISIQ;~ STAFF WILL FILL OUT ALL FEE ('.
CHARGES Dil 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 bt
a worksheet only. Where possible. Bullding Divisi ('
.will prepare a type written copy and return it to
applicant at the time the actual permit is issued
signature.
Fees and Charges
Plan check fees are due and payable at the time of ~.
application. and no plans will be processed until
fees are paid. All other fees and charges are due
payable when the permit is issued.
~,..,I
OF
SPRINGFIELD
r.'"
I\C)
i-\
1/;
I
)V~LOL!
, 'Ir()
10.CJO
. L\()
pj-)
fV
L\C )t-,
I -
~n(/
'?CJ? _5 0
be'delive
by his el
is.not au
c
IV,
35n:c?9-_~
()J (
AulHOR1"tED SIGNATUIt"E .'.0' ~.,,,..
...I:U?...T\..,....tJ~~ ".'"'1:''' . I:Uo;;lO..l:. 0 ..
Amount Received
~-
V.
FOR OFFI CE USE miL Y
"
\.
l-
g
'" II.. '''',~" .., _...,. ~ "
'.."_'0' "_ ".~'.' .,."_ ......,.._, .' --.-.-..".," ..."....~ ..'''.'' ".,
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
'.L ... .,. ." .. ____ ,_.........'. .... ......_ ._..._ ._, .. ...,
PLANS REVIEWED BY:
name
signa ture
date
.....,..._..,-~ ,..,,~-~.......... . . .,......._,.... ,... ''',,.,--,,,'_,,,..'
c
( <
:i
i:
i:
.
'-'
(
("
,
(
(
I
"
(l
,~ ,
\
I
CD J
~