HomeMy WebLinkAboutPermit Building 1981-6-29 (4)
INSPECTION LINE
716-3769
fI
Job Addrl!U
,2.43 '-5
i)6RI/Dc:!'
h':Jol Demiotion ~ -'2..::;
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k'onA J,~ ("'fe.lF/rlcL
.2 LI~r-:; D,-..2/lM),
Addr.u
ConHructio" lend.r
Add,."
Of SIGN TEAM
(nomei
Primory
SGt:...F
StrucTurol
Electricol
.v.echo"icol
(nome)
CONTR-'.CTORS
G,"".' \ 1Ae:.-:t. - ;:;:';:;)14-6<1';
5<iFCF
CITY OF SPRINGFielD .
COM81NA nCN APPlICA flON I PERMlf~
INFORMATION LINE
7'26-37SJ
iSq'~~It~ ~.
:;oal:r Heater B~~r: I ~:: Ftg: Oth.r . - '"
Ronqe _ , _N.w ~Add .)C:Alt.r _Ritp. ().
I Volu. of War.: 7'1S'2. ~ _._fence_Demo_Chang.iU,. ~
J _45A -,~ _O,h.. N
Pho", '-::211/ A(}>7 Buildtng Perm;llnfo: OeiCrib. Work ii.o., Build Sing I. I ....n.
T'f -L.' ") Fomi!.. Re,idl!"c~ With Attl1ched Gora.!!:.1 "U'
IJop ~~ J\~M. ,&TN-R~ .yI I
b(~tE ~..t# dE?"IV~ -~4'l
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ENERGY SOURCES;
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Phon.
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. (addr.,,) (licl. nO.)
(expir.,) (phon. no.1
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€MJPiLo>V€er:' 0yC. ~/:::>IE'-t.. c:::."....,sr. I ~
(oddrllss) flics. no.)
(..?ir.l) (phOM no.1
Plvmbinq
EleclticClI
L: - ...:..
~ .~-'- r
Mec"onical
-?cl?':'F ,
PLUMalNG
.'
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ELECTRICAL
MECHANICAL
R.lider". of
F:;: CHARGE NO, I FEE !CHARGE
furnoc.(burner !o 'j
BTU', I
IJ.- Applianc. vent --' - .';l--'
I.parale
Stationary e...ap.
~oier
/ V.nt fan wilh ~.-,
,ingl. duct
Vent IYlt.m apart from
heatinq or A.e.
M.chonical exhault
hood ond duct
Wood ,to...e/heat.r
Heat Puma
Air handler to
10000 CFM
Air handl.r o".r
1 0.000 CF M
i
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ISSUANCE OFl'PfRMIT lIP. Cl:>
-
IS-:- TOTAL CHARQES /3 -
Eocn ,;"qle filltur.
R.locored building
("ltW fill. odditio"oll
S.F. ~Illidltnc.
(1 bOlh)
FEE t CHARGE I NO. I
!~-~-
I ,e
I
,
~~: ft.
New circuih. alt.ralionl
or eJl\t.nlions
NO. I
~I
I
I
i
Duolu (1 bOlhl I'och
Addilio"ol bOTh
Water ,It' "ice
I
I
I
I
I
I
r-
Sewer
Sh:lr,," Se_er
SERVICES
T.mparary Conltruction
AmOI.
FHCERS
Ampl.
TOT AL CHARGES
ItfP. -I TOTAL CHARGES
WHERE STATE LAW REOUIRES thot Ih. EI.ctrical work b. dene by th. El.rtricol Contractor. the .Iectrical portiofl of this p.rmit ,hall not b. yalid until a
1ab.1 ha, been li9".d by on Electricol Contractor ond attached to th. el.ctricol pan.l.
I HAVE CAREFULLY EXA.....INED the compl.ted opplicCltion fCl, permit. ond do her. by certify that all inFormotion her.on i, trve and correct, and I further
certiFy thot ony ond 011 ","ork performed ,hall bo don. in occ.ordanctl with Ihe OrdinonclU of th. City of Springfi.ld and th. low I of the .Stot. of Oregon
pertaining to ,h. worlr: descrio.d herin. ond that NO OCCUPANCY will b. mode of any I'ructur. without th. permiuion of th. Building Di...ilion. I further
certify that my regilrtation witn the 8uilder'1 ~Qrd is in full farat ond m.ct 01 required by ORS 701.033, lhat if u..mpl'th. balil for ...mption i, noted"
h.,on. and Ihot only ,ubcantracton and omplay.., who Clr. in compliance with ORS 701.055 will b. used on 1hi, praj.ct.
BOli. far Build.r's Board eJl\emption:
NAME (pleCls. print)
~~V\ ~ H r C~ \ \<\--,,\
iI<. ~ I
Type/ Conll._ "1Z:- AI
Bedroom.
'itori.-
Zone
fir. Zone
Flood Plain
I
,-
'1'1. ..rr>
~-------
1.7~
/0.-
.. 'fO
/<): d'O
.~e.
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BUilDING PERMIT
Charg., Clnd
Surcha,g.1
PLUMBING PERMIT
Charg'" and
Surcharg..
elECTRICAL Pf~MIT
Charge, a"d
Surchargll.
MECHANICAL PERMIT
Charge. ond
S",,,"or9.1
,.-l
'1GNATUR' ~~(~ \0...~~
FOR OFFICE USE ONLY
'q,Ftg,Mo;"~ '-;Z"-l~./~€~
C:q; ff9'~- et..~ x II:>.
Sq. Ftg. 011'1., .II:
i
. DATE (,.,';;'1-55 \ I
I
~1/2...,si
bCfO.. _0 !
i
7~';>~::> ~
{
~alue
Valu.
VCllu.
Unih
I""Iccy load
Oecy Group _:K!' - :s
. TOTAL VALUATION
Plan Ck. Comm/'nd
6S~:'/Bldo: Per Fell
Plan Ck. Ite.
30~:.1 atdq Per Fee
1"2 ::;>~ 1"-"'~"'7t>
/' ~:P..
~
Syslem. De....lopm.nt
Choroe /1..5%1
/Y-.
Fence
~s: :zS
Oemo
Totol Comb. P...rmit
Sidewolk
..1\ tin..;"..
"'T' .~ <G>" '-,.iLJ
...-,--'",c.."= ,,' _ -"""U' ~~
TOTAL,1i:-n ...t,..... .c:; ...~...
~~l.7~f""'
... .
'/a-;;;,i../",-
Curb Cut
,.',;.._,...........
. .. ,v~. _"!'.. ~...,..,. ,.~~;:,,""". <:':~:;~~'i'"..... ~~!...-..::~.:,' .1::......"':~::... .'....~b;.~,:t.~...!\~-
.
COMBINATION APPlICATlON,'PERMIT .P)
I. Applicaru. ta furnish
A. Jab Address
B. legal Description
1. examDle.tax lot 100. lane County Map Reference.
2. exam ole-lot I. Block 3, 2nd Additian to Springfiel
c. Na.me, ele. of owner and construction lender
D. Energy Sources
1. examole.heat/electrical ceilinQ/or forced air (Iris
2. cxamole.warer hearer; electrical/or solor
E. Square footage or valuarion, etc.
I. exomole.1250 sq, foot house, 500 sq, foot garage
2. examDle-if new project, check ri'eW-if addition, chf
odd. etc.
F. Building permit information:
1. exomolp..construct single family house with on ott.
garage
2. examole-remodel existing gorogl!:- into faniily roar
3. exo:nple.convert single family residence into
rCSlauront (change of use)
G, Value or work as defined in Section 303 (a) of Ihe
Structural Specialty Cede
H, DESIGN TEAM AND CONTRACTORS
To ovoid design or construc!ion deleys, Building Divi$.
Stoff musr be able fa contect oppropriate persons reg
. design informcrion or job site c.orrections, etc.
II. Abbreviated Plumbing, Mechanical & Electrical Schedule!
A. Except where blcnk spaces occur in the description pc
of the Mechanical and Electrical Schedules. the opplic
need fill.in only the No. Boxes adiocent to the cpprol=
. item(s) ro be installed. ___
.. -S.' Full Plumoinq. Mechanical. and f:i:!,;t,(cal Schedules .
'are available at the Buildinq Div;'ii',JIi
1. To conserve space on the pen,..it form the schedule
hove been abbreviated
2. If the item(s) to be installed ore not covered on the
ored scheaules you should consult the fuil schedule
C. BUILDING DIVISION STAFF WilL FilL OUT ALL FEES At
CHARGES ON THE SCHEDULES
III.
Applicant to sign ana dole
Whenever possible. the initiol application will be used as
worksheet only. Where possible. Building Division Staff v.
prepare a typewritten copy and return it to the applicant
the lime the actual permit is issued for his signaturE.
Fees and Charges ~.
Plan check fees are due and payable ot the time of the 01 )CI'
.. ~
and no pions will be processed until these fees are paid. ,l-
ather fees and chorges are due and payable when the permit
is issued.
IV.
V. FOR OFFICE USE ONLY
.--
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
PLANS REVIEWED BY,
name
LoR~ ({~~
signature
-......
..
~MIT VALIDATION
17 03 43
CITY OF
SPRINGFIELD
(
City Hail
. Springfield, Oregon
Department 01 Public Works
OFF I C I A l R E C E I PT
(
(
No. B 5 6 8 2 9
'/-1- 19ft
Rec'd From QonoJ.ct te~land
Address ;2 LI.3 '5 (J,0 Y'" Nyj,,-,
(
Dale
(
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,
\
Receiv~d For:
( I-
y),'f) L/L-I 00
Lje, J. 7&
( Ie) , ,,'"
I)~' 10, Or)
ft~ LjC .i.fi)
'70 I
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( L/C;~, ,(00 (
fYl.A'7 I~.CO
(: I. ~;;;. (
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?;::) . ,=i, B c2hJJ.cJC
(l ~dU--
Amount Received
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AUTIoIOA1Zl:D SIG~...rUlU:
...CLTO...TU.......LL ~",..T"".. ru'n"c. 010 .'_0'
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Permit Cieri-' .
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