HomeMy WebLinkAboutPermit Building 1980-10-8 (2)
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i;ISPECTIO" L11.E
726-3769
CITY tlf SPRInGFIELD
COMB! riA TlON APPLl C~,T101l/PERI1I T
Job Address 95'0 W. FA/RV/SW l/;p ~A:"?'
l.e9al De,cription 17-<J?-77. ~I 7"L.~. ::ro/ '-foe:>
r I - " ,
~6~ 7t!>O,?a/ ~':2 111 ~.
Owner' (name/address/phone) '-p.....NN.I ~ WA4€k
9~o W. FA~pV.leW i::>ii?
~rl'?/ ,y~F/c:="P.
I ~.- Vent system apart from I
heat;na or A.C.
158~~ Mechanical exhaust I
hl"lod nnd rllJrt .
I I I ~lood stove/heater I
n
I n
I n 211
COMN./INO. FEEDERS
Install/alter/relocate
.d..i..s1J:jh. fppf'lprc:.
Of '. amps.1
New circuits. alts. I
..o.r.....ext.en".5rnc:
M~B';.tf: ~Q- I'A.- ~_.c:
.., UP;:>t. V Y...... "",
I I SSUAriCE OF PER!1lT I I
I I ..tr ~............
TOTAL CHARGES TOTAL CHARGES W' :;> ~'"'"
that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division.
Construction lender (name/address/phone)
UI:.~Hiil ItA/1 ,(name I
Primary 13'7<A;"c.#
Structural
6,c::.,.; ~!.:b~/~
E1 ectrica 1
/1echan;cal
CQrlTRACTORS
enamel
General
Plumbino
Electrical
~'echanica 1
I
FEF [HARC.F i NO
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I
I
I
I I
Sewer /8oo'<€~' 1/.!b.~
~ Storm Sewer ';lQ:l ~ ~4i>'
M"I!JIL~ HoMe 1',....-
Hoe>k'lJ~ V;J.
ar I
- I
PLUllBlIIG
1':0,
Each single fixture
I Relocated building
(new fix. additional)
"s. F. Res i dence
{1 bathl
IDuplex (1 bath) each
Additional bath
~!a ter serv i ce
I-
I
TOTAL CHARGES
WHERE STATE LAW REOUIRES
shall not be valid until the
I
8:;5"
p~
NFORl!A II Qrl Ll liE
726-3753
IInergy Sources: /Sq. rt. maln&accsy, bldg.'
heat . \
Hater heater Lnew _add _a I ter _rep. ~.
ranC'f'\ ____ [~.~ fence demol Hion
1 -fk-tc::: I -;:';";"':lbc';hangeTuse other
..a ue 0 war: ~..:llr-'. lA.....LI. L...:::::::.-.~ _-=-__ _._, C.
~Ulldin9 pennit info.: describe work (~e.. bulld -, ;
kinole fam. res. with detaChed ouaael ~
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1;() 1-/1 A h .tJ.i)
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7;t!(;-6803
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I I'Jfr.;f.(~_tt()V'\
Dl ~_'r--+--- .
e , . -, tI
,
(address) (lies. no.] (exoiresl
/c:;S 'Q" 6-r. S-,,~7tS :?-B
/W;~~
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(ohone no. I
,
(addrpsc; 1
(l ice;. nn.)
(".xoirp<:. ,
(ohnn". nn_)
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MECHANICAL
ELECTRICAL
FFL'~\
\
furnace/burner to
BTU's
l~~1="
I r~ -HP
I
I New circuits alts.
or extensions
I SERVICES
I
Res i dence of
SQ. F1.
I Floor furnace
and vent
Recessed wall
Sn~l'"'" hp~tpr ~nr1
v".nt
Appl iance vent
c;eoarate
Stationarv evan.
cooler ~ .
I Vent fan with
sinole duct
I
I
I
I
ITemporary Construction
IChange in existing
1"''''~j1Pn'''e
I mult i fami ly. corrm. or
TnnlJ<:.trial
Of
amps.1
I HAVE CARE FUll Y EXAl-1ItlED the comp 1 eted app 1 i ca t i on for penni t. and do hereby cert i fy that all i nfonnat ion hereon is true
and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the. State of Oregon pert.aining to the work de~scribe herein. and liha NO OCCUPANCY will be made
of any structure without the permission of the BuildinQ Division. .' , J J I !1 /
IIAr.IE (please print) _/),~ J.i ;,;'/5 .S ()JL) J. p ~JSIGrlATURE .... 4"-nf...{J .t{)c:tlkd'& IOI<::;,;,r<r--,
._____.1/ . .... . ... .. /
Zones ;:zm- .MNP Flood Plain Bdrms Type Const.
Oeey L~3d. O~cy Group - Sto~ Units :3")(
A L [ U U rl r S U 1-1 ~1 A R Y
Plan Ck. Comm/lnd
6Sr./Rldn Ppr F".p
Plan Ck. Res
30%/Blda Per Fee
Fence
BUILOIrrG PERI.IIT
Charges and
Surcharges
__n.:27J. eo
I 'i .8'1
';;;>0 CO "'co
____Si!..'_iti'...!.___
:1'2.:10
____~2'q~~.:__
1~(j;O
PLU1.IB IIIG PER11IT
Charges and
Surcharges
ELECTRICP.L PER111T
Cha rges and
Surcharges
11ECHANlCAL PERMIT
Charges and
Surcharges
FOR OFFICE USE 011LY
Sq Ftg. Value
~'7~/UNlrVnluc /S'~.~.-
~'I/. IS"
Storm Sewer Connec.
Other
Other
Sprinkler System
Other
Demo.
I Total
SOC
Comb. Permi t I
::>Cc; e: JOt r","",."Y r;<;,'V
"l7"r~H-~p. U=> ~H"
~~939. ~
A/C Paving
Curb Cut
.... jt). CO
~.~
I TOTAL
.
Sidewalk6&>O
-e
ee
. '
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CO:.:BWAllG:1 APPLlCATlOrl/PER:'1!T (CAP)
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CITY
Of
s-p-iii N G FIE L 0
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City Hall
Springfield, Oregan
Department 01 Public Works
OFFICIAL RECEIPT
No. B
Dote 10 - <2., 19 <nO
Rec'd From Oflnnl'S U mt.pn
AddressqS() Jo i h /JI j) J) D-Jr
I. Applicant to furnish
A. Job Adaress
B. legal Description
1. eXdmole- Tax lot 100, lane County Map
11 OJ "J
2. '''.,'1,- Lot 1. Block 3, 2nd Addition
Sprlngfield Estates
C. flame. etc. of owner and construction lendel
O. Energy Sources (
1. eXJ:'!':oJe. heat/electrical ceilinQ/or fOI .
2. eX~~3Ie- wJterheater/eleCtrlcal/or s~
E. Slluue footage or valuation. etc. -
1. ,xamole- 1250 sq. foot house, 500 sq. f '9
2. eXfI..'7::lle- if new project. checknew - if ~,..j~
C;l'2Ck add, etc.
F. Building pernit information:
1. eX~r.l::l1e - construct single family house" ,en
att~cned gararye ~
2. exa~:lle - remodel existing garage into
3. eXdm~le - convert single family residen.
restau~ant (change of use)
G. Value of work as defined in Section 303 (a) '.tl
Structural Specialty Code
H. OESIG:I TEAI.I AriD CONTRACTORS
To avoid design or construction delays, Buil [g,
Division Staff must be able to contact apprc ~
persons regarding design information or jab
corrections. etc.
II. Abbreviated ?luffioing. Mechanical, $ Electrical S ~~
A. Except ~here blank spaces occur in the descr ~n"
por:ion of the Mechanical and Electrical Sch
the ap~licant need fill-in only the No. Saxe
to the appropriate item(s) to be installed (,
B. Full Plumbing, :-lechanical, and Electrical Scl tlF
are available at the Building Division
1. 70 conserve space on the permit form the
have been abbreviated ~
2. If the ite:n{s) to be installed are not cc ~ecf
the abbreviated schedules you should con~
full schedules
C. BUIL~I;;G OIVISlOlI STAFF WILL FILL OUT ALL FEE "
CHARGES Q:j THE SCHEDULES (,
O. As noted on the CAP, the label must be delive
electrical contractor for signature by his el
suoervisor. The general contractor is not au
to sign the electrical label. -
Applicant to sign and date .
Whenever possible. the initial application will bl
. a worksheet only. Where possible, Building Divis' ,
will preoare a type written copy and return it to ~
applicant at the time the actual permit is issued
signature. +-.
IV. Fees and Charges
Plan check fees are due ~nd 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
. payable when the permi t is issued.
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Received For:
'it%P r a IV S:I..0 Y/ ~.
pp.. . ~()G.OO
- 37 :1.0
3'1 l ,00
IL\-. <fA
3dn.06
I~ .?,(l
l?H ' U5
70. CO
Received t q ::l1. ,...-t4 ~P:_= (
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4,01n
1-
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L\Ob
y/r
i\OIO
pC y: CD\'\Wl
~ L- / .CJj)
Amount
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'V. FOR OFFICE USE ONLY
Permit Clerk
.. . -..". . .. .... -- ~ ....... '.". ..., ..... ,-,.,... -~......_.,
PROJECT CmlDITIONS 'TO BE SATISFIED BEFORE OCCUPANCY:
j- ~z::?:: ~A;;rc.~5 A-.Ee z;.. ~ A/P'>
. Sr.::..";' h-;:;>L~~Ll'" /5 ~7'A/~='7>
Lz- #0 ~c ....;!:>~A/...-~< ~//~<sr-. U:.'!"~-:....
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Additional Project Information:
PLANS REVIEWED BY:
na~e LoPN!E /2t!?--=. ,:,'
Signature~~
, - . v ~
--............--.....-..-.--......."........,...... "'"-''''''.'''
.
date /e>-,b-/9. I
........... :.. ...._ .::.' . ....:,:,.....J