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HomeMy WebLinkAboutPermit Building 1980-6-24 (2) I HiSPECTlD:1 LIIIE 726-3769 Job Address Legal Oe~cription 688 , 'M'-~" JUN 2 i Iseo .' ,,-;.:1.. CITY UF SPR!iIGFIELD COllBlilATlON APPLICATION/PERMIT EilERGY SOURCES: Heat Baseboard Elect !.Jater Heater Elect. Ran~e El:ct I [g W \0 V1 . Map Reference 18 02 05 1 2 INFORtlATION Lli'It. 726-3753 So. Ftg. (.lain J.UUU ~q. Fta. Access. 5q. Ftg. Other Ilel< Add A Iter rep. --Fence Demo Change/Use Other -- - Owner Fern Way Minor Partition 607, Lot B Joseph P. Tabor Phone ValUE: of l'Jork: 11,805.30 Bui~:inQ Penllit Info; Describe \'lork(Leo. Build Single Familv nesidence With Attached Garaae' Address 1445 West 11th Street Eugene, Oregon 97401 Construction lender Address Ut:Sllii{ I E.All lname) Primary R.C:. Rrp~~pv Structural Electrical t1echani ca 1 CONTRACTOR5 (name) Genera 1 Owner Plumbina Owner E1 ectrica 1 Owner ~1echan;cal Owner PLUfIBIrlG 110.1 lEaCh single fixture IRelocated building X (new fh. additional) S.F. Residence (1 bath) Duplex (I bath) each Additional bath ~!a ter servi ce Sewer Storm Sewer 683-4889 Foundation & renovation of moved house Phone (address) (lics.no.) (exoires) (phone no. J 1 h4~ Wf'st. 11 t.h St.rf'f't.. RlI"'f'nf' 683-4889 (address I (l le,,_ no.) (expires) (ohone nn.) ELECTRICAL MECHANICAL FEE' CHARGE: rm ~~~ rH~Rr,~ NO rH~Qr,i=' ><> Residence of furnace/burner to BTU's SQ. FT. New circuits alts. 15.00 or extensions Floor furnace and vent I SERVICE5 CHANGE I 115.0C Recessed wall ScaLe heater and vpnt ITemporary Construction IChange in existing re~.i qe;nce ImultifamilY, camm. or Indus.trial Appliance vent seoarate Stationary evao. cooler ~ . Vent fan wi th sinole duct I Vent system apart from I heatinq or A.C. I Nechanical exha4st hood and duct I Hood stove/heater I I I I amps.1 Of C011H./lND. FEEDERS Install/alter/relocate distrib. feeders IOf I I I amps.j ISSUANCf nF PFRrllT TOTAL CHARGES 1'1. Oc. TOTAL CHARGES 15. OC TOTAL CHARGES WHERE STATE L~W REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit shall not be valii until the label has been signed by an Electrical Supervisor and returned to the Building Division I HAVE CAREFULLY EXAMINED the completed application for ~ermit. 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 Laws of the State of OreC)on pertaining to the work described herein, and that tiC OCCUPAllCY 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 force and effect as;required by ons 701.055. that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used_on this project. , /i , , I",/} (2 _}.(""./.::>__otf;::.'''7"'~ ....... IWIE(please print) Zone 'R_ 1 Fi re Zone Flood Plain III NO BUILDIIIG PERIIIT Clla rges an~ Surcharges PLUI1BlNG PERlllT Charges and Surcharges ELECTRIC~.L PERI~IT Charges and Surcharges 11ECHANICAL PERI1IT Charges and Surcharges JOSEPH P. TABOR ./ , ( -J.~ DATL ':'{vS- SI"IIATURE FO~ OFFICo USE 1 S~, Tyoe/Const. V N Bedrooms or~L Y ., ." , f1aiti 893 x 12. 10 Value 10.805.,0 F~_g. Ft~. Access FDN x Value LOOO.OO Ftg. Other x Value TOTAL VALUATION 11,805.30 Units Occy Load Occy Group R- 3 Sq. S~. Stories 1 FDN 10 00 Plan Ck. Comm/lnd . 65%/Blda Per Fep --------40--PTdn Ck. lies 30~/BldQ Per Fpe Systems Development Charae (1.5") 1-11.7.08 1 I I I I 41. 60 218.68 3.00 PD REC# 6-11-80 I I I ITotal (omb. rermit ______l2-...QQ__ 60 I Fence Demo 15.00 - --- -- --- --- 60 Sidewalk A/C Paving Curb Cut I I TOTAL . .. _. ... - - -.. .~'. COMBlIMTION APPlICATI01//PERHIT (CAP) N I II. I. Applicant to furnish A. Job Address 8. legal Description 1. examole- Tax lot 100, lane County Map Ref' II OJ 43 2. examole- lot 1. Block 3, 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender O. Energy Sources t" 1. examole- heat/electrical ceiling/or forcel \ir 2. examDle- waterheater/electrlcaJ/or s~ E. Square footage or valuation, etc. - I. examole- 1250 sq. foot house, 500 sq. fOOl /" 2. examole- if new project. check new - if de tir check add. etc. F. Building permit information: 1. exa~Dle - construct single family house wi at tJched garage 2. examole - remodel existing garage into fan 3. .examale - convert single family residence restaurant (change of use) G. Value of work as defined in Section 303 (a) of ~ Str~ctural Specialty Code H. DESIGN TEAN ArlO CONTRACTORS To avoid design or construction delays. Buildi Division Staff must be ?lble to contact appropr ~.. persons regarding design information or job si corrections. etc. II. Abbreviated P1Ulr.bing. ~lechanical. & Electrical Schl ).... A. Except where blank spaces occur in the descrip' q portion of the Mechanical and Electrical Schedl the applicant need fill-in only the No. Boxes ( to the appropriate item(s) to be installed B. Full Plumbing. Mechanical. and Electrical Schec ~s are available at the Building Division 1. To conserve space on the permit form the sc have been abbreviated 2. If the item(s) to be installed are not cove (0: the abbreviated schedules you should consul full schedules C. BUIlOIiiG DIVISION STAFF WIll FIll OUT All FEES CHARGES Oil THE SCHEDULES D. As noted on the CAP, the label must be delivere electrical contractor for signature by his elec supervisor. The general contractor is not auth, to sign the electrical.label. --- Applicant to sign and date Whenever possible. the initial application will be I a worksheet only. Where possible, Building Oivisiol wi 11 prepare a type written copy and return it to tt ( applicant at the time the actual permit is issued fc signa ture. IV. Fees and Charges Plan check fees are due and payable at the time of t I application. and no plans will be processed until th ~ fees are paid. All other fees and charges are due ~ payable when the permit is issued. PERMIT VALIDATION - CITY OF SPRINGFIELD c Date f). II City Hall Springfield, Oregon' Department af Public Warks OFFICIAL RE.CEIPT No. B 19/[) '-,!) h'Y-(' 53924(. (' Rec'd From ':.~, c. Address \ L\l\ c.::::-:\ \. .L ~ \ f'\ \""-.. \D DO 110 111\' n"\ '(j \ e:!.)()() {\ {,' . "\ ->r1'/" tee. I, Q. ?\l\N/L\ ,~" \-::;.~)~') Y7() lr.(j ('Y-\. C' ~" rTlcf;< \V\ l\\~ () (, Received For: ~D/O (.. c ( ..~ f ../ \.~,' Amount Received ~\(o \.(i") , ",'j ~.t) ( J ( "' (I '-~ .",r- / . i I ~l,_'- _/" "UTHOR~ 0 S;C,....TURE S..~~fQ...TU.N.Ull ~..'..TI[". . IUGo:..l. Oil "7_0' !.."'S (. tt' c c V. FOR OFFICE USE ONLY j Permi t Cl erk ] j' I I , j I I I I I I I PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: " DRIVEWAY CULVERTS REQUIRED Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: SEPARATE PERMIT REQUIRED FOR ANY ADDITIONAL WORK IMPROVEMENT AGREEMENT REQUIRED THIS PERMIT IS TO BE ISSUED AFTER HOSUE MOVING PERMIT IS APPROVED AND SIGNED .. I .. .. oM' ..... ... . ..~. . ... .. PLANS REVIEWED BY: name DAN SMITH signature I~.n . Jm'(2h _' da te t, -18- f?Z) rID '''''-'N.' ""'''''' .'.