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HomeMy WebLinkAboutPermit Building 1980-7-31 (2) IiISPECTIOi"l LWE 726.3769 . CITY OF SPRii;GFIELD CQ/1BI,IATION APPLlCATlOCl/PERMlT /; '\-;11 <'_ . Job AddressStJSQ hU? \'///1"/1 Legal DescnptlOn AW\Iro..';c. _ I,..,{.. '. \ E:iERGY SfURCES: . Heat rei 1>19 dlcf..,IL \'later Heater 't fn4-"'f(_ Ranqe t._l" L'/-"'I ; lUFORllA TI ON ~ 726-3753 So. Ftq. 1,Iain '-'I c-I '/ /., ~q. ,t9. Access. LlU f(" ''':; Sa. Ftq. Other ,liJle"_Add-",1 ter_~ep. Fence Demo Change/Use Other- - , k ,. Valuh~ I-Iorf.: ..('\ I ,'\,J / I [j; V Bli11C;no Permit Info: Describe t.Jork(i.e., Build Single Familv l1esidence \'Iith ",ttached Claraoe) ~.LJ-ft-mJ 1u A p/1Jdp/Yi/'I ) hU' n. H/J.I'~',/'I')/1rJA/)O/1 ,f P Owner ,--iERR( 'J; b'l/? Addreso>-.,) ,,~/,. ?I} 1'\ / '" CA) //./1_',."'/..- ,'I /{ '-' Phon~vfil;r;~ Construction lender /Ar hi I~ (' 1 Address DES I GII TEAtl Primary 7d DM7 . Structural 'n !.../lP (name) Phone (address) ~ /".Nr/ /,7/11,.--;- Electrical nA "'.' /~;;,~I t1echanical CONTRACTORS (name J Genera 1 --;I'd ,b"" ""U!lJ-T Plumbina ~.1...__ Electrical /) 'j1..1./~ /1 *,N' r,lechanical PlUI1BlflG 110. . '." ~ :" ~ .' :~ F, 121': PL.P<. F, (lies. no, l (exn; res) ;' , , .. . i (address) (lie<;.. no,) (~xnirp'i ) (ohonp no_) I)l'i."./" J'/ k'?~")i~./..t_ 1-%tJ.lD 1-f_1i?/'J ELECTRICAL FEE I CHARGF fin I IResidence of X 99;;" SQ. FT. INew circu~ts alts. or extenSlOns. Each single fixture Relocated building (new fix. additional) S. F. Res i dence (I bath} Duplex (I bdth) I Additional bath x ~!ater service 1 Sewe r IStorm Se\'/er ;Zs-.oc SERVICES each j{j..~tJ ,I Temporary Construction Change in existing re<;.idenr:e multifamily, COrr.r.l. or Induc;trial Of I I I I I I I 3S,ad TOTAL CHARGES that tile Electrical Hork be done by an label has been signed by an Electrical COW1./! NO. FEEDERS Install/alter/relocate distrib, feerlers [Of TOTAL CHARGES WHERE STATE LAW REQUIRES shall not be valiJ until the "',(;''<.~/I'C;_, amps. MECHANICAL '"' nIAIU~~ Nn ," :r~ARr.~ furnace/burner to /;;.t;n BTlI's I Floor furnace and vent I I Recessed wall ~nar:p hpatpr anrl vpnt / I~I I Appl iance vent separ~te I I I StationdrY eV,\n. cooler 13 I Vent Jan wi th I -:1..?:J sinol!? duct ';C"l I Vent syste~ ~pdrt from I heatino or J\.C. I / j.lechan i Cd 1 exhaust 1'/.:,0 hood and duct Wood stove/heater i amps. ISSUANCE OF PFRi1IT /(J.tJd ..;J,<;'.m TOTAL CHARGES ~,)3,:,o Electrical Contractor, the electrical rortion of this permit Su~erv;sor and returned to the Building Division .. I HAVE CAREFUllY EXMllNED the completed aprl;cation for permit. 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 Orel)on pertaining to the work described herein, and that rm OCCUPAlJCY l.,.i11 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 ORS 701.055. that if exempt the basis for exemption is noted hereon, and that only subcontractors and employees who are in compliance with 025 7nl.055 will be used on this project. IW1E(please print)~ tZi?:/ 1161/1 Zone 2-1 Fire Zone - Fload Plain NO BUII.DWG PERI.1tT Charges an': Surcharges PI.UI,1BING PERMIT Charges and Surcharges EI.ECTRIC~,L PERlilT Cha rges and Surcharges /IECHANlCAI. PERI'IIT Charges and Surcharges Lw, .0: DPTE 7/j/ /1<-1 SI(;il/\TL1RE F02 OFFICE USE Dill/( / / 1 Tyoe/Const. Ti.-i/ Bedrooms 3 Stori es / Occy load Dccy Group.r-?- 3 Sq. Ftg. r1ain 09;.l Sq. FtQ. Access ~/,-/'3 Sq. Ftg. Other x .2if.dO x tt.cfO Value /ll/.OOt;" "D Value'i.3 J ~-, <).0 Value Units Plan Ck. ______j~pg_ 65Z/Bldo d ,,, Plan Ck. rr. ~ 7 30%/Glda ?S.:!JC I Fence -------~---- I ,'+0 I Demo I 'S ~OC; ..~::. ;:,' I Sid~~~l k G;;L I - -.7:i5 --/~ ~~-I A/C Paving Cl3,SD I Curb Cut /8' c--------~~;;-I Commit nd Per Fee Res Per Fee 3n.3J ---1S \..\ \ q L 1 [ x TOTAL VALUATION ,)'7, :1,:21. I,,'} ISystems Dev~lopment Charoe (1.5,,) I I Ljd!,~::J I I I I ;)31'). it) ff ;$ ~40.5D J b.ao Total Comb. rermit II. ',fo I I TOTAL co 'l)' ;j , 4!':'; '. :.". 2- 'I C " . . PERMIT VALIDATION , 1 COMBIIlATION APPLlCATION/PERl-IlT (CAP) 1. Applicant to furnish A. Job Address ' B. legal Description 1. examole- Tax lot 100. lane County Map'Reference 1103 43 '2. example- Lot 1. Block 3, 2nd Addition to, Sprlngtield Estates . C. Name. etc. of owner and construction lendE ( D. Energy Sources 1. examole- heat/electrical ceilinqlor fc 2. examole- waterheater/electrlcal/or sOl E. Square footage or valuation, etc. - ( 1. examole- 1250 sq. foot house, 500 sq. 2. exa~Dle- if'I1ew project. check-new - i check add. etc. F. Building permit information: ( '1. example - construct single family hOU51 ~'~, attached garage 2. examole - remodel existing garage into 3. examole - convert single family resider ('1. restaurant (change of use) G. Value of work as defined in Section 303 (aJ Structural Specialty Code H. DES I GN TEAI-t AIIO CONTRACTORS ( To avoid design or construction delays, Bui ~ Division Staff must be able to contact appr persons regarding design information or job corrections. etc. II. Abbrevia~ed Plumbing, Mechanical, & Electrical A. Exce:lt, ",here blank spaces occur in the descl por:ion of the Mechanical and Electrical Scl the applicant need fill.;n only the No. Box~ ('" to the appropriate item(s) to be installed B. Full ?Jumbing. r'lechanical, 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. BUILDI1;G DIVISION STAFF WILL FILL OUT ALL FE. G" CHARGES atl THE SCHEDULES o. As noted on the CAP. the label must be deliv! electrical contractor for signature by his e' suoervisor. The general contractor is _not al ~~i to. sign the electrical label. - Appl icant ,to sign and date Whenever possible. the initial application will b a worksheet only. Where possible. Building Divis will prepare a type written copy and return ~t to applicant at the time the actual permit is issued signature. IV. Fees and Charges' ( Plan check fees are due and payable at the time 0' application. and no plans will be processed until fees are paid. All other fees and charges are dUE payable when the permit is issued. 111. V. FOR OFFICE USE ONLY ~ CITY OF SPRINGFIELD ( ! I City Hall Springfield. Oregon Department of Public Works OFFICIAL RECEIPT ( S4209( c q 1tO. B Dale4J -a 19(}U, Rec'd ;'arn \J}l h ,t ~')~~~il ' j Address ~ 71 (I-lj( f?{ ~(],,~. . _ It < \2tt. \2-\ OC) L\~ 4- ~C) ,00 \ ,Dc) '!?JOCI ~(\'" 2.35. fjU . CIa (f) f-b Lj,cGi . 'i}i-- (o~O ,If) (L ( ( ( Received_For: bV ( L\O \0 L-\,c'l /) - I 4-''lJ 4- 401 () ?(.J ( Y --,t-) ( - uv ( 40 'V\ ~)ICL ,- c;bt- ( (s Arnaunl Received l c ('If) ~ AUTi'lOI'lIZED 5IG,.....TUR~ P , ....t:lTO...TU~...U~~ ....'..Ttl"$ . 1lI,I01l:..1. Oil '7.0' ....,,'. ( (- . (I J ~ 1- l' I-'erml t Cre'rk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPArKY: I, Permit applicant exempt from registration with the Builder's Board because: l .l f ~ !~ Additional Project Information: FttJo;? E./t"!/Jf:I'tlnN 7'1' P;E. ::J PEEr- ,i:J.A~rle aves PLANS REVIEWED BY: ... .. ..-., . . ..". ~ - "... . u, .,. . name signature L)~ ~_ ;~d date !?-I-~t:J