HomeMy WebLinkAboutPermit Building 1981-5-28 (2)
Job Add,... 6:;<,lot Fc:.y:c.,i~f1j0-- 5&e~
l'9010..,,;p"on~~OJ~~~ .
dffG ~ :.:..)7 _ 1~{Jj!S3..JD iL852 IvoIU. of Wo'" C1
Own., !-Y{})I) H(J, r./e.'S ;;;9; SO(), 0_
Add.... ;{ f) M5 ;'./tlvlP1 In 0 :St. Phon. "7 41://09.. "S'
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INSPECTION LINE
726-3769
Co",truc:tion lend.r
Addre..
DESIGN TEAM
(nomei
Primory
Structural
Electrical
Mechanical
i-CI.
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'-
. Sq. FIg. Main
Sq. FIg. Acei'll,
Sq. fIg. Other
_Ne..... _Add_Alter _Rep.
_. _Fence _Cemo_Chang.! U 5.
_Olner
INFORMAJlON LINE
726-.375J
CITY Of SPRINGfiELD
~OMal~lnOtt APPLlCATION/PERMlf
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ENERGY ~OURSES:. /).
Heat g 1~/CIc.'r ~ Yr')
Water Healer p ~(.fi/ti.
Ran'll! eJ,,.-t _,r
Building Permit Info: De,cribe Work (i.o.. Build Si"gle
Fomil'(. Re,idt!l1ce With Alfoched Gorcu:'Iel
_ ,()1171 hi" IJ JI;';o" VJI/ r.hl &.. f1 OJ1'\.L
:5Pj-i~r> (21')'1.':'>'2)
Phone
. (addressl
(lies. no.)
(phone no.)
(e.-:pires)
G..nera\
CONlR.A.CTORS (nomel (addren) Wes. no.) (upir.s)
Awk't>Hs 7i::g,jjev _<;all'S - 1j-4-0 Fi/O.it!ldlkPJ,~d - EU:tlJA.L
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Plumbing
{I..etricol
'Z
Mechonical
PtUMBING
NO. I
Each lingle fi.-:ture
R.local.d building
(new fi.-:. additionol)
S.F. R.uiden~.
(1 bath)
Quoin. (1 bathl each
Additional bath
,
I
Water ser"ice
!.'-:;;;Tt-If:,,"1.
Sew!', iC'O F.::.ET
St::lrm Sewer
(phon" no.)
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ELECTRICAL MECHANICAL
f::e: I CHARGE' NO. I FEE CHARGE NO, I FEE I C.HARGE l
I Residence of I furnace/burner 10
.g: ft. "TU's
I New circuits. alterations I Appliance Yent "
or e.-:tensions seporato
I I Stationary eyap.
SERVICES cooler
I I Vent fan with
Temporary Construction single dutt
j Vent system aport from
Amps. heating or A.C.
I I I I SI,} ~Pl. Y ~~f'::'> /iY2. /O,~ I Mechanical exhoust
!A..,r-.,,_f. :-",;J.!.-:. hood and d~ct
I/)~i/{),O~II / MDl3rL-f. f...f<)/./:; ;j,~l),O~ I
c...ONNEC:n.y.,.. Wood stoye/heater
I I I FEEDERS I Heat Pumc
I I I I Air handler to
Amps. 10.000 CFM
I I I I I Air handler our
10.000 CFM
I I I
i I I I
I I I I I
I I I I I ISSUANCE .bJi.,PE'RMIT -G-
-Fjr),~~ I TOTAL CHARGES -$ XI),6:- I TOTAL CHARGES -e-
j
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I TOTAL CH.A.RGES
I WHERE STATE LAW REQUIRES thai the Electrical work be done by the E!ertrical Contractor, the .Iectrical portio" of this permit shall not b. .,alid until t.l
lab.1 ha, b_n signed by an EI.ctrical Contra nor and attached to the oledrieol panel.
I HAVE CAREFUltY EXAMINED ,he completed application for permit. Qnd do hereby certify that all information h.reon is true and corr.ct, and I furth.r
certify that any and all work performed ,hall be done in accordance with the Ordinances of the City of Springfield and the lows of the State of Oregon
pertaining to ,h. worlt d!'scribed herin, and thot NO OCCUPANCY will be mod. of any structur. without the permiuion of the Building Di...ision. I furth",
~rtify that my registration with the Build.r's Boord is in full force and effect 01 required by ORS 701.055. that if u.empt the bltui, for uemption is noted
h.ron, and that only lvbcontroctOI1 and employees who or. in compliance with ORS 701.0'.5 will be used on thi, project.
8asis for Build..,.. Boord e.-::emptian:
NAME (pleas. print) ~6/'.J r h/1, v-,.,
.).L,. III "":
SIGNATURe- -fjaA//-d/'I.A.
FOR OFfiCE USE ONLY
f">,,-\E
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DATE
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Zon.-J::1~~'i. Type/Cons!.kH (~Nd"
Fir. Zone L_l ~~droom. Ttt2-f"~
flood Plain~f'\~ c;toriCls_^N.t;:
Units
('leey load
Occy Group
Sq. Ftg. M~in
c". fIg. Accen
R':>'
_Sq. ftg. Other
i4S&, ijt Volu.
x Value
x Value
, TOTAL VALUATlON;;I4 7_-5Cl~."~
BUilDING PERMIT 4.0:00 h Plan Ck. Comm/lnd -@- I System. Development 447., 50 n
Cho~ges ~ P~H~LE- 65~ol Blda Per Felt , Chorc:'le (I.,5~1 -
Sl.._;..u~~'\"ilbl0 . ~- PIon C!t. Res _ 3--').O.,Q 01 I c..oP'I O,~4D
5~.T"jP ,~ 30%1 Bldc:'l Per Fee
PLUMBING PERMIT 1/\ :;>0 31 ')we> ,q
Charges and .' c......,- Fencll '..-",.-
Surchargu () -'ill "" 1 Tolal Comb. Permit 4f58;:(.ftS
,- Demo '--'
ElECTRICAL PERMIT :::'), )..2 3'>- 17,'3:0 I~ L-o"bt. } I ~
Charges and Sidewalk 17S""'.r
Surcharge. )"<) i -Q-
r, .--.:..- AIC Pa",inCl
MECHANICAL PERMIT --;-::+- /)!..FEf3T I 1(, 20 ,<-
Charges and ----~--- Curb Cut - 5~.(g~
Surcharges I TOTAL
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COMBINA nON APPlICA nON/PE.(CAPl
lit PERMIT VALIDATION
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'I. ApplicarU. ta furnish
A. Jab Address,
B. Legal Descriptian
1. examole..ax 10' 100, Lane Caunty Map Referenc~ 17 O:l 43 '
2. examoie.lo. 1. Block 3. 2nd Additian ta Sprin\ (' CITY ,0 F S P R I N G FIE L 0
C. Name, etc. of owner and construction lender
City Hall
D.. Energy Sources
1. examole.hea./electrical ceiling/or forced air c Springfield, Oregon
2. exam ole-water heater; electrical/or solar ( Department of Public Works
E. Squore footage ar valua.ion, e'c. 0 F F I C I A L R E C E I P T
1. examole.1250 sq, foot hause. 500 sq, foat gar, No B
2. examole.if new praiect, check n;;;...if addition, (C, , n<7 .
add. ere. Date X\\\l. \. CJ (') 196 \
F. Building permit information: f.~ " r\v' \ 1~
1. exomDle.~onslructsinglefomilyhousewithan ( Rec'd-From \VX\.5\\'0S\O ! '1"\..)...) . -' . (
garage _(\", r) \ ^l\\'""'\ ~
2, examole.remodel existing garagb into faniily r dd ~lI O'K 1\ \S)~ \ j\
3. example-convert single family residence into A ress" .i~ _) (".,,'
restaurant (change of use) i,.
G. Value of work o. defined in Section 303 (0) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction delays, Building D. '4
Stoff must be able to contact appropriate persons
design informcotion or job site corrections. etc.
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S 6 612"
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II. Abbreyiated Plumb;ng, Mechonical & Electrical Sched,
A. Except where blcnk spaces occur in the description
of the Mechanicol and Electrical Schedules, the apF
need fill.in only the No. Boxes adjacent to the app:
item(s) 10 be installed
B. full Plumbing, Mechonicol, and Electrical Schedule,
are available at the Building Division .
1. To conserve space on the permit form the schedl
hove been abbreviated
2. If the ilem(s) to be installed are not covered on 1
aled schedules you should consult the full sched,
C. BUilDING OIVISION STAff WILL FILL OUT ALL fEES
CHARGES ON THE SCHEDULES
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Received.J:ar:
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(\ '}) 60
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'Sf\~OO (/
80.10
440) 50
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Fees and Charges ','~ /
Plan check fees are due anCf payab'ie at the time of the I'.~I'
and no plans will be processed until these fees are paic.\:-:. n_
other fees and charges ore due and payable when the permit
is issued.
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Amaunt Received'. Sy:.,~ 'S
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AUTHORIZED SIGNATURE (
tHllTOH'TUR".Ull..""..TIRS' IUGIHI, QR 'UG' ...".. \,..
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III. Applicant to sign and dale
Whenever possible. the initial application will be used
worksheet only. Where possible, Building Division Stafl
prepare a typewritten copy and return it to the applica
the time ,he actual permit is issued for his signatur€..
IV.
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V. FOR OFFICE USE ONLY
Permit Cler"
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,
'Additional Project Information:
PLANS REVIEWEO BY,
name -r,;I'.o\ ~t1Elg;:<,'),,\
(J CD
SignOlured.v-rf\) ,)'\-u..uj~
"ate..s-~A-lqA\
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