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HomeMy WebLinkAboutPermit Building 1981-5-27 '. '" ~ INSPECTION LINE Westt'IVI "OtJYt:6 CITY OF SPRINGFIELD 726-3169 72vtJ1I1/AJ.. A J i .tfl JIll"" J COMBINA.TlON APPLlCAflON/pERMIT " f INFORMATION LINE 726-31 S3 I ENERGY SOURCES: Heat . rJ... r L I u.. I Water Heater iJ.~ r - - Ranqe -r7 ::.;4 ao I Vcjre of Work: __Fence_Dema_Changel Use . I Y:P 0 nCO _O,h" I Own" A-l.LlC3.t-l l/l/i'fJ:bnfiJ'p':-.. ___ ~._... ...... ..n.J? ... .. .. ..n....... .__um_ P~/~ A~ Building Permit Info: Describe Work (i.e., Build Single Ao'd;;!,',' . _ _ ~ 1 Phon"TJT m;lv R,,'d,n,. With Atto,h.d Go,aa.' '7f1.:t?!JUMTliJ CLUfiJ?J> P;:JPTITiON MIA-l.lh I f./ I Can.t,u:on~ ~1rIJJf-? .W/lt.D/UIA k, I Add,... Phone'- C.OMPl.~PS (l?/JS~ 5PA-l';cF' I DESIGN TEAM I Primory I StrucTural Job Add".JL'7 U, 61rrF IMLLcx.}j:? i 7- ()3 -,;;):;? - d Atvt nf Legal Description Sq. ftg. Main Sq. Fig. Accen. Sq. Ftg. Other _New_Add..XAlter_Rep. ilil..+>~1 ~ ..... (\ v 'vJ " a\ QF/2jt:'^-I /:7(I~'J (oddreu) pc.; .f!t2X ':?4-?E RbBJt3 "774tY~ (lies. no.) (eJtpires) I . I ,,~. .., I . 1 ~4 -_. -I I I I (phonf; ;lC'.) (name) Electric,,1 Mechanical CONT1~ACl'ORS t:r(j/~_~bJEt"'~ 4m!t}~:E-.!IJ/t:id!;r{ _ .1i11:JJ:ILJ-!Y .fJ:Li L I~ (name) (oddreu) (1irs. no.) (expires) General A:.6---.M30vtr. Plvmblnq x NtiW d~r;;\J:t:. I"llteraliv"s or e;;jen5~lJr.s /~- I J fur.la~a/bu~ner to __._BTll's J,ppliCIllCi. \'an~ ~oparots 5totionary evap. cooler -:1 , ! -----, -~.' " ~-' ~c~-'-1 F,,!; CH"'~'."I' I -- <<"'.1 . I ---j'-J Electricc:! etEL~~___.. Mechanical :'l'JMcn..:O ElECTF:!CAl T MECHN~i<":AI, Nci'~~=':::'~__ _._i FEE rCH.\~-i;F. Is-:<>~ J ;~o. _....:..!!"L ..':HARGE NO. _J --:.. _ Eccll ~inQle fi;.:ture P.Illocarcd Luilding (ne...... fj,;. od~.i;-iO:Kn_.. S.F. llesidence (1 bot},) ResiGE-:-lct} of ~q: ft. -:=1 _._ _ S~,V!CE$ ,___.__, ___ __.. _ _~'_. Duoln (1 both) each "e~n})Orr!i.j.' Cm;stllldiuOi Vent fan with single dud Vent system apart from . heatin!:! ar A.C. Mechcmical exhaust hood a...d duct Additional both Amp,'. Woler service Sewer I 1 1 FEEDERS Heat Puma I Air handler to 10.000 CFM Stor.m Sewer Amp,. .1__.. -----I___L......-___ _._' TOTAL CHARGES z;: .~ TO'!..\l CHARGES WHERE STATE .tAW REQUIRES thut the f.lecfrital wodl"bv c:!ono by thlQ Elc~litor.e:on'ractCll, tbl! .l..d,.icol'il.,;-~l,,:, o~ ,hi: Pllrmit Sh3U noJ b. '~lid until ~ label has bHn signed by on Eledricaf Contrad!:r and, oNochcd to' tho .!:!id,icc;;1 panel. I HAVE CAREFULLY EXAMINED the ~mpleted applicCltion for permit; and do'hereby certify. that 011 informotion heron" j!'i :rue one! corre~, and I further certify that any and 011 war!:. performed sholl be done in accordonce with the Ordinances of the Cil)' of Sprillgfield ane! ~he laws of the ,State of Dregorl pertaining to the work described herin, and that NO OCCUPANCY wiiJ b~ r.1ade. of any structure without the permission of the Building ,~visiall. I further I' certify that my registrution with the Builder's Board is in full force and e-ff"ect as required by ORS 701.055, that if exempt the bosis fUi. exemptiC'n is noted heron, and that only subcontractors and employees who ore in compliunce with ORS 701.05.5 will.~e usad on this proi.ect. ~. .a.i. fa, .ulld.... Boa,d ...mp.!ia'" .../ / ~ ; .. NAME (pl.o," p'in,? hL//.7A-1 ,/ b""A'/ ,-~,"" <IGNATUR< ~ ~ /~.<TE:' ,-,7.5"-;Y J -" - ::;-"'-'-~==-_~r'''-!./~-:::_~_.....!..'''';;:''!::.-.V__'_","~--''-_7T' FOR OFFICE USE ONLY , Zone ':"':'~Lf Type/Const.~/;f;i? Fire Zone~"':"""-'-Bedrooms _ flood Plain Ne:> C:~ori.. I -~---"---;;/c., . Units Sq. Ftg. j.~ain "'ccy loud __// Sq. Ftg. Aecel' Oecy Group...22:-_~",,---Sq, F~g. 0Ih",,_--':"'_ x .--:--Val::-'~!"'ao. "",->' x ','olue --:-- x _. V-:.lue TOTJo.L VALUAT~ON ..1.J~.. ~~ BUILDING PERMIT 2&', 0<> Plan C!:. Comm/lnd Charges and -------- 65%/ BIde Per Fee Surcharges f 'f":'co (./< Plan Ck. Res 30%1 BldCl Per Fee PLUMBING PERMIT s-: ~.. Charges and Fence Surchorges :20 Demo ELECTRICAL PERMIT /5..,,0 Chorges and Sidewalk Surcharges ,.;;'~ AI C PaviM MECHANICAL PERMIT (/ ""'" Charges and O. Curb Cut Surcharges ------7 '( ,0 , \h.ID?1 <;:,\oCQ ~€; Systems Development ChorQo n.5%l L 5"2, S".:::s ;",..\q Total Comb. Permit r.;~. 5'6 I TOTAL 1/1.CJ<O I. Applicant to furnish A. Job Address B. legal Description 1. examole-tax 101 100. Lane County Map Reference 17 03 43 2. example-lot 1. Block 3. 2nd Addition 10 Springfield Estates C. Name, etc. of owner and construction iender ..'; C I T Y D. Energy Sources 1. example.heat/electrical ceiling/or forced air gas 2. exomole.wofer heater/electrical/or solar E. Square footage or valuation, etc. . ( 1. examole.1250 sq. fool house. 50D sq. foot garag. 2. example-if new project, check new-if addition, ch add.. etc. F. Building permit information: 1. exam ole-construct single family house with an at. ~~c ~~ 2. examole-remodel existing goragt; into family roo ( 3. exompie-converr single family residence into restou~ant (change of use) G. Value of work as defined in Section 303 (a) of Ihe Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction delays, Building Divi: . Stoff must be able to contact appropriate persons re~ (~i' design information or i,ob site corrections. etc. COMBINA nON APPlICA nON/PE"T (CAP) II. Abbreviated Plumbing. Mechanical ~ Electrical Sched~le A. [;~"t!pr where blcnk spaces occur' in rhe descriprion pI ot rhe Me.:hanical and Electrical Schedules, the opplit need fill.in or.ly rhe No. Boxes odjacenr ro the.opprol item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedules ore available or the Building Division , 1. To conserve space on rhe permit form rhe schedulE have been abbreviated 2. If rhe item{s} to be installed are not covered on thf: ated schedules you should consult the full schedul. C. BUILDING DIVISION STAFF WILL Fill OUT ALL FEES AI CHARGES ON THE SCHEDULES III. Applicanr to sign ana date Whenever possible. rhe initiol applicarion will be used os worksheer only. Where possible. Building Division Stoff 'I prepare a typewritren copy and return it to the applicant rhe rime rhe acruol permir is issued for ~is signarurE. IV. Fees and Charges Plan check fees are due and payable at the time of the a and no plans will be processed until rhese fees are paid. . orher fees and charges are due and poyable when the Plt- is issued. V. FOR OFFICE USE ONLY / " · PERMIT VALIDATION OF SPRINGFIELD City Hall Springfield. Oregon Deportment of Public Works OFFICIAL RECEIPT ( ( .' '. f\\( 'V' No. B 56606 Date ,\\1\t).--('y{\19~ \ Fram \.~1('Y\\ ~ >{,\\Q~ ( .. \ ~<:)"', \). . Address \,>,\). ~ <.~~'\ 0 ~11 Received For: b~cr\.1[t, <:DO.cP \. - .~ {J 4'/0 / ,I;). ( {1!ffiD n. CD t~ '. 4D/() . DO J 0 QK I~ 00 40/0 .fd) \'\\0 tH .'y \(0 .dO ... 4\..1 Q .t d::f___ ( CY1L-.. c'--b).5U- . ( c. ( c ( ( c ( ReCeiVeq.-aq- OW 'C~ ( Amount " I cch.'(ffi ) ( (I AUH401'llZED SIGNATURE I.."'. (~. ...UTON.TU.....Ull ~",..T[.. . [UCI:NI, 0" 11"01 (, c Permil Cler~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: j- FiRe: OcP7'. /,v-Si<>6c7/':;'--, /rd tr:&o<V/j"c,..-'-~ Additional Projecr Information: .t;;I€t..L r h C" f7:.&a=>e =z "2:::L.", . _ rc/.,/'-/// / PLANS REVIEWED BY: -,...., Lo/?NfF: h~c-c:~ ",ignaru~1'" name , ~ .... -' .iolp S"'-2?-B I