Loading...
HomeMy WebLinkAboutPermit Signage 1980-11-6 (5) . o ,-' . INFORllATlON liNt 726-]75] Sq. Ftg. f.iain ~q. Ftg. Access. Sa, Ftg, Other Ue\'I Add Alter Rep. Fence_Demo _Change/Use _Other c/) S2, ~c: if.., I ,~ I I INSPECTION lINE i26-3769 Job i\ddress -.. H1~ J~'hto 11 lOLL r1~()(,)O l () j I - I Ranqe Legal De5cription Address UtSllill IU\1,' (namel Phone (address) Value of Hark: I IV.... ~~, L CO, \J..) BuildinQ Permit Info: Describe Hork(Le.. Build Single Familv nesidence With ^ttached-Garaoe) 5JrH-1 - C~hClld' ~Q.Dill no nh l :O~b:..b..-\' D~ N"\ C1( Q .\.. Gv- "-- ~, (j I 0 \) ) \ I (lies. no.) (exnires) (ohone no.) Owner '-'1V"\ (' +. , \ \ \ ,.. .\ l 11'"""\ Address P,h, 8v,')( rn , J %:,'Y' n Construction Len e ~11 fY, ~l 'c,rY'IL\ "'d.oloq - ~Phone O/Le.(~ ") Pri rna ry ;::"".tct:lr:;! 1 ,ieneral (na2e~ (address) rql\..J1.J\'v) ~l'>"l. ~I~-'Y\/) ~CntO (1 ics. !le:.) (exoires) (dhOrlP no. I I ~ ! I ::1 e::r~:a I ~'.;,:;.~nl;:a 1 .:::;7~;'C:w.::;'S :;h;;:':Dlno :lec~ricGl ";::-~~~(~l ?lUlmlr:G :lECTRrCAL MECHAiI [CAl I~~cn slngie fixture , ~ ~_ ~ i r.Hf\RCiF tm I i r-~~ I r;':':';<:I";F ;;0. Residence of furnace/burner to SQ. FT. BTU'<; I r-Fi= I nH~.rU;F ).. i Relocat~1J cui lding l(new fix. dCdltion"lj , I' S.r. P.~sidence f1 bath) IDuplex (1 bath) each Additional bath New circuits a1ts. or extensions Floor furnace and vent SERVICES Recessed wall 50are heater and vent Storm Sewer Of amps. Appliance vent seaa ra te Stationary evao. cooler J . Vent fan with sinole duct Vent system apart from heatinQ or A.C. Mechanical exhaust hood and duct Wood stove/heater ~!ater service Temporary Construction Change in existing rp,idenre multifamily, comm. or Industrial Sewer COMM./IND, FEEDERS Install/alter/relocate r1i<;tr'ih. fpprlpr, Of amps. TOTAL CHARGES TOTAL CHARGES WHERE STATE UH REQUIRES that tile Electrical "ork'be done by an. Electrical shall not be valij until the label has been signed by an Electrical Supervisor ISSUANCE OF PFRlllT TOTAL CHARGES Contractor. the electrical portion of this perQit and returned to the Building Division I HAVE CAREFUllY EXN1IrlED the completed apfJlication for flermit, 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 Soringfield and the laws of the State of Oregon pertaining to the \Vork described herein. and that rw OCCUPAHCY will be made of any structure without the permission of the Building Division. I further certify that my re9istration 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 emn10yees who are in compliance with OP.S 701.055 ~e used on this p~oject. IlAIIE(please print){!'~~{.,A<2.'-;) IJ71C II SIG;jATUR~!../.."''''//j./ // DATE/i/fr/FO FO~ OFFICE USE ~iJl\.. Sq. Ftg. f1ain Sq. Ft9. Access Sq. Ftg, Other Zone Fi re Zone Tyoe/Const. Bedrooms Stories Units Occy load Occy Group x Value Value Value x Flood Plain x TOTAL VAlUATlOl1 PlUI.1BING PERIHT Charges and Surcharges SJ rrn d (?- ,(';(J i I I BUILOIllG PERI.IIT Charges an': Surcharges Plan Ck, Camm/lnd 65%/Bldo Ppr Fpe ------------ Plan Ck. Res ]O%/Bldo Per Fee -, Fence ------------ Demo Systems Development Char"" (1.5") ELECTRIUl PERI:IT Cha rges and Surcharges 11ECHAIHCAl PERI1lT Charges and Surcharges Sidewalk A/C Paving J / Total Comb. Permit TOTAL U-J~,co -, Curb Cut -of' . '.., " COMBINATION APPLICATION/PERMIT (CAP) 1. , 1 I Applicant to furnish A. Job Address B. legal Description f 1. examo 1 e- Tax lot 100. Lane County Map Refer 'e ]7 03 43 2. examole- Lot 1. Block 3, 2nd Addition to ~pringtield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examole- heat/electrical ceilinq/or forced 2. examole- waterheater/electrical/or solar E. Square footage or valuation, etc. - I. examole- 1250 sq, foot house, 500 sq. foot 2. examole- if new project, check-new - if add cheer. dad. etc. F.' S:..dl,jing p€lT.ii: infor:::~tion: I. exawoie - construct single family house wit H:.:.r.:i1eo gar~ge 2. exc~ole - re~odel existing garage into fami (' 2. e~a~ole - conve~t sinole family residence i rest2ur~nt (c~ance of.use) - G. ~;alue of wor/.; as defined in Section 303 (a) of Structural Soeeialtv Code H. D::SiG:~ TEAi.j Aim CONTRACTORS To dvoid design or construction delays, Buildin, Division Staff must be able to contact approprii persons regarding aesign information or job sitl corrections. !tc. ( Abbreviatea Plu:,.,bing. ;'ieehanical. & Electrical Sene: A. :xce~t ~here blank soaces occur in the descriDt. ;:rtion 07' :.-:e ;':echanical and Electrical Schedu' ~i":e applicant need fill-in only the No. Boxes d( (en :J :~e ~opropriate item(s) to be installed S. ~'..:ll Pit:r:;jing, r'!echanical, and Electrica1 Sc~edt are available at the Building Division 1. To conserve space on the permit form the sct ~e have oeen abbreviated 2. If the item(s) to be installed are not cover the abbreviated schedules you should consult full scnedules ( C. BUIL911:G OIVISlOi; STAFF WILL FILL OUT ALL FEES I . CHARGES Oil THE SCHEDULES O. As noted on the CAP, the label must be deliverec electrical contractor for signature by his elect suoervisor. The Qeneral contractor is ,not authc to sion the electrical label. ---- Applicant-to sion and date Whenever Dossibie, the initial application will be' u a ('",: BY a worksneet only. Where possible, Building ~ivision will prepare a type written copy and return it to th applicant at the time the actual permit is issued fa signature. Fees and Charges Plan check fees are due and payable at the time of t~ application, and no plans will be processed until these' fees are Pdld. All other fees and charges are due and payable ...men the permit is issued. I II. I I IV, V, FOR OFF I CE USE Q;IL Y -";," Ii, . CITY OF SPRINGFIELD .. . cfJ I I~~, ( A'\Q ( L G-,~~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: .. - 1 j ... PERMIT VALIDATION (' City Hall Springfield, Oregon Department of Public Work. OFFICIAL RECEIPT r B 5 5113 .. r' ,,-,).( Gn1 iJ f ( No. J / - 0 1980 Rec'd From mar(!lh t?vin~ Address PO, frry c9Ci() q -( 1 3, ('f) ( Dole ( ( Received For: &'(yD ((,,~9 w, CQ.IY\-t.l - 0 - .sl~:r [1\1 L\ (\ntHlJa.i rip) &C\--i\. It\l4 'J 800 , ( GCLL LLY.LL,.\. (J _~(n'I [1I1~ () (--0. 'b uJJ.u ') U '64 ,00 " ~I, . Amount Received <I AUTHORI'ZI:D SIGNATURE: !JHE~TOH'T""N.ULl "~'NT''''. . EuGENE. O~ .T.O' CJR,{f) .. { ( ( ...".. (. ( ... ,-,...................;;;,...~.'..,.- - _...... _.,."~".........,.~'-'....,,...,...--'._- ... " j , , ( Permit Clerk Permit applicant exempt from registration with the Builder's Board because: I I I I 1 r- I Additional Project Information: PLANS REVIEWED BY: - . ... .1 . ~~...".'.~,.. _~_.. ~. .,~ ...._.._~, .. ._.~'......... , _., .~.. name '"S i gnature " date ~, .J'. l '.;.0....' --.,. ,...._........ 0,."_... '..,..,.,,_..... _'.. ...11. ".......__ . ., "~~.' ......,... _ ......, ,...1._. ... .. .. ..m.,.". ... _, ..