HomeMy WebLinkAboutPermit Building 1980-9-23
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'J IrISPECTION LIrIE) /<\ / '.~ CITY OF SPRIiIGFIELD .''-.....
1726-3769 ;:.. u . COtfBIiIATION APPLICATION/PERMIT ,
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n ErIERGY SOURCES: .
Job Address Kt"1Jnl-Y'IA\ ~nr /...L)+.A Heat..LUM,&'rJaLi'"
Legal DescriptionTL /7-D-=>' -_-:)"1-4.::J. /30() Hater Heater ,+
, , I RanqeJl u~:f
P-.Jvflr) i3 rJ~ I"VIIVYW (11vf,tir,1'l -.<q~ -RuttllJ1b.JVll Valu, of Hork:
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Owner(JJm ll: ,}r/(j nnl r_ Ih()I'Yl(J5.f\() ..$ 3/ bOO-~
Add '~ 174-"1-1 Builriinb Permit Info: Descr be \/ork(i.e,. Build Single
re /47,-:;) Q ....c::.,+. Phone I...(::rJC/ Familv nesidence Hith A,ttached Garaae)
~nv>- Q'/4-77 I ^i"f"")'~lfl~..!LuLi./1r,"(l~
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Constr cticn lender
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IIIFORllATION LI Nl
726-3753
Sq. Ftg. Hain rJfD()
~q. Ftg. Access.
Sq, Ftg, Other
~Hew Add Alter ~ep.
Fence_Demo _Change/Use
_Other
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Address
Uc~IGN ltAM (name)
Primary 'fuh 1Y, '11 or
!
Phone
(address) (lies. no.l
II,::)() 1=/% ~O/l ,j)y '7_'.:J~::)
(exoiresl
(ohone no.)
t...Ji?5 -653..+.
(., -Iq -?I
Structura 1
Electrical
f
l1echanical
CONTRACTORS (namel (addresc;) (lies.. no.
General "K",h L'50 ~v lI~n j:'LV ~(1n..t\ d)y '7...::>~.::1
Plumbino ..sp~n PLuvY\Io~ /SSN IR+h,"':,/ri'OdOq
Electricad3u.D.d~v'<; ~+ .7/~ monvor,h'5 ;)O-Gl.,.,
Hechanic'al~+ 1/0105 ..rVVl~l'J ?-I,a"<3O!dJA
PLU1tBIIIG ELE~TRICAL..I I
(~)(nire<;)
(ohnnl) nn. )
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It) ->?f
I..J >/'-5 -653"':).
7"'7-(.\o~-
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MECHAN I CAL
rlD.
I FFF
CHJ\Rr.E
.J{f\
Residence of
t-- '1{Tr..',.:!~,~~q, FT,
N . I
I furnace/burner to
34, 12f) BTlI's
I Floor furnace
and vent
I Recessed wa 11
So~~e hp~t~r Ann vent
F
FFF
r,J1'J!liE.
{,.cb
4f Each single fixture
Relocated building
(new fix. additional)
I..,,,..
l_oJ'c.);
New circuits alts.
or extensions
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I I Install/alter/relocate I I I Uood stove/heater
rli~trih fpprlpr~- ,
, I IOf amps. I I
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I I I I IS5UANCf OF PFR!lIT /().ot)
,~S,r)>)l TOTAL CHARGES d.~.oc.1 TOTAL CHARGE5 37"<;0
that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division .
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13_"-' Ilda.>
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I/,(~D
l,sa'J
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/ S.F. Residence
(] bath}
Duplex (1 bath) each
I Additional bath
~!ater service
Sewer
Storm Sewer
:l5.x
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SERVICES
I!emporary Construction
IChange in existing
rp5 i rlJ'~nrp
Imultifamily, comm. or
TndlJ<;,tr;;d
I Appl iance vent
<;,poaratf'
I Stationary evap.
cooler
q I Vent fan wi th
.f sinale duct
I Vent system apart from
heatina or A.C.
I Meehan i ca 1 exhaus t
l hood ~nd dud
Of
amps.
C0I11'1. /lND. FEEDERS
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be valiJ until the
I HAVE CAREFUllY EXN1ItlED the completed application for permit. and do hereby certify that all information hereon is true
and correct. and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Oregon pertaining to the .work described herein, and that NO 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 ORS 701.055. that if exempt the basis for exemption is noted hereon. and that
only subcontractors and employees who are in compliance with ORS 7nl.055 will be used on this project.
I~AllE(please print) Kc")bt:r+- J -5~Lor .. SIGII^TUR0:~/"'r!) -/~
FOr. (Jr r 1 Lt. u~t. Ui~l y ....
I Sq, Ftg. 11ain /;::)4'9
Sq. Ftg, Access 3/~
Sq. Ft9, Other
OATE ~~.yzd
Zone_I:: - I
Type/Const. :;/.-il
Bedrooms '3
Stories '2...
Uni ts
Occy Load
Occy Group
xQ3."I(Jvalue..,%! .,59/,70
x 9.$'0 Value . _;1/,;1. On
Fire Zone -
Flood Plain /'/1)
R-3
Value
TOT^L VALUATION 4/.933.70
x
L_____L&_~,2Q
r 1~?,s3
7.5.&0
------~-----
Plan Ck. Comm/lnd
65!;/Rlrtn P""r F"f>
Plan Ck. Res
30%/Blda Per Fee
Fence
BUILDING PERfIIT
Charges an~
Su.rtharges
, ,/" ~ ISystems Development
';<0, uO Charoe (1.5~1
!3CJ . q o-C:F? 4- - XC>
PJJ ~C Sq,(r, I ~
-'
"1.cf:) DUE I PL. t!,J::. .DCe
I
(,,;1,9,01
PLUt1BING PERMIT
Charges and
Surcha rges
I,JI"J D_
. / ..~
ds.OQ I Sidewalk
------ /~;;-I AIC Paving
37.5'0 I Curb Cut
-------I,s~-I
9.60
ELECTRICAL PERI:IT
Cha rges and
Surcharges
ITotal Comb. Permit
..;< '70,Q3
$9()g,91
flECHANICAL PERMIT
Charges and
Surcharges
I
I TOTAL
PERMIT VALIDATION
C I T Y 0 F S PR I N c:; F I.E L 0
City Hall
Springfield. Oregan
Department al Public Warks
OFFICIAL RECEIPT
No. B S 4 9 2 6 (-
Dale I n- I r'] 191)0 . ...
Rec'd Frombj{?f\ ThDmr~Y)
Address \41?n ,~ty~.Pf:,
. I
Forr ~_p /103 ,DO
4-(!)ln (rL 53
SC;f"Y')
1.4n
?~~ 00
1,00
?/7 .5 ()
_ 1 . GJO
Uf ,60
fozq.6/
I, Applicant to furnish
A, Job Address r
B, Legal Description) ,
I, example- Tax Lot 100. Lane County Map R .Jren
II 03 43
2. example- Lot 1. Block 3. 2nd Addition tt r'
sprlnglield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources : .:
1. example- heat/electrical ceilin~/or fore -i,d,
2. examole- waterheater/electrlcal/or solar' -
E. Square footage or valuation, etc. -
1, example- 1250 sq, foot house, SOD sq, fc
2. example- if new project, checkMw - if t,'
check add. etc.
F. Building' permit information:
1. example - construct single family house
attached garage
2. example - remodel existing garage into f
3. examole - convert single family residenc
restaurant (change of use)
G, Value of work as defined in Section 303 (a)
Structural Specialty Code
H, DESIGN TEAH AND CONTRACTORS
To avoid design or construction delays. Buill
Division Staff must be able to contact apprOI
persons regarding design information or job ~ ,..,
corrections. etc.
II. Abbreviated Plumbing, Mechanical. & Electrical SI
A. Except where blank spaces occur in the descr"
portion of ,the Mechanical and Electrical Sche G~
the applicant need fill-in only the No. Boxe~
to the appropriate item(s) to be installed
B, Full Plumbing, Mechanical. and Electrical Sct (.
are available at the Building Division .
1. To cons,erve space on the permit form the
have been abbreviated
2, If the item(s) to be installed are not co
the abbreviated schedules you should cons Ct;
full schedules
C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEE
. CHARGES ON THE SCHEDULES
O. As noted on' the CAP, the label must be delive \,tr
electrical contractor for signature by his el. Amount
supervisor. The general contractor is not au"
to sign the, electrical label. -
App 1; can t to s 1'gn and da te (' BY
Whenever possible, the initial application will bl \. ,
a worksheet only. Where possible, Building Divis"
will prepare a type written copy and return it to
applicant at the time the actual permit is issued (h
signature. '
Fees and Charges t-
Plan check fees are due and payable at the time of the
application. and no plans will be processed until these
fees are paid. All other fees and charges are due and
payable when the permit is -issued.
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COMBINATION APPLICATION/PERMIT (CAP)
III.
IV.
V, FOR OFFICE USE ON~Y
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Received
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pet=: ~ '&Jj
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Received qO~ .q~
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. .otAJTHORIZED SIQNATURE
, ."I:LTOH"TU.H."ll ~""H'[..' 1:"4[10[, 0" .'.0'
.1''''1 C.
Permi t Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:.
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Permit applicant exempt from registration with the Builder's Board because:
I Additi ana 1 Project Informati on:
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PLANS REVIEWED .BY:
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name
signature
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date /0-3-8'0
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