HomeMy WebLinkAboutPermit Building 1980-7-23
.. CITY or SPRINGFIELD .' "
COHBWATION APPLICATION/PERMIT
J) $ t>LQV -, EilERGY SOORCES: I
Job Address 10,-r.o, V"\ /- -" l' .If I -'--j- Y1 rrvvQ"v-;;:v J' _ ~ '
1<'"'..&1.w.ry,. ~ /-1 Heat.. I~H";~ 'r;~'"''''r
Legal DescriptionT/... 17-63 -,::l7,-w:J J 2,r,/\ !~ater Heater oIlQ._'__
/J Ranqe II p~.j
1ZZYC'Ll A4 m'rn~{ rnvtitiDt'I"tQ/o.2.- Bl-Hen!iY9 ValuE of Hork:
Owner Er, b ,Sn . ~ I->V It d g (j[)Q!!9-
Address r- V'\~ PhoneL/-'i55 Bull,ii'iie Permit Info: Describe I~ork(i,e,. Build Single
Il.::::t{"') C!.f t::!.L'Y 1./\ f).{'2'-', Familv nesidence I'lith Attached Garaqel
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t-LLP~--1 f'lv 0 _^'lI"IL}LL ~,I " V I .~j d I V1 (I fL.)
ConstruUion Len~erFRr-l...0e.4-t F....t~vaJ Snv,:vvtrioibr Worli rn rpr;v-+ I
Address qj.p t.. r8 i/OarLl.I.:.l1uC'-'f! Phoneld ~j}/~ i -
UI:.~ll:iN TE.Ar'1 {name).J {address! (lies. no.) (exoires)
Primary &h ,~ I'~ iA-V II':>/l 1=i vn(lV"~ 11 ~y 7.;).3;:). lD-/q-f(/
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'1- HiSPECTION LINE / I ~ ~
726-3769 It?V - )
, Structura 1
Electrical
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INFORlIATION LWt "
726-3753
Sq, Ft9. "lain---=zL"Q
:q. Ftg. Access.~~ ~~
S9. Ft9, Other
--:llew_Add_AI ter ~ep,
Fence Demo Change/Ose
Other - -
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18
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(ohone no.-'j
I.../J?S ~3d
(address)
f
(lics_ no.)
(f!xoirpc;)
r1echanical
CONTRACTORS lnamel
General 6A-h.:'\a J f f::Hr
Plumbine '<>f""kr:l PI1J Y\tt h
Electrical j!2,t J~' J d 0 v<: rJ~+
'Iechanic'al (1-Y1\f~-f-
PLUIIBIrlG
110,
(ohnnp no, \ ~
4gS;-~s:+'
'74-7- CO:~c;
4'5S-(JQ.J.?'
(eX'q- 'l7l1t"2_
(12.D h v IQrlVdll-.J\ filS
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ELECTRICAL
MECHANICAL
FFF r.HARr.t NO
~~~ r~ARr.~ NO_
~I='I=' rUAOf.!:'
Residence of
/ ~-'<j'9SQ. FT,
furnace/burner to
;o,L\. ,..::,,, BTU's
Each single fixture
'-I
,;b:c.<:: /
~.tZ
Relocated building
(new fix. additional)
Floor furnace
and vent
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ls~ 1/2."',~
1d.'l.0?1
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I /J. ~-, I I App Ii ance vent
CIC...J ./ Temporary Construction /&'.a:l seoaratp
I [Change in existing I I Stationary evap.
rp~i1pnrp cooler
I Imultifamily, COITrn. or I // Vent fan with
Tnrlll~trial ~ sinole duct
I Of amps,l I Vent system apart from
heatina or A.C.
I I' / I Meehan i Cd 1 exhaus t
CO~1,/IND. FEEDERS hood .nd duct
I I Install/alter/relocate I Hood stove/heater'3:,J..,,~
rli~trih_ fpprlpr~ ~~yl
I IOf .mps. I I
I [ I I
I I I I
I I I ISSOANCf OF .FRrllT /~~
TOTAL CHARGES ,1<'-'o:J- TOTAL CHARGES ,3>:'1)1 TOTAL CHARGES _3:l.s0
WHERE STATE LAW REQUIRES that the Electrical work be done by an 'Electrical Contractor. the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXA~lINED the completed aprlication 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 Ore<]on pertaining to the ,work described herein, and that rm OCCUPAHCY 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 OP.S 701.055 will be used on this project.. .
SIG1IATURE~''''~ DATE 1;/2 ~(J'
FO~ OfFiCE USE OIILY
, S F' 11a~'" 1:'4:.:;
o. ...g. '-'_ ~ 1-~_~f
S9, Ft~, Access Lf.S
Sq, Ftg, Other
/
S.F. Residence
(J bath)
Dup 1 ex (1 ba th)
!
Additional bath
~Iater service
Sewer
Storm Sewer
INew circuits alts.
or extensions
I SERVICES
Recessed wall
So~~P hp~tpr ~nrl vpnt
each
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IWIE(please print) Rbbf-rl ,), ,')O'-Ll()V
Zone_I< -I
Fire Zone -
Flood Plain /./{j
BOILDING PERfIlT
Charges anc
Surcharges
PLU!lBING PERMIT
Cha rges and
Surcharges
ELECTRICAL PERr~IT
Cha rges and
Surcharges
11ECHANtCAL PERMIT
Charges and
rcharges
~/
Tyoe/Const, \/- "-'
Bedrooms 3
Stories--'z-
Units
x .~~,?-oO Value t.,(j,S91,70
x "1..':;0 Value 'fS&.OO
Occy Load
Occy Group
R-~
Value
TOTAL VALUATlDrI-.!i:J, ()47......lQ.
~
x
I . I Plan Ck, COIltTl/lnd
______L~("cn fi5VBldo Ppr Fee
Plan Ck. Res
1_. {n4 30t/Blde Per Fee
_______;,-S.no Fence
1,'fO I D~mo
3s,<!)-" Sidewa I k
----------~
/, ~ A/C Pavin9
- , 3;:.(~~1 Curb Cut
------- /.101
'J,.fCf, 13'0
ISyste,ms Development
Charee (1. 5~)
%,:::x) P'CPq-Z~- '80
-Pii,'54tp7(o I
,)
/3,Sd/~
G,~ '1.2
/2, (!,,((.O:/F
f-I #'- '7}Ji3
ITotal Comb. rermit
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I TOTAL
/1.,s-D
,9.0
I :J79:,;?<f
I~ !,:.(3, ~~_I
,
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COMBINATION APPLICATION/PERMIT (CAP)
iii
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
17 03 43
2, examole- Lot 1. Block 3. 2nd Addition to
springtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam!? 1 e. hea tie 1 eetr; ca 1 ceil i nq/or forced air qa s
2. examOle. waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. examoie- 1250 sq. foot house, 500 sq, foot garage
2. examOle. if new project. check new - if addition,
checl< add. ete.
F. Building' permit information:
1. examole - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. examole. convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the.
Structural Specialty Code
H. DESIGN TEfu~ AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
Abbreviated Plu~bing. Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill.in only the No. Boxes adjacent
to the appropriate item(s) to be installed
8. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the .permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbl'ev i a ted schedu 1 es you shou 1 d consu 1t the
'full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D, As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is not authorized
to sign the electrical label. ---
Applicant to sign and date
Whenever possible. the initial application will be used as
a worksheet only. Where possible. Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
Signature.
Fees and Charges
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.
II.
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I III.
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IV,
V. FOR OFF! CE USE Om,Y
PROJECT CO~DITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
:ITY OF SPRINGFIELD (,
City Hall
Springfield, Oregan
(.
Department of Public Works
OFFICIAL RECEIPT
54927(
~ No. B
L.-\.~~). \\ 13-)
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Permit Cl erk
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Permit applicant exempt from registration with the Builder's Board because:
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Additional Project Information:
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PLANS REVIEWED BY:
[)~d
name
signature
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It) -;:;, -!5'U
date