HomeMy WebLinkAboutPermit Building 1981-8-20
f()<(; l\ PL~F\<; a~IT
\
L,gal Omd.';a. 1'1-0~- 3(" - '11 "TII(LOT" - ""00
JoT:l~ St4I1M. To !jO/!rH"nE F-t.l~.
9w.., ~ Q p;::--.,.0R'J Oi\i-<E
I \0<;<;4 PLI.=lA<:AIIII', ~f,Q,
I
I
I
I
I
I
I
I
I
CA<.fs:::L1n;::- ~j<:;
CA<:k'8f)P Rn}..;
()\-0I\)FO
()\r\Il\\FR
~R<::; kADF
CA<:::KElf}E"
c<)",,) l\':-Fe
, 0 V\)~'EJ?
INSPECTION LINE
72~J169
Job Addr!!u
Addreu
Corutruction hndt!,
Addrl!U
DESIGN TEAM
Primary
Structural
electrical
,v..ecnonicol
C:ONT~ACTO~S
~..nt!rnl
PlvmbinQ
fl~(fricol
Mechanicol
Eoen ,in'll. f;.luflt
Rotlocared bvilding
(new lix. oddilionoO
S.F. if~"d.n~1t
{1 bOlh}
01.0011'11: (1 bOI;') ~o(h
Additional bOlh
WOIl!r 'erv;ce
Sltw.,
Storm Sl!....,
n",h.\'::-p
- - .
(nome;
(noml!l
f-?. ') k
f('l....J<:;
?tUMBINC
-~-
" p,r;:
.
-.
INFORMAIION LINE
726-.J7S3
I ,
~,
.......-..j
D'
CI)!
0).
,9-J1
CITY OF SPRINGFielD
CQM61NArlCN APPlICAflONJ PERMIT
C::::::-n F'.D
)
ENERGY SOURCES: I Sq: ftg. Main
Heat I Sq. fIg_ Acton.
Water Heoter Sq. Ftg. Other ~~.u:Jr Poo L
Ronge ~ _Ne......__Add _Alte,_Rep.
Value of Wo,k: I' - ._Fence_Oemo_ChongeiUse
'?flOC). .':3 _0'""
Building Permit Info: Delc,ibe Worlr. ii.e., Build Single
Fomil)' Relide"c. With A.lloched GoraClel
9-.W'MNf'>o.U:: PO'"' ~
Phone
(oddre,,) (tin. no.) (eKpire,) (phone no.) I
~ Ynf\lttJ <:::'T ;:;( 1.!:L!79 U.:..8../ f).!:L?-1"Jr:J'-Kl
~~,<if m.G}/I\\ sr; r:JIW7Q 1/-3/ 0..4 ')Jf) Jj J;j !
;,
,
I
(oddre,,) (lics. no.) (upiuu) .(phone no,}
,<"<f.:~LL VYlA / AJ ::J IJJ!19 [[-gl I) LJ f)-f").:)t.f-J:!,
,':?K~LLmA) r\l ;:) Iftq Lf.2.)<.) I) lj '7 - 1),.)Lf. r:;
-
r-
~.---_.
I
,
CHARGE) NO.
MECHANICAL
ELECTRICAL
"
----.----.''I''E
iCHARGf
i
~.",.
1 CHA.RGE i NO. i
Sq: ft.
BOlil for Builder's Boord eumptionl
NAME (please print)Mh I~n.r~
R-I
lone
Fire lone
flood Plain
BUilDING PERMIT
Cho'ges and
Surcharge,
PLUMBING PERMIT
Charges ond
Surc"orgel
ElECTRICAL PERMIT
Charge, and
Su,chorgel
MECHANICAL PERMIT
Choll]e s ond
SUfCnarges
! /t:J.tJlJ
I
I
1
I
1 I
1/0.001
FE::
Residence of
I
IS-col
rurnace/burner to
qrU's
I NO. I
I~
I
I
I
I
I
II
I
I
I
I
I
I
t
I TOT At CHA.RGES
I WHERE STATE lAW REQUIRES thaI the Electrical work b. done by th. Elertrical Contra CIa'. Ih. electrical portion of this p.rmit shall nor bo vnlid ",ntil Q
label has bun signod by an Elec.trical Conl,ador ana attached to the oledrical panel.
:2
New circuil1. alteratiaHs
or exutnsionl
Appliance vent
leparote
SERVICES
Statianar}' evap.
cooler
Vent fen with
singiCl ducl
Vent nstem aport from
heatinq or A.C.
Mechanical exhalut
hood and duct
,
,
I
i'
,I
I
j
I
Temporary Construction
Amps.
'-jr'ooa 1I0veinealer
FEEDERS
I Amps.
Heat Pump
Air handler to
10.000 CF."~
A.ir handler 0....'
10.000 CFM
/
Go A'" To '"l O~t"~"""
:1.00
ISSUANCE OF PERMIT
''''.",0
.:20""01 TOTAL CHARGES
/5.00 TOTAL CHARGES
I
1':;,(Jt'l~
Type/Conlt. -
l\edroom.
-
<ta,ier
I HAVE CAREFULLY EXAMINED Ihe completed application for permit. and do hereby ce,lify that all information hereon is truo and corr.ct. and I further
certify Ihat any and all work performod shall b. done in accordance with th. Ordinances of the City of Springfield and the laws of the State of Oregon
pertaining to the work delC,ii:Mo herin, and that NO OCCUPANCY will b. mad. of any structure without the p.rmiuion of tho Building Division. I further. i
certify that my regislTolion with the Builder's Boord il in full forca and effect as required by ORS 701.055, that if exempt the bash fOr exemption is noted I
heron, and that only lubcontractors and employees who are in compliance with ORS 701.0'5 w' led on this projecr.
11[(.00
1.9:J
;;0.00 Fence
, ~O
IS.no
. (.()
.____Q..:.,ooJ Cu,b Cut
I"I~ I
?&~qIrtoNAT ,~
V FOR OFfICE~ONlY
M--~~f5/"0Jh-/i
. -- . r-, I
I
i
I
I
-
Sq. Fig. Main
Sq. ftg. Acce..
Sq. FIg. Other
x Volu.
x Value
... Valu.
TOTAL VALUATION -Xj.an!!!!?
I Systems De...elapment
Cha'~. fl.5~..\
Units
"<oy Lood -. 'g
Ocey GroupAA-::L
Plan Ck. Comm/lnd
65%/ BJda Per Fee
Plan Ck. Res
:l0~:'1 Bldq Per Fee
/..;. c,I{) &.
'ir-r?-8"1
D~ma
I Sidewalk
I Ale Po...;n..
Total Comb. Permit
9r1. ~O
1
I
lTOTAL
if 95,80
.
.
COMBINATION APPLICATION/PERMIT (CAP)
II. Abbreviated Plumbing, Mechanical & Electrical Schedu
A.' Except where .blcnk spaces occur in the description
of the Mechanical and Electrical Schedules. the app
need fill.inonly the No. Boxes adjacent to the appr
item(s) to be installed
B. full Plumbing, Mechanical, and Electrical Schedules
ore available at the Building Division
1. To conserve space on the permit form the 5ched"u
have been abbreviated
2. If the item(s) to be installed are not covered on t~
ated schedules you should consult tlie full schedu,
C. BUilDING DIVISION STAFF WilL Fill OUT ALL FEES I>
CHARGES ON THE SCHEDULES
III. Applicant to sign and date
Whenever possible. the initial application will be used a:
worksheet only. Where possible, Buiiding Division Staff \
prepare 0 typewritten copy and return it to the applieanj
the time the actual permit is issued for his signatur&.
Fees and Chorges
Plan check fees ore due and payable ot the time of the 01
ond no plans will be processed until these fees are paid. J
otner fees and charges are due and payable when tne pe
is issued.
IV.
V. FOR OFFICE USE ONLY
l-
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~
-'\'.."
Additionol Project Information:
PLANS REVIEWED BY,
nam-
signatur...
.
.
-I
I
PERMIT VALIDATION
i
'I
CITY
OF
SPRINGfiELD
"
City Hall
Springfield, Oregan
Department of Public Works
OFFICIAL RECEIPT
No. B
(\~' m 19A (
Date f'o..V l),. r'~ ^'_ ~l~-:,
Rec'd From , \\ 'UC-A~ -
Address 0~?:A \'\'0 q f-..j
57 A A t:;
1 J.v (
(
-(
--
("
~,
F~t1{\l. ~ CD
- - \ Af~/) '\ q~
V(~ . , c.\1),CO
4% ' r:o
-. Sex>
~:~OOf'-t7 '-.J)
. .~ .10/
- \1\ 00
N\~_~.t4 .d . Ll.t:"
\~'-- ~~ . ~
(
,
'.
(
(
(
(.
(
(.
(
(
C(,
(
Received . g.~ t5-.J
~~
S"~f,.TO"'TUIl"'U~~ ~"'"T~'" . ~UQ~"~ Oil ""0'
(I
Amount
(I
..."., C.
it (]
(
.
I
I
I
fla
~ate ?~ ~~-lf/