HomeMy WebLinkAboutPermit Building 1980-7-25
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726-3769
Job Address / -7.') c:
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Lega 1 Descri pt,i on
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
/) . . /;> . , ErlERGY SOURCES: ,."/'0. .
,"-o.J()('.i;")(JJ/! /'"Ur-I- Heat\'-Ifl;\ "I"~\kel(I'+n(.
q 0 Hater Heater eil'L-Hr"( ~
l. jl/ rn iHr.' if I . .
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INFORf1ATION UNt
726-3753
So. Ftc). r,jain i.1.0Y.iJ:j
:q. !"tg. Access.~:?,;( .rf;
Sq. Ftc). Other . - 1_
AJ~e\~_Add _A Iter _Rep.
Fence Demo Change/Use
-Other - -
,00
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O~mer J )~/Yl
. Address q r..(;?
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ValuE. of l'lork:
.27 /'.;)..0
~~JO 7.-
Buil6inq Permit Info:
Family nesidence With
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. TOTAL CHARGES 36-,Oel TOTAL CHARGES
~JHERE STATE '-..'H REQUIRES that tile Electrical \~ork be done by an
shall not be val i-J until the label has been signed by an Electrical
. Constructi on Lender
Address
DES I GN TEAtl
(name)
Primary 0 'N \ll..P_)r
Structural
Electrical
r~echani ca I
. CONTRACTORS
(name)
. Genera 1
CJ V\! nO f\r
"PI umbi nq
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f)
Electrical
~1echani ca 1
PLUIIB I rIG
NO.
Each single fixture
Relocated building
(new fix. additional)
\( Is.F. Residence
.' (I bath)
Duplex (1 bath) each
,
J !
Additi ona I bath
~Iater servi ce
Sewer
I Storm Se~'er
IWIE(please print)
,/lOtJ
Phone.~
7'1" aD,I;.,-
. i"{':;'~ 0 l~'-'
_<( ,en
Describe Hork(i,e., Build.Single
f\.ttached Ga race)
C).+h-1[j/)pA Of). ;'-(]llt1 J
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(lies. no.)
(exoires)
(phone no.)
Phone
(address)
(address)
ELECTRICAL
FEE CHARGE NO,
Residence of
i. ;:2..0t..J SQ. FT.
New circuits alts.
or extensions
ISERVICES
Temporary Construction
Change in existing
residence
multifamily, comm. or
Industrial
Of
ICOMM./IND. FEEDERS
I Install/alter/relocate
distrib, fpeders
10f
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amps.
amps.
(lies. no.)
(expires)
(phone no, )
MECHANICAL
FFE CHARGF NO.
FFF CHARGF <
15:c~
furnace/burner to
BTlI's
Floor furnace
and vent
1/~7.CO
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I Recessed wall
Soace heater and
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I Appliance vent
separate
I Stationary eva.p.
cooler
I Vent fan with
sinole duct.
I Vent systel!l apart
heating or A.C.
J I ~lechanical exhaust
f hood and duct
I \'Jood s tove/hea ter
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from
vent.
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ISSUANCE OF PFRrHT
)u.OCJ
...;)~ -') / ..5t7 ,
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
,5S CO I TOTAL CHARGES
Gl.,) EI j'J M ~4 III rJ
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DATE 7-.21 - is [) I
x~~}-,,~-,:Value =?.3/f O..QO
x 7.4D Value .3CJ()'1;:J..D
x
Value
I HAVE CAREFULLY EXAtllNED 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 perforl!led shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Oregon oertaining to the work described herein, and that ~O OCCUPANCY will be made
of any structure without the permission of the Building Division.' I further certify that my registration .lith 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 comDliance with ORS 701:055 will be used on this project.
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S I GiVITURF. fJc1i {;V <-t?L~.-tA,~
FOR OFFICE USE ONLY
Zone E-I TYDe/Const. 7lZ-}./ Units / So. Ftg. r1ain //10i/
. ...
Fire Zone - Bedrooms ::z, Occy Load Sq. Ftg. Access <S~8
_.-/
Flood Plain ;'/0 Stori es I Occy Group k?- -:z Sq. Ftg. Othe r
TOTAL VALUATION 31, 0/7. ~o
BUILDING PER~1IT I Plan Ck. Comm!Ind I ~~stems Development I
J -/Il 65%/Bldo Per Fee (.' arqe (1.5?:) SS5: 0'2 ~
Cilarges an~ _____.L~"'>_..!..=-Q- ...:z-L! /I
Surcharges &_ t~L./ I Plan Ck. Res f7"5.3D /~t~v T~
30%/Bldq Per Fee . I ,- /'
PLUf'1B ING PERr1IT .3S\CJDI Fence I ;:;:;4 )'1,~t I I
:..7 ( I~
Charges and - ~,- - - - - / ~y;1 Dt;mo I I I
Surcharges
ELECTRIU,L PERt~IT _ ___ _ _ _J5~~-'Sidewalk J '" I I (~.d. CJ I
Cha rges and b,";""
Surcharges I/WJ A/C Paving J Total Comb. Permit d 1~~ .:2.15
MECHANICAL PERMIT _ _ _ _ _ _ _r:1J..$P_ Curb Cut j{/I I 11~?f() I-nr ~Z~1ISY J
Charges and '.J
Surcharges (91 I II U I-\L
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CDr1BINATION APPUCATION/PERr-HT (CAP)
.
IV.
I. Applicant to fu~nish.
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County.Map Ref QCl4
17 03 43
2. e~ample- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of OWner and construction lender
. D. Energy Sources
1. example- heat/electrical ceilin%r forcec
2. examole- waterheater/electrical/or solar
E~ Square rootage or valuation, etc.
1. example- 1250 sq. foot house, 500 sq. foot
2. example- if new project, .check-;;ew- if ad
check add, etc.
F. Building permit information:
1. example - construct single family house wi
attached garage .
2. example'- remodel existing garage into fam"
3. example - convert single family residence; ~.
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of
Structural Specialty Code
H. DES I GN TEAr,! AND CONTRACTORS
To avoid design or construttion delays,' Buildin:
Division Staff must be able to contact appropri
persons regarding ~esign information or job sit
corrections, etc. (
II. Abbreviated Plumbing, Mechanical, & Electrical Sche,
A. Ex~ePt where blank ~paces OCcur in the descript.
portion of the Mechanical and Electrical Schedu'
the app 1 i cant need fi 11- i n on ly the No. Boxes ae ~n
to the appropriate item(s) to be installed .
B. Full Plumbing, Mechanical, and Electrical Schedu
are available at the Building Division
. L To conserve space on the permit form the sch 1 e:
have been abbreviated
2. If the item(s) to be installed are not cover
the abbreviated schedules you should consult
full schedules ,'~
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AI \,
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered
electrical contractor for signature by.his electr ;1
supervisor. .The general' contractor is not author ~
to sign the electrical label. -
Applicant to sign and date
Whenever Possible, the initial application will be us ~s
a worksheet only. Where possible, Building Division";+" BY
will prepare a type written copy and return it to the d
appliCant at the time the actual permit is issued for 't
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 char~es are due and
payable when the permit is issued.
PERMIT VALIDATION
CITY
OF
SPRINGFIELD
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City Hall
Springfield, Oregon
Department of Public Works
o FF I C I A L RE C E I P T
. No. B
Date~~AA19&J
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Received For: \...J-v\)J \J() /\ (-'7)' . _oJ Oi- (II
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Amount Received. ~! V \ I
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"U~'Z~D'''!ll<(NUUR'-- 5.5"'.
SHELTON-TURNBULL PRINTERS, EUGENE. OR 9740'
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V. FOR OFFICE USE ONLY
Permit Clerk
t :'oOIi~I.".I." I".. L I
PROJECT CONDITIONS TO BE SATISFIED BEFORf OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
Additi ona 1 Project Informati on:
PLANS REVI EWED BY:
name
signature ,(,<< d,,3r"/'
date 7-25"- ,Yo
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