HomeMy WebLinkAboutPermit Signage 1980-11-10
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INFORllATlOlj UNt I
726-3753 I
Sq, Ftq, I"ain f
~q. ~tg. Access.
Sa, Ftq, Other ~
1iew Add Alter Rep. ~
Ranqe ""0 -Fence Demo Change/Use ~
, ValuE qf Hork: &> -Other- - ~
S\r",Y\ ,01,. sea. Ui
~h ,,(21/' /7'f BUllt:inQ Permit Info: Describe \1ork(i'.e.. Build Single ~
O":...nL- lJi' Family l'Iesidence \'lith ft.ttached Garaoe) \) -
.~.1:qil_~-J-/ a JM - rY'ef'It'x '/(~ 1\ rom!.
rei el'lb iLl I l1f'1l\ hlr.mcC'; rn1e.,
EilERGY SOURCES:
Heat
Ha ter Hea ter
I HISPECTIOII L1I1E
726-3769
Job Address I-r rl
Lega 1 Deser; pt; on
CITY UF SPRlilGFIELD
COI1BIilATlON APPLlCATIOII/PERMIT
Owner ~\ CA" rl:i (\ t=\v-r)~
Audressj>0 P\f\'{ An(nq-
<?,\ )r1tL~~~ -- Or~()(~,U
Constructlon Lender
Address
OE51Grl TEAI-'
(namel
Phone
(address 1
nics. no.)
(exnires)
(ohane no.l
Primary
Structural
Electrical
:1echan;cal
cornRA,CTORS (name)
Genera I ^-Icurh n 0 (OS.
{address)
\. ~rYre.
(1 ir:". no.'
(p.xnires)
(ohnnp nn )
PllJmbinQ
Electrical
~'echanical
PLUlfSII'G
ELECTRICAL
I~ECHANICAL
';J. J
lEaCh single fixture
IRelocateO buildino
(new fix. additional)
IS. F. P.es idence
(I bath)
Duplex (1 bath) each
Addi ti ana 1 ba th
I FFF fHARr.F Nn
I ~j:"F rl-iARf,F WJ.
I FFF nl~RgF
SQ, FL
furnace/burner to
BTlI' 5
Res i dence of
New circuits alts.
or extensions
Floor furnace
and vent
Storm Sewer
Of
COI~'L II NO, FEEDERS
Install/alter/relocate
clic;trih. fpprlpro:.
ilmps.
I Recessed wa 11
SDn~P hPntpr noel vpnt
I
I Apo 1 i ance vent
seoarate
I Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood and duct
SERVICES
~!a ter serv i ce
Temporary Construction
Change in existing
fPsld€'nre
multifamily, camm. or
Inrlu<:;trin.l
Sewer
Wood stove/heater
Of
amps.
ISSUANCE" OF PFR!iIT
TOTAL CHARGES TOTAL CH^RGES TOTAL CHARGES
WHERE STATE L\\4 REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valij until the label has been signed by an Electrical Surervisor and returned to the Building Division
I HAVE CAREFUllY EXMllHEO 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 Soringfield and the Laws of the State of Ore~on pertaining to the work described herein, and that tlO OCCUPArKY will be made
of any structure without the permission of the Building Division. I further certify that my registration It/ith the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption 1S noted hereon. and that
only subcontractors and employees who are in comDliance with ORS 7n1.055 will be used on this project.
HAi'IE(please print) S Ir,;I.~TURE
FOr. OFFICE USE DilLY
Zone Type/Canst. Units Sq. Ftg. riain
Fire Zone Bedrooms Occy load Sa, FtlJ. Access
Flood Plain Stories Occy Group Sq, Ftg, Other
DATE
x
Value
Value
Value
x
x
TOT^L VALUATIDrI
BUILDING PERI.IIT
Cha rges and
Surcharges
Plan Ck. Comm/Ind
65%/Rlrla Ppr Fee
------------P'f'an Ck. Res
30%/131 do Per Fee
Fence
Syste, r.:s Development I
Charqe (L 57,)
PLUI~S ING PERMIT
Charges and
Surcharges
Dl;mo
'<:::'Ifjn
/)LI, 00
ELECTRICP.L PERI:IT
Charges and
Surcha rges
Sidewalk
AIC Paying
Total Comb. rermit
TOTAL
~ cY1 00
rlECHANI C^L PERM IT
Charges and
Surcharges
Curb Cut
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COMBINATION APPLICATION/PERMIT (CAP)
L
II.
Applicant to furnish
A. Job Address
B. legal Description
1. examo1e- Tax lot 100. lane County Map Refere~r~
17 U3 43
2. examD1e- Lot 1. Block 3. 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examo1e- heatJe1ectrica1 ceilinqlor forced a &:
2. examDle- waterheater/electncal-/or solar
E. Square footage or valuation. etc. -
1. examole- 1250 sq. foot house. 500 sq. foot 9
2. examole- if new project. check-nEw - if add; ~,
check add, etc.
F. Building permit information:
1. eXdmple ~ construct single family house \'lith
atteched garage (
2. examDle - remodel existing garage into famil. -
3. examoie - convert single family residence in
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of t (
Structural Specialty Code
H. DESIGN TEMl AND CONTRACTORS
To avoid design or construction delays. Building
Division Staff must be able to contact appropria (
persons regarding design information or job site
corrections, etc.
Abbreviated Plumbing, Mechanical. & Electrical Schedl
A. Except \.Ihere blank spaces occur in the descriptil (
POn:iOil of the r'lech.;:nical and Electrical Schedul. -
the applicant need fill-in only the No. Boxes ad,
to the appropriate item(s) to be installed
B. Full Plumbing. ~lechanica1, and Electrical Schedu. (
are available at the Building Division
1. To conserve space on the permit form the schl
have been abbreviated
2. If the item(s) to be installed are not coverr In
the abbreviated schedules you should consult \
full schedules
C. BUILOlliG DIVISION STAFF WILL FILL OUT ALL FEES AI
CHARGES ON THE SCHEDULES t'
D. As noted on the CAP. the label must be delivered \t:
electrical contractor for signature by his electl
supervisor. The general contractor is ,not au thaI
to sign the electrical label. ~
Applicant to sign and date
Whenever possible. the initial application will be u~
a worksheet only. Where possible, Building Division
will prepare a type written copy and return it to thE (
applicant at the time the actual permit is issued fat ~
signature.
Fees and Charges
Plan check fees are due and payable at the time of tt .
application, and no plans will be processed until the (
fees are paid. All other fees and charges are due ar~
payable when the permit is issued.
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FOR OFFICE USE ONLY
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PERMIT VALIDATION
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CITY
(,
SPRINGFIELD
OF
City Hall
Springfield, Oregon
Departmen' of Public Work.
OFFICIAL RECEIPT
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No. B 55142(
J/;.. If) 19 XO
Rec'd From ~ nTI'If\ ,frr-0" S,/ ~ (
Address Pn, ~f... ~nln<1. [AJO'fl/tP,
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Received For:
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,::;) (-I. 00
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Amount Received
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AUTHO"'IZED SIGNATURE
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S"HTQ".TU_..8ULL P_,"T~_S . ~uCi~"~. 0_ 97.01
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I' Permit
Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPArJCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
,-.-- . - -- -. -,
PLANS REVIEWED BY:
name
~ignature
date
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