HomeMy WebLinkAboutPermit Building 1986-9-12
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CITY Uf SPRINGfiE,D
COMBINATION APP,ICATION/PERMIT
EIIERGY SOURCES:
Heat
I~ater Hea ter
Ranqe
ValuE of Hark:
7oc:>. c>t:O>
BuildinQ Permit Info: Oeser be Work(i.e.. Build Single
Familv nesidence With Attached GaraQe\
/p--Sr.4,cL ~??~;V-VA4<'" ~/."i,~jL.~P" >
lELc.c./ /')~c;q.c. C~ C V/ ~ -i
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(lies. no.l (exniresl (ohane no.)
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IHFORllATIO~ LHit
726-3753
Sq. Ftg. Hain
~q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
Other- -
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Ij~~~ECTION ,INE
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Job Address / ~g/ ~o 7A ;c; ''S:T'.
,egal Oescription/7_o::::>'.~~.::1'2. ~h"'Jt!:)?
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Owner. p/'/ L rR~.r.:: ~~.?-?,ZJA/, "'" ..-
Address hl r M~/...vr.,c c,,> Phone
__ '130/ . 0 <j 6,/
/-V~E.h"c / ~.
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Construction lender
Address
DES I GN I tAr~
(name)
Phone
(address)
Primary
Structural
Electrical
Mechanical
-CONTRACTORS
(name)
(address 1
(1 ir:s. no.)
(exoir~s)
(ohnnp no. l
Genera 1
Ow~E??
Pl umbi no
Electrical OW.tV~
~1echanical
PLUI-IBING
ELECTRICAL
MECHANICAL
NO.
FEF r.HARr,F Nn
~~F rHARr,F NO.
FEF rHARr,F
SQ. FT.
furnace/burner to
BTU' 5
Each single fixture
Residence of
Relocated building
(new fix. additional)
S.F. Residence
(] bath)
Duplex (1 bath) each
./'
New circuits alts.
or extensions
'2c-r-? ~E
SERVICES
-:l-;z..5'=.
Floor furnace
and vent
Recessed wall
Sn~cp hp~tpr ~nrl vpnt
~Iater servi ce
Temporary Construction
Change in existing
rpc;, i dJ'nrp
multifamily, camm. or
Tndllc:tr;i'l.l
"?
Apoliance vent
seoarate
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and duct
;5
y,ec>
Additional bath
Sewer
Storm Sewer
Of
amps.
CDI~I.1. fiND. FEEDERS
Install/alter/relocate
d;c;trih. fppdprc;
Wood stove/heater
Of
amps.
TOTAL CHARGES
HHERE STATE L~H REQUIRES
shall not be vali1 until the
TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
ISSUANCE OF PFRI11T
<.2 _51> TOTAL CHARGES M.rN. t: s-. --
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXMllNED the completed apfllication for permit. and do hereby certify that all information hereon ;s 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 UO OCCUPAIKY 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 701.055 will be used on this project.
NAf.lE(please print) h_rry /'1.n H\_.....e,o, SIGNATURE
FO~ OFF I CE USE DIlLY
Zone L'<::' Type/Const. Units Sq. Ftg,
Fire Zone Bedrooms Occy Load Sq. Ft!).
Flood Plain Stories Occy Group 73-"2- Sq. Ftg.
..,4' Yrto...-D.. ~.
DATE "II,'>.. /'d t.
~in x Value
Access x Value
Other/#/- ;:1c/4Zi!io~<:: Value
TOTAL VALUATION
7~--
BUILDING PERfllT
Charges and
Surcharges
/::1 coO> Plan Ck. Comm/lnd
____J_/..:____ 65%/Bldo Pj'r Fpp
-2 Plan Ck. Res
- ~ 30%/Bldo Per Fee
Fence
g s.o-
Systems Development
Charoe (1.5~) . .
Yd.
PLU~BING PERMIT
Charges and
Surcharges
Dt,imo
I
I
ITotal Comb. rermit
I
I TOTAL
6,0, '17
ELECTRICP.L PERIHT
Charges and
Surcharges
I1ECHANICAL PERMIT
Charges and
Surcharges
-=<:7_50 Sidewalk
------------
. '70 AIC Paving
/ S ~ Curb Cut
____J__.:____
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CITY OF SPRINGFIEI,.D _. ..
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City HIli
Springfield, Oregon
Department of Public Work.
OFFICIAL RECEIPT .
No.8
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67072
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COMBINATION APPLICATION/PERMIT (CAP)
Olte~. /2./ 19 ~6
C Rec'd From -g,....c.<.F;;!"'d>b E#~~/~~
~7::>M~~5,e-
.Address Pl:/.:;;,.e-~,.......,." _ <7-::> <I =-"-
/ '-r ~
I. Applicant to furnish
A, Job Address
B. Legal Description
1. example- Tax lot 100, Lane County Map Reference
)7 03 43
2. examyle- lot 1. Block 3. 2nd ~ddition to
~prlngtield Estates
C. Name, etc. of owner and construction lender
D.' Energy Sources ,
1. exam~le- heat/electrical ce;lin~/or forced air qa~
2. examyle- waterheater/electrlcal/or solar
E. Square footage or valuation. etc.
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. example- if new project. check new - if addition,
check add, etc.
F. Building permit information:
1. exam~le - construct single family house with an
attached garage
2. example - remodel existing garage into family roar
3. examjle - 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 TEAM 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.
II. Abbreviated Plumbing, 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
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division (
1. To conserve space on the permit form the schedule~
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOULES
O. 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.
IV. 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.
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Received For: J d'R\ ? 86. c-s--s y
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Amount ReceivedJ!( ~,97
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V V" AUTHORIZED SIGNATURE / .....
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Permit Cl erk
V. FOR OFFICE USE ONLY
PROJECT CONDI.TIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
Lcn#c ~~C2c-r~ signature ~--:'./ p~--::
date C)~/;;> -~b
name
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BULLFROG ENTERPRISES
1581 S. A, STREET
SPRINGFIELD, OR 97477
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