HomeMy WebLinkAboutPermit Signage 1980-12-31 (2)
/INSPECTlOtl LItlE
726-3769
Job Address~~~
Legal Description
.
J4 ..-f:> q-fJL
CITY Uf SPRIIIGFIELO
COI1BlliATlON APPU~~l)ONi\.~RMIT
EilERGY SOURCES:
Heat
!-later Heater
Ranqe
.
INFORlIATlON UNt
726-3753
Sq, Ftq, 1.la i n 'L\C!O
~q. Ftg. Access.
Sq, Ftq, Other
flew ACh:f...t Alter P.ep.
Fence _Demo_Change/Use
_Other
~
~
Owner, :Jm 0 ;.'^----"~-f u., )
Address:V'l7c::,S HLGCI ~ ,
(Jlh(\--\A .-l~) r-- C1 -: 'OJ .!,
Construction len~~
Phone
Valu€-9f t.lark: CJ6
l":)OQ,
Buildino Permit Info: Describe Work(i.e.. Build
Family nes;dence \,1; th ,I'l~~~~hed Garaof)
J~ ilh('JOArV. .I / A12o,O
-PU )(y"",n
Single
Address
UI:.:::'ll:iN f!:.A11
(ni:lme)
Phone
{;;'r1rlY'",<:<:1
(1 ire:, no.)'
(exo;resl
(ohane no.l
Primary
Structural
Electrical
t1echani ca 1
CO~HRACTORS
(n~me \
(address I
'1 ir-<: ng
(pxo;rps)
(ohonf' nn.)
General ~lT'i1l ~()-V"--
Plumbino
Electrical
'4~cha n 1 CJ 1
PLUilSIrlG
ELECTRICAL
MECHANICAL
~. :). I
lEaCh single fixture
Relocated building
(new fix. additional)
S.F. Residence
(] bath)
Duplex (I bath) each
SQ, F1.
:EL...cJ:i.8..B.G. ..lill.......-' ~~!= r~j'1RGL
furnace/burner to
BrU's /
~!=. ~~18.liL -1lC__
Residence of
UINel'J circuits a1ts.
or extensions
I SERVICES
I
Floor furnace
and vent
Recessed 'ria 11
Sn~rp hp~tpr And vpnt
Storm Sewer
Of
amps.
Appliance vent
seo.ar~t~
Stationarv evao.
cooler ~ ,
Vent fan wi th
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood nnd ourt
Wood stove/heater
Additional bath
Sewer
Temporary Construction
Change in existing
...p~irlpnrp
muitifamily. camm. or
Tnrll,c::tri;d
~later service
C0I11'1. !lNO, FEEDERS
Install/alter/relocate
rli"trih ft>prlp.r<:,
Of
amps.
ISSUANCF OF PFR!llT
TOTAL CHARGES
WHERE STATE L'H REQUIRES
shall not be valij until the
, TOTAL CHARGES
tha t the El ectri ca 1 work be done by an
label has been signed by an Electrical
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFUllY EXN1INED the completed apnlication for germit. 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 Orellon oertaining to the work described herein. and that NO OCCUPArlCY 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
:~::(:~::::t:::::~~~;;:~;o ::~n;:;iance with :~:11:::~:55 OL~j3~~ DATEj?/Y/ /XC'
(
~:::~ ~~!=!~:: I~~: ntJI Y
Zone
Fi re Zone
Flood Plain
Tyoe/Canst.
Bedrooms
Stories
Units
Occy load
Occy Graun
So, Ftg, 11ain
Sq. FVJ. Access
Sq, Ftg, Other
x
x
Value
Value
Value
x
BUILDING PERMIT
Charges anc
Surcharges
~J-'^()D - ,
_ ~J~____
TOTAL VALUATION
PLU'~BING PERMIT
Charges and
Surcharges
Pfan C~ -Comm/lnd
65%/Bldq Per Fee
Plan Ck. Res
3Q%fB10~ P~r !=~~
Fence
I-~
rSystems Development I
Charqe (1.51,)
Demo
u__~ I
-- --
I
ELECTRICP.L PERI~IT
Cha rges and
Surcharges
Sidewalk
AIC Paving
Total Comb. rermit
I TOTAL
JJ5. ()O
I
11ECHAN I CAL PERMIT
Charges and
Surcharges
Curb Cut
.
if ;. '....
COMBINATION APPLICATION/PERMIT (CAP)
,
1
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examDle-' Tax Lot 100, Lane County Map f ~r€
11 03 43
2. examole- lot 1. Block 3, 2nd Addition 1
~prlngfield Estates
.C. Name, etc. of owner and construction lender (
D. Energy Sources
1. examole- heat/electrical ceiling/or for
2. example- waterheater/electrical/or sOla
E. Square rootage or valuation, etc. - (
1. examole- 1250 sq. foot house. 500 sq. f -.
2. examole- if new project. check new - if
cneck add. etc.
F. Buildin<; permit inform'ltion: C'
1. examole - construct single family house
attached gar~ge
2. exa~Dle - remodel existing garage into
3." examole. convert single family resideni fin
restaurant (change of use) \
G. Value of work as defined in Section 303 (a)
Structural Specialty Code
H. DESIGN TEA~ AND CONTRACTORS (
To avoid design or construction delays. Buil
Division Staff must be able to contact apprc
persons regarding design information or job
corrections. etc. (
Abbreviated Plumbing, j'1echanical. 8. Electrical S "
A. Exceot where blank spaces occur in the descr
portion of the Mechanical and Electrical 5ch
the applicant need fill-in only the No. Saxe ~c
to the dopropriate item(s) to be installed \
B. Fu.l1 Plumbing, ~lechanical, and Electrical 5cl
are available at the Building Division
1. To conserve space on the permit form the ~,'
have been abbreviated \
2. If the item(s) to be installed are nat cc
the abbreviated schedules you should con5
full schedules I
C. BUILOn;G OIVISfON STAFF WILL FILL OUT ALL FEE ~o
CHARGES 011 THE SCHEDULES
D. As noted on the CAP, the label must
electrical contractor for signature
supervisor. The general contractor
to sign the electrical label.
Applicant to sign and date
Whenever possible. the initial application will b,
a worksheet only. Where possible. Building Divis
will prepare a type written copy and return it to
applicant at the time the actual penmit is issued
signature.
Fees and Charges (
Plan check fees are due and payable at the time 01
application. and no plans Io-,ill be processed until ~I~~e
fees are paid. All other fees and charges are due and
payable when the permit is. issued.
II.
be delive
by his el
is .not au
III.
IV,
V, FOR OFFICE USE ONLY
-,
.
~
PERMIT VALIDATION
CITY
OF
SPRINGFIELD
City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
No. B
Date 1'7_-~1 19 ~() .
Rec'd FrarYL~()rP~"':--:...~) n [0
Address,"'X'O ff) tt I J)' ~
(
55507(
^ r,.
Received For:
~.c'\~
- - - ~
)r-700
n' --- Ie::: -6CJ
~1' ~~~t. Re~~~ed.~~-
c~
CSf BY
l~
(1)0
- ':ifTHOIllIZEO 51G,.....TUIIlIE
"HI;LTOH.TU"HIIULL ""'HTE"'" I;UGU,o; 0.. '7.0'
.",,,.,, (....
Permit Cl erk
PROJECT CONDITIONS TO ,BE SATISFIED BEFORE OCCUPANCY:
A
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
date
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