HomeMy WebLinkAboutPermit Building 1980-3-5
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Job Address
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CITY OF SPRliIGF'IE'LD
CDrIBlilATlDrI APPLICATION/PERMIT
, EflERGY SOURCES;
I.He~t '
L\iater Heater
"5"7) !'
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'Range
ValuE of Hark:
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,.,/l ,Bull<iina P'ermit Info:
Phon_..A,I;?/t2s sFamilv r.esidence J'lith
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INFQR11ATION lJi'tt -I
726-3753
I Y-3q. Ftg. f.lain
:q. Ftg. Access. 7/L'J"
Sa, Ftg, Other
..Jlew ~Add _A 1 ter -,~ep.
Fence Demo Change/Use
Other- -
lilSPECTION tIllE' .
726.3769
Address
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Describe Work(i~e..
Attached Garaae'
Bui ld Single
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Legal De~cript;on /"/
O...mer
Construction lender
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Address
DESIGil lEAI-1
(name 1 1f.J N /4.~ //
Phone
(address 1
(1 ics. no.)
(exoires)
(Dhane no. J
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( ohonP no. ) ii
Primary
, Structural
: Electrical
~ !1echan; ca 1
, CONTRACTORS
5/1/1'11 fI3//-C-Ch
c-~>.@-'r; (} L
(name)
(address) (lies. no. \
(eXD; rE>~;)
Genera 1
c?gLP - fr(ll'11lA.J
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Each single fixture
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Plumbina
Electrical
_.'.l~"lechani~a 1
PLU!IBII1G
ELECTRICAL'
MECHANICALj
1='1='1=' 1..cl:iARG.I. NO. I
SQ. FT,
furnace/burner to
BTU's;
Residence of
Relocated building
(new fix. additional.)
S.F. Residence
(1 bath)
Duplex (1 bath) each
New circuits alts.
~ or extensions
T,.(/o 0 e. ~'AnPF
/ S .(XJ
Floor furnace
and vent
SERVICES
Recessed wall
Sn~rp hp~tpr ~nd vpnt
Of
amps.
Appliance vent
~pni'\rnt.p ^
Stationary evap.
cooler 1\ /; J )
Vent fan with J
sinole duc't r
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Sewer i\
\ :,j...
Storm S'eweni \
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Temporary Construction
Change in existing
rpc;..i (tenc@
multifamily, comm. or
Inrlllc:.trial
Additional bath
~!ater service
C0l1l-1. /I NO. FEEDERS
Install/alter/relocate
rlic:.trih. fppflprc:. ..
Wood stove/heater
Of
amps.
ISSUI\tKf OF PFRP1IT
TOTAL CHARGES
WHERE STATE L,W REQUIRES
shall not be valii until the
TOTAL CHARGES
/5.00 TOTAL CHARGES
that tile Electrical work be done by an Electrical Contractor. the electrical portion of this perlilit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXNlINED the completed apfllication for permit. 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 Soringfield and the lal'Js of the State of Orel]on pertaining to the work described herein. and that IlO OCCUPAHCY 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
~Subcantractars : employees \=~.in ;;:nce With'; 701.055 dus~n /~~>>.-. /' . /'" a-')
IW,IE(please print).' Mile: <c:-L- [//ilf 'If"-.~ SIGII.~TURP---"::f;.<A'LJ /#~~/:d - OATE:?~ ~.l5 {..
FO~ OFFICE USE DilLY / /
Zone d-4 Tyoe/Canst,~/-H"- Units / S~. Ftg. 11ain/ /7/00 x 19, 71,/ Value /~.~=~
Fire Zone T[ Bedrooms Occy load Sq. Ftg. Acce"? x Value'
Flood Plain NIJ Stories / Occ,Y Group lJ-Lj Sq, Ftg, Other x Value'
. '2_Zq-'SOTQ:\A.L VA~IQlI: IS'P9CJ,-
\:'0 ('."1 tl L>"I 1_)<,
;"1. ( D 0 'Syster.:s Development
-1 (), r ) Charoe (L5~) . !J:;'5".co
BUILOHlG PERI.JlT _ _ ___ __ '~Ld..:.f2O Plan Ck. Comm/lnd
Charges an': 65%/Rlda Ppr Ff'e
Surcharges d "Ii?' Plan Ck, Res
, 'd 30%/Bl dQ Per Fee
PLU'~BING PERMIT Fence
Charges and ------------
Surcharges Demo
ELEETRIUL PERI~IT _ ___ _ _ .Ls'.O.!?_ Sidewalk
Charges and
~.Jrcha rges ,(pO A/C Paving
11ECHAtiICAL PERI~IT Curb Cut
Charges and ------------
Surcharges
Total Comb. rermit
TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. examole- Tax lot 100. Lane County Map Reference
11 Us 43
2. "example- lot 1. Block 3. 2nd Addition to
Sprlngfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exa~ole- heat/electrical ceilin~/or forced air Q3S
2. exa~oJe- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1. examo1e- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check new - if addition,
check add, etc.
F. . Building permit information:
I." examole - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. examole - 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 TEAi'J ArlO 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. ~lechanical. & Electrical Schedules
A. Except l'lhere blank spaces occur in the description
portion of the Kecnanicol 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 schedules
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. BUILOB:G DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. 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. ---
III. 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.
V. FOR OFFICE USE 0i1LY
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CITY
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DCOMTT \/1\1 Tr"I\TTn.'
OF SPRINGFIELD
City Hall
Springfield, Oregon
Department 01 Public Works .
OFFICIAL RECEIPT
No. B 5 2 9 5 0 f
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c'd From\u:i~~'" ~~ f
Jdress \ u.\XD '?i-' - ,~ ' & .
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ceived For:
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..ui";jO~IIE:D SiGNATURE t
S"""TO...TU.""Ull ~",..n"s ' ~u(>~.." O. ...<<0' 515".1 \..
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Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
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signature date
name