HomeMy WebLinkAboutPermit Building 1980-5-21
IIIISPECTlOII LiIIE
726-3769
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lIlFORtIATlON Li ,'jt
726-3753
Sq. Ft!=!. f.lain
~q. Ftg. Access.
Sq. Ftg. Other
rje\~ Add Alter ~ep.
-Fence Demo Change/Use
-Other - -
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CITY Of SPRlilGF IHD
COIIB[;IATION APPliCATION/PERMIT
-,
E!lERGY SOURCES:
Heat
~'la ter Hea ter
RanCje
ValuE of Hark:
$1.4,735.00
BuHr:ina Permit Info: Describe Hork{i.e.. Build Single
Family Residence \-Jith i\.ttached r,araoe)
Job Address
250 N "A" Street
Legal Description
Address
'Springfield Utility
250 N "A" Street
Board
I
741i-R4~' I
Phone Ext. 63.
Owner
Remodeling of Main Office at 250 N "A" St,
Construction Lender
None
Address
DESIGil ltN1
(name)
In-house
Phone
(address)
(1 ics. no.)
(exniresl
(ohane no .-1
Primary
Structural
Electrical
11echanical
CQtlTRACTORS
Plumb;na
(name) (address) (1 its. no. ) (pxnirp<;) (ahonp no.'
Powell Industrial Builders Inc. 2570 W. 21st Eugene 485-7036
Alert Electric 1970 W, 28th Spfd 20-55C 6-30-81 747-2213
Christian Bros. Heating P.O. Box FF Spfd 726-0246
Genera 1
Electrical
r~echanical
PLUliBlIlG
ELECTRICAL
I FF> I CHARr,F! flO.
MECHANICAL
rID.l
I FEE I CHARGE Nn
I FFF I rHAR(;F
SQ. FT.
furnace/burner to
BTlI's
Each single fixture
Residence of
Relocated bui lding
(new fix. additional)
,v--
New circuits alts.
or extensions
C;~/c
/ IJ_CD
Floor furnace
and vent
S.F. Residence
(l bath)
Duplex (l bath) each
Additional bath
SERVICES
Recessed wall
~n~cp hp~tpr ~nrl vpnt
Storm Sewer
Of
amps.
Appl iance vent
"eoaratl"
Stationary evap.
cooler
Vent fan \-li th
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Sewer
Temporary Construction
Change in existing
rp" i dp,nee
multifamily, comm. or
Inrlu"t.riill
v!ater service
COMM./IND. FEEDERS
Install/alter/relocate
rlic;trih. fpprlpr"
Wood stove/heater
Of
amps.
riel/V nuc.. r- "/,.,.'n<'
Z'/'<..-1
ISSUANCf OF PFR!lIT
/0.0'1
TOTAL CHARGES TOTAL CHARGES
WHEnE STATE L.\H REQUIRES that tile Electrical work be done by an
shall not be valii until the label has been signed by an Electrical
lCJ.O(] TOTAL CHARGES . . ._.-.It(, <~p_
Electrical Contractor. the electrical portion of this per~it
Supervisor and returned to the Building Division
1 HAVE CAREFULLY HArmlED the com!)leted appl ication 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 Springfield and 'the La\'/s of the State of Ore<]on pertaining to the \-Iork described herein. and that 110 OCCUPAflCY \-lill be made
of any structure without the permission of the Building Division. I further certify that 1T1Y registration \'lith the Builder's
Board is in full force and effect as required by Or.S 701.055, that if exempt the basis for exemntion is noted hereon. and that
only subcontractors and employees who are in com~liance with O~S 7n1.055 will be used on this project.
Zone
Fi re Zone
Flood Plain
Type/Canst.
Bedrooms
Stories
Uni ts
0ccy Load
Occy Group
SIr,II.~TVRE ((i17 Ju JaY' On./\rYIJt.fJ.6Pf)/)
FO!! OFFICE USE OillY r 1
S1'1. Ftg. rlain v
Sq. Fta. Access
Sq. Ftg. Other
om y..;;-Q ) -p()
HAi.1E{please print) \ Cn-th \} ,,'
p(l.<:ml :"<::C.:r) n
x
Value
Value
Value
x
x
TOTAL VALUATION ~~ f(tJ(J~
BUILOING PER:.I!T
Charges an::
Surcha rges
_______.;,~c.og_
..J;),'If
--.- .-
. Plan Ck. Commjlna
6S~/Bldo Ppr Fpe
Plan Ck. Res
30Y~.~,~9 J:~r ..Fee
Fence
:J.O."ifo
;~ysteh.s ueveJopment
Charoe (1.5')
PLUMBING PERMIT
Cha rges and
Surcharges
Demo
ELECTRICf..L PERI~IT
Charges and.
Surcharges
. 11ECHMIl CAL PERM IT
r.~'l;~-=; .]i"j
/o.()() Sidewalk
- --- - - - =_~~O -j ~!~__Paving
/u,SO I Curb r.ut
________L____u,._
,5'6
':?.(H'" "c.
20.;-lO
S'fi', '1 (h
I ' ..
:~ry'1.5t, ~
Total Comb. rermit
. 70F.L
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S3537(
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CO~':Sj;;;'TIO:: .4PPLlCATlOII/PERNIT (CAP)
J
CITY
SPRINGFIELD
PERMIT VALIDATION
r. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax lot 100. Lane County Map Rl
11 U3 43
2. examole. Lot 1. Block 3. 2nd Addition t (
sprlngtield Estat~s
C. ilame. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceiling/or for ~
2. examole- waterheater/electrical/or sOla (,
E. Square footage or valuation, etc. -
I. examole- 1250 sq. foot house, 500 sq. f
2. example- i.f neh' project. checknew - if (
check add. etc. Rec'd
F. Building permit information:
1. example - construct single family house
attached garage
2. examole - remodel existing garage into (il - h -"0-
3. eXcJr.1ole - convert single family resider
restaurant (change of use)
G. Value of work as defined in Section 303 (a.
Structural Specialty Code (
H. OES I GN TEAr.1 ArlO CONTRACTORS
To avoid design or construction delays, Bu
Division Staff must be able to contact app.
persons regarding design information or jo ~tl
corrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical
A. Except where blank spaces occur in the des
portion .of the I~echanical and Electrical S ~u
the applicant need fill-in only the No. Bo
to the appropriate item(s) to be installed
B. Full Plumbing. Mechanical. and Electrical
are available at the Building Division C.
1. To*conserve space on the permit form t
have been abbreviated
2. If the item(s) to be installed are not
the.abbreviated schedules you should, (U"I
fun schedules
C. BUILDUiG DIVISION STAFF WILL FILL OUT ALL
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 L
Whenever possible, the initial application wi
a worksheet only. Where possible, Building 0
wi 11 prepa re a type wri tten copy and. return i
applicant at the time the actual permit is is 6
signature. "-
Fees and Charges ~
Plan ch~ck fees are due and payable at the time of the
application, and nO plans will be processed until these
fees are paid. A11 other fees and charges are due and
payable when the permit is issued.
OF
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City Hall
Springfield', Oregon
Department 01 Public Works
OFFICIAL RECEIPT
No. B
r::. --,. <:::?n
Dole ') -' t:: _J 19 ') .J
From C'). 1\ . I~
Address ? ':-) Cj IU rt ~~-
Received For:
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be de
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~ Amount Received (,)
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rUT~OltrZI!:O SIGNATURE
S..ILTO....U....llucc "",..u..s" IUlOlNI 0.. .7"0'
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IV.
V. FOR OFFICE USE ONLY-
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
I
I Additional Project Information:
PLANS REVIEWED BY:
name
signature
/u
date <..--;;1/-:/'0
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