HomeMy WebLinkAboutPermit Building 1980-5-21 (2)
Board
7b.h-Rb.'il
PhoncExt. 63,
INFORIIATION LJNt
726-3753 ~
Sq. Ftg. [.lain
:q. Ftg. Access. ~
Sq. Ftg. Other ~
flew Add Alter Rep. V
Fence_Demo_Change/Use ~
Valu, of Hark: _Other "l::;,)
$14,735.00 ~
Buil~inQ Pernlit Info: Oescribe Work(i.e.~ Build Single J \ ~
Familv P-esidence With Attached Garaqe) I ~
Remodeling of Main Office at 250 N "A" St j-
.,
1. IMSPECTIOM LIME
726-3769
~.
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CITY Uf SPRIMGflELD
COIIBIiIATlON APPLICATION/PERMIT
Job Address 250 N "A" Street
Legal oml~~
Owner . Springfield Utility
EHERGY SOURCES:
Heat
I'Sater Heater
Ranqe
Address
250 N "A" Street
Construction lender
None
Address Phone
DeS HlN f EAf1 ( namel (address) (l ics. no.) (exn; res) (ahone no. )
Primary In-house
Structura 1
Electrical
f1echardca 1
CONTRACTORS (name) (address) (l ics. no. ) (pxo; fPc:,) (ohonp no. )
Genera 1 Powell Industrial Builders Inc, 2570 W. 21st Eugene 485-7036
Plumbinq
Electrical Alert Electric 1970 W. 28th Spfd 20-55C 6-30-81 747-2213
~lecha n; ca 1 Christian Bros. Heating P.O, Box FF Spfd 726-0246
PLUI1BWG
ELECTRICAL
MECHANICAL
Each single fixture
FEF rHAR(;F Nn I ~H ('I-lAQ(::~ NO.
Residence of furnace/burner to
SQ. FT. BTU' 5
~I="F nlAQ(::1="
NO.
Relocated building
(new fix. additional)
~ New circu~ts alts.
or extenslons
/'JAle
SERVICES
111-00
I
Floor furnace
and vent
IS.F. Residence
(1 bath)
Duplex (1 bath) each
Recessed wall I
~n~rp hp~tpr ~nn vpnt
Sewer
ITempOrary Construction
Change in existing
rpc; i df'J1CP
multifamily, comm. or
TnrllJc:.trial
Of
amps.
App 1 i ance vent
seoaratf>
Stationary evao.
cooler ~ ,
I Vent fan with
s;nale rluct
Vent system apart from
heatino or A.C.
Mechanical exhaust
hood and dud
Wood stove/heater
I New ()Uc. 1'I...fMofto' I
I
I
I </. <;"',;
I
I
IO.().?J
/L/".::o
Additional bath
~Iater servi ce
Storm Sewer
Of
amps.
COMM./IND. FEEDERS
I Install/alter/relocate
dic:.t.rih_ fperlerc;
TOTAL CHARGES TOTAL CHARGES
WHERE STATE L.\II REQUIRES that tile Electrical work be done by an
shall not be valij until the label has been signed by an Electrical
ISSUANC, OF PFmllT
/tJ.tJ() TOTAL CHARGES
Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFUllY EXJ\tlINED 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 Springfield and the laws of the State of Oregon pertaining to the work described herein, and that rw OCCUPAliCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 comDliance with ORS 701.055 will be used on this project.
Zone
Fi re Zone
Flood Plain
Type/Const.
Bedrooms
Stories
Units
Occy l~ad
Occy Group
SIGilATURE (rid Ju Jet p(J.f\m~JYl
FOr. OFFICE USE DilLY ( I
.v
Sq. Ftg. Haln
Sq. Ft0. Access
Sq. Ftg. Other
om ".sc~ ) -R()
ilAIIE(please print);,Cn--l-hy I ,PCl'<::'fY)tLCS()0
x
Value
Val ue
Value
VALUATIONJk'tJC7!!$Z
x
x
TOTAL
BUILDING PERi.IIT
Charges and
Surcharges
_______J!?'-t1!;I_
J, :lS(
Plan Ck. Comm/lnd
fi5%1Rlda Per Ff>f'
Plan Ck. R-es
30%/Blda Per Fee
Fence
.1.0,~o
Isystems Development
Charoe (1.5~)
I
I
PLU'1BING PERMIT
Charges and
Surcharges
I O~mo
_______to...()O I Sidewalk
''/0 I AIC Paving
~______l<i'AQI Curb Cut
IS~
Jf1J.".1f C 1:.,
20SJo
.51i', '1 (.,
~1Cj.5t, I
ELECTRICP.L PERI:IT
Charges and
Surcharges
Total Comb. rermit
I TOUL
i1ECHANICAL PERI~JT
Cha:-ges and
.
,'; ..
,
COMBINATION APPLICATION/PERMIT (CAP)
PERMf.t\VAL~AiION
. '(~"",,...
.\.'~ tV:! ~ ~ J J
1. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax Lot 100. Lane County Map Reference
-11 03 43
2. example- Lot 1. Block 3, 2nd Addition to
~pringtield Estat~s
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examQle- heat/electrical ceilin9/or forced air qas
2. examole- waterheater/electrical(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. example - construct single family house with an
attached garage
2. example - 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. DES I GN TEAI.I 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, Mechanical, & Electrical Schedules
A. . Except I'/here 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 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. BUILDING 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 OFFI CE USE ONLY.
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
dl.L~L
da te ,5--;;1 j- Yo
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