HomeMy WebLinkAboutPermit Building 1981-9-1
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I I~SPECTIO~ LI~E
726-3769
ClIY OF SPRI~GFIELO
COI1BIIIATlON APPLlCATIOII/PERMIT
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INFORt1ATION lUlt
726-3753
Sq. Ftq. I.lain
:q. ~t!J. Access.
Sa. Ftq. Other
--1lew__Add__Alter~qep.
Fence Demo Change/Use
Other - -
.A L)
Job Address ~;j'::: A/o. /1
I.egal Description 17-1)3-.::J.C;- _ 2,;2.
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E!IERGY SOURCES: . ...
Heat 11/ .T \
\'later Heater
Ranqe
.,
Phone
Va 1 u€ of Hark.: .,.C
0..-:70170 ~
BuilG10Cl Pennlt Info: Describe Hork(Le..
FamilY nesidence With Attached r,araae)
Build Single
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Owner:1 ~. .....:: , .\.; I J
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Address \ ~::.J._(~t:? .i.J....
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Construction Lender
Sr/{
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Address
lJl:.~luU f!::Af.1
Primary ~~,-
Structural
(name)
Phone
(address)
oN'd -to",,, J':" :iI' ./.., ...... '
(lies. no.) (exnires)
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J<>,_~
(ohone no.l
?~Z
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'2..La AI. Sz..
7<17- f?;/ ~"3
El ectri ca 1
!1echanical
COIITRACfoRS
(name I
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FEE'ICHARGEJiU- - .- =LEC.~~:AL - -G'(~AAGr -NO'T..,,-.._M~~J='-"F<:"'.CliAllliL~
Residence of furnace/burner to '1
SQ. FT. BTU's!'
(addrpso:;)
(1 ice;;. nn. 1
(pxnirpc;)
(ohnnp nn_ )
General ~(J B .
Plumbina
E1 eC'l:rica 1
_ !.~~cp.~I'Lca 1
PLU/1BIIIG
-=......-=---7
--.llih
Each
single fixture
Relocated building
(new fix. additional)
INew circuits alts.
or extensions
! SERVICES
I
Floor furnace
and vent
S.F. Residence
f1 bath)
Duplex (1 bath) each
Recessed wall
Sn~~p "P~tp~ ~nrl wpnt
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^;&+
tI,-,
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ITempOrary Construction
IChange in existing
,rP'lj~e.rcp
Imultifamily> camm. or
tnduc;trL'tl
! Of amps.!
!CO~1./INO. FEEDERS
!Install/alter/relocate I
distrib. f~eders
10f amps.1
I . A/J:l-I
r"'/V/l I
! I
Appliance vent
seoarate
Stationary evap.
cooler
I Vent fan with
sinole duct
I' Vent .system apart frOm!
heatino or A.C.
I Mechanical exhaust
hood tlnd duct
I ~Iood stove/heater
I
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Additional bath
Water service
Sewer
Storm Sewer
ISSUANCE OF PFRr1lT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L,\ll REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this pernit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Divisi~n
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I HAVE CAREFULLY EXN1INED the completed apr1ication for ~ermit. and do hereby certify that all inform~tion hereon is true
and correct. and I further certify that any and all work oerfonmed shall be done in accordance with the Ordinance~ of the City
of Soringfield and the Laws of the State of Oregon pertaining "to the work described herein. and that UO OCCUPArKY 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. .
IW1E(please print)
~'k1~~
Zone (!. - -..j.
Fire Zone
Flood Plain ...--
Tyoe/const.l1-1 H I~
Bedrooms
Stories :l..
SIG~ATURE J.,,, '".
FOP. OFFICE USE O~LY
Units -" Sq. Ftg. ria;n
Occy Load ---- Sq. Ft9. Access
Occy Group .B.1l Sq. Ftg. Other
D, I/D '.........
OA T$. / - rf' )
x
x
,x
Value
Value
Value
TOTAL VALUATION :;/0C>rJQ;;J
BUILDING PERI.lIT ____n_.:!~~~ - Plan Ck. COIll!lII nd
Charges an': 65%/Bldo p..... ~".".
Surcharges '3'() Plan Ck. Res
JO%/Rlrlo PPI" Fpp
PLU'1BING PERMIT Fence
Charges and ------------
Surcha rges Demo
ELECTRICAL PERI~IT Sidewalk
Cha rges and ------------
Surcharges A/C Paving
IIECHANICAL PERMIT Curb Cut
Charges and ------------
Surcharges
Systems Development
Charoe (!.5~)
(;..6t?
Irotal Comb. rermit
o?&. H-()
J.(" 8'0.,
I
I TOTAL
I. Applicant to furnish
A. Job Address
B. legal Description
1. examole. Tax Lot 100. lane County Map Refere
II 03 43 r
2. example- Lot 1. Block 3. 2nd Addition to I
sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ceilinq/or forced a
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation. etc. -
1. examole- 1250 sq. foot house. 500 sq. foot 9 !ge Rec'd'
2. examole- if new project. check-new - if add;
cneck add, etc.
F. Building permit information:
1. example - construct single family house with
attached garage
2. examole - remodel existing garage into famil
3. examole - convert single family residence in
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of t (
Structural Specialty Code
H. DES I GN TEAI.I AND COIITRACTORS
To avoid design or construction delays, Buildin~
Division Staff must be able to contact appropric \,
persons regarding design information or job sitE
corrections, etc.
Abbreviated Plumbing, Mechanical. & Electrical Schec ,6
A. Except where blank spaces occur in the descripti \
portion of the MeChanical and Electrical Schedul
the applicant need fill-in only the No. Boxes de
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedl
are available at the Building Division
1. To conserve space on the permit form the sct
have been abbreviated
2. If the item(s) to be installed are not covet \or
the abbreviated schedules you should consul:
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES I
CHARGES ON THE SCHEDULES (
D. As noted on the CAP, the label must be deliverel
'electrical contractor for signature by his elee'
supervisor. The general contractor is.not authl
to sign the electrical label. ---
Applicant to sign and date
Whenever possible. the initial application will be. I
a worksheet only. Where possible, Building Oivisio: (_
will prepare a type written copy and return it to t
a~plicant at the time the actual permit is issued f,~
s 1 gna ture.
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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COMBINATION APPLICATION/PERMIT (CAP)
II.
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IV.
V. FOR OFFICE USE ONLY
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CITY
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DI'DMTT VAl [fJATION
OF SPRINGFIELD
City Hall
Springfield. Oregan
Department af Public WarkS
OffiCIAL RECEIPT
~~nl-I No. B
Date Fra~ 1,9?'1
Address OJ"5-f:) "'" .'~' ~
S7203l
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Received For:
~fV"\ ~1) QU
L\~- - 9,0
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Amaunt Received ~21n .<6~.
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iIlun.OIUZ~D S10NiIlTUIU f
SHluOH.ru.....ull....'HU... 'IUCIHI. 0" '740. ..,,,., \..
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Permit Clerk
PROJECT CONOITIONS 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:
name
signature
A/2
date 9-/- 3"1'