HomeMy WebLinkAboutPermit Building 1982-7-8
I IrlSPECTIOII LlIIE'.
726-3769
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CITY Of SPRIHGflELO
COIIBIIIATION APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
Hater Heater
Ranl1e
Job Address 2 :2":? ;</0 7:~ R /1 S7-.
Legal Description 17-<:1~. ':for." 2~{;l)';I,-
, -
INFORl1ATION Lll'tt. I
726"37S3
Sq. Ftq. !.1ain
~q. f"tg. Access.
Sq, Ftg, Other
r~e\'t' Add Alter Rep.
-Fence Demo Change/Use
Other - -
Owner
-:; 0,- H-
Address :<S-O /(/c>T"J'TH A S/-
Phone
ValuE" of Horle
'7' )5', ""<,,,
Bullc:ina Perillit Info: Describe Work(i-.e., Build Single
Family ~esidence l'Iith .Attached Garaae)
C ~/,'T 7r<.-'<, '7- WA' 4"- ( Aew B;.;-,,<-,)
'7?-> a Y / De=
Construction lender
Address
DESIGU II:.AH
(name)
Primary
Structural
E1 ectri ca 1
~
f"
S'I
\t
II '
vl'i
~
... _.,
Phone
(address)
/htT> 2?=-~,=;'
!(~/-?'>7 .
(lies. no.)
(phone no.
(exoi res)
Hechanical
CONTRACTORS lnamel
General i/4h'a""->/?/' U &~::j/~_
Plumbina
Electrical
~'echan; ca 1
PLUI1BIrlG '
110,1
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(j bath)
10uPlex (1 bath) each
IAddi lional bath
1 ~!a ter serv i ce
[sewer
lstorm Sewer
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be vali1 until the
(address)
(lies. no.)
(pxoirps)
(ohnnp no.l
74[,"7';1'/.s-
ELECTRICAL
fEf r.HARGf Nn
Residence of
SQ, fT.
New circuits alts.
/ or extensions
SERVICES
MECHANICAL
~~~ I rHARr.~ NO
~H rHARr.~
/
furnace/burner to
BTU's
--~
IC!'
Floor furnace
and vent
Recessed wall
Snarl" heater and ypnt
ITempOrary Construction
IChange in existing
rpS; dpnf'p
Imultifamily. comm. or
Tnrlustrial
[Of amps.
I COI~I'1. /I NO, FEEDERS
I Install/alter/relocate
rl;<;.trih. fppder<:;.
Of amp~[
Appliance vent
seoaratp
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hood and dUl':t
Wood stove/heater
TOTAL CHARGES
that tile Electrical work be done by an
label has been signed by an Electrical
ISSUANCE OF PFRI11T
It? <"'- TOTAL CHARGES
"Electrical Contractor. the electrical portion of this per~it
Supervisor and returned to the Building Division ~
I HAVE CAREFULLY EXNIINED the completed ap['llication for permit. and do hereby certify that all infonnation 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 IW OCCUPAUCY 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 ons 701.055. that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
HAHE(please print)
Zone e:: - s
Fi re Zone
Flood Plain
Units
Occy Load
Occy Group
S IGtlATVRE
FO~ Off I CE USE OIIL Y
Sl"!. Ftg. t1ain
Sq. Ft9. Access
If-- 2- Sq, Ftg, Other
x
DATE
Type/Const,~-/J',1;:?,
Bedrooms
Stories
x
x
Value
Value
Value
TOTAL VALUATIOII
5"7)-' c;:.rr~
BUILOIllG PERfIIT
Charges an>::
Surcharges
PI an Ck.
6S%/BIda
-------,/-c:--Pidn Ck,
I" 30%/81 dq
/0, r.....~
CommlInd
Ppr Fp~
Res
Per Fee
Syste~s Development
Cha rqe (1. S1,)
PLUI~B ING PERfil T
Charges and
Surcharges
Fence
Demo
/0, "'=- Sidewalk
------------
ELECTRIU.L PERI:IT
Charges and
Surcharges
11ECHANlCAL PERMIT
Charges and
Surcharges
''Ie- A/C Paving
Curb Cut
jrotal Comb. rermit
I
I TOTAL
~ 20. $:"6
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COMBINATION APPLlCATION/PERfllT (CAP)
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I. Applicant to furnish
A. Job Address
B. legal Description
1. examole- Tax lot 100, lane County Map Reference
17 03 43
2. examole- lot 1. Block 3. 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ceil inq/or forced air qa
2'. examole- waterheater/electrlcal/or solar
E. Square footage or valuation', etc. -
1. example- 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 rOOI
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 TEAr,l ArID 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 where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules.
the applicant need fill-in only the No. Boxes adjacen;
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 schedulel
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 OIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered to tt
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 a~
a worksheet only. Where possible. Building Division Staff
will prepare a type written copy and return it to the
~ a~pl icant at the time the actual permit is issued for his
slgnature.
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.
t'
V. FOR OFFICE USE ONLY
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PERMIT VALIDATION
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CITY OF SPRINGFIELD
City Hall
Springfield, Oregon
Department 01 Public Works
OFFICIAL RECEIPT
No. B 5939 S
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IE, 19 ~::>
Dater /Ui. Or' 'l'~ _
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Rec'd Fro'; Vfi/vC; ",:/Y/?D C:-~'/"'Y'.7 C:c .
'Addre~s ,?o L20x 717 }?z;:-r"'/lrv ,-/k<./
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Received For:
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Amount Received '20-- B=,
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AUTHORIZED SIGNATURE.,.,.?"' (~",.
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BRIGGS PRINTERS/l.ITHOGRAPHERS, EUGENI:, OREGON
-..1.-. _ . . .
Permit Cl erk
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 ,,/"D;7/V~
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