HomeMy WebLinkAboutPermit Building 1980-9-15
1 IrISPECTIOII LWE
726-3769
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CITY UF SPRINGFIELD . IIIFOR/1ATIOII LH"
CmmfrlATIOIi APPLICATION/PERMIT 726-3753
"r E!lERGY SOURCES: _________ Sq. Ftq. 1.lain
Jr~r.-t" Heat ______ . ~q. !='tg. Access.
\'la:cer H ter Sq. F~er
Ra e _r~e\ ".Add Alter _ P.ep.
Fenc erno Change/Use
..........Valu€ of 1,lark.: a;;::;J Other- -
~)tJO
Buil<f111Q Permit Info:
Famil y Residence I'lith
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Job Address ;);l:3 ,4-IJ- e ,t1k47"/I '/;
legal De5cription ~(J()() _
11 ()3'~53z.. -
16/-'1/-/
'/1'
Owner S;-;JtZ/Ai:Jr/t:L-1)
Address' ~:SC' 44'-
g<M~ 0
7'>1' .
Phone,p<t.J I
R")i-r, 3'- ,.
Construction lender
Address
UESIGfl TEAr,
Phone
(address)
(lies. no.)
(name)
Primary
Structural
Electrical
r~echdn; Cd 1
CONTRACTORS
; Genera 1
PlumbinQ
"
1 1\ Ana~e/\ f!?W\ ~.10'\ (address) .
\ ~ _ \..Lit tJ)/U \ffL.,ti1J '1 ~ uY)p-
~~ -.Q()LfZ"
~/
(l ics. no.)
Electrical
-------
~'~echan;cal
PLU11BI1lG
C"ARCJ NO
ELECTRICAL
110.
FEE I (HARr,F Nrl
~H'
Each single fixture
Residence of
SQ. FT.
Relocated building
(new fix. additional)
1;5'>1
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New circuits alts.
or extensions
S.F. Residence
(1 bath)
IDup1ex (1 bath) each
IAdditional bath
~!ater service
ISERVICES
I
Sewer
Temporary Construction
Change in existing
rpc:.idpnce
multifamily. comm. or
Tndllc:.tri<ll
Storm Sewer
IOf
I C0I11.1. /I NO. FEEDERS
I ~~~;~~ ~~a.~;;~~~: 1 oca te
Of amps. I
amps.
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Describe Work(i~e., Build Single
~f~y\";a~\-\ em [)
,-
(exoires)
(phone no.
(exoires)
(ohonp no )
MECHAN I CAL
'"
rI-lARr:1="
furnace/burner to
BTlI's
Floor furnace
and vent
Recessed wall
SO<ICP heater <Ind vent
Appliance vent
seoarate
Stationarv evan.
cooler ~ ,
Vent fan with
sinole duct
Vent system apart
hea t i no or A. C.
Mechanical exhaust
hond ilnd duct
from
I
"ExTENt? /N/J.(", I
I
I
Wood stove/heater
ISSUANC, OF PFRtllT
I <;is!)
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II} 5!S!
/S?..s-{)
thi s perr.lit
TOTAL CHARGES
WHERE STATE L.\II REQUIRES
shall not be valij until the
I
TOTAL CHARGES ;I~-!2 TOTAL CHARGES
that tile Electrical work be done by an Electrical Contractor. the electrical portion of
label has been signed by an Electrical Supervisor and returned to the Building Division
1 HAVE CAREFULLY EXNllNED the completed apr1ication for !)ermit. and do hereby !:ertify 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 Soringfield and the laws of the State of Oregon pertaining to the._work described herein. and that IlO OCCUPArlCY will be made
of any structure without the permission of the Guilding Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by O~S 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in comoliance with ORS 701.055 will be used on this project.
HAf.IE(p1ease printJLf..::r Vol.! .I)E/l DIe- SIGII^TURE~~
I FO~ OFFICE USE OI'L Y 1/
/
So. Ftg. r1ain
Sq. Fta. Access
Sq. Ftg. Other
Zone
(~-;;., .
Units
Type/Canst.
Fi re Zone
Bedrooms
Occy Load
OccY'Grou~/:?--;;?
Flood Plain
Stories
BUILDING PERI.IIT
Charges an':
Surcharges
Plan Ck.
65%/Bldq
Plan Ck.
30%/B1 dq
Fence
Cj.(p[)
Comm/lnd
POl" 1="01'>
Res --
Per Fee
__ ___ 3f:.01?_o_
1,;)')(
-iff-/!- -- --- -
~----
PLU'.IBING PERI1IT
Charges and
Surcharg~s
D~mo
ELECTRIU.L PERIiIT
Cha rges and
Surcharges
15'.tJO I Sidewalk
, C?rJ I A/C -raving
_____j_~.c..s:-QI Curb Cut
&<#1
/1ECHAIIICAL PERMIT
Charges and
Surcharges
Dm 9hrlpo
x
Value
Val ue
Value
x
x
TOTAL VALUATlDrI 'if'llJO. aLL
Systems Development
Charqe (I. 5.,)
r-
ac.
'1'r/(J
ITotal Comb. rermi t
~3/1~
I
3'73,S&,
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I iOTAL
0...., _.,. ... ~
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it
COMBINATION APPLICATION/PERMIT ICAP)
I.
Applicant to furnish
A. Job Address
B. Legal Description
1. examDle~ Tax Lot 100, Lane County Map Reference
1I U3 43
2. examDle~ lot 1. Block 3, 2nd Addition to
Springtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources ..
1. examole~ heat/electrical ceilinq/or.forced air
2. exar.:Dle~ waterheater/electrlca(/or solar
E. Square rootage or valuation, etc. -
1. examDle~ 1250 sq. foot house, 500 sq. foot gar
2. example- Tflnew project, check-new - if additi
Check add, etc.
F. Building permit information:
1. examDle - construct single family house with a
attached garage
2. examole - remodel existing garage into family
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.l AIID 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.
Abbreviated Plumbing, Mechanical, & Electrical Schedul
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 adja
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedule
are available at the Building Division
1. To conserve space on the permit form the sehec
have been abbreviated
2. If the item(s) to be installed are not coverec
the abbreviated schedules you should consult t
full SChedules
C. BUILDlilG OI'lISIOtl STAFF WILL FILL OUT ALL FEES AII[
CHARGES Oll THE SCHEDULES
O. As noted on the CAP, the label must be delivered t
electrical contractor for signature by his electri
supervi SOl"'. The genera 1 contractor is ~ author~
to sign the electrical label.
Applicant to sign and date
Whenever possible, the initial application will be us{
a \',orksheet only. Where possible, Building Division;
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for
signa ture.
Fees and Charges
Plan check rees are due and payable at the time of thl
application, and no plans will be processed until the~
fees are paid. All other fees and charges are .due d(H
payable when the permit is issued.
I!.
I I I.
IV.
V. FOR OFF! CE USE Oll~ y
.,
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II
PERMIT VALIDATION
( CITY OF SPRINGFIELD
City Hall
Springfield, Oregan
Department of Public Works
OFFICIAL RECEIPT
1-.
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Date
/ Rec'd
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<\.. No. B S 4 5 7 E
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From ........ ') \. J D
Address cD~j()\\~)r.l-Y\ '\(\ I ~\.
Received For:
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Amount Received
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
. ,,.., ........" ,
.Permit applicant exempt from re~istration with the Builder's Board because:
;,g"'t"",;r,~ ~-<,i'~
Additional Project Information:
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PLANS REVIEWED BY:
name
au
12-0
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date
7-/52-gc)