HomeMy WebLinkAboutPermit Building 1980-6-2
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_~;'ISPECTIO,N L1iiE
/:1726-3769
, CITY OF SPRINGFIELD
Cm1BInATION APPLICATION/PERMIT
INFORf1ATION lllll:
726-3753
.. Sq. Ftg. r.lain 2O~ tb
:q. ~tg. Access.
Sq, Ftg. Other
Ne\~Add Alter, Pep.
--Fence Demo' Change/Use
Other-- '--
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Job Address if:;':::SC,.1-C:(/'f-/.ji;: .l.,)/2
Legal De~cri pt ion ~7 ,,'0/= 2-7 /s:r 4iJ J)
I 7--() J.-3'-/- Aj
Ol'mer Q4Uilj J .tV'EZ..<;dN
Address L/Z?: C-4 S:-r'" 4/J to:' 7);2
ErlERGY SOURCl'S! /'
Heat .i 6J1~ll LC:>~
, / ' 3o-Ca.A.--
~ f:::.7-J(7"}'-. ['Iater HeatereO~(.tLI.~_ .
c/-I,,--,/c.,. Y ) 11' .
. Range () 0 ~7~. '
:~alu,E: of I-/O,r k: 0-'" ~.~, "
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Bui'ttjinq Permit Info: Describe ~Jork(i.e., Build -Single
Phone7f7-3'&/: Famil y nes i den(1e l~iJi:h /lttached Ga raqe) .
~fE-22{i. a./'1,~dprnJ, I a CIdd-LlM-,
Construction Lender e/2E /;1/4.
Of
Icm~r'1.IIND. FEEDERS.
I Install/alter/relocate
distrib. feeder~ '
10f
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TOTAL CHARGES I TOTAL CHARGES
l'IHERE STATE, L'i\~ REQUIRES that the Electrical work be done by an Electrical
shall not be val j-j unti 1 the label has been signed by an Electrical Supervisor
Address
-DESIGrl TEAr1
(name)
Primary
A2-TG'U /0
Structura 1
'Electrical
!1echanical
, CONTRACTORS
, (name)
Genera 1
C) \'\/ V'd )',{ -
: P1 umbi nq
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: Electrical'
<~!.
~~echani ca 1
PLur18 IrJG
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i~O .
Each single fixture
Relocated building
(nel'l fix. additional) ,:
S.F. Residence
(1 bath)
IDuP1ex. (1 bath)
IA,dditiona1 bath
~'a ter servi ce
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Sewer
Storm Sewer
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Phone
(address)
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I ISSUANCE OF PFR11tT
/5~.~Y) I TOTAL CHARGES '
Contractor, the electrical portion of
and returned to the Building Division
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(1 ics . no. )
(lies. no.)'
(exlJires)
(phone no.)
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(address)
ELECTRICAL,
-~
FEE I CHARGE ! NO
Residence of
7</7-~~)~
(expires)
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SQ. FT.
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INew circuits alts.
!.../ or extens ions
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ISERVICES
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(ohone no. )
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MECHAN.! CAL
NO.
I FFF
ITempOrary Construction
IChange in existing
residence
multifamily, comm. or
Industrial
amps;
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amps.
furnace/burner to
BTlI's
Floor furnace
'and vent.
'I Recessed wall
, Sn~re hp~tpr ~nrl
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vpnt. f I
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I App 1 i ance vent
sepa rate
I Stationary evap.
cooler
'I Vent fan wi th
sina1e duct
I Vent system apart
, heatina or A.C.
Mechanical exhaust
hood and duct
,\
from
,
ft
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Wood stove/heater
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this permit
.1 HAVE CAREFULLY EXNlINED t~e 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 NO OCCUPAfKY. will be made
of any structure without the permission of the Building Division. I further certify that my registration \'lith the Builder's
Board is in full force and effect as required by ORS 701.055,' that if exempt the basis for exemlJtion is noted h~reon, and. that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
fW1E(please print) .h'-.1 ~tJ
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f\( FL~' uAJ
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S IGrVlTURE/
FOr! OFFICE USE GilLY
Zone' i~:'~- / Type/Const. \T~. ;1.~/ Units i So. Ftg. r1ain ~OX'
Fire Zone i7L Bedrooms Occy Load Sq. FtlJ. Access
Flood Plain fin- Stories ! r- ~ Sq. Ftg. Other
Occy Groupo~~'-
"Ji _c" Plan Ck.
, ~',").o7 65;0 Bld
------~---- Plan Ck.
), I..J-i.! 30%/Bldq Fee
___________-' Fence
;tIff I D~mo
/ ~()!:) I Sidewalk
- - - - - - ->-'-'- - - -
'. r{"u' A/C Paving
.1 '/,A ' . I Curb Cut
-7!Jfr - - - - -:--:-:-:-
f,
BUILDING PERNlT
Charges and
Surcharges
PLW1BING PERr~lT
Cha rges and
Surcha rges
ELECTR I CJl.L PERr~lT
Cha rges an9
Surcharges
11ECHANICAL PERt1IT
Charges and
Surcharges
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DATE
x
Va 1 ue ~6'~ ;l.-..? U" c:J6"
Value
Value
x.
x
TOTAL VALUATION ~"'?.?i O. <29
;..-'
Systems Deve 1 opment
~~l? Charqe (1.5%)
/0, g3;:~g.-&)
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Jota 1 Comb. Permit
. " f2e.{'.l1 'pJ-
-,- TOTAL 53b5;?...
~3.C)lL
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"1 53.0'1
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COMBINATION APPLICATION/PERMIT (CAP)
1.
'~,
Applicant to furnish
A. Job Address
B.' Le~al Description
, 1. example- Tax Lot 100, Lane County~ap RefE
17 03 43
2. example~Lot 1. Block 3, 2nd Addition'to
Springfield Estates
C. Name, ~tc. of o~mer and constru'ctionlendel'
D. Energy Sources '
1. . examole- heat/electrical ceilinq/or forcee ,(~
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. examDle- 1250' sq. foot house, 500 sq. foo1
2. example- if new project, checknew'- lf ae (;e
check add, etc.
F. Building permit'information: J
1: example - cbnstruct sin~le fam"~y house t.
attached gar~ge. :" ('
2. examDle - remodel existing garage 'into far
3., examo]e - convert single family residenc~
~iiurant (change of use);
G. Ifalue of work as defined in Section 303 (a) q he
SiTllC.tu,"a 1 Spec i a Hy Codei
H. DE:..i Gl1 TEAll AND CONTRACTORS
To avoid design or construction delays, Build
D'vision Staff must. be able to contact approp' ~(>
persons regarding desi~n inform~tion or job s
CDrre~tions, etc. j
Abhreviated Plumbing, Mechanlcal,' & Electrical sci
A. Except where blank spaces occur in the descri'\" (r1
portion of the Mechanical and Electrical Sch~
the "ppl.icant neeu fill-in only the No. Boxes
to the appr6pria'ceitem(s) to be installed ;
B. Fun Plumbing, Mechanical, and Electrical Sch' . (e~
. are available at the Building Division '
1. To conserve space on the permit form the,
have been abbreviated
2. If the item(s) to be installed are not co ~:
the abbreviated schedules you should ~ons
full schedules '
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FE~
CHARGES ON THE SCHEDU(ES . (
D. As noted on the ,C~P, the label must be delive '+
electrical contractor for signature by his ~l
supervisor. The general contractor is not,au
to sign the electrical label.
'Applicant to sign and date
Whenever possible, the initial application will b
a worksheet only. Where possible, Building Divis
will prepare a type written copy and return it to ~
appl icant at the time the actual permi:t is issued ~
signature. . r -l-
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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V. FOR OFFICE USE ONLY
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CITY
PERMIT VALIDATION
OF SPRIN'GFIELD
City Hall
Springfield. Oregon
Department of Public Works
OFFICIAL RECEfPT '
No. B
...,--. -:::::> Rp....
Date__~ U vV. _ ;:s, ,,19 (' ) \..J
Rec'd From Dn, y/r\ '~, N p (Sfl.\A
Address Lf::J?<' 0/\'<::(0 ri~jJ\V',
.c::.:....... C2-J
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Received For:,.q ~f\ 4-t, t.f
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~/~ ~ ,-=<I~. Of!
""--'0 _ - ,~ ,__-
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E/;?c/V'{cb { /~.i:;.OO i:C 1,//03
LjC07_ I /P 0
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4' --? 0 l./ I.
Amount Received __ ~ -."), -(':1') f' C/J!...
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~ AUTHORIZED SIGNATURE ('.
, SHELTON-TURNBULL PRINTERS, EUGENE. OR 97401
BY
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
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Additional Project Information:
PLANS REVIEWED BY:
Il
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signa ture A.! /.cz.:--,
name
J
J-cf,/t.- .z ::C/o /'
tp -~,~--,60
, date
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