HomeMy WebLinkAboutPermit Building 1982-9-24
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-I IrISPECTION LINE.
726-3769
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Job Address
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CITY OF SPRINGFIELD
C0/1BlilATION APPLICATION/PERMIT
ErlERGY SOURCES:
Heat
\'Jater Heater
Range
ValUE of l'lork:
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J Builc;inQ Permit Info: . Describe 110rk(i.e., Build Single
Phon~~~ .7J~)f Family nesidence With Attached GaraQe)
I~~ d/l40 ft
Phone !
(address)
INFORr1ATION UN!:
726-3753
Sq. Ftc). f,lain
:q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
~Fence Demo Change/Use
~Other ~ ~
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Legal Description /7-.1> :t-~;:J- ~ ~ ~ '1~ 0
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Owner~ Jfu~. ~ ..Jll4E~
Address tbt/3 1;/- ~d1
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Construction Lender
Address
DESIGN TEAM (name)
Primary 3017/7 K/5K()
(lics. no.)
(expires)
(phone no. )
, Structura 1
Electrical
r1echani ca 1
CONTRACTORS (name) (address)
General 1JrLL~ ~UU&~C
PlumbinQ /{~~.:. :!.. :;_ .:-" -:-.-;=t:.;_;A~
,Electrical' .~~-e{A.~ ?;;&-Z;L;~
(1 ics. no.)
(exoires)
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/led - ~ yr P/t..~
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. ~'echanical
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PLUf1B I NG
ELECTRICAL
MECHANICAL
NO.
I FEE I CHARGE j NO.
FFF
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fHAR(;F NO, I
SQ. FT.
furnace/burner to
BTlI's
'FFF' , A "F'
fH ~" "
Each single fixture
Residence of
//
Relocated building X New circuits alts. .--..1 Floor furnace
(new fix. additional) ~e~~i~~)$r~ ~ .., and vent
IS.F. Residence I SERVICES I" I Recessed wall I
(l ba th) Soace heater ilnd vent
IDuPlex (1 bath) each I I I. ".1 I
IAdditional bath I ITempOrary Construction I I, I I ~~~~~:~~e vent I
IHater service I IChange in existing ,. I I I Stationary evap. I
res i dence coo 1 er
I Sewer I I multifamily, comm. or I I I I Vent fan with I
Industrial sinole duct
I I I I I I I Vent system apart from I I
Storm Sewer Of amps. heating or A.C. .
I I I FEEDERS I I I I Mechanical exhaust I I
,COMM./IND. hood and duct
I Install/alter/relocate I I I I ~Jood stove/heater I I ,
distrib. feeders
I Of am~s.1 I I X 'b'~~ S-~9""~ I".~,
I I I I ~~.pP/F/~r/~~ I
I I I I I I I
I I I I ISSUANCE OF .PFRrllT /t'- c:c;
TOTAL CHARGES J TOTAL CHARGES /~I TOTAL CHARGES /6.0"11"
HHERE STATE L\\v REQUIRES that the Electrical work be done by an Electrical Contractor,theelectrical rortionof thi's permit
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAf1INED 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 oertaining to the work described herein, and that NO OCCUPAr~CY 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.
'<A'IE(pl,,,, p,;ptIMIl.eJt> K i c lJscA /f/l k SlG"ATURF~A.fh/-'" 4- M~ t!-cJY -:1:<_
FOR OFFICE USE ONLY ~.
Zone &;c:...... Tyoe/Const~R.. -:>,Prfr1il:s Sq. Ftg. 11ain x Value . ~
Fire Zone Bedrooms Occy Load Sq. Ftg. Access x Value
Flood Plain Stories I Occ.v Groupd'-2, Sq. Ftg. Other.if"~~;:>c- ~ Value '"f1!:>/':<r....
TOTAL VALUATION ~~r ~
BUILDING PER~lIT 7~ ClC I Plan Ck. CommlInd 115 4()od.... IS{;stems Development I
Charges anG ____ _~____ 65%/Bldo Per Fee . C arqe (1.5%)
Surcharges 'It! I Plan Ck. Res I q,2.4.<6?~ \ ,~q\4?1 I
/ · 30%/Bl dQ Per Fee
PLW1BING PERMIT I Fence I . I - I
Charges and ------------
Surcharges I Dt;mo I I I
ELECTRICP,L PERr~IT /~ ...-c> "Sidewal k I I I
Charges and ----- -~-
Surcharges ..I!f{i!> I A/C Pavi ng I ITotal Comb. Permit I ~9.~
MECHANICAL PERMIT ---_/~:~~- Curb Cut I q ~? ~8 ~
Charges and ,~
Surcharges, .6S1 , TOTAL S
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COMBINATION APPLICATIONJPER~IT (CAP)
, ~. ,
CITY OF SPRINGFfElD '
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, City Hall
Springfield, Oregon ,
, Department of Public Works
OFFICIAL RECEIPT
No. B 598 I] 0
Date ~t) lp 19 ~
C Rec'dFrom,,~_\ ,Y-\sh~ ~~,+-\()f)
Address {o~':3 41. (' Q f\~
- - -
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I. Applicant to furnish
,A. Job Address
B. legal Description (-
I. examp 1 e- Tax Lot 100, Lane County ,Map. Referer \
17 03 43
2. example- Lot 1. Block 3, 2nd Addition to
Springfi~ld Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced a'
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. examole- 1250 sq. foot house, 500 sq. foot gi
2. example- if new project, check-new - if addi
check add, etc.
F. Building permit information:
1. example - consiruct single family house with
attached garage '
2. example - remodel existing garage into famil, (Cil'
3. example - 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 TEAr" AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropria
persons regarding design information or job site (
corrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical Sched
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 ad
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedu
are available at the Building,Division " I '
1. To conserve space on the permit form the sch' '1,p',
have been abbreviated
2. If the item(s) to be installed are not cover
the abbrevtated schedules you should consult
full schedules (
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES A
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered
electrical contractor for signature by his elect
supervisor. The general contractor is ,not autho
to sign the electrical label. -
Applicant to sign and date
Whenever possible, the initial application will be, u
a worksheet 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 his
signature.
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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Received For:
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'L .L371)
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AUTHORIZED SIGNATURE
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Amount Received
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BRIGGS PRINTERS/LITHOGRAPHERS. EUGENE. OREGON
V. FOR OFFICE USE ONLY
Permit Clerk
~PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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l Permit applicant exempt from registration with the Builder's Board because:
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1 Additional Project Information:
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PLANS REVIEWED BY:
name ~€ a<!!o;~jif signatur
date
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