HomeMy WebLinkAboutPermit Signage 1980-11-6
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11726- 37 69 '
Job ,;ddress
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CITY OF SPRINGFIELD
'COMBINATION APPLICATION/PERMIT
ENERGY SOURCES:
Heat '
\-later Heater
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INFOR11ATION ,liNt.
726-3753
Sq. Ftq. r,1ain
::q. ctg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
--Other -- --,
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D
Legal Description
Ranqe
Address
-D[SIGi~ TEAr1
j Pri mary
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I 5t-:t!c:~ral
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1 ,__,,,",,""J"S
(name)
, Phone
(address)
ValUE of Hork: ()()
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Builcdnq Permit Info: Describe viork(i.e., Build Single,
Family Residence With Attached Garaae)
j or.' Crl/YYLQ./1.. C\.. S h.o L.U (l fU) 0 )
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(lies. no',) (expires) U (phone no.)
-
, Owner' ,'(\Ou'\ 1: ~ X'\ 0) f\.lF-,.
Address D, (1 ,P")())( AI) l 0 q
F) l X\-Q ru, (CJ J\.J c~G--0
Co~struction L~r '
~l~JJ ~ One.
, , Phone
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c2:1eral
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(address)
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(1 ics.. no. )
(expires)
(oherne no. )
(name)
n~ o~"iu~
It.
Piumbjnc
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I Electrical
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~LEC:RIC.~L
MECI-iAN I CJl,L
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i Each singiefixture
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Residence of,
.1 FEr::
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i CHARGE j NO.
1 '~FF
~lv _ '
Ft~
i CHr\RGE
NO.
SQ. FT.
furnace/burner to
BTlI's
.'
iRelocated buildind,
, i (nel'l fi x, additior;a])
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; S.F., Residence
! (1 bath) ,
.1 Duplex (1 bath) each
IAdditional bath
" I \-later service
I,se\~er
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,Storm Se'.'/er
New circuits ~lts,
or extensions
Floor fu rnace
,and vent '
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SERVICES
Recessed'wall !
SDace heater and w'nt,it:
ISSUANCE OF
COMM./IND. FEEDERS'
Install/alter/relocate
distrib. fpeders'
ApDliance vent
sepa ra te
I Stationary evap,
; cooler '
I V~nt fan: wi th
s,i no 1 e, duct
Vent system apart
heatino or A.Co
Mechanical exhaust
hood and duct
Wood stove/heater
Temporary Construction
Change in existing
residence
multifamily, comm. or
, Industrial
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Of amps,
Of
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amps.1
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TOTAL CHARGES
TOTAL CHARGES
TOTAL CHARGES
,I,JHERE STATE, L'\\{ REQUIRES that tile Electrical \10rkbe done by an Electrical Contractor, the electrical portion of{~hi's permit
,shall not be vali:J until the label has been signed by an Electrical Supervisor and returned to the Building Division;'.;
I HAVE CAREFULLY EXiVlINED the completed appl ication for permit, and do hereby certify tha~ all information her,eon<l;~ tr~~'",
and correct. and I further certify that any and all \'iork oerformed shall be done in accordance with the Ordinances of the City
of Soringfield and the Laws of the State of Oregon oertaining to ,the work described herein, and that rlO, OCCUPAIKY will;be made
.of anY,st~uc~ure \'iithout the permission of theBuildi,ng Division. I further certify that my registration l'lith the,8ulJder's::", "
Board lS,1n Tull force and effect as required byORS 701.055, that if exemot the basis for exemption is noted hereon,;and that:
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~ FOR OFFICE USE /)r'!L Y\. t,,/:,i; ,~' 'I
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Zone
Fire,Zone
Tyoe/.Const.
Bedrooms
Units
Occy Load
Occy Group
So.' Ftg. r1ain
Sq. Ftg. Access
Sq. Ftg. Other
x
vaiue
Value'
x
Flood Plain
Stori es
x
Value
TOTAL VALUATION
BUILDING PER~HT
Charges and
, Surcharges
I Plan Ck.
__~_ ___ _~ _ __ 65%/Bldo
, Plan ck,
30%/Blda
C.omm/!nd
Per Fee
Res
Per Fee
Syste, ms Deve 1, opment I'
Charqe tl.5rl '
---:--,
PLur~8ING PERr~IT
Charaes and
Surcha leges
'Fence
I~--
~J (:~rn,
A/C Paving
Total Comb, Permit
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W
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Dt;mo
ELECTRI(;,L PERrin
Cha rges and
Surcha rges '
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-------.-----
'Sidewalk
MECHANICAL PERMIT
Charges and
, Surchar']es
Curb Cut
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:",1 TOTAL
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I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map' Refer
17 03 43 i
2. example- Lot I. Block 3, 2nd Additidn to
Springfield Estates
C. Name, etc. of owner and,construction lender
D. Energy Sources, ' ,
1. example- heat/~lectrical ceilin%r forced
2. example- waterheater/electrical!orsolar
,E, Square footage or valuation, etc., '
1; examole- 1250 sq. foot house. 500, sq: foot
2. examole- if new project, check-new ~ if adc '.
check add, etc. '
F. Building pennit information:
1. example,~ construct singl~ fa~ily house ,wi4 R-ec' 'd'
attacnea gar'age " 1 .
2. example - ,remOdel, existing garage into fami- ,
j. examol~ - con~ert singl~ family'residence
restaurant (cnanae'of use) " '
G. Vaiue of \~ork as defined' in Section 303 (a) of
Structural, Specialty Code
H. DES I Gii TEAn jl,ND CONTRACTORS
To avoid design or construction delays, Buildir
Division Staff must be able to contact appropr~' A
persons regarding design information or job sit ~
corrections, etc;' ,
II. Abbrevialea PIGmbing, Mechanical. ~ Eleciricai SCh8
A. EXcept where'blank spaces occur in the descrip1
portion of the:~echan i ca l..a nd E-l ectri ca ISchedL
'the applicant need fill-in only the No. Boxes 2
to the appropriate item(s) to be installed
B. Full Plumbihg, Mechanical, and Electrical Schec
are available at the Building Division .'
L To conserve space on the permit form the 'sq,
have been abbreviated ' I
2. If the item(s) to be installed are not cove
the abbreviated schedules you should consul
full schedules '
C~ ' BUILDING DIVISION:STAFF WILL 'FiLL OUT ALL FEES
CHARGES ON'THE SCHEDULES'
D. As ,noted on the CAP, the label must
electrical contractor for signature
supervisor. The general contractor
to sign the electrical label. '
III. Applicant to sign and date ,
Whenever possible, the initial appl ication ,will ,be
a worksheet only. Hhere' pos'sible, Building Divisio:
will prepa re a type' written copy and return it to t:
applicant at the time the actual permit is issued f, . BY,
signature.
IV, Fees and Charges
Plan check fees are due, and 'payabl e 'at the time of ' A'
a~plitation. and no plans will be processed until tl ~
fees are paId. All other fees and charges are due q
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1 PROJECT CONDITIONS TO' BE SATISFIED' BEFO'~E O~CUPANCY.:
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.~I::," . Additional Project Information:
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I.. PLANS REVIEWED BY:
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COMBINATION APPUCATION/PERMIl (CAP) ,
be del;vere
by his elec
is not auth
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PERMIT VALIDATION
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CITY"OF
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SP R I N G FIE!. D
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, , City Hall ,
Springfield, Oregon
Department of Public' Works
OFFICIAL RECEIPT
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Date,
c:: r::: 1 '1 '';), '
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, No. B
-1/,.r ;" C;.A;
,/.' -;... to 190U
FromUr70JrtU1 fB.An~ ~5{ crfl
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Address P. O. f~Y c9c(oCf '
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Received For:
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._. '. AU.THO.RIZEO "SIGNATURE.
;SH~L,TON"TUANrUL'L.'PAI~.T:,~~RS -';~,-!G~~E. OR 97401
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Permit applicant exempt from registration with the Bu,i1derls Boar.d because:
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signature,
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