HomeMy WebLinkAboutPermit Building 1982-8-5
ll1lSPECTIOIl L1IlE.
726-3769
Job Address 1126
.
.
Gateway Loop
CITY OF SPRIrlGfIELO
C0I1BIIlATlON APPLICATION/PERMIT
E!iERGY SOURCES:
Heat
\.la ter Hea ter
INfOR11A TI ON LJ l'je.
726-37S3
Sq. Ftg. r'iain
~q. !=tg. Access.
Sq. Ftg. Othe,8334
-I1e\<--^dd)LA 1 ter ---,~ep.
Fence Demo Change/Use
Other- -
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I.egal Description 17 03 22 2, T.L. 2401
Address
Owner Springfield Investment Co.
Phone
Ran(]e
ValuE of Hark:
$12,000.00
Builc;nQ Pernlit Info:
Familv nesidence With
Describe Work(i~e," Build Single
JI..ttached Ga raQe)
Construction Lender
Address
Dt;Iljf' ItAI'
finish commercial shell
lname)
Phone
(address J
(ohane no. J
flies. no. \
(exoiresl
Primary George R. Mayer
345-3711
Structura 1
Electrical
1065 High Street, Eugene
11echanical
CONTRACTORS (name)
Fi rst Northwest
General
PlumbinQ
Electrical
""echanical
NO.
(address)
(lies. no.
(expirps)
(phnne no.l
Const. CO., 8383 N.E. Sandy, Portland
779-6684
(veri fy)
PLUI1BIrlG
ELECTRICAL
MECHANICAL
FEE CH^RGF NO
FFF rHARr.F NO.
HI=' rHAQr,f'
,/
Residence of
furnace/burner to
BTlI's
Each single fixture
SQ. FT,
IRelocated building
(new fix. additional)
I'S.F. Residence
11 bath)
IDuplex (I bath) each
IAdditional bath
1~later service
Sewer
x
INew circuits alts.
JJr extensions
t. or more
ISERVICES
I
Recessed wall
SD~~P hp~tpr ~nrl vpnt
15.0(
Floor furnace
and vent
ITempOrary Construction
IChange in existing
rp~ i d_ence .
Imultifamily. COlllTl. or
, TnritJstrial
I ~"
I ,-
Appliance vent
spoarate
Stationary evao.
cooler ~ ,
Vent fan with
sinole duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hood and rllJct
IOf amps.1
I cor~'1.1I NO, FEEDERS
IInstall/alter/relocate
dic;trib. feederc;
10f amps.1
I
I
I
5.00 " TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
Storm Sewer
X Relocate Water
Hea ter
.......
5.00
I
I
Mech~nical plans I
Not Yet Submittedl
I
Wood stove/heater
ISSUANCf OF PFR!llT
15.0C, TOTAL CHARGES
TOTAL CHARGES
WHEP.E STATE L~W REQUIRES
shall not be vali~ until the
.Electrical Contractor. the electrical portion .of this permit
Supervisor and returned to the BUilding Division
I HAVE CAREFUllY EXN1IrlED 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 Springfleld and the laws of the State of Oregon pertaining to the work described herein. and that NO OCCUPAUCY will be made
of any structure without the permission of the Building Division. I further certify that my registration ,with the 6uilder'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 7Ql.055 will be used on this project.
IW'E(please print)
Zone-er '
Fire Zone
Flood Plain
BUILDING PERI,IIT
Charges an:::
Surcharges
PLUI.lBING PERHIT
Charges and
Surcharges
ELECTRIC~,L PER!:IT
Charges and
Surcharges
11ECHA!IICAL PERHIT
Charges and
Surcharges
SIGlIATURE
FOP. orF I CE USE Di'L Y
DATE
Type/Canst.
Bedrooms
Stories
S-l~Units
Occy Load
Occy Group---B=.?
x Va 1 ue
x Value
x Valuel?,nnn
TOTAL VALUATION l?, nnn
S~. Ftg. l1ain
Sq. Ftl]. Access
Sq. Ftg, Other R~~1l
I Plan Ck.
60.00 65%/Bldo
------------""Pian Ck,
2.40 30%/B1 do
5.00
------------
. 20 I Demo
____J~'_QQ___J Sidewalk
hn I A/C Paving
~__ _ __ _ _ _ __ -1 Curb Cut
1~1 .60 ch B59491 'm~~~s(~~5WPment
Corrm/lnd
PJ'r Fpp
Res
Per Fee
180.00
Fence
Total Comb. rermit
?,3.20
263.20
I TOTAL
~
,
COMBINATION APPLlCATION/PERNIT (CAP)
1. Applicant to furnish
A, Job Address
B. Legal Description
1. examole- Tax lot 100. lane County Map Reference
II U3 43
2, examDle- Lot 1, Block 3. 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air Qas
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,
chee k add. etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. example - convert single family residence into
restaurant (change of use)
G, Value of work as defined in Section 303 (aJ of the
Structural Specialty Code
H. DESIGN TEAI'I AND 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 adjacent
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 schedules
have been abbreviated
2. If the item{s} to be installed are not covered on
the abbreviated schedules you should consult the
fu 11 schedu I es
C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
0, As noted on the CAP. the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is.not authorized
to sign the electrical label. -
Ill. Applicant to sign and date
Whenever possible. the initial application will be used as
a worksheet only. Where possible, Building Division Staff
will prepare a type written copy and return it to the
t applicant at the time. the actual permit is issued for his
".,' signature.
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 penmit is issued.
V, FOR OFFICE USE ONLY
.
'.
PERMIT VALIDATION
'%\~
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~O.CO,
-490 c9 .~l
~oOO i:
4% . 2.0 I
t ~ .00 .1
-40/0 .1.00 i
t~O.OO
2w'3. '2.D
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Permi t Clerk ~., J
l
.
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
1. An Additional Plan for HVAC work sha11.be submitted and approved, and required permits
obtained Drior to installations of anv such eouiDment.
2. In addition to relocating the water heater, If Any Plumbing is intended, plans shall be
submitted to the City Building Division and permits obtained Prior to. installation.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
j
PLANS REVIEWED BY:
name
Lc~e ?c.c9~
Signaturc.....~ ~
,.
date 134S'~82
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