HomeMy WebLinkAboutPermit Signage 1980-11-6
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INFORllATlON LINt
726-]75]
Sq. Ftg. f.iain
~q. Ftg. Access.
Sa. Ftg. Other
Ue\'I Add Alter Rep.
Fence_Demo _Change/Use
_Other
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I INSPECTION LINE
i26-3769
Job i\ddress
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J~'hto 11 lOLL r1~()()O l
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Legal De5cription
Address
UtSllill IU\1,'
(namel
Phone
(address)
Value of Hark: I IV,
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BuildinQ Permit Info: Describe Hork(Le.. Build Single
Familv nesidence With ^ttached-Garaoe)
5J(H-1 - C~hClld' ~Q--Dill no nh
l :O~b:..b..-\' .o~ N"\ C1( Q -l Gv- "-- ~,
(j I 0 \) ) \ I
(lies. no.) (exnires) (ohone no.)
Owner '-"Y'\ ~ +.
, \ \ I \ ,.. .\ l 11'"""\
Address P.n. 8v,)(
rn , J %:,'Y' n
Construction Len e
~11 fY, ~l'c\rnL\
''d.oloq - ~Phone
OA.eJ~ ")
Pri rna ry
;::"".tct:lr:;! 1
,ie!1eral
(na2e~ (address)
rqI\.AJ\'V) ~l'>"l. ~I~-'Y\/) ~CntO
(1 ics. !le:.)
(exoires)
(dhOrlP no.
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::1 e::r~:a I
~'.;,:;.~nl;:a 1
.:::;7~;'C:w.::;'S
:;h;;:':Dlno
:lec~ricGl
";::-~~~(~l
?lUlmlr:G
:lECTRrCAL
MECHAiI [CAl
I~~cn slngie fixture
,
~ ~_ ~ i r.Hf\RCiF tm I i r-~~ I r;':':';<:I";F ;;0.
Residence of furnace/burner to
SQ. FT. BTU'<;
I r-Fi= I nH~.rU;F
)..
i Relocat~1J cui lding
l(new fix. dCdltion"lj
,
I' S.r. P.~sidence
f1 bath)
IDuplex (1 bath) each
Additional bath
New circuits a1ts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
50are heater and vent
Storm Sewer
Of
amps.
Appliance vent
seaa ra te
Stationary evao.
cooler J .
Vent fan with
sinole duct
Vent system apart from
heatinQ or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
~!ater service
Temporary Construction
Change in existing
rp,idenre
multifamily, comm. or
Industrial
Sewer
COMM./IND. FEEDERS
Install/alter/relocate
r1i,tr'ih. fpprlpr,
Of
amps.
TOTAL CHARGES TOTAL CHARGES
WHERE STATE UH REQUIRES that tile Electrical "ork'be done by an. Electrical
shall not be valij until the label has been signed by an Electrical Supervisor
ISSUANCE OF PFRlllT
TOTAL CHARGES
Contractor. the electrical portion of this perQit
and returned to the Building Division
I HAVE CAREFUllY EXN1IrlED the completed apfJlication for flermit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Soringfield and the laws of the State of Oregon pertaining to the Nark described herein. and that rw OCCUPAHCY will be made
of any structure without the permission of the Building Division. I further certify that my re9istration with the Builder'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 emn10yees who are in compliance with OP.S 701.055 ~e used on this p~oject.
IlAIIE(please print){!'~~{.,A<2.'-;) IJ71C II SIG;jATUR~!../"'''//j./ // DATE/i/fr/FO
FO~ OFFICE USE ~iJl\..
Sq. Ftg. f1ain
Sq. Ft9. Access
Sq. Ftg. Other
Zone
Fi re Zone
Tyoe/Const.
Bedrooms
Stories
Units
Occy load
Qccy Group
x
Value
Value
Value
x
Flood Plain
x
TOTAL VALUATlOII
PLUI.1BING PERIHT
Charges and
Surcharges
SJ rrn
d tr [Xl
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BUILOIllG PERI.IIT
Charges an':
Surcharges
Plan Ck. Camm/lnd
65%/Bldo Ppr Fpe
------------ Plan Ck. Res
]O%/Bldo Per Fee
-, Fence
------------
Demo
Systems Development
Charo" (1.5")
ELECTRIUL PERI:lT
Cha rges and
Surcharges
11ECHArl I CAL PERI1lT
Charges and
Surcharges
Sidewalk
A/C Paving
J
/
Total Comb. Permit
TOTAL
U-J~.CO -,
Curb Cut
-of'
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COMBINATION APPLICATION/PERMIT (CAP)
1.
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Applicant to furnish
A. Job Address
B. legal Description f
1. examo 1 e- Tax lot 100. Lane County Map Refer 'e
]7 03 43
2. examole- Lot 1. Block 3, 2nd Addition to
~pringtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
I. exarnole- 1250 sq. foot house, SOO sq. foot
2. examole- if new project, check-new - if add
cheer. dad. etc.
F.' S:..dl,jing p€lT.ii: infor:::~tion:
I. exawoie - construct single family house wit
H:.:.r.:i1eo gar~ge
2. exc~ole - re~odel existing garage into fami (_
2. e~a~ole - conve~t sinole family residence i
rest2ur~nt (c~ance of.use) -
G. ~;alue of wor/.; as defined in Section 303 (a) of
Structural Soecialtv Code
H. D::SiG:~ TEAi.j Aim CONTRACTORS
To dvoid design or construction delays, Buildin,
Division Staff must be able to contact approprii
persons regarding aesign information or job sitl
corrections. !tc. (
Abbreviatea Plu:,.,bing. ;'iechanical. & Electrical Scne:
A. :xce~t ~here blank soaces occur in the descriDt.
;:rtion 07' :.-:e ;':echanical and Electrical Schedu'
~i":e applicant need fill-in only the No. Boxes d( (en
:J :~e ~opropriate item(s) to be installed
S. ~'..:ll Pit:r:;jing, r'!echanical, and Electrica1 Sc~edt
are available at the Building Division
1. To conserve space on the permit form the sct ~e
have oeen abbreviated
2. If the item(s) to be installed are not cover
the abbreviated schedules you should consult
full scnedules (
C. BUIL911:G DIVISIOi; STAFF WILL FILL OUT ALL FEES I '
CHARGES Oil THE SCHEDULES
O. As noted on the CAP, the label must be deliverec
electrical contractor for signature by his elect
suoervisor. The Qeneral contractor is ,not authc
to sion the electrical label. ----
Applicant-to sion and date
Whenever Dossibie. the initial application will be- u a
('r' BY
a worksneet only. Where possible, Building ~ivision
will prepare a type written copy and return it to th
applicant at the time the actual permit is issued fo
signature.
Fees and Charges
Plan check fees are due and payable at the time of t~
application, and no plans will be processed until these'
fees are paid. All other fees and charges are due and
payable ...men the permit is issued.
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IV.
V. FOR OFF I CE USE Q;IL Y
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CITY
OF
SPRINGFIELD
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
(
City Hall
Springfield. Oregon
Department of Public Work.
OFFICIAL RECEIPT
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B 5 5113 ..
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No.
J / - 0 1980
Rec'd From mar(!lh t?vin~
Address PO. frry c9Ci() q
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Dole
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Received For:
&'(yD ((,,~9 w. ('~Il'\-tl
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.sl~:r LII1L\ (,ntHUQirip)
&C\--i\. It\l4
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800
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GCLL LLYJ..-L..\,
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(--0. 'b lJJJ.u ')
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'64 .00
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, Amount Received
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AUTHORI-ZI:D SIGNATURE:
!JHl~TON'T""N.ULl "~'NT''''. . luGlNl. O~ .7.0'
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Permit Clerk
Permit applicant exempt from registration with the Builder's BDard because:
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Additional Project Information:
PLANS REVIEWED BY:
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name
'"S i gnature
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date
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