HomeMy WebLinkAboutPermit Building 1980-9-16
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I NSPECT ION LINE
726-3769
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CITY OF SPRINGFIELD ,_-
CQ/1BIrlATION APPLICATION/PERMI
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E!lERGY SOURCES:
Heat ElE.cjy,t)
Hater Heater
Job Address4\o d... C\ ~'\c;.,\(.s1-
Legal Description rOO /'\<60'26512-
s ~ ~ o...,\:\r. eJ)" D ~,
Owner L~ ~Q.v ~::::JfT-t0 t..i\
AddressL\~i.C\ -:.\)(). ~.....\i
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Constructi~ Lend~r
Address
, liES I GN TEAr,
Primary
Structural
Electrical
f1echani ca 1
CONTRACTORS
Genera 1
Plumbina
Electrical
~1echani ca 1
NO.1
f.Jo~r.;
(name)
S~LF'
S'C..LF
Scc...L"F
&Lf-
(name)
PLUI1B I fIG
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RanC)e
WI\LL
INFORI'ATlON LiN!:.
726-3753
Sq. Ftq. r'la i n
~q. Ftg. Access.
Sq. Ftg. Other
~le\~....:.. Add KA 1 ter _ Rep.
_Fence_Demo_Change/Use
Other
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C)C)
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l\41o -~P\9.. ~
Val,uE of l'lork: r:.. "':\
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BuilC:ina Permit Info: 'DesC'f"ibe' l10rk(Le.,
Family Residence Nith Attached ~araae)
Q~VV\trrl~ ~.
(address)
ELECTRICAL
Build Single
~~~v
(1 ics. no.)
(exnires)
,
(ohone no. )
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(l ics. no,)
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(exoires)
(ohane no, )
r'
"l'-t7 ~9~b,)
MECHANICAL
FE E . CHARGE l NO, I FEE rHARr,F NO.
I Res idence of furnace/burner to
SQ. FT. BTU's
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Tyoe/Const. \7 -l..,!
Bedrooms
-
Phone
(address)
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a It )"Y\ c;i ..e' )
,~CJ tJ~~ 9LuVYlb'k>\ ~.c .o~ b~~
()w JJ '21t2)
OWt)E10
Each single fixture
Relocated buildina
(new fix. additional)
IS.F. Residence
(1 bath)
IDuPlex (1 bath) each
I IAdditional bath
IHater service
I Sewer I
Istarm Sewer I
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New circuits alts.
or extensions
SERVICES
Temporary Construction
Change in existing
residence
multifamily, comm. or
Industrial
amps.1
I
Install/alter/relocate I
distrib. feeders
Of
COMM./IND. FEEDERS
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/.t.9.tI.~ I TOTAL CHARGES
that tile Electrical work be done by an
label has been signed by an Electrical
TOTAL CHARGES
WHERE STATE L~W REQUIRES
shall not be valiJ until the
...
Zone
,'.7-1
. --
Fire Zone -
Flood Plain -
BUILDING PER~lIT
Charges and
Surcharges
PLUr1BING PERMIT
Charges and
Surcha rges
ELECTRICAL PERr~lT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Stories
Of'
amps.1
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'FEF rHARr,F'
Floor furnace
and vent
Reces sed wa 11
Soace heatpr and vpnt
I Appl iance vent
seoa ra te
I I Stationary evap.
cooler
I ... I Vent fan with
d- sinole duct
I I Vent s'ystem apa rt
heating or A.C.
I I Mechanical exhaust
hood and duct
I I Hood stove/heater
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from
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ISSUANCE OF PFRr1IT
;0.00
/~?110 TOTAL CHARGES
Electrical Contractor, the electrical portion of
Supervisor and returned to the Building Division
Units
Occy Load
Occy Group
/2- 3
, I HAVE CAREFULLY EXAf1INED the completed appl i cati on for permit, and do bereby certify that a 11 i nformat i on 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 OCCUPANCY 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 DRS 701.055, that if exempt the basis for exemption is noted hereon, and that
"'y ,"b","""" "d ,",l,y", wh, '" i, "m,li"" wi'h D'S 'Ol.0SS will b, ""d " 'hi, ~~".
NAf'1E(please print~ ,Pru) ~Qe.....:\. DC u)Jt", SIGrJ.r..TUREL~.A -'t.UA D/l.TEQ Ib L~()
FOR OFFICE USE ONL l
.-.. So. Ftg., r1ain x Value
Sq. Ftg. Access x Va 1 ue
Sq. Ftg. Other x Value
Plan Ck.
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_______v!?i./QO 65%1Bldo
Plan Ck.
I . :1.1: 30%/Bl dQ
/O..ol'l I Fence
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, 1",'0 I D!;mo
/.t) . 00 I S i dewa 1 k
---~----~lfO -, A/C Paving
/~ .c.o I Curb Cut
--- - ---- -,-& ~I
Comm/l nd
Per Fee
Res
Per Fee
C I
fu()
/6.00
this permit
.
.!.fCi /' 7 -
TOTAL VALUATION . I. I' ~
ISystems Development I
Cha rqe ("1. 5%)
PDq'-fb- dO
ITotal Comb. Permit
I TOTAL
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t.f 7 () : 1 :J".
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COMBINATION APPLICATION/PERMIT (CAP)
1.
PERMIT VALIDATION
II.
Applicant to furnish
A. Job Address,
B. Legal Description
1. example- Tax Lot 100, Lane County Map Refer
17 03 43
2. example- Lot 1. Block 3; 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/o'r forced'
2. examole- waterheater/electrical/or solar
E. Square footage Dr valuation, etc.
I. examole- 1250 sq. foot house, 500 sq. foot
2. examole- if new project, check-new - if adc
check add, etc.
F. Building permit information:
1. example - construct single family house wi1
attached garage
example - remodel existing garage into fam' (i..
examole - convert single family residence ~
restaurant (change'of use)
G. Value of work.as defined in Section 303 (a) of
Structural Specialty Code
H. DES I GN TEM! AND CONTRACTORS
To avoid design or construction delays, Buildir
Division Staff must be able to contact appropr:
persons regarding design information or job si1 (,.
corrections, etc.
Abbreviated Plu~bing, Mechanical, & Electrical SchE
A. Except where blank spaces occur in the de$cripl
portion of the Mechanical and Electrical Schedl 1>_
the applicant need fill-in only the No. Boxes c 1C.
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schec
are available at the Building Division ~
1. To conserve space on the permit form the sc~'
have been abbreviated
2. If the item(s) to be installed are not COVE
the abbreviated schedules you shoul,d 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 signatur-e
supervisor. The general contractor
to sign the electrical label.
Applicant to sign and date
Whenever possible, the initial application will be ~d
a worksheet only. Where possible, Building Divisic
wi 11 prepare a type wri tten copy and return it to j
applicant at the time the actual permit is issued f
signature. (~
Fees and Charges
Plan check fees are due and payable at the time of t,c::- .
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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CITY OF SPRINGFIELD
(
City Hall
Springfield. Oregon
Department of Public Works
OFFICIAL RECEIPT
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Rec'd Fro~JCLtJ
Address ~\(() (?C{
Q No. B
190()
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()QLL\~1.
54587(1
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Received For:
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Received lC), cr 2- (~~
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be delivere
by his ele(
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Amount
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BY
A ITHORIZED SIGNATURE
SHELTON-TURNBUl.L PRINTERS' !:UGENE. OR 97401
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581511"8 \
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V. FOR OFFICE USE ON4Y
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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PLANS REVIEWED BY:
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name
signature
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date
9-/~ - 2"0
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