HomeMy WebLinkAboutPermit Building 1980-4-25
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726-3769 _ _
Job Address oj J.f9 j ",k ~',., h ~ "
I.egal De;cription 1", L ')
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Owner l,~. /IN)..., /J.,.,. -1/;
A'ddress'-'6'/ L.^,t <-'''~''_ L.-1
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Construction Le~er < ~~~
Address
OESIGll TEAll
Primary
Structural
Electrical
!-1echanical
CONTRACTORS
Genera 1
Pl umb; no
Electrical
,',1echanical
liO.
(name)
(name)
c: ;: /,c
PLUllBWG
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
fl bathl
IDuplex (I bath)
~IAdditional bath
~!ater service
Sewer
-I
Storm Sewer
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CiTY Uf SPRI;:GF I ELD
COIIBI ;IATI ON APPU CATlONI PERlIn
JA
IIIFORJIATlON lIiil
726-3753
Sq. Ftq. j.lain
~q. Ft!J. Access. t...YO
SQ. Ftg. Other
flel" : Add Al eer Rep.
Ranqe _ . Fence_Demo_Change/Use
Valu, of Hark: )"3 60(' I =, Other
--/. ... - ," ,.u-ifJ> L
Pho BuilillO'Permit Info: Describe \4ork( i-.e.. Build Single
ne)1 i--/(""? Fami 1 y nes i dence Hi th "'.ttached Garaqe 1 .
_.~ JaW~ QA:tQ D...Q; nrJd:ttt ~'YL>
ErlERGY SOURCES:
Heat
t']a ter Hea ter
,
~
,-
R)J,--I
L,.. .
Phone
(address 1
(lies. no.)
(exoiresl
(ohone no. 1
(address)
(l ir.~. no.)
(pxoirpc;)
(ohonp nn. \
ELECTRICAL
MECHANICAL
FEF I CHARr,F I NO I
I Residence of
SQ. FT.
.'1 New circu~t,salts.
f..../ ~.r e~tenslOn~.
__I ~i"'_ .'~.~l'"1 :.....
I SERVICES
I
FFF
rHARCFj
NO_
I FFF
rHAPr,r
furnace/burner to
BTlI's
/'0::- ,.,1
.,.._'v
I
I Floor furnace
and vent
1 Recessed wall
~n~cp hp~tpr ~nd vpnt
I
I I
I/C).cd
I
I
H-Of
I
lTemporary Construction
IChange in existing
re<:;denr:p
Imultifamily, camm. or
Tnrlll<;.tri~l
1 Appl iance vent
/ seoa ra te
Stationary evap.
cooler
Vent fan with
sinole duct
I Vent system apart
heatino or A.C.
I ~lechanical exhaust
hood ~nd duct
! [WOOd stove/heater
:JnrJ
amps.
from
cor'U'1. /11m. FEEDERS
I Install/alter/relocate
di<:trih fppopr<:
Of amps.!
,<:;".,.,.,.,
I
I
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I SSUANCr OF PFRlII T
!.Q,r....,
TOTAL CHARGES /1),,'Y.1J TOTAL CHARGES I'-~ ",., TOTAL CHARGES I~,IJCJ
WHERE STATE L~W REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valiJ until the label has been signed by an Electrical Surervisor and returned to the Building Division
I HAVE CAREFULLY EXArlINED the completed aprlication for permit, 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 Springfield and the la\-/s of the State of Oregon pertaining to the work described herein, and that IlO OCCUPAIICY \'1i11 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 Or,S 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 701.055 will be used on this project.
11A:-IE(please print) v;/I,.:> ""7
Zone k:-I
Fi re Zone iz/
Flood Plain ,,~/S..
BUILDING PER:.IIT
Charges an~
Surcharges
PLU'1BING PERMIT
Cna rges and
Surcharges
ElECTRIUL PERI~IT
Cha rges and
Surcharges
IIECHANlCAL PERiHT
C!':1~~es J~t:1
Type/Cons t.
Bedrooms
Stori es
[)
CC/II",-"i, SIGil^T~RE~~~:,~ p ~@"~_
- FO~ OFFICE USE OilL Y /'
I'
Value
Value
Value
DATE "1-2. S- 3"/)
-7.:..'11
Units
Sq. Ftg. flain
Sq. Ftl]. Access
Sq. Ftg. Other
x
/"';1"'(}
J
Occy load
Occ,Y Group /C""!-.';..
x .2.0. [,~~
x
TOTAL VALUATlOlL! ~ ,I...,/)./') G'
J
. r' Plan Ck. CarrmJInd
_______:0J!~C.P_ 65%/B1do Ppr Fpp
'1 Plan Ck. Res
~~ .1,;)... 30~/B1dq Per Fee
_______1-1.2.0_' Fence
. "10 D@mo
ISystems Development
Charqe (1.5")
I (2t212,. ,j;J:.
1/?J-S337:1,Q
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20.40
l,s'.t)!') Sidewalk
--_h_--~':';;'~J-I AIC Paving
L _ h __ _(,L,/22 -' Curb Cut
,'I).
J 1.5'. 1(1./
S:9) / S.lf If
Total Comb. Permit
7.~'T""l
C~'~BINA~ION ;PPLI;ATlO~'/~~RM;T'P; .....
e., ,..
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II I.
I. Applicant to furnish
A. Job Address
B. legal Description
1. examole- Tax Lot
1I 03 43
2. examole- Lot 1. Block '3, 2nd Addi';O"l' ~
Spnngfield Estates. C\ 1
C. Name, etc. of owner and con~ (".
D. Energy Sources .
1. examole- heat/electrical
2. example-. waterheater/ele(
E. Square footage or valuati~ (',
1. examole- 1250 sq. foot ho.
2. example- if .new project. (
check add, etc.
F. Building permit i~formation:
1. examole - construct single <il
attached garage
2. examole - remodel existing ~
3. example - convert single fa~
restaurant (change of use)
G. Value of work as defined in Sect~
Structural Specialty Code
H. OESIG:{ TEA;.! AIIO CONTRACTORS _
To avoid design or construction dE: ,.
Division Staff must be able to con
persons regarding design informatil
corrections, etc.
Abbreviated Plumbing, Mechanical, & Ele ,~.
A. Exceot where blank spaces Occur in ;
portion of the Mechanical and Electr
the applicant need fill-in only the I ('-'~
to the appropriate item(s) to be inst \er
B. Full Plumbing, Mechanical, and Electr
are available at the Building Dlvisiol
1. To conserve space on the permi t fc ":1,
have been abbreviated (
2. If the item(s) to be installed are
the abbreviated schedules you shaul
full schedules
C. BUILOI;;G DIVISION STAFF WILL FILL OUT AL 'EF
CHARGES 0:1 THE SCHEDULES
O. As noted on the CAP, the label must be d.
electrical contractor for signature by hi ,It
supervisor. The general contractor is' no "It'
to sign the electrical label.
Applicant to sign and date
Whenever possible. the initial application wil
a \./orksneet only.. Where pOssible, Building Di\. 'or
will prepare a type written copy and return it
applicant at the time the actual permit is lssul
signature.
IV. Fees and Charges
Plan check fees are due and payable at the time l
application, and no plans will be processed until
fees are paid. All other fees and charges are dUt
payable "'hen the permit is issued.
PERMIT.VALIDATION
.
100, Lane County Map Reference N G f \ E l 0
Of SPR\
. City 1-1011 1\
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spril\ghe . public \{I/or
ort",el\t 01 R E C E I p"! -
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V. FOR OFFICE USE ONLY - \.-., - -' ~ Permit Clerk
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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signature f!'_./L-_
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date
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