HomeMy WebLinkAboutPermit Building 1980-5-23 (2)
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CITY OF SPRliiGFIELD lNFORIIATlON L1ilt
COIIBIiiATlON APPLICATION/PERHIT 726-3753
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I.enal De,cription /)2 _ :QL/ j"" II 7-0Z-35-:2.3~!ater Heater ", J1 ""L ..srr: Ftg, Other --3.2.~ s;
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, ... - , . : " ......."'...- I Ranqe ,,()n ~ _ eN.L::::f' er ..eD.
:.,iXi)l .hlC11i1Cil tr, lrLk'<;-,{:llf!l PIU-/(/ I.t.valu, of I-Iork: ~ --- 6~~~~_Demo_Change/Use [00
Owner OOUQWC, (\1()S'Jl1 . 7-.B'2,L./. 7~o I)
Address J (.- r l (11-"J11el'L J ^ n Phone Buil':inQ Permit Info: Describe \'\ork( i.e., Build Single I 'v)
AJH r f U';(\ Familv Residence !,~ith Attached (;araoe)
H:Jrif1.aP1~ 1.i.7-r{I'"4-__f0ivti\1rr/1YiVVI- rU1.ditfu/?,-- L01~L i ,
Construction Le r ~:X~/J /1_ ' ' fi'L--- ,--J/ '
Phone
(address)
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/;fVY) I TOTAL CHARGES
that tile Electrical work be done by an'
label has been signed by an Electrical
.
I I;ISPECTIOII
716.3769
Job Address
LIiiE
},(,
, ~ )
Address
Ut:.~IGii TEj\j1 (name)
Primary !=.f~
)
Structura 1 I'
Electrical \1
t1echanical l'
CONTRACTORS (name)
Genera 1 (,'Jo..A)<('.~'r-S
Plumbino II
Electrical "
t.lpchaniral 1\
PLUltBIrlG
ilO.
FEE
I rHARr,F
I
Each single fixture
/Relocated building
(new fix. additional)
IS. F. Res i dence
, (l bath)
',jDu.plex (1 bath) each
J Additional bath
~!ater service
I Sewer
I Storm Sewer
//)..~')
TOTAL CHARGES
WHERE STATE LW REQUIRES
shall not be valiJ until the
. ......'" .'l!:
(lies. no. \
(pxOlrpc;. )
(ohon!:' no.)
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(address)
(l ice:" no.
f"",<oirpc:\
(I)hnnp (In
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ELECTRICAL
,
f~ARr,j:'~
fHAQr,1='
HECHA:llCAL
~ln
Residence of
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I furnace/burner to
BTU's
Floor furnace
and vent
tln.
FFF
FFF
SQ. FT.
:r..
INew circuits alts.
or extensions
;). {J~: .vlO.eC!.
ISERVICES
Recessed wa 11
(jl),)rp hPFltp.. ~"rl IIpnt-"
/~'S':.G:"J
Temporary Construction
Change in existing
rpS.i q!i'ncp
Imultifamily, comm. or
Tnrl1Jc:triill
Appliance vent
5~oariltp
Stationary evap.
cooler
I Vent fan wi th
sinale duct
Vent system apart
heatina or A.C.
Mechanical exhaust
hood and durt
I Hood stove/heater
I
from
Of
amps.]
COI.11-1. II ND. FEEDERS
Install/alter/relocate
rlic:trih fpprlpr<:.
IOf
amps.1
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I SSUArlCF OF PFR!tIT
1.<;,6C) TOTAL CHARGES
Electrical Contrac or, the electrical.portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFUllY EXM1WED the completed application for permit, and do tlereby 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 Springfield and the la\'/S of the State of Oregon pertaining to the work described herein, and that UC OCCUPAfICY \'/111 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 ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
HAlIE(please print)'" Detora..h g, Ma&Jn SIr.;IATURF. \)( ~ J.~ OATEa-Z3-30
FO~ OFFICE USE' DilL Y
Zone e.-I Tyoe/Const. .E:-~~{I Units .' So. Ftg. f1ain , Value
Fi re Zone .In. Bedrooms Occy Load Sq. Ft/]. Access x Val ue
Flood Plain _,A Stories J Occy Group !2~':.) Sq. Ftg. Other 5.;7 S. 7 S' x Value
TOTAL VALUATlOtl~ 'if3 ,/, 7'>
_______Lt212'O_ Fence
ItlC I Demo
- ---. -,--' '-,-'-- -----
1,{;;..::Y.l Sidewalk
_______L---".___
1,0 I AIC Paving
~ Curb Cut
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BUILDIIlG PERt.IIT
Charges anc
Surcharges
___u__':!:Jd2tL
1,'1&
PLU'1BIIIG PERHIT
Charges and
Surcharges
ELECTRICA.L PERI:lT
Charges and
Surcharges
:';CHANICAL PERI1iT
~ ,;'r~~<; Jnd .
Plan Ck. Comm/Ind
65~/Bldo Ppr ~""F'
Plan Ck. Res
30%/Bl de Per F"''''
Syste~s Development
Charae (l..5~)
'-"0
-:-- ~Z/-f<J ~
1-:::<.
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1>f~/.7h
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Total Comb. Permit
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COMBINATION APPLlCAilON/PERNIT (CAP)
I.
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Applicant to furnish
A. Job Address
B. legal Description
1. examole- Tax lot 100, Lane County Map Re:
J/ 03 43 ....
2. examole- Lot I. Block 3. 2nd Addition to l
Sprlngfield [states
C. Name. etc. of owner and construction lender
D. Energy Sources ~
1. examole- heat/electrical ceiling/or fore 'i
2. exa~Dle- waterheater./electrical/or solar
E. Square footage or valuation, etc. -
I. examole. 1250 sq. foot house, 500 sq. fa ~
2. examole- if new project, checknel'Y' - if \it
check add, etc.
F. Building permit information:
1. examole - construct singie" famlly house (,'
. .,attache-d garage
2. examole. remodel existing garage into f
3. examole - convert single family residenc
restaurant (change of use)
G. Value of "ark as defined in Section 303 (a) G:,
Structural Specialty Code
H. DES I GN TEMI ArlO COilTRACTDRS
To avoid design or construction delays, Bui'
Division Staff must be able to contact apprl G1
persons regarding design information or jOb
corrections, etc.
Abbreviated Plumbing, ~lechanical, & Electrical 1:,'.",.,
A. Except where blank spaces occu~ in the desc ~
portion of the Mechanical and Electrical Sc
the-applicant need fill-in only the No. Box
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and. Electrical S (~u
are available at the Building Division
1. To conserve space on the permit form tr
have been abbreviated
2. If the item{s) to be installed are not ~er
the abbreviated schedules you should cc
full schedules
C. BUILDUiG DIVISION STAFF WILL FILL OUT ALL f
CHARGES ON THE SCHEDULES (
D. As noted on the.'CA~-, the label must
electrical contractor for signature
supervisor. The general'contractor
to sign the electrical label.
Applicant to Sign and date
Whenever possible, the initial application wil
a worksheet only. Where possible, Building Di
will prepare a type written copy and return it (~l
applicant at the time the actual permit is iss
signature. ~
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 permit is issued.
be del'
by his
is not
(
Ill.
IV.
V. FOR OFFICE USE ONLY,
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_OCPMI.T '/:.1 I,~:.li _, I
OF SPRIN fI1:10"'----~
City Hall &
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
No. B
Dote c:=.. --r -.;z... 19~O
Rec'd From CiJIJ110 LLJ-10-MYJ'1
Address 4.~5 I'=K~ oiUp
44,00
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CITY
Received For:
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53567 fl
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Amount Rece~ved I ( . f h
" . (lAP
~ AUTI-IOR'ZEC SIG.....TUR[
\f. S"UTON Tl"~"'UlL ""I"T.:"S lUCl'U 0.. 07"01
,.,,,'.
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPMICY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project. Information:
PLANS'REVIEWED BY:
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name
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signature ,{ Va...,
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