HomeMy WebLinkAboutPermit Building 1980-7-21 (2)
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I COI~rl./IND. FEEDERS
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TOTAL CHP.RGES I TOTAL CHARGES
WHERE STATE L'i~ REQUIRES that the Electrical "ork be done by an Electrical
shall not be vali1 until the label has been signed by an Electrical Surervisor
WSPECTIOil l WE
726-3769
Job Address 80 Cl ear Vue
I.egal De,cription 17 03 27 1
Lane
7100
OWMrRichard P. Ferguson
Address 80 Cl ea r vue Lane
Springfield, Oregon
97477
Construction lender
Address
UI:.S I (jr~ H.N1
(name)
Pri ma ry
Structura 1
Electrical
f1echanical
CONTRACTORS
{name'
Owner
General
Plumbina
Electrical
~.lechanical
PLUllBI NG
NO.
FEE I CHARGF l NO
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(I bathl
Ouplex (I bath)
each
Additional bath
~Iater service
Sewer
Storm Sewer
Range
ValuE of l'lark:
. 5,683.20
Buil[.ina Permit Info: Descnbe tJork(l,e.,
Familv i"lesidence I'lith Attached Garaoe)
JUt 2 1 1QeD
NOTIFiED
CIn OF SPRI;IGFIELD .
COIIBI;IATlON APPLICATION/PERMIT.;
E!lERGY SOURCES,
Heat
t.Jater Heater
Phone
746-1348
Residential Garage
IIlFORtIATlON LUit II
---- (- 726-3753 ----------I
Sq. Ftq. 1.lain . (00
eq. ,tg. Access. 768.00 is
Sq. Ftg. Other.. ~
-.rJel..._Add_ Al ter _f~ep. to
__Fence__Demo__Change/Use I
Other
8ui Id Single I
(exo;res}
(ohone no.' 1
Phone
(address)
(lies. no.)
(,exoiresJ
lohonp no.)
(address )
(lies. no.)
MECHAN I CAL
furnace/burner to
BTll's
~J:"J:" ,
,
r,",AR(;~
ELECTRICAL
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I J:"J:"J:" 'rI-lARr,J:"1 NO.
--t
Floor furnace
and vent
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Recessed wa 11
Sn;wp hp~t"p... ;Inri Ifont
Residence of
SQ. FT.
New circuits alts,
or extensions
SERVICES
Temporary Construction
Change in existing
rp<:; i rlpnr:~
muftifami 1y, comm. or
IndlJ<;trial
Of
amps,
ApDliance vent
seoa ra tf'
Stationarv eVaD.
cooler W ,
Vent fan ".Ii th
sinole duct
Vent system apart from
heating or A.Co
Mechanical exhaust
hood nnd dur:t
\-load stove/heater
ISSUANCf OF PFRrIlT
CHARGES
Contractor. the electrical portion of this perQ;t
and returned to the Building Division
Comm/lnd
Ppr Fpe
Res
Per Fee
10.80
Install/alter/relocate
distrih. fepders
Of
amps.
I HAVE CAREFULLY EXN1mED the completed apfllication for permit. and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work Derformed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Ore(]on pertaining to the work described herein, and that lW OCCUPAHCY will be made
of any structure without the permission of the Guilding Division, I further certify that my registration with the Guilder'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 comoliance with OP.S 701.055 will be used on this nrojeet,
. ./? -.~P
RI CHARD P. FERGUSON SIG;I^TUfE//,/ytrz:C?~L"''/_~'',_~",:> DATE
FOr. OFFICE U5l:..OiIL.Y /.i
IWIE(please print)
Zone K-I Type/Cons t. V-N Units Sq. Ftg. r1ain x Value
Fire ZonE" NU Bedrooms Occy load Sq. Ftg. Access 100 1.'fU Value :J,Oljj.C.U
x
Flood Plain Stories Dccy Group M-l Sq. Ftg. Other x Value
TOTAL VALUATION 5,683.20
BUILOING PERI-IIT
Charges an~
Surcharges
.-1
PLUi.IBING PERMIT
Charges and
Surcha rges
36.00 'PlanCk.
65%/Bldo
------------PTan Ck.
1. 44 30%/BI do
I Fence
ELECTRIC~.L PERI:IT
Charges and
Surcharges
Sidewalk
A/C Paving
~___________I Curb Cut
IIECHANICAL PERI~lT
Charges and
Surcharges
Syster.lS Development I
Charqe (1.5',)
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Demo
Total Comb. Permit
l-oT..
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37.44
,,--"".----.-
d,...r ._.
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COMBINATION APPLICATION/PERMIT (CAP)
I.
Applicant to furnish
A. Job Address
B. Legal.Description
1. example- Tax Lot 100, Lane County Map Refere
II 03 43 <.:
2. examole- lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources (
1. examole- heat/electrical ceilinq/or forced a
2. examole- waterheater/electrlcal!or solar
E. Square footage or valuation, etc. -----
1. example- 1250 sq. foot house, 500 sq. foot g ~~
2. example- if new project, check new - if addi
check add, etc.
F. Building permit information:
1. example - construct single family house with (
attached garage
2. examole - remodel existing garage into famil:
3. examole - convert single family residence, in.
. restaurant (change of use) {
G, Value of work as defined in Section 303 (a) of tl
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building (
Division Staff must be able to contact appropria;
.persons regarding design information or job site
corrections, etc.
Abbreviated Plumbing, Mechanical, & Electrical Sched\ >
A. Except where blank spaces occur in the descripti( '.
portion of the Mechanical and Electrical SchedulE
the applicant need fill-in only the No, Boxes ad~
to the a ppropri a te item( s) to be ins ta 11 ed l.
B. Full Plumbing, Mechanical, and Electrical Schedul
are available at the Building Division
1. To conserve space on the permit form the sehe
have been abbreviated (
2. If the item(s) to be installed are not covere -
the abbreviated schedules you should consult
fu 11 schedu 1 es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES A~ <:
CHARGES Oil THE SCHEDULES
D. As noted on the CAP, the label must be delivered
electrical contractor for signature by his electr
supervisor. The general contractor is .not author (,Q
to sign the electrical label. -
Applicant to sign and date
Whenever possible, the initial application will be us
a worksheet only. Where possible, Building Division t..l
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for
signature.
Fees and Charges (
Plan check fees are due and payable at the time of th .:
application, and no plans wlll be processed untll the~
fees are paid. All other fees and charges are due ana
payable when the permit ;s issued.
II.
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IV.
V. FOR OFFICE USE ONLY
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PERMIT VALIDATION
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. CITY OF SPRINGFIELD
I.
City Hall
Springfield, Oregon
Department of Public Works
OFF I C I A L R E C E I PT
No. B 54121(
bate -,,.::J ~~
19;12-,0
Rec'd From L--~;~ il/l, n ..r r1
Address 9,(')
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C".\erur \/ \! ,) L 0.\1\0.
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~--..nceJ
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Received For: [~Ldq pQJV V'/\ \ \- tf>
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~~o~nt Received 'If_ <.
"un..tOFlIZEO 5IGN"TURE
SM(lTO"'-TU~""U~C PR"<lT~R5 - EUca..E. 0" "~.O'
585"-B \._.
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
,tgo,t"" j)a-~
Additional Project Information:
.- .. .. .. """ ..--. . '- . .. .
PLANS REVIEWED BY:
name
DAN SMITH
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date 7-17-80