HomeMy WebLinkAboutPermit Building 1982-7-27
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IIIFORllATlON LHlt "
726-3753
Sq. Ftg. 1.lain
~q. ~tg. Access.
Sq. Ftg. Other
flew Add A Her Rep.
-Fence Demo Change/Use
Other- -
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'I IrISPECTIOII L1IIE.
726-3769
Job Address :<'/0 Mil/Ai ST.
Legal Oe,cription 1"1-03 ~ 3S -,3;2
CITY OF SPRIIIGFIELO
carIB I IIA TI 011 APPLI CATlON/PERMIT
EnERGY SOURCES:
Heat
Hater Heater
Owner Goon WILL TND"572..t:.S.
Address 388'$ EL""'.12f1. 1?Ol4fl
Ct./&;IENE.. neE
Construction lender
Pho'd;I9. If! 1/
(7'1t,'9(J~7)
Ranqe
ValuE of Hork: 00
2,000
Builriina Permit [nfo:
Familv nesidence With
Describe Work(;~e," Build Single
,I1.ttached Garaoe)
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on ()4'100
M(JV~
o lVe Wlf-I-'- 0
Address
OESIGN I cArl
lname)
Phone
{address l
(lies. no.)
(exoires)
{ohone no .~\
Primary
Structural
Electrical
11echani ca 1
CONTRACTORS (name)
General OWIt&,e
(addres~l
(lice:.. no.
(exoir~o;,} (ohonp no. )
~
;;
Plumbina
Electrical flAMIL.TO;</ E.L.$C.
~1echani ca 1
PLUlIBIrlG .
FEF CHARr.F
ELECTRICAL
NO
Residence of
SQ. FT.
:t New circuits alts.
or extensions
SERVICES
MECHANICAL
-1!lL
FFL J:HARG.E. NO
Each single fixture
furnace/burner to
BTU's
QL J:HARG.E.
/,'
Relocated building
(new fix. additional)
/S,'~
Floor furnace
and vent
S.F. Residence
(j bath)
Duplex (1 bath) each
Recessed wall
Snnr:p hPntpr nnd vpnt
Storm Sewer
Of
amps.
Appliance vent
~eoariltp
Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and dur:t
Wood stove/heater
Additional bath
Sewer
Temporary Construction
Change in existing
ree;. i dPJlr:p
multifamily, comrn. or
Industrial
~Iater service
COffi~./IND. FEEDERS
Install/alter/relocate
rli~trib. fpprlpr~
Of
amps.
TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be vali1 until the
ISSUANC, OF PFRrIIT
TOTAL CHARGES /S(b TOTAL CHARGES
that the Electrical work be done by an 'Electrical Contractor. the electrical portion of this perlilit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXN1INED the completed application 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 Spri ng fi e 1 d and the laws of the Sta te of Oregon perta i ni ng to the work descri bed herei n, and that UO OCCUPAHCY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 compliance with OP.S 7nl.055 will be used on this project.
^ u 66.s SIr.11ATURE...4 d. j;;r..fPrJ
IWIE(please print)
JV;i ke
DATE 7-2)- 9 ~
FO~ OFFICE IISF OiH V
Zone Type/Const. Uni ts Sq. Ftg. f1ain
Fire Zone Bedrooms Occy Load Sq. Ftg. Access
Flood Plain Stories Occy Group Sq. Ftg. Other
x
x
x
Value
Value
Value
BUILDIrlG PERI.IIT
Charges an~
Surcharges
____n_t2~.an
dO
Plan Ck. Comm/lnd
65t/Bldo Ppr Fpp
Plan Ck. Res
30%/Bldo Per Fee
Fence
/3.00
TOTAL VALUATlOl,_ ~ Of:)
Syste~s Development
Charqe (1.5%)
PLU/1BING PERMIT
Charges and
Surcha rges
D~mo
ELECTRICAL PERI~IT
Charges and
Surcha rges
___n_.L$..~EJ_
. (PO
Sidewalk
I1ECHMIICAL PERMIT
Charges and
Surcharges
A/C Paving
I Curb Cut
-------=.~-]
Total Comb. Permit
____I
I
I TOTAL
! #')127/0
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COMBINATION APPLICATION/PERMIT (CAP)
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CITY OF SPRINGFIELD
City Hall
Springfield, Oregon ('
Department of Public Works
OFFICIAL RECEIPT B C;9482
No. v (
\ rO~) /\ .
Date -....J(.\ Q~ ~"I1 19(),~ \."-._1
r' ~ -, 00 ,,'\)/\'\"'t
Rec'd From\.'"\ (") )f.' 1 f J -
...QQ r\"\.L~~
'"
1. Applicant to furnish
A. Job Address
B. legal Description
I. example- Tax Lot 100, Lane County Mal
11 03 43
2. example- Lot 1. Block 3, 2nd Addition (.
Sprlngtield Estates
C. Name, etc. of owner and construction lend
D. Energy Sources
1. examole- heat/electri~~l.~_eiling/or ~ f\J.
.2. examale- waterheater/eleCtrlcal/or so. r--
E. Square footage or valuation, etc. -
I. example- 1250 sq. foot house, 500 sq.
2. example- if new project, check-new _ i ~,."
check add, etc. \
F. Building permit information:
1. example - construct single family housl
attached garage (
2. example - remodel existing garage into il
3. examole. convert single family resider.
restaurant (change of use)
G. Value of work as defined in Section 303 (a) C.,
Structural SpeCialty Code
H. OESIGN TEM~ AND CONTRACTORS
To avoid design or construction delays, Bui'
Division Staff must be able to contact appr( p.
persons regarding design information or job ~
corrections, etc.
II. Abbreviated Plumbing, Mechanical, & Electrical S
A. Except where blank spaces Occur in the descr ~.
portion of the Mechanical and Electrical Schl Il.e~
the applicant need fill-in only the No. Boxe,
to the appropriate item{s) to be installed
B. Full Plumbing. Mechanical, and Electrical Sct C'
are available at the Building Division
1. To conserve space on the permit form the
have been abbreviated
2. If the item(s) to be installed are not co'
the abbreviated schedules you should canSt (th
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEE'
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be deliver
electrical contractor for signature by his ele
supervisor. The general contractor is.not aut.
to sign the electrical label." -
Applicant to sign and date
Whenever possible. the initial application will be
a worksheet only. Where possible, Building Divisic.. ',.n.elI1'
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
signature.
IV. 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.
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Received For.
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BRIOGS "RINTERS/LITHOG~APHt:RS. EUGENE. OREGON
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V. FOR OFFICE USE ONLY
Permit Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
;=
PLANS REVIEWED BY:
:11
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date 7,:z? -3'<"
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