HomeMy WebLinkAboutPermit Building 1980-6-11
-,,,--,.
. ('. CITY OF S,'Rr;iGFIELD T
, . . " corlBIIIATION APPLICATION/PERM!
E,iERGY SOURCES:
Job Address 1'-=:;,,5 /-I1"':/nwKoO..d Heat
I 1 0 .' I ~'later Heater e../e.CfYi;
.e~a e<cnptlOn T- O~'=<,- ::< 7- ';::; I -
Ra""e_"c..-/~cIX 't, ~_
!b,h6Y,.,:> 0t mx. lor 10/-1 ::?DO .JJlu< of Hark:
Owner L t)/I-I-rti.,ftl...t-fl.)t5 V'r'llZ/:::.J.. f2.K.. 9'(,,/,3/SQ.J1
Address 00 q.e.... _ /C:--.2. ~"P_hane., /-9 Buil-t:ino PermilInfo: Oeser be I-Iork(i.e., Build Single
r(./ r;...7/"i"':'" c...;) /~7. J;:;-~ Far.lilv nesidence IHth J'l.ttached (;araae' ..
r;:;:re.IAXi F/6-c-c:> Od-. 97/( 7?
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~iOlI LWE
IX6- 37 6g
WFORJIATION LI".
726-3753
Sq. Ftq. 1.lain
~q. r=tlJ. Access.
So. Ftg. Other
lIeI' Add A lIer ~ep.
--Fence Demo Chan~e/Use
Other~ -
Q)
8
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Pe,,,,,-lvr,,"Im
1='11 { ill-/- "i,<,
Construction Lender
,\ddress
DESIG;; lEAII
Phone
(address'
2 -,,/') U /.:'111/-
...., t.:.,.c....../ I I (-"-J C/!
[;p.
flies. no.)
(na~e)
/JeT
'PAz
Primary
Structural
r ~ ,v't.; , ~ ~
~:eC~M:1;~;iil
cmHS:'CTORS
(name}
f{ u W)Zc.) b
(addresc;' (lics. no.)
C7'l/6TV-LCL71I)'>') 6UL7C,UE
General
Plumbi nQ
, Electrical
'~echan i ca 1
PlUrmHlG
ELECTRICAL
..-'.-----. .---~
r:o.
FFF rHARr,F.lID
FF ~ J:I!ARliE. JllL.
. /~
,'-
Each single fixture
Residence of
<'!=
0.../
,/ "'!c
()U-:.~.
SQ. FT.
Relocated building
(new fix. additional).
S. F. Res i dence
(I bath)
Duplex (I bath) each
New circuits alts.
or extensions'
SERVICES
Additional bath
I Temporary Construction //).~;.
/
Change in existing
rpc;idf'ncp
multifamily, corran. or
Induc;tritll
. Of /./._-s- amps. ~-
; ....1....1.,~..'
~:ater service
Sewe r
I Starm 'Sewer
COI'II'I./I NO. FEEDERS
Install/alter/relocate
dic;trib. feederc;
Of
amps.
{exoires\
(ohane
I
I
no. )
{exnirps'
(.'ohone no. ,
'-
.
~,
'I
MECHANICAL
~j:'j:' rH~
furnace/burner to
BTU's
Floor furnace
and vent
1 !
Recessed wall
~o~rp ~p~tp~ ~nrl ~pnt~
Apoliance vent
"poarat!?
Stationarv evao.
cooler ~ .
Vent fan wi th
s;nole duct
Vent system apart from
heatinq or A.C.
Mechanical exhaust
hand and duct
Wood stove/heater
'1
TOTAL CHARGES
~IHEr.E STATE L,\:~ REQUIRES
shall not be valiJ until the
ISSUAtiCF OF PFRiIlT
,1,D.06 TOTAL CHARGES ,':S.OC TOTAL CHARGES
that tile Electrical \'Jork be done by an Electrical Contractor. the electrical portion Of this permit
label has been signed by an Electrical Supervisor and returned to the Building Oivisi9n
1 HAVE CAREFUllY EXN\INED the completed aprlication for ~ermit. and do hereby certify that all information hereon is true
and correct. and I further certify that any and all \'Jork oerformed shall be done in accordance with the, Ordinances.of the City
of Soringfield and the laws of the State of Orel]on pertaining to the work described herein, and that flC OCCUPAflO \'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 DRS 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 vtill be used on this project.
1iAi-IE(please print'f
S IGil.~TURE
FO~ OFFICE USE OilLY
Units /
Oeey Load
Oecy Group "'-7
DATE
Zone ~:,:.L.
Fire Zone ~
Flood Plain ..~/11
TyoelConst. 7/1..- Ij
Bedrooms
Stories I
Sq. Ftg.. 11ain /~tt;t.:)
Sq. FlQ. Access
Sq. Ftg. Other
BUILDWG PERI.IIT
Charges an~
Surcharges
... . Plan Ck.
______C;;-lj1..J?!..J_ 65~JBldo
<I. t./, '-I, Plan Ck.
e 30%JBldo
, , A./ (~_K
.. ':l;'1" 5" .-: ..':. - 9':)
#- 5:.:r~ X ()
Conm/l nd
Ppr Fpf>
Res
Per Fee
PLUMBING PERMIT
Charges and
Surcharges
_______6a=-=~Q
Fence
:; . .t,I{;:
Demo
ELECTRICAL PERI~IT
Cha rges and
Surcharges
IIECHAIIICAL PERI11T
Charges and
Surcharges
_ ___ __ _- ~~.!::(') Sidewalk
/ ,l.!t) A/C Paving
Curb Cut
'--
~,
x
x
Value
Value
Value
I . ~/~'90
VALUATIar:'",/,,;, ,,-
/
x
TOTAL
Systems Development
Cha roe (1. S~.)
. ~/q 77
7/. J. .
Total Comb. rermit
,~,r:< ,::'0:
"
I TOTAL
.;-/.
r." /..~ ~ r;,'J .I'll
I (/'..-.J(.,JIU
.,
2
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COI.:BWATIO:-i APPLICATION/PERI.IIT (CAP)
J.
Applicant to furnish
A. Job Address
B. Legal Description
1. exar;;ple- Tax lot 100, Lane County (-lap Refe
11 03 43
2. examole- Lot 1. Glock 3. 2nd Addition to
Springtield Estates
C. flame. etc. of owner and construction lender
~. ~neroY Source$
1. examole- heat/electrical ceilinq/u~' fo!"ced.
2., exarr.~le- waterheaterjelectrlcal/or solar
E. Square footage or valuation, etc. -
J. examole- 1250 sq. foot house. 500 sq. foot 'a~
2. exam~le- if new project, check-new - if ad
check add. etc.
F. Building permit information: ~
J. ~xaf'l1D12 - construct single family house ;.JIi an)
a~ttac'hed garage :J '
2. examole - remodel existing garage into fa1
3. examDle - convert single famny residence
restaurant (change of use) ,
G.' Value of work as defined .i~ Section 303 (a) ri'
Structural Specialty Code
. H. ' DESIGN TEM! AilO CONTRACTORS
To avoid design or construction delays, Build
Division Staff. must be able to contact approp
persons regarding design information' or job s
corrections, etc. :!
Abbreviated Plumbing, Mechanical, & Electrical Scl Jl~
A..' Except \';here blank spaces occur' in the descril
portion of the Mechanical and Electrical Sche/
the applicant need fill-in only the No. BoxeS:.
to the appropriate item{s) to be installed "
B. Full Plumbing, I-l~c:han;cal, and Electrical Schl 1)
are available at the Building Division 'J
1. To conserve space on the permit form the ,:i
have been abbreviated . .
2. If the item(s) to be installed are not co 0)
the abbreviated schedules you should cons
full schedules i
C. BUILDli:G DIVISION STAFF WILL FILL OUT ALL FEE "'",
CHARGES Oil THE SCHEOULES
D. As noted on the CAP, 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 will
a \'Iorksheet only. \.Jhere possible, Building Divi
wi 11 prepare a type written copy and return it t ,:o,p
a~plicant at the time the actua,' permit is lSsu~
slgnature.
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. ~ll other fees and charges are due and
payable \'/hen the'pe.rmit is issued.
I
II.
be deliv
by his e
is not a
I I I.
IV.
V. FOR OFFICE USE 'ONLY
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PFRMIT VALIDAT!ON
OF SPRINGFIELD
City Hall '
Springfield, Oregan
Department af Public Warks
OFFICIAL RECEIPT
fl
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No.
S 3 71 7 Q)
B
Date (~-II_
19 ~t.>
Rec'd From bu v-.....i">\J\; <:. () ,I, + .
_ __ ,:",!'\c..:"tv""Vc... If",,'^
Address Po :7:;yW :;:;6eJ.I- E vo, e~
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Received For: BJd Ii
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~jecllf":c... 35."-9 4-1-110 7 f(.~11.p
<('to 1.'-13 It"-/o.J/o1
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mount Received / o.:0U, 0_ c..~
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) A.UTHOAIZ[O SIGI'<"'TU~E
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Permi t C1 erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
,.. _II,,,..
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Permit applicant exempt from registration with the Builder's Board.because:
i
Additional 'Project Inforl11ation: fL_'H.;:)~_
',nV~/
'f- "''''~_' ,oS 7'
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13......~.~..,.'.. ,;v...Y ~d0...:'_....-:-- C,J'I'Y.~.. ~...a-~~::_ 7//7"J~. (";7500./'.5.:: lC>c--..-'."
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'PLANS REVIEWED BY:
j
name
s i gnatyre
1\
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