HomeMy WebLinkAboutPermit Building 1982-6-3
Job Address 1:2.5 A.\AlkJ ~T. ~?FL-"
Legal Oe<cription 17-d.,.3-!)-(j '2. Toe.,
I IrISPECTIQ;1 LIIIE,
726-3769
Owner
I
I
INFORflATION LINE ,I
726-3753
50. Ftg, 1'1ain
~q. f'tg. Access.
Sq. Ftg. Other
New Add Alter ~ep.
--Fence Demo Change/Use
Other - -
CITY OF SPRI1IGFIELD
COIIBHIATION APPLICATION/PERMIT
EilERGY SOURCES:
Heat
/1---- t'Jater Heater
~
~
I~
I\)
I
AeT t NTH w.....TT€eS
'-:loo li- 3" ~ AVt:-
ffijlr€1.J/;. De (;. 4'7 C/-D5
Phone'fi~,S'~ .
Ranqe
ValUE of Hark:
., 1,000 -
BuildinQ Permit Info:
Farnil y l1es; dence \-lith
Describe Work(i~e.. Build Single
JI..ttached llaraQe)
Address
Construction lender
Address
UDHifl IEAH
(name)
Primary V~/5;C: ~~
Structural
Electrical
f1echanical
COfITRACTORS
(name)
lteT W~
Genera 1
Pl umbi nQ --
" .
c.v-r ~)(7 'IJ#Oii!.WAY TIt~V MA5ZWeel" WA~
,
, Mo.l..Ioe. iiL.Ec:r, CHAloJtrbS
Phone
(address)
(lies. no.)
(exoiresl
(Dhone no.
~.
~B7.12<3
(address)
~').O 6""~t. t:!' eu~E;
(lin. no.)
(exoires)
(ohnnp nn
" IJJ AJ bR..
'-i t:,s.- <;;,t..&'f..
,J ^,-I< ~ liYAl 0 t.: D <; 5l.8:::re.1 c.
3 '(-,;-71- 91
Electrical
f,lechanical
PLUllBlIIG
NO.1
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
OupIex (1 bath) each
IAdditional bath
j~later service
I Sewer
Istorm Sewer
TOTAL CHARGES
WHEnE STATE L1N REQUIRES
shall not be vaIiJ until the
ELECTRICAL
FFF rHARr,F NO
Res i dence of .
SQ; FT,
y New circuits alts.
or ext~sions
':<1 &' , /Y7C7?<!F
SERVICES
MECHANICAL
FF~ r~A~r.F Nn_
FFF rI-lA~rF,
/
furnace/burner to
BrUls
/$.'"
Floor furnace
and vent
Recessed wa 11
~n~rp hp~tpr ~nrl vpnt
I!emporary Construction
IChange in existing
l"posjdp.;nr:p
Imultifamily, COI11T1. or
Jnnustrial
10f amps.j
ICOffi1./IND. FEEOERS I
IInsta11/alter/relocate I
rl;<;.tl'"iIL fppdpr..
10f amp,,1 I
I I I
I I I
I I I ISSUANCF OF PFR!IlT
TOTAL CHARGES IS: - I TOTAL CHARGES
that tile Electrical work. 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 Division
Appliance vent
seoaratp
Stationary evap.
cooler
Vent fan with
sino1e duct
I Vent system apart from I
heatino or A.C.
I Meehan i ca 1 exhaus t
hood and durt
I Hood stove/heater
I
I
1
I HAVE CAREFULLY EXN1lfIED the camp leted apfl 1 i cat i on for permit. and do hereby certify that all i nformat i on 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 laws of the State of Drel)on pertaining to the work described herein, and that HC OCCUPAUCY will 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 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 7~1.055 will be used on this project.
6$17-/)..1.-'3
'~ DATE ~-3~f?2
Uni ts
Occy Load
Occ.v Group
S IGilATURE <;;7}- : ,
FO~ OFFICE USE Q;IL Y
Sq. Ftg. r1ain
Sq. Ftc]. Access
Sq. Ftg. Other
x
x
x
Value
Value
Value
UAf.IE(please print) '"P (F1oJ1V1 S 'F. Cel Le
Zone C. . 3
Fire ZonE'
Flood Plain
Tyoe/Const.
Bedrooms
Stories
j
TOTAL VALUATION
BUILDING PERI,IIT
Charges an~
Surcharges
I/> ~D Plan Ck.
~. 65%/Bldo
------------""""PTan Ck,
. ~~ 3D%/Bldo
1/ {O pef ~"::;-B~ Systems Development
"':..:/ ;t;t.'>"'[I';z"r Charoe (1.5<)
I
I
PLUf1BING PERMIT
Charges and
Surcharges
CorrmlInd
Ppr FpE'
Res
Per Fee
Fence
ELECTRIU.L PERf~IT
Charges and
SurCharges
I Demo
IS"". - I Sidewalk
--------,-i.;-I A/C Paving
I1ECHANICAL PERMIT
Charges and
Surcharges
'-
Curb Cut
jTotal Comb. rermit 2~~ ""'"
I ,/} -;z f/G, OP
I TOTAL ,
.. b
PROJECT CONDITIONS TO BE SATISFIED BEFORE QWJP.~.tIGY: ~,Il~/'" IS:5p~~/~ :
A'~~/A.E""'T ~~~ ~cr......:!';)P.T"'" ~~...r
#", ~A<FI.vt'~ c.
CL..otorE2' A' - "--" ~_ r_L"i' ~.-.
.. .....
~h~ L~<r- ~ ?-?.sn;r~#1G;. ~C"CF"~~~....,
from registration with the Builder's Board because:
I
COMBINATION APPLICATION/PERM]T (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
11 U3 43
2, exam~le- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources .
1. examo 1 e- hea t/ e 1 ectr; ca 1 ceil i nqjer forced air (I,
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
1. examole- 12S0 sq. foot house, SOO sq. foot garag.
2. example- if new project. check new - if addition
cneck add, etc.
F. Building permit information:
1. example - construct single family house with an
a ttached garage
2. examyle - remodel existing garage into family rOI
3. examyle - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (aJ of the
Structural Specialty Code
H. DESIGN TENI AIID CONTRACTORS
To avoid design or construction delays. Building
Division S,taff must be able to contact appropriate
persons regarding design information or job site
corrections. etc.
II. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacel
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical. and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedulE
have been abbreviated
2. If the item(s) to be installed are not covered or
the abbreviated schedules you should consult the
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANO
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered to 1
electrical contractor for signature by his electrical
supervisor. The general contractor is.not authorizec
to sign the electrical label. ---
III. Applicant to sign and date
Whenever possible. the initial application will be used a
a worksheet only. Where possible, Building Division Staf
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.
V. FOR OFFICE USE ONLY
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1- )?6iC:l..>/Rt9;
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Permit applicant exempt
(\J1A Q Q m 0 1(\1. 1\ \' '-."f"
Additi!,\,al Projec~ Information:
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CITY OF SPRINGFIELD
I
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City Hall
Sprlngflald, Oragon
Departmant 01 Public Works
OFFICIAL RECEIPT
No. B 59263
DatJ "'~l\O. t ~ ~9 ?/2 .
Aec'd~rmQ-(\\\\..~~~\:Qf\~O. :
Address 4(1\0 l h \ \\-t~ \1 \Y\fJ
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Received For:
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Amount Aecelved ~(() _0 u
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- AU'ft)bRlZEOSIGNATURE
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BY
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BRIGGS PRINTJ:ItS/LlTHOORAI'HI:IUI.I:UG.l:NI:. OREGON
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Permit Cl erk
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PLANS REVIEWED BY:
name ~~ ~6:;?lf" Signature~~__~ date (;;.9-~
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