HomeMy WebLinkAboutPermit Building 1980-06-10LiiiE
Cgt'B I iIATI 01 AppL I CATI0i{/pERxtT 7?6-37 53
Job Address EIIERGY SOURCES
Hea t
l,later Heater e lec h"i i
Ranqe
Structura I
Lesal Description / T- () 3- 2 7- R 1
Po,t,cn= bl hL toi ic/* ADI I ue of l.lorkcA
q. Ftg. l.lain_
Sq. Ftq. Access._
So. Ftg. 0ther__
l.lew_AddJ1 ter_llep.
_Fence_Demo Change/Use
0ther
owner / ;)IL)
q
Re
Bui ltli n
Farni I y
Pernli t Info: Describe l^lork(
sidence l'lith Attached Garaqe
e., Buiid SingleAdrrress 7a b* / ris 74*1"bb9 (---F-
h
Ph
DCA ">
.\.ld re s s
Construction Lender
I
lics. no.exoi res phone noDES I G:i TEAI.I nare ( addres s
"/1 T?.
Prima
l'
dre
{LrtD-. )C)
ELE CTR I CAL MECHANICAL :
.HAPT:FFFF lr^UlnCr N0_FFEFEEC I.lARGE NO
fur'nace/burner to
BTLI ' s
Residence of
SQ FT
l'lew ci rcui ts al ts
or extensions
Fl oor furnace
and vent
Relocated building
(new fix. additional )
STRVICES
Recessed wal I
SDace heater and vent
S. F. Res'idence
( l bath)
Duplex (l bath) each
Apol iance vent
s e oa rat-eTemporary Construct'i onAddi r.ional bath
res i dence
Change i n exi sti ng Stat'i onary evap
cool erlr:a ter Serv i Ce
Vent fan w'ith
sinole duct
multifamily,
I ndustr.ia I
comrn.0rSewer
Vent system apart from
heatino or A.C.Ut amPS.
I Storm Sewer
Mechanical exhaust
hood and ductC()I4I'1./IND. FEEDERS
llood stove/heaterinstal I /a l ter/rel ocate
distrib. feeders
0f E
ISSUAI.ICT OF PFRI',iIT
TOTAL CHARGESTOTAL CHARGESTOTAL CI1ARGES
, ..
l,lHERE STATE Lli,l REQUIRES that tlte Electrical rvo
shail not be valil until the label has been signed
rk be done by an E
by an Electrical S
'lectrical Contractor, the electrical portion of this permit
upervisor and returned to the Building Division
only subcontractors and ernoloyees who are in comcliance with Oi?S 701.055 r'rill be used on this Droject'
I GiIATURE DATEliAilE(please print
fy
ruhe re ec rt t tha a onf,trrna 0n h tsreonctaoforrmitandaI{eAVE b.y fyDEYLXAIliDcothepl')mp
do an crdan e t thh 0 rd n nc of Cthefrtandat{0 r Derk 0f rmed ah be ne c0ctha tycocrretandrthUecerndanyfy
n thand La il c 0 UPACC IIC tvr ma debertanntto\^lOhe k scde r edb rehe$So r ad thnd Lawse tof S teLd 0reoof on eongp g
s atr L on thtr/ I het Bu der sft
I U U ni S on fu errth C rt hat t reoSUCtrrethouwithtsnoothBm.y ganypermn9
on S ednot reonhe a thnd tathatfebatheSf,S exor t055xemptemprdBoasnfufoarcednetffecaedrORS0req u by
Fl ood PI ai n , .' - Stori es i 0cc.v Group Il'-.':- So
FFI
4
Tyoel Con s t
dtLoa d
al
Val ueits ,' so,_t
TOTAL VALUATION
F ire Zone-1"..Z. Bedrooms
l'1a i nFtg
Ftg
Ft9
Zone ',-'
Acce s s
0the r
o pment Qt?,:' ;rqe ( 1.51
Svs
CIra
tems DevePl an Ck. Comm/Ind
65illBldo Per Fee #E*"XnPlan Ck. Res
30:1/Bldq Per Fee
BUILDING PERTlIT
Charges anC
Su rcha rge s 't ,i t
Fen ce
Demo
PLUI4BING PERI'lIT
Charges and
Su rc ha rges
Sidewalk
Total Cornb. Permit
ELECTRICAL PERIlIT
Charges and
Su rc ha rges A/C Pavi ng
Curb Cut
TOTAL
MECHAN I CAL PEP,I',IIT
Charges and
Surc ha rges
{ F'oclt iz r t
i'jeclia;ri:..'. i
Electrical
PLUIlB I IIG
Each single fixture
!
'I ics nn trYnt rcq thonc nnil r:T0RS n ana
Nechanical i
alIfie
1ii
)
I. c.)iample - construct si
1\
COI'18 I i'IAT I OII APPL I CATI ON/PERI'1I T ( CAP )
Appl i cant to furni shA. Job AddressB. Legal Description
1. exarnple- Tax Lot 100, Lane County Map Refer
N-T3-T:
?. examole- Lot 1. Block 3, Znd Addition to i
SprlngTield Estates
CITY OF SPRINGFIEI.D
Ciry Holl
Springfield, Oregon
Deportment of public WorksOFFICIAI. RECEIPT
No. B Is717
PFRI.4IT VALIDATION
I9
(
t,
C. Name, etc. of ovrner and constructionD. !nerly -sources1. exanole- heat/electricai ceilingr?. examcle- waterheater/electrical/oE. Square iootage or valuation, etc.
I ender
or'folced
1. examole- i250 sq. foot house, 500 sq2. effilef if new project, check-i-ew -
check add, etc.F. Buiiding permit informat'ion:
ngle family house
attac6-ea garage
rso ar ole
S
R ved For:
foot
if ad
.al F l'
Ir
B
)
)
L fiim
i.t i anl
)
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remodel existing garage into
3 convert single family res'ide nce
restaurant (change of use)G. Value of work as defined in Section 303 (a) 61
Structural Specialty Code I I
examol e -
exa,lip Ie -
+/1o O0 ,"1:!DESIGN TEA|'I AND CONTRACTORS
To avoid design or construction delays, Build'
Division Staff must be able to contact appropr
persons regarding design information or job sl
corrections, etc.
@9,o3
-f &.q9
II. Abbreviated Plumbing, l"lechanical, & Electrical SclA. Except vrhere blank spaces occuli n the descri g
portion of the Mechan.ical and Electrical Scher
the appl i cant need fi l l - i n on1.y the No. BoxeS
to the appropriate item(s) to be installedB. Ful l P'lumbing, Mechanical, and Electrical Sch
are available at the Building Division
1. To conserve space on the permit form the
have been abbreviated2. If the item(s) to be inltalled are not co
the abbreviated schedules you should cons
ful I schedul es
C. BUILDIIiG DIVISION STAFF I^IILL FILL OUT ALL FIE
CHARGES ON THE SCHEDULES
D. As ncted on the CAP, the label must be deli
electrical contractor for signature by his
supervisor. The general contractor is not
to sign the electrical label.
App l icant to sign and date
l,Jhenever possible, the initial application will
a r.rorksheet on1y. l,Jhere possible, Building Div
wi'11 prepare a type written copy and return it
applicant aL the time the actual permit is issu
s i gna ture.
Fees and Charges
Plan check fees are due and payable at the time of the
appl ication, and no pians will be processeci untiI these
fees are paid. All other fees and charges are due and
payable vrhen the permit is issued.
V. FOR OFFICE USE ONLY
EJe.irl<- 3s,,'e * i-//o? lc,1.
ir\L
17"/,19 Et<top.gtvVlc.
s D."iq -?7 )
)l t
Amounl Received R36,ol C-i4rzc-Q
e
a
BY
III.
iV,
AUTHORIZEO SIGNATURESHELTOA.TURftBULL PRINI€iS EUGENE OR 97'OI
Permi'L C'lerk
)
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI'{CY:
perm'i t appl i cant exempt f rom reg i strati on wi th the Bu'i l der' s Board because :
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1;=*--*v< .tL-<--Cl*<+''*'1"; -
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PLANS REVlEWED BY:
da te !,' * ,t 7' ?jns i gnaturename
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Additional Proiect Information:
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