HomeMy WebLinkAboutPermit Building 1980-05-19I
7
ECTIO
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C()IlB I iIA AP I CATI RMIT 7?6-3753
Job Address O1c-r
E;IERGY SOURCE
Heal I 11 dn
Ranoe
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lJa rterteHea
Va I ue of l.lork :
/ $,ooO.49
So. Ftq. I'lain
l-egal Description
Owner G Sr,
Bui lt. i n
Fani I v
q Pernri t I nfo: Descri be l^lork (
Residence llith Attached Garaqe
s., Build SinglePhoncgswJe.Address BLIO ) Er-:oev€,(J ,ln,thLh^A n" /t Po,iln n urxj
Construction Lender )/n-;;/^T a*0.
Addre s s Phone
Io
Ews
DES I GI{IEIJI--name address ics. no. ) (exnires (ohone no.'
Primary t . U-C'.:.zJrs
Structural S an \(,
Sean r.e-El ectri ca l
l'lec ha n i ca l
CONTRACTORS n arne address )I ics. no.exo'i res ( ohonp no
K.oxtcq,D 5rb
1n
Ge \
\o
'81 *t4ldFIA
A\e..2*
I
hani
ectrical
PLUIlB I IJG EL TCTR I CAL MEC HAN I CAL
FEF CHARGF N0-;FF l-HA ANF FFF II'I]AACF
t Each si ng l e fixture
S.oo J>t{
Residence of
FTSQ
furnace/burner to
BTLI' S
Relocated bui Iding
(new fix. additional ),'r'2
New ci rcui ts al ts.or extens i onsTJ/a o2,t,rqEE
Floor furnace
and vent
S , F. Res i dence(l bath)SERV I C ES Recessed wal I
Soace heater and vent
Duplex (l bath) each
Additional bath Temporary Construction Apol iance vent
s eoa ra te
l,later service e in existing
ENCF
Chang
resi d
Stationary evap
coo I er
Sewer multifamily, comm. or
Tndrrstrial
Vent fan with
sinole duct 4.1 L.ce
Storm Sewer 0f amps.Vent system apart from
heatinq or A.C.
cor.lr.'r. / rND. FEEDERS :L Mechanical exhaust
hood and duct t!',lQ 9,ao
Instal I /al terlrel ocatedistrih- fepderc tlood stove/heater
0f amp s.
ISSUANCF 0F pFRrlIT /c,oo
TOTAL CHARGES TOTAL CHARGES /S,oc TOTAL CHARGES o?S,cC
REQUIRES that the Electrical rvork be done by an Electrical Contractor, the electrical portion of this perr,rituntil the label has been signed by an Electricai Supervisor and returned to the Buildin! Divjsion
l,lAtlE (p l ease pri nt )S IGiIATU
LJHERE STATE Lll,.lshall not be valiJ r
0req
the Iany
rd f exemp
.055 rii
E INE t etI iI tica foon r t1edc0mpl-)ap he tcer 'I ttha Ia iI forman 'It 0n nreo 1Dermrebyhe uetrfy
nda rrec t a Ind rtherfu tcer 'I ttha a nda Ia workIfyny rrnedoerfo Isha 'I n nceaccorda thvll t 'I oIdonbehe0rdsna nce eth Ic tyfSfiprtedIndaLavlsthefotn9heLOSoftenIonaItothklrorcrtdesherebednIathndtaI'Irtq0circwlCUPANCY mabe deDCtsfruwlcturetthouethIpermIssnoof1UdiIvlDr's on hefurt cer '1rt tha t 'I tS ra I I1InqtonthynButhe der sfym.y re-q
S'1 jBoa n II afo rce nd ctffeue '|ed 7asrORS t ba Is foS r t 0nI athereq u 0 055 th ta 1by ex emp s henoted reon nd ttha
n I S trubcon torac ans d IvernD se awho 'Ire n I 1 beI0yeIncaw'l nbcrh n 1 edus thon s'I tcomDro.l ecp
: USE 0llL
Fire zone-Z_pedrooms 0ccy Loaa .f 1i sq
Fts. t4ain /-fCC x___Value /,?,&y!&
0t her
4-.<
Acce sc
Flood Plain ty'q S tories ,/
I
Val ue
croup #-f- sq
TOTAL VALUATIOII /
x Val
So
Ft!
Ftg
Zon"_Q*- A__tyDelconst. Un.i ts_
Plan Ck. Comm/lnd
65:1/8ldo Per Fee s tems
rqe 1
VC
57
opmen tBUILDING PER}IIT
Charges anC
Su rcha rge s
84tc-
Plan Ck. Res
30:1/Bldo Per Fee
FencePLUI4BING PERMIT
Charges and
Surcha rges /,
?( nn-!---'g---
D6mo
Si dewa I kELECTRICAL PERI,:IT
Charges and
Surcha rges
ao
, {rA Total Cornb. IermitA/C Pavi ng
Curb CutI,IECHAN I CAL PERM IT
Charxes and AS,po-
/,DO
r-crl1 f /---:' 5.31..5{-#/Ls s,-
".t
Sq
Acces s
0the r
Van $i:v<.v.r 3AS-3oS!
s
t
COI.IBINATI ON APPLI CAT] ON/PERI'II T ( CAP )
I . Appt i cant to furni sh
A. Job Address
B. Legal DescriPt'ion
l. example- Tax Lot 100, Lane County l4ap Re
l7l3-T3
2. examole- Lot 1. Block 3, ?nd Addition to
SFFingTield Estates
C. llame, etc. of owner and construction lender
D. EnergY Sources
PERMIT VALIDATION
OF SPRINGFIELDC trv ?
o
l. exanro l e- heat/
2. ExamcTe- rvater
e'l ectrical ceili
a r e ec tr ca
on,
CirY Holl
Springfield, Oregon
o"o.ri-"it of Public works--SrFtclAt REcEIPT
No. B
Ior forcer soTar 53656oE. SquareT6otage or valuati
1. exanole- i250 sq. foo
?. example-
-if
new proje
check add, etc.3 ^,19
t house, 500 sct, check new
q. foo:
- if a<
c.
{:
te irlr-0
II
F. Building permit information:
1. examole - construct single family house wi
attached garage
?. example - remodel existing garage into fam
3. examole - convert single family resjdence
iEsTi-urant (change of use)
G. Value of work as defined in Section 303 (a) of
Structural Speciaity Code
H. DESIGN TEAI'I AND CONTRACTORS
To avoid design or construction delays, Buildin
Divjsion Staff must be able to contact appropri
persons regarding design information or job sit
corrections, etc.
Abbreviated Plumbing, Mechanical, & E'lectrica l SchetA. Except ,irhere blank spaces occur in the descript'portion of the l'lechanical and Electrical Schedul
the applicant need fill-in only the No. Boxes acto the appropriate item(s) to be installedB. Full PIumbing, Mechanical, and Electrical Schedu
are ava i lable at the Bui lding Division1. To conserve space on the permit form the sch,
have been abbreviated
2. If the item(s) to be installed are not coverr
the abbreviated scheduies you should consult
fu l I schedulesC, BUILDING DIVISION STAFF t^IILL FILL OUT ALL FEES AN
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be delivered
electricai contractor for signature by his electr
suoervisor. The general contractor is not author'
to sign the electrical label.III. Applicant to sign and date
!,lhenever possible, the initial application will be use
a r,rorksheet on1y. Where possible, Building Division Swill prepare a type written copy and return it to the
applicant at the time the actual permit is issued for
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 thes
fees are paid. All other fees and charges are due and
payable yrhen the permit is issued.
V. FOR OFFICE USE ONLY -
PLANS REVIEI,JED BY:
BY
I
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SHaLron luiaouLL PililERS
Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
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Permjt applicant exempt from registration with the Builder's Board because:
Addjtional Project Informatjon:
name SI snature l2^ A)-il,
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