HomeMy WebLinkAboutPermit Building 1980-05-20/a.7'*r:l .- *, - -._-i
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COI1BI iIAii ON APPLICATION/PERMIT
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I IiS PECT I
7?5-37 69
E 726-3753
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Job Address
f-ega1 Description /
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EIIERGY.SOURCES: \Heat 1>,"1 -lp !r.rc r.gl-itut.@
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Sq. Ftq. Access
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Va I ue of liork :'L,)c, )?,f, o2\l itt'Mer-LnnFMctr 1?. lnlt e., Build Sing)eBujll.inq Pernrit Info: Describe l'lork('-FaniIy llesidence ili th Attqched Garaqe
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Construction Lender
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Addres s Phone
ohone no.lics. no.exo i res )addressnameDIS IGN TEAI.I
Primary ('5 Vi watN
Structura I
El ectri ca I
i-aec ha n i ca I
ohone no-lics. no. ) (exoiresaddress )name
Genera i C) Vrl r,t ,, i "/
Pl umbi nq
El ectri ca l
l'lec ha n i ca I
MECHAN I CALELE CTR I CALPLUHB I NG
FFF NHA RGFFFFCHARG F NOFEECHARGENO
furnace/burner to
BTU' S
Residence of
FTSQEach single fixture
New circuits alts.
or extensions-\.Ur: ,a:r 7,1t 'v .$,,.f,::.
Floor furnace
and vent
Rel ocated bui 1 ding
(new fix. additional )
Recessed wal l
Soace heater and ventSERV I CESS . F. Res i dence(l bath)
Duplex (l bath) each
Apo'l 'iance ,rent
seoa ra teTemporary Constructi onlo.an "'a:,r'Addi tional bath
npq i dpncc
Chan_oe in existing Stati onary evap
cool erl/ater servi ce
!.r,C{:,J
Vent fan with
sinole ductIndustrial
multifamily, comrn. orSewer
Vent system apart from
heatino or A.C.0fStorm Sewer
iilechanica l exhaust
hood and duct-col,lr'r./tND. FEEDERS
tr'Jood stove/heaterInstal l /al ter/rel ocatedistrib. feeders
0f s.
ISSUAIICE OF PFRIIIT /E,CA
TOTAL CHARGES / L,, ooTOTAL CHARGESTOTAL CHARGES
l,lHERE STATE L1l'J REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be valij unt.il the label has been signed by an Electrical Supervisor and returned to the Building Division
apnlication for oermit, and do hereb.y certify that all information hereon is true
and all work oerformed shall be done in accordance r+ith the Ordinances of the City
0regon oertaining to the work described herein, and that i,l0 0CCUPA|ICY lvill be made
of any structure without the permission of the Building D'ivision. I further cert'ify that my registration vrith the Builder's
Board is in full force'and effect as required by ORS 701.055, that if exemot the basis for exemption is noted hereon, and that
only subcontractors and ernoloyees who are in comcliance with OPS 701.055 r.rill be used on this nroiect.
l,lAl,lE(please pri nt)DATE
i HAVE CAREFULLY EXAI1INED the completed
and correct, and I further certify that anyof Soringfield and the Laws of the State of
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S IGiIATURE
Ftg
Ftg
Ftg
TOTAL VALUATIOtI .?#, *r-=.'P
f'1
x
Occ.y Gro ,p ,-i:-.9 sq
, itS,/.-Y value rle/Const. -:i*; t' Un i tsZone ,2*i
Load Sq
l'la i n
Fire Zone lff Bedrooms
Flood PIain ,'.2'r-; Stories
Val ue
Val ue
Acce s s
0ther
Svstems Deve
charqe ( t.5z
o pment
65il/Bldo Per Fee
Plan Ck. Comm/IndBUILDING PERi'lIT
Charges and
Surc ha rges
!r*'.
Plan Ck. Res
30%/81dq Per Fee
5--L-aii5a.. oo
Fen ce VtC d\T:4-\--t>I rLr!)raPLUI4BING PERMIT
Charges and
Su rc ha rges Dgrno
S idewaI k
Tota'1 Con:b. Permi t
ELECTRICP,L PERIlIT
Charges and
S urc ha rges
- -jS,og-
!
!/{'s,3aA/C Paving
Curb CutIlECHANICAL PERMIT
Charoa s :nd lr-,gg-
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T'l-i;'' L F/ /r€,s,
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Address j q k /v /,* sor./; 'no"')?d-cyJ
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COI'IBINATiON APPLI CATION/PERMiT ( CAP)
I. Applicant to furnishA. Job AddressB. Legal Description
1. example- Tax Lot 10C, Lane County itiap Referenc
I7-I3-T3?. example- Lot 1. Block 3, 2nd Addition to
5[rr- ngTi e) d EstatesC. Name, etc. of owner and construction lenderD. Energy Sources1. example- heat/electrical ceilinq/or forced air2, exancle- waterheater/e'lectrical/or sojar-E, Square footage or valuation, etc.l. examole- 1250 sq. foot house, 500 sq. foot ga'2. efiffile- if new project, ctreik new - if addit
ilec k--add , etc .F. Bui)ding permit information:1. example - construct single family house with
attached garage
2. examole - remodel existing garage into famill3. exaffiTe - convert single iaiily-residence inr
restauiant (change of use)G. Value of work as defined in Section 303 (a) of tl
Structural Speciaity Code
H . DES I GN TEAI.I AN D CONTRACTORS
To avoid design or construction delays, Building
0ivision Staff must be able to contact appropria
persons regarding design information or job site
corrections, etc.II. Abbreviated Plumbing, Mechanical, & Electrical ScherA. Except r.rhere blank spaces occur in the descript'portion of the l''lechanical and Electrical Schedu
the applicant need fill-in only the i,lo. Boxes a,to the appropriate item(s) to be installedB. Full Plumbing, Mechanical, and Electrical Sched
are available at the Building Divislon1. To conserve space on the permit form the sc
have been abbreviated2. If the item(s) to be installed are not cov€
the abbreviated schedules you should consu'
ful I schedul esC. BUILDiI{G DIYISION STAFF I^JILL FILL OUT ALL FEES
CHARGES ON THE SCHEDULESD. As noted on the CAP, the label must be deliverelectrical contractor for signature by his ele
supervisor. The general contractor is not autto sign the electrical label.III. Applicant to sign and date
Hhenever possible, the injtial application wil1 br
a worksheet on1y. [,Jhere possible, Building Divis'will prepare a type written copy and return it to
applicant at the time the actuai permit is issued r
signature.IV. Fees and Charges
Plan check fees are due and payable at the time of the
appiication, and no plans r./i l1 be processed until these
fees are paid. All other fees and charges are due and
payable vrhen the permit is issued.
V. FOR OFFICE USE ONLY -
PLANS REVIEWED BY:
PERMIT VALIDATION
CITY OF SPRINGFIEID
Ciry Holl
_ Springfield, OregonDeportment of publiJ Wo.ksOFFICIAT RECEIP;
No. B 13160
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SIGNATURE
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EUGENE oP graor 5A5rr.8
or
Permit Clerk
si gna tu re n da te .f-.?c- i/t
PROJECT CONDITiONS TO BE SATISFIED BEFORE OCCUPAI.ICY:
Perm'it appljcant exempt from registration with the Builder's Board because:
Additional Project Information:
name
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