HomeMy WebLinkAboutPermit Building 1980-09-237?6
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COIIBI iIATION APPL ICATION/PERMIT
l.!"aal DescriDtion
..lob rlddress </ *--Sr.7Z rY-EIIERGY SOURCES
Hea t
l.rater Heater
Ranqec/
Nrner I
varue I li'hr-r').c'o
l,lew Ad
-Fenie Oerno Cha-0t
dAl ter_P.ep.
nge/Useher-
Sq. Ftq. Hai
Acces s
0ther
Sq. Ftg
Sq. Fto
.1dd rc s s e^-/Bu
Fam i
tnq
Re
.e., Bui d ng
s i dence
cri
Atta c h
),ot,l"F,)lJ' o re-qo) 7 Trro ?
con(ruiu{ Lender /
,A , f<__P
..1rld rc s s Phone
lr$!
J-J
dressu en
Pri na
[]ectrical
l"lechanical
TO
P I unrb r'7
rical
tlec ha n i :l
PLUI:3I:I3 ELECTR I CAL MECHAN I CAL
N0-FFF IHA RG F rJ0 FFF ictrnpcr
Each single fixture Residence of
SQ. FT
furnace/burner to
BTLI' S
Relocated buildinc
(new fix. addjtional )
Ner,r c ircui ts al ts
oq.extens i ons
Floor furnace
and vent
5.F. Residence(t uatn)SERVICES Recessed wal l
Soace heater and vpni
Duplex (l bath) each
Addi t.i ona I ba th Apoi iance vent
se Da ra te
,,25,l,later service *Change in existino
res i dence
Stati onar.v evap
coo i er
Sewer 7'r1 S{.a< i)-ua -.- a6
industrial
multifamily, comm. or Vent fan with
sinoie duct
Storm Sewer 0f apart from
.c.
Vent systen
heatinq or A
/%ar.'ne*tq Ilfr'-c0141.1./IND. FEEDERS Mechanical exhaust
hood and duct
rJb*ap Instal I /al ter/re'l ocatedistrih. fccderc llood stove/heater
0f s.
/p,*,{.hw<e il*rafuva
"&exd r**rr-' t/r*LrP :5t
ISSUAIICF OF PFlIIIT3t"'TOTAL CHARGES TOTAL CHARGES 46J6 TOTAL CHARGES
by an Electrical Contractor, the electrical portion of this permittrical Supervisor and returned to the Building Division
erformed shall be done in accordance r,r.ith the Ordinances of the Citying to the work described herein, and that f{C 0CCUPANCY will be madlI further certify that rny registration vrith the Builder'sif exempt the basis for exemotion is noted hereon, and thatn1.055 r.ri I j be used on thi s oroject
liAilE(please prjnt)1l,r,ll\DATE
i,iED tte compI HriVE Y Ej:,1'11 eted apnl icat on foand correct, and I further certif,v that any and aj1 work oof Soringfielci and the Laws of the State of Oregon Dertai nof any structurc without the sermission of the 3uil dinq DiBoard is in full force and ef fect Js reQuired by OnS 701.0onl-v subcontractors and er:Dl oyees rvho are 'comcl iance wi
r Dermi t, and do hereb.y certify that all inforrnation hereon .is true
vi si
(q
th0
on.
tha t
rk be done
by an Elec
tIHEI'lE STATE Li:l AE,_tUlntS that rlre Electrical woshalI not be valiI until the label has been signed
OFF
(,,
Ftg
Ff^
Uni ts Val ue
So
TOTAL VALUATION
X
X
x
0 ccy Load
0cc v Grouo
"*:.=a 1
Flood Plarn Slories
f'1a i n
. Val ue
Value
zone /l d S _T;rner consr
Fire Tone tf.A. Bedrccns
ft|og<e- .#)r4€' ;,8y1<€ :l 5e72;f
Acces s
0ther
Plan Ck. Comm/lnd
65;./Bldo Per Fee
Systems DevG
Charoe ( 1.5r'
opment Q/4 J\>BUILOIiIG PEii.iIT
Charqes anJ
u narc Pl an Ck Re
Pe3Ci,/Bl dq ee
srF
FencePLUI'BI}IG PERi,,IT
Ci;a rges and
Surc ha rges I
I
/2{ 6o
I
Dgmo
5idewalkiLECTRICAL FERI:IT
Charges and
5urch6 rgg5
--,t1 'o
;i.>Total Comb. Permit 8?. >eA/C Pavi ng
Curb Cut
/ 7z- -7o
XECIIAII I CAL PEPI.I I T
Charges and
5urc ha rqes TOTAL
be l,lorkd Garao
-J\
Structura I
name,ohonp nn
Temoorary Construction
t
I
..,tro. u J4bb-u
CO
l-.r9
(R
COMBINATION APPLICATION/PEP.NIT (CAP)
App
A.
B.
c.
D.
E.
lican
Job
Lega
l.
t.
Name
Ener
1.
2
Sql.)
L
Ad
I
fr
res
esc
LL.
Sou
to
d
D
9v
examo I e-
exanolE-
Fe-i6otas
exampl e-
examp I e-
aIEtI add
ua
rnu
n
h
x
s
a
i
t
T
hea
wat
eo
1?(
p
Sri
e-
l7-03-T3
examo I e-
SprlnsTi
(
renceRef
to (
re
t
I
gar
dit'
PROJECT CONDITIONS TO BE SATISFIED BEFORE OC(
Permit appl icant exempt from registrat'ion wit f ,
Loexam0
tr
aneL
3k
100
loc
s
ch
hout
ontfoo
ta
qs
r
0
i
n
Co
nd
MUnty
Add
ion
ap
on
nde
;
fo
(
a
{
t
Lot
id
truct
rces
owner
e
of
JT new
nd
ua
scona
te
proj
or
rt/electrical ceiIinq/. -: : =}erheater/e I ectrl ca I /o
foot
fad
r
r
aso
ced ra 6-
l-
500
. neweck
qs
trLL
II
F. Building perr:rit information:
1. example - construct single family house with '
;tt"aci-,ea garege
?. examole - remodel existing garage into family
3. examole - corlvert s.ingle famiiy residence int
iEsTiurant (change of use)
G. Value of work as defined in Section 303 (a) of th
Structural Specialty Code
H. DESIGii TEAt.i AI.ID COIITRACTOP.S
To avoid design or construction delays' Building
Division Staff must be able to contact approoriat
persons regarding design information or iob site
correcti ons . etc.
Abbreviateo Piurnbing, i'lechanical, & Electrical Schedt
A. Except where blank spaces occur in the descriptit
portion of the i4echanical and Electrical Schedulr
the applicant need fi1'l-in only the No. Boxes ad.1-
to the appropr.iate item(s) to be installed
B. Full Plumbing, Ilechanical, and Electrical Schedules
are available at the BuilCing Division
1. To conserve space on the permit form the schedu
have been abbreviated
2. If the item(s) to be installeo iie not cov?rec r
the abbreviated schedules you should consult tht
ful I scnedul es
C. BUiLDII,iG DIVISION STAFF I,JILL FILL OUT ALL FEES AND
CHARGES CiI THE SCHEDULES
D. As noteC on the CAP, the label must be delivered to
electrical contractor for signature by his electrica
supervisor. The generai contractor is not authorize
to sign the electrical label.III. Appiicant to sign and date
Hhenever possibie, the initial appl ication will be used
a urorksheet only. Where possible, Building Division Sta
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for hi
si gna ture.IV. Fees and Charges
P'lan 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 0FFicE Usr oli"r,v
CITY OF SPRINGFIELD
CirY Holl
SPringfield, Oregon
DePortment of Public Works
OFFICIAL RECEIPT
I'lo. B 54507
g19o
g
fAmounl Rece ived
Dote
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(LY)
Received For
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Amounl Received
BY
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Additional Project Information
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PLANS REV I EI.IED BY :
name gna tu re date ?-:F-s3 c5poq"q,+ ri
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