HomeMy WebLinkAboutPermit Building 1981-11-30
I INSPECTIOII LIIIE
726..3769
.
CITY UF SPRIIIGFIELD
COIIBHIATlON APPLICATION/PERMIT
EIIERr,y SOURCES:
Heat
!'Iater 'Heater
..
INFORllATION liNe
726-3753
So' Ftq. 1,la;n
:q. ~t9. Access.
Sa, Ftq, Other
lie" Add ~ lter Pep,
--Fence Demo Change/Use
Other - -
Jab Address 153 3. rr,GJ,.'X ':;
l.e9a1 Description //'()-:J-25.3~_
,
~#r
8 "/"'----
"
Owner (:,~; U ,...~(~ J-/ fo; ,c .-r~s::,...::" :'" N '(j S ,;.-
Address
;
<.~t; . ~~';r~~ .' '/.......
, '-;~.. :
Phone
Construction lender .~/r.)}.; ,';:;:
Address
UES I (iN II:Ar~
(name)
Phone
(address )
. Primary
,-'
i-'- i;
Plumbina .JClI..J ;. .,,:-~ ~^-..'i\1 ___ /1/')'}"~~/~
.!.l~triill_J),lJrJ !.-:-r:: E;:1..:::c.:.L.t-!C_~__ __. __ _:-n/':J/).) ~~;:J_D _' _......~.
I !~
,.'i
._ ___"_ _.__.~.-~__.____ _. .__,____---l..
\ S1:t:.L!Ct.u!:~.!
! E'I:;ctl"ic.';l
GE::nerf'il
W-tZ
'I
J'~~~i~al.. .. .....:~~~:n~N,G '~~~~f':E'-E--'~~C"H~~R-;:...,";~_Ji'~;-::--~_~" --..:~E~'i.1 ~:..L_..'_ _ ~~~ ~ ~::HAR"~~~" .." .._~- .. - -..~- ~
:~~~Q;, ~..:.:::.-~~- H " -'->"- ~, __
, E h ' 1 f' t": r Residence of ~ furnace/buiner to
/ ac SlOg e lX ure ; r~ ~Q"-':Ij . SQ. FT:, I~ BTU1s
! \c7 .). ;r'" - n__
t----Refo-cated building.-:'..-----~--- New-circuits alts. --~-- Flooi~ fUfilace
;. (new fix. additioncll) ~ ,or extensions IS1 anci vent
I
I
" __""~.~:~~:~~,"L,~-=,..__"
.LEJ_
S.F. Residence
(] bath)
Duplex (1 bath)
SERVICES
Recessed wall
Sn~cp heater ann
I
vpnL Ii
,- I
' r,---i
I I
I
I
I
I
.cHARGf. '
I'
~
!
each
.
-}----,.
Appliance vent
seoaratf'l
Stationary evap.
cooler .
Vent fan with
sinole duct
I'Vent system apart fr<1'11
heatino or A.C. '
I Mechanical exhaust I,. I
hood and duct
I ~'Jood stove/heater l I
I I
,-- I----=,---ii
I ~ ~
" I
, i
I
thi s pemit I
I SSUANCf OF PFm\IT
Additional bath
I ~!ater seivice
I Sewer
Istorm Sewer
Temporary Construction
Change in exi'sting
res,i denee
multifamily. COl11!l. or
Industrial
Of
amps.
COl11,I,/I NO, FEEDERS
Install/alter/relocate
rHc:tr;h. fppcfprc:
Of
amps.
I
157""> I TOTAL CHARGES
"Electrical Contractor, the electrical portion' pf
Supervisor and returned to the Building Oivisipn
t
I HAVE CAREFUllY EXMlINEO the completed application for permit. and do hereby certify that all information herfon 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 Oregon pertaining to the work described herein) and that UO OCCUPAUCY will be made
of any structure without the permission of the Building Division, I further certify that my registration with thetBUilde~ls
Board is in full force and effect as required by ons 701.055, that if exempt the basis "for exemption is noted here n. and that
only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project." "
TOTAL CHARGES
WHERE STATE L'W REQUIRES
shall not be valiJ until the
:3a.... TOTAL CHARGES
that tile Electrical work be done by an
label has been signed by an Electrical
IlAr-IE(please print) jJ,<\U I r,
W...q (_D~7_.':_
/j ,'- //7
1.'/ '/ // <'..-,/
SIGil^TURE ,,;'>-;"'Y.//~'---=.; .Jr"_'~///j"
,
i
DAT~ /1-,..;''-./.....7/ I
,'- .,
Zone1(.j ~(Jp
Fi re Zone
Flood Plain
Type/Const,~ .N
Bedrooms
Stories
Units
Occy Load
Occy Group A. < ./
FOP OFFICE USE OIILY
Sq.-Ftg.
x Va 1 ue
x Value
'V......' ' ,.... c-=
"'-"__-.:\. value-, "."
TOTAL VALUATION_l
...,'" ""0 ISyste. ms Development j
~~.<? Charae (1,5~) ~
PPI/-;l.'-f-~~P. 1
Sq. n9.
Sq, Ftg,
t1ain
Access
Other 1JI7/I.ll~
I
BUILDING PERHIT
Charges an~
Surcharges
, -:;i!:<"""
-----/--!.._--
/. :z:!5.
_____~9_~_ Fence
I. 2~ D~mo
_____LJ. Qc:> I Sidewalk
(;0 I A/C Paving
I Curb Cut
I
Plan Ck,
65%!Bldo
Plan Ck,
30%/Blda
Ca""'/lnd
PI'>\" !=''''e
R'es
Per Fee
PLU'1BING PERMIT
Charges and
Surcharges
ELECTR I CAL PERI~IT
Cha rges and
Surcharges
Comb _ rermi t
8~,a8
~80. .~S\"
'ITotal
I
I TOTAL
11ECHANICAL PERMIT
Charges and
SurCharges
"
-
'.
COMBINATION APPLICATION/PERMIT (CAP)
I
CITY
PERMIT VALIDATION
OF SPRINGFIELD
~
IiI.
I. Applicant to furnish
A, Job Address
B. legal Description
I. examp I e- Tax Lot 100. Lane County Map Refe,
II 03 43
2. example- Lot I, Block 3, 2nd Addition to
Sprlngfield Estates
C. "Name. etc. of owner a"nd construction lender
D. Energy Sources
~: :;:~6~:= ::~~~~~:~~~;~~~c~~~~~~t~~rs~~~~ed -. ~
E. . Square footage or valuation, etc. -
I, example- 1250 sq, foot house. 500 sq, foot
2. example- if new project. check"""""iiew - if add orf
check add, etc,
F. Building permit information:
I. i!'xam~le.. construct single family house witl
attached garage
2. examgle" - remodel existing garage into fam;., "OM
3. examole - convert single family residence ir
restauran:t. (change of use) .
G,'Value of work as defined in Section 303 (a) of t
Structural Specialty Code
H, OESIGN TEAM AND CONTRACTORS,
To avoid design or construction delays. Building
Division Staff must be able to contact appropria I
persons regarding design information or job site
corrections, etc.
II. 'Abbreviated Plumbing, Mechanical; & Electrical Sched,
A. Except ~/here' blank spaces occur in the descriptic (
portion of the Mechanical and Electrical Schedul( \
the applicant need fill-in only the No, Boxes ad;
to the appropriate item(s)' to be installed
B, Full Plumbing, Mechanical, and Electrical Schedul (
are available at the Building Division
1. To conserve space on the permit form. the sche
have been abbreviated
2. If the item(s) to be installed are not covere, '
the abbreviated schedules you should consult
full schedules
C. BUILDING DIVISION STAFF WILL FilL OUT ALL FEES ANI
CHARGES ON THE 'SCHEDULES
0, As noted on the CAP, the label must be delivered 1
electrical contractor for signature by his electri
supervisor. The general contractor is .not author;
to sign the electrical label. ---
Applicant to sign and date
Whenever possible, the initial application will be use
a worksheet only. Where possible, Building Division S
will prepare a type written copy and return it to the
applicant at the time the actual permit is.issued for
signa ture.
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.
(I
(
'City Hall
. Springfield. Oregan
Department of Public Works
OFFICIAL RECEIPT
N.O. B 5 7 6 8 4 1
Date \\\\') 3CJ9?-' \ ,
Rec'd From ~~ ~ r \) ~. 01\-r-1
Address~\, ~~,~
- -~aJ c.
Received FoR: ~ 'c (..1", '0
~..- -- ~\lWth ,010
~\..ffib -on.c:Q
4% I blO
( 00 O(J't-. "1 c;:;~o 0
.. - 4-~ Jrf')
,-
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,
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the Amount Re~~;e\ p..() PB
(=- -''n ~'"~ ~"'?
"' ( "<"0"""'""" ,..",... ' .,.... 0' '>00'
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V, FOR OFFICE USE ONLY
Permit Cl erk
..
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
, .
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
.
name
signature
date