HomeMy WebLinkAboutPermit Miscellaneous 1980-9-19
j ItISPECTlOrI L1IIE
726-3769
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CITY OF SPRItlGFIELD
CDr1BItIATION APPLICATION/PERMIT
EIIERGY SOURCES:
Hea t -':::LB'::r'
~'later Heater ~.
HlFORf1ATION lljit. I
726-3753
~q. Itg. I.lain "Z.\Zo -c:"'\;~
~~: ~~~: ~~~:~s. - [$
~~e\;,_Add_Alter_Rep. --
__Fence__Demo__Change/Use
Va~ "7.ofAI~ Other I
'(it v'-rL--'....... -IW::>D: "'6 ~P;"
BUllclnalPernl1t Info: Deser.be Work(l.e., Build Single I
Fa~ilv nesidence IHth Att~ed Garaoel . ..D
1t4'l~ keD 9-,0 ~\.\'\)'2..Y {l I M
10>S.'lZ'>LL ,=; ~ r::,L~ <;., >o1v,- ~
-r~~
(fics. no.) (exo;res)
Job Address ~'1'10 MA.eL..a.-A
Legal Description \ 1-02- W
Owner ~
Address
t..c> <:J7/2.. ~ FiR
I .
LL-ib,Do
~E-
Ranqe
('J-/-1 Lop CA...~
'S4"i <S M1Jf...Lo LA e.c.
Sf l.1 .01'" F- I t'Z:.LP 1>L -n 4-77
Construction lender
Address
Ut5 I GrI I tAil
Primary
Phone
~
Phone
(address 1
(ohane no. )
lnameJ
~._--..
Structura 1
Electrical
11echani ca 1
CONTRACTORS
Genera 1
Plumbino
Electrical
~\echa n i ca 1
rm.
(name)
-;,~J~ -i
','j X'.\
t'Y'" .
(exo'i res)
(ohnn,. nn \
(address)
(lics. no.)
e:;rz ~F":iL
tSb0>~
L ~ S fC.le:LTIClC-
D~e-
c~t-JW- ~
~1'6~ ';;'44-.2V; 0
PLUI1BIIIG
ELECTRICAL I flECHAlHCAL
FEE CHARr,F NO ~ ~H I rI-lAQr,C NO.
Residence of furnace/burner to
SQ. FT. BTlI's
I J:"cc I nll'll~hC
I
Each single fixture
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
^-
"",-';!
~
S.F. Residence
(] bath)
Duplex (1 bath) each
Additional bath
Hater service
Sewer
Storm Se\'ler
SERVICES
Recessed wall
Snnce hPntpr ~nrl vpnt
Temporary Construction
Change in existing
res. i deno'
multifamily. corm:. or
InrllJstriill
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sinole duct
I Vent system apart
heatino or A.C.
I Mechanical exhaust
hoorl rind rluet
from
Of
amps.
, ! kL
IV I .
COMM./IND. FEEDERS
Ilnstall/alter/relocate
rli~trih. fppdprs
IOf amps. I
I
,
Wood stove/heater
t1 /"1
11/ /j"
ISSUANCF" OF PFRrHT
TOTAL CHARGES I TOTAL CHARGES
f/HERE STATE L1t1 REQUIRES that tile Electrical 'lOrk be done by an
shall not be valiJ until the label has been signed by an Electrical
!()o.od TOTAL CHARGES
Electrical Contractor. the electrical portion of this per~it
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXMlItlED the completed aprlication for )')ermit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Soringfield and the Laws of the State of Ore90n pertaining to the .work described herein, and that 1m OCCUPAfKY \'1ill be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and emnloyees who are in comollance with OP.S 7nl.055 wlll be lsed on ,h'S rroject.
IWIE(please print) q~ ~J..) L~ SIGIIATURE ?""',?~~UM.. OATE~
rn~"", FO~ OFFICE USE OIIL Y ,
Zone..e.-A ..........~._.
Fire Zone -
Flood Plain -
BUILDING PERl.lIT
Charges anc
Surcharges
PLUI1BlI1G PERI1IT
Charges and
Surcharges
ELECTR I CAL PERI: IT
Cha rges and
Surcharges
11ECHAN ICAL PERM IT
Charges and
Surcharges
iyoe/Const. ~ -.A/ Uni ts S~. Ftg. ~la i n x Value
Bedrooms Occy Load Sq. FtQ. j\ccess '3"'0 x Val ue
Stories Occy Group E - ~, Sq. Ftg. Other x Value
TOTAL VALUATION ....-:" Ir.r:,'_f J
.-,-:-- ' .-
/
^ d I PI an Ck.
_______::1._'!../1.'L 6S%lBlrla
I Plan Ck.
. '1(, 30%/Bldo
Comm/lnd
Pl'!r Fpe
Res
Per Fee
1/5.roo -fd q_/I~;~ilopment I
1&,8\-v'j1/1) I
I
,'" !
~nce .
-11//'--------
D~mo
_______.l2,o.{)J Sidewalk
. -;-:"? AIC Pavin9.
Total Comb. Permit
I
;;%3$ Sc".
.,
1/1.1
-7:7;:--------
Curb Cut
\
TOTAL
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COMBINATION APPLICATIOrl/PERi.IIT (CAP)
I.
PERMIT VALIDATION
II.
Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax Lot 100. lane County Map f
II 03 43
2. example- Lot I. Block 3, 2nd Addition
Sprlngtleld Estates .
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or for
2. examole- waterheater/electrlcal/or sora
E. Square footage or valuation, etc. -
!. examole- 1250 sq. foot house, 500 sq. f, (?'
2. examole- if new project. check-new - if
check add. etc.
F. Building perr.lit information:
1. examole - construct single family house
at lached garage
2. exa;;:::lle - remodel existing garage into f
3. examole - convert single family residenc
restaurant (change of use)
G. Value of work as defined in .Section 303 (a)
Structural Specialty Code
H. DESIGII TEN; MID CONTRACTORS
To avoid design or construction delays, Buill r'
Division Staff must be able to contact appro[ '-...
persons regarding design information or job ~
corrections, etc.
Abbreviated Plu~bing, j.lechanical. & Electrical Sc ~~
A. ~xcept \':here blank spaces occur in the descri ->'
portion of the Nechanical and Electrical Sehe
the aoplicant need fill-in only the Ho. Boxes
to the approDriate itEm(s) to be installed ~
B. Full Plumbino, Mechanical, and Electriea J Sch, '..'
are available at the Building Division
1. To conserve space on the permit form the!
have been abbreviated ,-
2. If the i tem(s} to be installed are not CO\ \:I
the aboreviated schedules you should conSL
fu 11 schedu I es
C. BUILOING OI'IISIO;1 STAFF WILL FILL OUT ALL FEES (
CHARGES 0:1 THE SCHEDULES
D. As noted on the CAP, the label must
electrical contractor for signature
supervi sor. The genera 1 contractor
to sign the electrical label.
Applicant to sign and date
Whenever possible, the initial application will be
a worksheet only. \.Jhere possible, Building Divisl( ("
will prepare a type written copy and return it to t 8'1'
applicant at the tlme the actual permit is issued f
signature.
Fees and Charges
Pl an check rees are due and paya b J eat the time of (
application, and no plans will be processed until t
fees are paid. All other fees and charges are due s..u
payable when the permit is issued.
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CITY
OF
SPRINGFIELD
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City Hall
Sprin9field. Oregon
Department 01 Public Works
OFFICIAL RECEIPT
(
r; No. B
Dole q -14 19'10
Ih Rec'd ~rom S-tzL1/\ j/O-U,fl d) ml (
, Address~.a q ,ct) '7Y1CLrU; --,CI'''-l{ . (- .
(-
54629(1
Received
h-P
For:
L\O)o
'2-L~. 90'
(.;L 6
"
,y;p
L1~fO
LO ,(~o
L\U
be deliver
by his ele
is not aut.
. d ~'-J .30 L~
Receive ~ . -
O/D
('.
Amount
III.
IV.
o
--;'U~iolORIZED SIGN...TURE
5"~LTO".TU"".'l\.L ~"'''T~''5 . ~uc;~,,~, 0" .,.0'
...5"'. C.'
V.
FOR OFFICE USE 0;14Y
.I.'p,~it
Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the 8uilder's Board because:
Additional Project Information:
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PLANS REVIEWED BY:
..' "I)
signature/i ./..7/1"'./
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.1... ,._. .. .....
I
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date 9-//- /f/:) I
name
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