HomeMy WebLinkAboutPermit Building 1981-1-19
Range
ValuE of Hork::;:-' , I'
..4{ ;;6;)- . 'J :J.-tHJ
Builriino Pernlit Ififo: Descrlbe Work(i~e., Build Single
Familv nesidence Hith P.ttached Garaae)
- /) ,
'!lilfI, /tIC I,/;(]'-t'p& 1 ""
I Temporary Construction
I Change in existing
rp",idflnt'p
I multifamily, carrrn. or I
Tnnuo:;trial
I 10f amps I
:):...., IC0I11'1./IND. FEEDERS I
I Install/alter/relocate I
dic;;trih fppdprc;;
I Of amp~ I
I I
I I
I I I
TOTAL CHARGES 5: ~c I TOTAL CHARGES /t-:-:...... I TOTAL CHARGES
WHERE STATE L\ll REQUIRES that tile Electrical work be done by an Electrical Contractor, the electrical portion of this
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division
~llrrSPECTIOrr LWE
726-3769
-
.& CITY OF SPRIHGFIELD
~IIBI;IATJON APPLICATION/PERMIT
, EilERGY SOURCES:
Heat
\'later Heater
Job Address .f7 tJ L{ 7 /YJ/J; III
Legal Descripti~n -0.; T 'P,l}l} /7;J7r, mXie
r;? .,. I.. CJ
~or- hl.~.~..J..".2.- <"'l-~7~
Owner t"f?".1Y....T F /-I/ll\ ke r'
'?..l/~" /1/ ~/} 1'4 Phone7f%4$i
- !Il-X L P' LfJ.tW ..$-1 I< i?Y
Construction Lender /)//)1)/1'" ,
Address
Address
Dt::'lbt{ TI:.A11
Primary
Structural
El ectri ca 1_
11echanical
CmHRACTORS
Genera 1
Plumbino
Electrical
:.~~chani ca 1
PLUllBIrlG
ELECTRICAL
,\"J.!
lEaCh single fixture
I Kelocateo bui ldinq
(new fix. addition~l)
S.t. Residence
(J bath)
Duplex (I bath) each
FEE
rHI\.Rr:;F
NO I FF~
(HAP(.:F I ~IO.
Residence of
sq. FT.
~ New circuits alts.
or extensions ~
~ o,e MaR""
SERVICES
,-....,
...'
Additional bath
~Jater service
Sel'ler
Storm Sewer
I
5;........., ?U/71P
.
I'
INFORJIATION lHlc
726-3753
Sq. Ftg. r.lain
~q. ~tg. Access.
Sq. Ftg. Other
---.!le\0;:.Add_ Alter -..:~ep.
Fence Demo Change/Use
Other- -
00
......
~..
IW
I",
MECHArllCAL
'"
(I-lARr,r
furnace/burner to
BTU's
/
Floor furnace
and vent
Recessed wall
~n~r~ he~tpr ~nrl vpnt
I Appl iance vent
seOd ra te
Stationarv evao.
cooler ~ ,
Vent fan wi th
sinale duct
Vent system apart from I
heatina or A.C.
Mechan i ca 1 exhaus t
hnnrl rind rlur:t
Wood stove/heater
ISSUANCE nF PFRrllT
perr.lit
I HAVE CAREFUllY EXN1INED the completed application for ~ermit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and 031' work oerformed shall be done in accordance with the Ordinances of the City
of Soringfield and the laws of the State of Orel]on pertaining to the work described herein, and that IJO OCCUPAHCY will 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 701.0~5, that if exemot the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 7rJl.055 will be used on this project.
IWIE(please printf'-P~.:-I'
EJ:J~" h.....
FO~ nrFICE
SIG;I~TURE-d8Ld e!.}nl
DP.TE
I-If:- ?j'(
Zone c-"
Fi re Zone
Flood Plain
/J-if
USE miL Y
Sq. Ftg. 11ain
Sq. Fta. Access
Sq. Ftg. Otherk7l:>
Tyoe/Const. ~
Bedrooms
Stories
Units
Occy Load
Occy Group
BUILDING PER~IIT
Charges and
Surcharges
~.., _~ Plan Ck. COllllllInd
.)~. 65%/Rldo Ppr Fpe
------------ Plan Ck. Res
I. <8 30%!Bldo Per Fee
e tltSp I Fence
-----Q..:._---
, . ';;?e> I Demo
/..<Z.-.~
,", Sidewalk
------------
x Value
. x Value
S'~~"'.~ n7', Value~~. .....
TOTAL VALUATION
..,.......... J'__~I Syste~s Development
...... "-t;>q I'.... Charae t1.Sr,)
. ~
PLUI1BING PERMIT
Charges and
Surcha rges
ELECTRICP.L PERI:IT
Charqes and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
.(~O
A/C Paving
Curb Cut
"
Total Comb. Permit
~;'J G---:...-q
<.J .f. ~.
1-
I'OTAL
--....,;
~.-..:--
.'
.
COMBINATION APPLICATION/PERMIT (CAP)
j:
I. Applicant to furnish
A. Job Address
B. Legal DescriPtion t.
!. examole- Tax Lot 100. Lane County Map Refe. .e
1/ 03 43
2. examole- Lot I. Block 3, 2nd Addition to
sprlngtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceiling/or forced
2. examole. waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
1. examole- 1250 sq. foot house. 50D sq. foot
2. examole- if new project. check-new - if add
check add. etc.
F. Bullding permit information:
1. examole - conStruct single family house witl
attached garage
2. . examole - remodel existing garage into fam;"
3. examole - convert single family residence ir i,.
restaurant (chanae of use)
G. Value of work as defined in Section 303 (a) of t
Structural Specialty Code
H. DESIGN TEAl-I.AllO CONTRACTORS (
To avoid design or construction deleys, Building
Doivision Staff must be able to contact appropria
p€rsons regarding design information or jab site
corrections. etc. (
XI. AL~reviated Plumbing. Mechanical. & Electrical Sched
A. Except l'lnere blank spaces occur in the descripti
portion of the ~echanica1 en~ Electrical Schedul,
tne aDplicant need fill-in cn1y the No. Boxes ad. t~t
to the aopropriate item{~) to be installed
B. Full Plu;jjbing. Mechanica1. and Electrical Schedu.
are available at the Building Division
1. To conserve space on the permi t form the scht (~s
have been abbreviated
2. If the item(s) to be installed are not covere
the abbreviated schedules you should consult
full schedules l
.C. BUILDIrlG DIVISION STAFF WILL FILL OUT ALL FEES' AN ..'
CHARGES ON THE SCHEDULES
D. As noted on the CAP, the label must be delivered
electrical contractor for signature by his electr
supervisor. The general contractor is ,not author
to sign the electrical label. -
Applicant to sign and date
Whenever possible.. the initial application will be USl
a worksheet only. Where possible. Building Division ~
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.
III.
V. FOR DFFICE USE ONLY
.
II
Ii
PERMIT VALIDATION
CITY OF SPRINGFIELD II
~.
City Hall
Springfield. Oregon .
Department of Public Works !j
OFFICIAL RECEIPT
No. B 5 5 6 6 5 q
Date \-Al (-0 19~ \ .
Rec'd From e\\\'l:l \\ -T f 0 \<\0ntQ)\...
Address ;::A ~ <;:)(\ . f;:j0\f\
Received Far: Nr1,t'\ ~~ cD
~) I;}<t,
~\ffin ~OO
. '*)h c9.(). (
\ 0 Oilf't- !~ cD
-: - 4'ln ,(00 C
...
4
f
(
/(
"
\
(
---sq O~
~\J\~
(
Received
ILL
~ Amount
e~ .~'.
(
"UTHOI'I'ZEO S'~"TURE
...l:lTO...TU.....Ull ....,..u_s. IUGI..1: Oil .,.01
...".. (
(
Permit Clerk
J
.,J
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPA1lCY:
., .",.1:
Permit applicant exempt from registration with the Builder's Board because:
,
1 Additional Project Information:
.'
PLANS REVIEWED BY:
name I_ORNe n~6l:;> signature
date . 1-~--81