HomeMy WebLinkAboutPermit Building 1983-3-4
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726-3769
CITY OF SPRHlGFIELD
C0I1BIilATlON APPLICATION/PERMIT
E!IERGY SOURCES:
Heat
!~ater Heater
Ranqe
Job Address L' 7 I n Ii ~ ,__ 'V'" "\
r_ -I - fi, :::--. ' II cCU...r ,
Legal Description \(\(")1.'51.32. ()V:~C:t)
INFORllATlON LINE
726-3753
Sq. Ftg. 1,Iain
~q. Ftg. Access.
Sq. Ftg. Other
flew Add Alter ~ep.
Fence_Demo _ C ha ngel Use
_Other
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? j 2..i:~ '?I" rr--Lr-/.L';i' f) Phone C!:'l4..IIF,'X
r- '",''' U-Cl-<..\{,\, /1-/2::;,'
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Construction Lender (j tfg5-()~ ~I
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Phone
(address) .
ValUE of Hark: ~ CC>
1~.!Jn, '
Buihiina Permit Info: Oeser be \~ork(Le" Build Single
Familv nes;denc~ \~ith J'l.tt.a<:~t;rl Garaop)
C-~, (lj1(U' , ,...,1 t'"oV- .-
'01X+~i-'lY"\" -In
(J''I fY\ ;r-l'. ~ ..n' ) 0....0 h J rl..A ,
(lics. no.)
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1';0 "I TOTAL CHARGES
Electrical Contractor. the electrical portion of this permit
Supervisor and returned to the Building Division
Owner
Address
,\ddress
DESIGII TEAll
(namp)
Primary
Structura 1
Electrical
l1echanical
CONTRACTORS
(namel
,/I-IC
(address)
nics. no.)
(lb ~ \.".\-. C\c)
Genera 1
Plumbina
Electrical
~lechani ca 1
PLUIIBIIIG
ff.L.1JJJAlllil:.! 'In
ELECTRICAL
~
FFF r.HAR~F Nn
Each single fixture
Residence of
SQ. FT.
I Relocated building
(new fix. additional)
I' S. F. Res i dence
(l bath)
IDuplex (1 bath) each
IAdditional bath
-1~later service
I Sewer
I Storm Sewer
~ew circu~ts alts.
lor extenslons
ISERVICES
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Temporary Construction
Change in existing
res. j qerH:~
Imultifamily, comm. or
Tnrlll"trir11
IOf
ICOI1fI./IND, FEEDERS
'~~~~~~~~a~~:~~~~locate I
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+
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TOTAL CHARGES I TOTAL CHARGES
WHERE STATE L\li REQUIRES that the Electrical work be done by an
shall not be vali1 until the label has been signed by an Electrical
amps.1
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amps.
(exoires)
, \, (ahane no. )
'-.J
(exnirps) (ohnnp nn l
^
~[k,.
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MECHANICAL
...
r"-MlGL
,.
furnace/burner to
BTUls
Floor furnace
and vent
I Recessed wall
~o~rp hp~tp~ ~nrl
1
vpnt I
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1
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I App 1 i ance vent
seoarr1tp
I Stationary evap.
cooler
I Vent fan wi th
s.inole durt
I Vent syster.l apart from I
heatino or A.C.
I Mechanical exhaust
hood tlnd duct
j Hood stove/heater
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ISSUANCf OF PFRI1IT
I HAVE CAREFUllY EXN11NED the completed application for permit, 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 Springfield and the laws of the State of Ore9on pertaining to the work described herein, and that IW OCCl!PAI~CY 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 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 7nl.055 will be used on this project.
1lAt-IE(pledse
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print) . IZYG Ve
10' /<-SIr,II~:RE ~~ J
FO~ OFFICE USE Q;ILY
So, Ftg.
Sq. Ft~.
'J'- ~ Sq. Ftg.
.5.
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Zone ~ c::::.
Fire Zone
Flood Plain
Tyoe/Const. ,-r;:~
Bedrooms
Stories I
2J~ "
_(7/),' DATE E/'7L/J3
, I
Units
Occy Load
Occy Group
t1ain x Value
Access x Value
Other,rr~b€"'- Value
TOTAL VALUATION
BUILDING PERmT
Charges an~
Surcharges
IJ r 6..... Plan Ck. COIl1l1!lnd
_ _ __ VJ_- _ _ _ 65%/Blda p.pr Fpe
~40 Plan Ck, Res
. 30%/61 do Per Fee
I Fence
I D~mo
/5". 4Q I Sidewalk
-------:~--I AIC Paving
I Curb Cut
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9,7S-
PLUI1BING PERMIT
Charges and
Surcharges
ELECTRICAL PERlm
Charges and
Surcharges
11ECHANICAL PERMIT
Charges and
Surcharges
I,~-
Systems Development
CharDe (L5~)
ITotal Comb. rermit
I TOTAL
1._-
70.9S,
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COMBINATION APPLICATION/PERMIT (CAP),
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CITY OF SPRINGFIELD
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Ill.
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax"Lot
II 03 43
,2. exanj>le- Lot I. Block 3, 2nd Addition to
~pr'ng7ield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinQ!or forced.
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
I. examole- 1250 sq. foot house, 500 sq. foot.
2. examyle- if.new project. check-new - if add
cneck add. etc.
F. Building permit information: (
1. example - construct single family house wit ~
attached garage
2. examole - remodel existing garage into fami
3. examole - convert single family residence i (
restaurant (change of use) '.
G. Value of'work as defined in Section 303 (a) of
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Buildin (
Division" Staff must be able to contact appropri
persons regarding design information or jab sit
corrections, etc. ('s
II. Abbreviated Plumbing, Mechanical, & Electrical Sche ~
A. Except where blank spaces occur in the descript
portion of the Mechanical and Electrical Schedu
the applicant need fill-in only the No. Boxes a
to the appropriate item(s) to be installed (
B. Full Plumbing, Mechanical, and Electrical Sched
are available at the Building Division
1. To 'conserve space on the permit form the sc
have, been abbreviated ('
2. If the item(s) to be installed are not cove
the abbreviated schedules you should consul
full, schedules
C. BUILDINGilOIVISION STAFF WILL FILL OUT ALL FEES
CHARGES ON THE SCHEOULES
D. As notedlon the CAP, the label must be delivere
electrical contractor for signature by his elec
supervisor. The general contractor is .not auth ~.~t
to sign the electrical label. ---
Applicant to! sign and date
Whenever possible, the initial application will be
a worksheet only. Where possible. Building Divisic
will prepare a type written copy and return it to t
applicant at the time the actual permit is issued fv. "...--
signature.
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 whenllthe permit is issued.
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V. FOR OFFICE USE ONLY
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100, Lane County Map Refer, . '( "
CilyHall
Sprtngliald, Oregon
Dapartmant 01 Public Works
OFFICIAL RECEIPT
( No. B 60.524.
Dille 1\\(\" 4. 19a~
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Address\tnO N\~
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Received For.
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Amount Received Al\ .C\ ~ ( \ )~
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Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit app11cant exempt from registration with the Builder's Board because:
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Additional Project Information:
PLANS REVIEWED BY:
~7Pb~ 11:~CSF~ Signature~ .,.";~;..
name
date_:5- ~ - SC '3
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