HomeMy WebLinkAboutPermit Miscellaneous 1983-6-28
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"j IrISPECTlON LlflE
726-3769
Job Address
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legal De~cription
75'77 /114'-"
17.~~."3/- :31
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E!IERGY SOURCES:
Heat
Hater Heater
INFORllATlON liNt ,I
726-3753
Sq. Ftg. "'ain
~q. Ftg. Access.
Sq. Ftg. Other "~ge>
New Add Alter Pep.
Range -Fence Demo Change/Use
Valu, of Hork: e- Other7.RV/.....,:::;...
Builaino pernli~n~~esc~ibe Work(;.e., Build Single
Family nesidence With Attached Garaoe)
~?~ (Ar.d4/~) #b'/t/1..'* 4.7-
~ ~~MIo' .::k'f'I#$..$ .7 7'9':7
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. rfics. no.)
.
CITY UF SPRINGFIELD
COIIBI!IATlON APPLICATION/PERMIT
./Jt::/"t, Ji,,,,A,'MA4
2 Yr ~ ~ J...!L '"
J/,df ~;i'S
Construction len(e~
Phon.v?I';;j?
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Owner
Address
Address
Ut~Hirl It:.Ar'
(name)
Phone
(address)
(exoires)
(ohone no.l\
Primary
III
~'--"
&4.T
~
Structural
Electrical
Mechanical
CONTRACTORS {name}
AJ,...5
A~/.,/t
(addrpss)
~;,:~~ ~.
r
(lir:e;. no.)
(pxnirpo;.)
(ohnnp'l)n.
b 1 i- /J'"/J
General
M~
//;"("4"1,,, J5..,
Plumbino
Electrical
Hechanical
PLUIIBIrIG
ELECTRICAL
MECHANICAL
NO.
Each single fixture
FEF rHARCF Nn 1OEL1J:JJAJlG.E. NO.
Residence of furnace/burner to
SQ. FT. BTU's
1..EEL1.ClfARG[
I
i
'/
Relocated building
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
C1 bath]
Duplex (1 bath)
IAdditional bath
Iwater service
I Sewer
I Storm Sewer
SERVICES
Recessed wall
~o~r:P hp~tpr ~nrl vpnt
each
I
I
I
I ISSUANCE OF PFRltIT
TOTAL CHARGES TOTAL CHARGES I TOTAL CHARGES
WHERE STATE L\I/ REQUIRES that the Electrical work be done by an"Electrical Contractor, the electrical portion of 'this permit
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
!TempOrary Construction
IChange in existing
r~~ j dr.nr:p .
Imultifamily. corrm. or
Inrlustrii'll
IOf amps.1
ICOMfl./IND. FEEDERS I
IInstall/alter/relocate "
tlic:.trih. f",,,,r!pro;.
I Of amp..1
Appliance vent
c;.poaratp
S-tationary evap.
cooler
Vent fan with
",i"ole duct
Vent system apart
heatino or A.C.
I Mechanical exhaust
hood and dur:t
I ~Iood stove/heater
I
I
I
from
I HAVE CAREFULLY EXAMINED the completed ap~lication for permit. and do hereby certify that all information hereon is true
and correct. and 1 further certify that any and all work Derf~rmed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Or!,!!on pertaining to the work described herein, and that NO OCCUPAI~CY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder1s
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 ORS 701.055 will be used on this project.
!/AI.IE(please print) ~AI ~~.v..,~ SIG!/ATURE ~ :::?
FOr: OFFICE USE DilLY
Sq. Ftg. rl3in x
Sq. Ft~. Access x
Sq. Ftg: Other ~J9J'/~x
~
TOTAL V ALUA TI 0/1
DATE ~..?J'J?
Zone G ~
Fire Zonp
Flood Plain
Tyoe/Const. r21w~ .Units
,
Bedrooms Occy load
Stories Occy Group
Value
Value
Value
~~ 60
BUILDWG PERf1!T
Charges and
Surcharges
I Plan Ck.
65%/Bldo
Plan Ck.
30%lBldo
COI1111/l nd
Ppr Fpe
Res
Per Fee
18. ~o
Systems Development
Charoe t1.51,) .
PLU'~BING PERMIT Fence
Charges and ------------
Surcharges O~o
ELECTRICAL PERI~lT !-sldewa I k
Charges and ------------
Surcharges A/e Paving
I
I
:Z23.-
ITotal Comb. rermit
rlECHANICAL PERMIT
Charges and .
Surcharges
Curb Cut
I
TOTAL
f'6 <a
.
..
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. example- Tax Lat 100. Lane County Map Reference
II OJ 43
2. example- lot 1. Block 3, 2nd~ition to
Sprlngtield Estates
C. Name. etc. of owner and cons,truction lender
D. Energy Sources
1. example- heat/electrical ceilina/or forced air Qa~
2. examole- waterheater/electrica(/or solar
E. Square footage or valuation. etc. -----
1. example- 1250 sq. foot house, 500 sq. foot garage
2. examp'le- if new project. check new - if addition,
cneck. add, etc.
F. Building permit information:
1. example - construct single family house with an
attached garage
2. examEle - remodel existing garage into family roem
3. example - convert Single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEN1 AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
persons regarding design information or job site
corrections, etc.
11. Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To.conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BOILDING DIVISION STAFF WILL FILL OOT ALL FEES AND
CHARGES ON THE SCHEDOLES
D. As noted on the CAP, the label must be delivered to the
electrical contractor for signature by his electrical
supervisor. The general contractor is.not authorized
to sign the electrical label. ---
III. Applicant to sign and date
Whenever possible, the initial application will be used as
~ worksheet only. Where possible, Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for his
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.
V. FOR OFFICE USE ONLY
(
..CITY OF SPRINGFIELD
. City Hall
Springfield, Oragon
Dapartmant of Public Works
OFFICIAL RECEIP'T
No. B 6117
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Date,jo"'~::?8. 19~5
( Rec'dFrom U~M -(k/Y/-<//,.yS~"'/
Address ~C;-2::;a. MH-Ho./ .:Jr.
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Racelvad For.
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v ,; AUTHOlUZEo SIGNmtlRE " \,
alUOGa P'UNTIUl:a/UTHOClRAPHlI:lla. I:UClI:HI:. OIl:I:OON
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BY /
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Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
.
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Permit appl; cant exempt from reg; strati on with the Buil der I s Board because:
Additional Project Information:
4-pD~7~ON.lf.c.. 'h-I!i'M/r ~e-~;<r?~ _F~ r~~P#'T/C>__ ~
~lJc....,_~ Z/P;=:-/<:'~ ::;r~.'7LJ~c-
PLANS REVIEWED BY:
name
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STORIES
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RECIEVEO ~. < ~- ~ L:Oe, No. B< 3:
~c:: O.:CU~ANC~. GROUP~&-/~
NITS OCCUPANCY LOAD
TYPE: CONST.
_'::EG.AL ..DESCRIPT~ON I /~~ . '3/.~. i!">/;' ~
_'::OORESsJSI 7? ~<o/ <?-.
OWNER ~N...';:;_~~~?';;::'yce
TH~ Cr:-N''"'~H~ H'ZRF; OF HI\VF. P.'"FN R::::V:r:WEI). WITH
AL TER.\TI()NS ".;'=lI,-^T~O IN r:Ot.OR~O ~r.N-'~, <':HoII NOts
on ALT::"RA':"IOt-lS MADE />FT I~ D,Il:"-' nCLCW SHALL BE
APPROVED BY THE SUILDIN;; OFFICIJl.L.
CITY OF SPRINc-.F1EW? ORE'GON
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ApPROVED BY"""-: ~ " nATE e.~R
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