HomeMy WebLinkAboutPermit Building 1982-4-24
'I INSPECTION LINE
726-3769
,
CITY UF SPRINGFIELD
CDrIBIIIATI ON APPLI CATION/PERMIT
E!/ERGY SOURCES:
Heat
TCLX .'[0 f xOO Hater Heater
~
Job Address I~)O MAli.) ST.
Legal omriPtma'i?_1?3 - ~c, - 4..;::;
INFORlIATION L1N. I
726-3753
Sq. Ftg. l'lain
~q. ~tg. Access.
Sq. Ftg. Other
~iew_Add){AlterHep.
Fence Demo Change/Use
Other- -
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\)
1*
~'
Owner YJ.l /<.1 1"... B. F6-.z / R I
Address ~j;. 't") q~::-",.. 1J.l1UE...
$,PFLC. OR
Ranqe_._~_
ValuE of Hork:
3I!)d). M
BU11riinQ Permit Info: Oescribe Work{i~e.. Build Single
Familv nes;dence With Attach~d G~raa~\
('~O"'MEE~ C 1':/ I A/ 1/f'JR.4 r/"JJ
74/0<1<1<
Phone
Construction lender
---Phone
(address)
!lies. no.)
Address
Ut~lu~ ItM1 (name)
Primary k!MJA t.f'l_tJ. Pfu9..P.
I
i Structural
, Electrical
, II I" C -"'~RI)I
l;?R .
Mechanical
CONTRACTORS (namel
'General RalVhL;-' uJ. {~j{?>'2-
(address)
,/
(lies. no.
I~ 2/-:'-
Plurnbina
Electrical \=>.u.._r,e.e:.~ED EL"-"-TRIC-
~'echani ca 1
PLUllBlIiG
ELECTRICAL
NO.
I FEE I CHARhF Nn
I ~I='LI...c.HAB.G.E. NO, I
Each single fixture
Residence of
SQ. FT.
I'Relocated building
(ne~ fix. additional)
Is.F. Residence
II bath 1
10uplex (1 bath) each
Additional bath
/fNew circu~ts alts.
or extenslons
Z aR M~.s.
ISERVICES
[
;s:-
!TempOrary Construction
[Change in existing
r~~ j 1e!H'P .
[multifamily, comm. or
Industriill
I [Of I&:? amps.1
[CO~1./INO. FEEDERS
I Install/alter/relocate
rli~trih_ fpprlpr~
Of amps.l
I
[
[
ks:",...
I
I
~Ia ter servi ce
Sewer
Storm Sewer
I
I
30.....
{axoiras} J (ohona no.)
IJ. 7~C Sf?;:' l
~
(E'xoirpst
'12-111"'
('ohanE' no _ )
"
I
MECHANICAL :
.-.--~~.. I r~ABiif~
furnace/burner to
BTU's
/
Floor furnace
and vent
Recessed wall
~nilrp hpiltpr ilnrl vpnt
Appliance vent
<;.enaratp
Stationary evap,
caolE'r
Vent fan wi th
sinole duct
Vent system apart from
hpiltino or A. r.
Mechanical exhaust
hood and duct
Wood stove/heater
.'
ISSUANCE OF p~RmT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L~W REQUIRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Buil~ing Division
I HAVE CARE~ULLY EXA/l1NEO 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 Oregon pertaining to the work described herein, and that liD OCCUPAIICY 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 ons 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 701.055 will be used on this project.
IIA1.IE(please printl\c:'.kJb.LO W .~Il. ~ SIr.tIATUR~ '\ ~~r ~
OAT~i(h 1- '
1
"'3'. c:;l:::l::::l. C>C
~O~ Or~ICE USE DilLY
Zone c.. - 'f Type/Const. -SZ:,A/ Units Sq. Ftg. f1ain x
Fire Zone_ IJ.A . Bedrooms Occy Load Sq. Ftg. Access x
Flood Plain Nt::? Stories I Occy Group #-'1 Sq. Ftg. Other x
1'fJ.;).(j CQ<i:.~ Systems Development
+2".82- *t:;'h4S"J Charqe (1.5~l .
BUILDING PERf1lT
Charges and
Surcharges
_n_n?Y:.~~_
."6
Plan Ck. Comm/Ind
65%/Bldo P~r F~~
Plan Ck. Res
30%/Bldq Per Fee
Fence
PLU'1BING PERMIT
Charges and
Surcharges
Demo
ELECTRICAL PERtH!
Cha rges and
Surcharges
IIECHANICAL PERMIT
Charges and
Surcharges
___n_~"-~:_
/.20
.Sidewalk
AlC Paving
I Curb Cut
I
Value
Value
Value
TOTAL VALUATIDrI ~~,.....
~
I
ITotal
I
I TOTAL
Comb. Permit
5"6.1~
L
.56.16\
.. .
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax Lot 100, Lane County Map Refer, (
II oj 43
2. examp'le- Lot I. Block 3, 2nd Addition to
springtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced a
2. examyle- waterheater/electrlcal/or solar
E. Square footage or valuation. etc. -
I. example- 1250 sq. foot house, 500 sq. foot c
2. example- if new project. check-new - if add1
.chec K add, etc.
F. Building pennit information: . (
1. example - construct single family house witt
attached garage .
2. . examele - remodel existing garage into famil
3. examJ'le - convert single family residence. ir (
restaurant (change of use)
.G: Value of work as defined in Section 303 (a) of t
Structural Specialty Code
.H. DESIGN TEAM AND CONrRACTORS (
.To avoid design or construction delays. Building :.
Division Staff must be able to contact appropria
persons regarding design information or jOb site
corrections, etc. (
II. Abbreviated Plumbing, Mechanical, & Electrical Sched .
A. Except where blank spaces occur"in the descripti
portion of the Mechanical and Electrical Schedul
the appli.cant need fill-in only the No. Boxes. ad "'."
to the appropriate item(s) to be installed. \,
B. Full Plumbing, Mechanical; and Electrical Schedu
are available at the Building Division
1. To conserve space on the permit form the sch ~t
have been abbreviated ~
2. If the item(s) to be installed are not cove,
the abbreviated schedules you should consult
fu 11 schedu 1 es
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES A
CHARGES ON lHE SCHEDULES
D. As noted on the CAP, the label must be delivered
electrical contractor for signature by his elect ~,
supervisor. The general contractor is ,not autho ~cl:-
to sign the electrical label. '-
Applicant to sign and date
Whenever pOSSible. the initial application will be u
a worksheet only. Where possible, Building Division
will prepare a type written copy and return it to th
applicant at the time the actual penmit is issued fo
signa ture.
IV. Fees and Charges
Plan check fees are due and payable at the time of t
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.
~
COMBINATION APPLICATION/PERMIT (CAP)
""- ~
III.
V. FOR OFFICE USE ONLY
,
~
PERMIT VALIDATION .
CITY OF SPRINGFIELD
(
(
City Hall
Springfield, Oregon
Department 01 Public Works (
OFFICIAL RECEIPT -
No. B 59015(
D~\O 19 X'~
'--
Rec'd Fron\ x:<. (~ Q (l 1\..5'\ (
Address A. 4\ S . CXn 5\0 (J, D\-
,.
c
Received For.
9\QO~qS
4
, .
lha1.i)> 0JLA .00
no L\;C)o ,Lf6
( .~ ~90
L1.,DJo 1.m
V ' .
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Amount Received
oLQ .I tp
K~[)r>-
-AUTHORIZED SIGNATURE
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BRIGGS ~AINT~RS/LITHOGRAPHERS.ItUG~NIE, OR~OON
'Permit Clerk
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 1_t:>7?#E ~~";='R Signature~.-Ya.........,
., ,
da te 5"7"- ::;'~