HomeMy WebLinkAboutPermit Building 1982-5-13
IriSPECTIOrl LItlE_
726-3769
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Job Address 1. 'i3 .., :3
legal Description
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CITY Of SPRlrlGFIELD
C0I1BIilATION APPLICATION/PERMIT
EiIERr,y SOURCES:
Heat
('later Heater
Ran!1e
INFOR/1ATION LINE
726-37S3
Sq. Ftg. I.lain
~q. Ftg. Access.
Sq. Ftg. Other .
r1ew Add Alter Rep.
--Fence Demo Change/Use
Other - -
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C).
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Address
Phone
Valu, of 1'lor~$1. " d
/99'ff, .'
Builc;ina Permit Info: Describe \~orkli~e..
Familv Residence With Attached Garaae)
J2. €Y"ont=';^Q
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Owner'
Address
Ut.~HjN n.N1 lnameJ
.1'rimary &Jd~~o..p4::i.-,^,
j Structura1
. ~E~ctr'~~:~-__,.__.
Phone
f address 1
flies. no.)
(exo;resl
Build Single I
I
r ohone no..l
Construction Lender
~f)t')(} Teru:;:<\/ltJ<ky ")..}'6('
"3 -I /,,-~y JI'il5-'/W2 !
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I HAVE CAREFULLY EXM1INED the completed application for permit, and do hereby certify that all information het~n is true
and correct. and I further certify that any and all work oerformed shall- be done in accordance with the Ordinance5 of the City
of Springfield and the laws of the State of ,Oregon pertaining to the work described herein, and that NO OCCUPAHCY ill be made
,of any structure without the permission of the Building Division; I further ceitify that my registration with thclBuilder's
Board is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted herebn, and that
only subcontractors and employees who are in como1iance with ORS 701.055 will be used on this. project. I
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x Value ',' 11
x Va 1 ue ' ~
x Value J ~
TOTAL VALUATlOtl~, ~ ~
Systems Development I
Charoe (1.5~) . -i
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:;.t!e~.!!t~,~.~._...;.-=-."",,-~ .-.=...... _............r-.....~. ._...=-_...,....~."..,.,,-='"'"'-=,.~,"""",.,:.....~,._...c "'''''''''-=-"'_'''''':;_ ~._~___-."'_"-="".--""- ~~~.""'".=
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:' , PLUllBING! ,. _' .,____u._u~~E~~R_IC;~_; _ _.__ . r _ : f~ECHANI:A~I___ _.._ , }
"Nir-"~:'".'-~-~=- -;'m"!r:H-'(RGF- .~n~<I-~---=--=--~-~;::::-~~_. 'THL':Di8QGFNn:'~~-~'~ '. u-:-.1:'ln:_~'CHARG( I
, ". Each s';ng1e fixture i . '." R.~~d~r,ce_~ SQ. FI! . . '. . ~. ~u,.nace/bu::rB~~~st /' i!l
Relocated building-;' --- ---. [NeW d-~'cuit5 bltS. ;" ---.-. - ~-- Ti -'- -Floor furnace _.~~"'- "i
(new f'ix. additional): L or exteil:iioi1s . ", -. i:.i1d vent 11
S.F. Rasidence ~ ---......:....---. . ; 1-- ---I' Rel;essed wall . .--- lj
11 bath' " SERVICE~,__~__---!-, _ _1__...:.C;.~hP;jtPr' ;Inn 'It:>nl_.. ._" ~
:_'~e." (1 bath) each fl
. IAdditional bath ~I 1-'-'-- - Tempo~~'~it~uction ___'__u ~~~~~:~~e vent -r--------:-"fi'
IHater service 1 I ,Change in existing Stationary evap. I I I H
1 1 I ;~i~~i;~~lY. 'con-rn. or I,~~~~e~an with . II . ~
Sewer Industrial sinole duct. !
I I 1 Of amp. 5.1 Vent system apart frein 1 I
Storm Sewer I heatinq o~ A_c..1 ;\
1 I /C0I1I-i.IlND. FEEDERS -=~a~~~a~'J~~haust_l_ __._ __'i
I I -1~~:~~~~/a~~:~~~:locate I Hood stove/heater _ ___ _ n. i
I I Of amp~ i
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,--.-' --,_. .- --, -'~ij
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.1 I ISSUANCE OF PFR!lrr '. 'i '
TOTAL CHARGES I TOTAL CHARGES ! '
that the Electrical work. be done by an,'Electrical Contractor, "the ,electrical portion )f this pernit !j'
label has been signed by an Electrical Supervisor and returned to the Building Divisi m 11
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i Mechi:.nical
, CONT~6DORS :.-. :: ("ome)
, Genera 1
, Plumbin..9.__
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. TOTAL CHARGES
WHERE STATE LAW REQUIRES
shall not be va111 until the
NAME(p1ease print)
Zone
Fire Zone
Tvpe/Canst.
Bedrooms
Units
Occy Load
Occy Group
S I GIlA TURE
FOrr-2[FICE USE ONLY
Sq. Ftg. t1ain
Sq. Ftg. 'Access
Sq. Ftg. Other
Flood PlaiD
Stories
BUILDING PER~1lT
Charges an~
Surcharges
Plan C~.
----__..A~~.9_ 65%1Rldo
Plan C~.
''10 30%lBldo
CO"",/lnd
P€'r Fp~
Res
Per Fee
PLU'1BING PERMIT
Cha rges and
Surcha rges
Fence
I Demo
I Sidewal~
I A/C Paving
j Curb Cut
I
Total Comb. Permit
ELECTRICAL PERIHT
Cha rges and
Surcharges
I1ECHANICAL PERMIT
Charges and
Surcharges
: TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. examole- Tax lot 100, lane County Map Refer
il 03 43 (
2. examele- Lot I. Block 3, 2nd Addition to
~pr'ngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinq/or forced
2. examEle~ waterheater/electrlcal/or solar
E. Square footage or valuation; etc. -
I. example- 1250 sq. foot. house, 500 sq. foot
2. example- if new project, check .new - if add
check add, etc.
F. Building permit information:
1. examele ~ co~struct single family house wit 6
attached garage
2. example - remodel existing garage into fami
3. example - convert single family residence i;
restaurant (change of use) C.
G.' Value of work as defined in Section 303 (a) of.
. Structural Specialty Code
H. DESIGN TEM1 AND CONTRACTORS .
To avoid design or construction delays, Buildin'
Division Staff.must be able to contact appropri; I..
persons regarding design information or job.sitl
correct ions, etc. " . .
II. Abbreviated Plumbing, Mechanical, & Electrical Schel ~s
A. Except where blank spaces occur in the descript. '.
portion of the Mechanical "and Electric~l"Schedu'
the applicant need fill-in only the No. Boxes ae
, 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 set
have been abbreviated C.
2. If the item(s) to be installed are not cove. '
the abbreviated schedules you should consul1
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL. FEES I
CHARGES ON THE SCHEDULES . .
D. As noted on the CAP, the label must be deliverec
electrical contractor' for signature by his elect
supervisor. The general contractor is.nat authc
to sign the electrical label. ---
Applicant to sign and date .
Whenever possible, the initial application will be L
a worksheet only. Where possible, Building Divisior
will prepare a type written copy and return it to tt
applicant at the time the actual permit is issued fc
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 when the permit is issued.
III.
V. FOR OFFICE USE ONLY.
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CITY OF SPRINGFIELD
City Hall
Springfield, Oregon
Departmant 01 Public Works .
OFFICIAL RECEIPT
No. B 59031. ",
19 <?; 2-
"RotJ~/1Y 6 $4 R
A1tf.ilI 51 s/?~L P.
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Dale 6'-13-
fg~ Rec'd From Bu/ LD';J!:;
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Address ,2r'f ~
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Received For.
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."Ioeas ~RINT.ItS'LITHOQRA"HlER.. EUGENI:. OREQON
. . . . --1_ .
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature
A/2
date .5"-/.7-8"<-
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