HomeMy WebLinkAboutPermit Building 1983-2-9
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Builriinq Pernlit Info: Describe Work(i~e.. Build Single
Family nesidence With Attached GaraQe'
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INFORllATION UNt
726-3753
Sq, Ftq. ','a i n
~q. Ftg. Access.
Sq, Ftg, Other
New Add Alter Rep,
-Fence Demo Change/Use
Other- -
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I IrISPECTION LIIIE,
726-3769
Job Address 7000 IV(a;..-c.
Legal Description \ rr D~?-' \
CITY Uf 5PRINGFIELD
COI1BliIATIDN APPLICATION/PERMIT
ElIERGY SOURCE5:
Heat
('Sater Heater
/)() (X,Sl(,) {
Address
r--,..-."Tlr.
rh,~t ( lA.I?'.""1
Construct; n Lender
7??,- CJZL-
Address
Ut:illiN 11:.M1
(name)
Phone
(address)
Primary
,
Structural
~
W
Electrical
11echanical
CONTRACTOR5
Genera 1
{name}
~ECF.
(address)
(1i~s_no_l
(pxnirps) (nhone no.)
Plumbina
Electrical
~lechanical
PLUJIBIIIG
ELECTRICAL
MECHANICAL
NO,
FEE CHARGE NO
FFF fHARr,F NO.
SQ, FT,
furnace/burner to
BTU's
FFF fHARGF
/
Each single fixture
Residence of
Relocated building
(new fix. ,additional)
New circuits alts.
or.extensions
Floor furnace
and ,vent
S.F. Residence
(1 bath)
Duplex (1 bath) ,each
SERVICES
Recessed wall
Sn~~p hp~tpr ~nrl vpnt
Of
amps.
Appliance vent
seOaril:tfl
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from I
hea t i no or A. C.
.Mechanical _exhaust I
.hnorl.and duct
Wood stove/heater I
I
I
I
Additional bath
Sewer
Temporary Construction
Change in existing
res.; d~.''lCP
multifamily, comm. or
Jndu"trial
~!ater service
Storm Sewer
Of
~amps.
COffi1,/IND. FEEOERS
Install/alter/relocate
di~trih. fppder~
ISSUANCE OF PFRI11T
TOTAL CHARGES TOTAL CHARGE5 TOTAL CHARGE5
WHERE STATE L\lj ,REQUIRES that the Electrical work be done by an, Electrical ,Contractor. ,the electr.ical ,portion 'of this ,perr.:i,t
shall not be valiJ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXM1INED the completed~pp]ication .for permit. and ~o.hereby certify that all information hereon is true
... and 'correct, and I further certi fy that any and all work performed'shall be done; n .accordance wi th the 'Ordinances of -the City
of Springfield and the laws of the State of Ore(]on pertaining to the work described herein, and that fW OCCUPAfKY 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.
C// ~
rWIE(please print) a" _ J't6,~ SIGIIATURE---""-.;'~~_L
FOr. OfFICE USE Q;lL Y --
Sa. Ftg, l1ain
Sq. FVJ. Access
5q, Ftg, Other
DATE 2/9/./ J
Zone_M- '3
Tyoe/Const. !Zl:-/V
Bedrooms
Units
Occy Load
Occy Group
x
SC>.<P. co=
Fi re Zone
x
Value
Value
Value
Flood Plain
Stories
x
,
TDTAL VALUATIorl <"'"~ &>c.
BUILDING PERflIT
Charges an~
Surcharges
,.,-- '0- Plan Ck, COlrrn/lnd
';::> , 65%/Bldo Peor Fpp
------------ Plan Ck. Res
-:< c:> 30%/Bl da Per Fee
Fence
~ .:sO
Systems Development
Charqe (!.5~1 '
PLUl1BING PERMIT
Charges and
Surcharges
. ------------
I Demo
I Sidewalk
I A/C Paving
I Curb Cut
,____________1
ITotal Comb. Permit
g. ~=
I fi1 8."< =
~ '
ELECTRICAL PERI:lT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
L----_._
I
I TOTAL
I. Applicant to furnish
A. Job Address
B. legal Description
1. examole. Tax lot 100, lane County Map Refer
II 03 43
2, exam~le- Lot I, Block 3, 2nd Addition to
~prlngtield Estates .
C. Name, etc. of owner and construction lender
O. Energy Sources
1. examele- heat/electrical ceilinq/or forced
2. examole- waterheater/electrlcal/or SOlar
E. Square footage or valuation. etc. -
I. examole- 125D sq. foot house, 500 sq, foot
2. example- if new project. check-new - if add
check add. etc. ....-.
F. 'Building permit information:
1. example - construct single family house wit
attached garage (_
l. example - remodel existing garage into fami ~Or
3. example - convert single family residence i
restaurant (change of use)
G, Value of work as defined in Section 303 (al of
Structural SpeCialty Code
H, DESIGN TEN1 AHD CDNTRACTORS
To avoid design or construction delays, Build;nl
Division Staff must be able to contact approprii
persons regarding design infonnation or job Sitl (
corrections, etc.
II, Abbreviated Plumbing, Mechanical, & Electrical Sche,
A. Except where blank spaces occur in the descript'
portion of the Mechanical and Electrical Schedu' C
the applicant need fill-in only the No. Boxes a{
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedl
are available at the Building Division (
1. To conserve space on the penmit fonm the sct
have been abbreviated
2. If~theitem(s) to be installed are not covel
the abbreviated schedules you should 'consu11 Ci
full schedules ..
C, BUILDING DIVISIDH STAFF WILL FILL DUT ALL FEES I ~~~I
CHARGES ON THE SCHEDULES "
D. As noted on the CAP, the label must 'be delivere, (~,
electrical contractor for signature by his elect la'
supervisor. The general contractor is ,not authG. (zed --. .
to sign the 'electrical label. ---
-Appl Jcant to sign and 'date
Whenever possible, the initial application will be used as
a worksheet only. Where possible, Building Division Staff
will prepare a type written copy and return it to the
applicant at the time the actual pennit is issued for his
signature.
IV, 'Fees .and .Cha rges
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
.'payab le 'when .the.pennit-;s issued.
,
.'
II
CDMBINATIOH APPLICATIDN/PERMIT (CAP)
.111.
V, FDR.DFFICE,USE ONLY
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-.
ctOF SPRINGFIELD
J
City Hall
Springfield, Oregon
Departmant 01 Public Worka f
OFFICIAL RECEIPT
No.B60392.
Dale FCE~ 'l 199..":3:'
( Rec'd From ~,R"..,/S ~p.,.. C:;;~F
Address /3c:. Ai' <J?"'P ~ .
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Received For.
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+ BRIOe:;;_ PRINTtER_/LlT"OOJUr,PtIER_,.tEUGENE. OREGON
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PennitCl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
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Additional Project Information:
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PLANS REVIEWED BY:
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name
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signature' --7~
date "2 :; d' ~
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OCCUPANCY GROUP .1/- ~
DATE REelEVED :(,---:;L ~ '3
UNITS
OCCUPANCY LOAD
STORIES
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TYPE CCNST.
;:;:(T,I:'-#
LEGAL DESCRfPTlON
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'ADDRESS . '3~/77;t;./,u""";/"_ _
=OWNER _ Vv...n-v //-.....a:;z€6f:.- _( 6..~J t ..z?j'n'0
T,.'=: CCNTl'i"NTS HERE OF HA\'~ er:tN REVIEVJEn. WITH
ALTr.RATIONS lNOICATF.O IN COLOR:::O PENCIL.. CHANGES
OR ,4LT(:R...\T,ONS M!'OEAFT-"R o~r':: !:lELQW SHALL BE
APPROVED BY THE 8UILOIN~ OFFICIAL.
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CITY OF SPRiNGFIEL.D,
ApPROVEO ~~"?ttf- _-_
-
DATE ':?-'7-,!;,. S-
OREGON