HomeMy WebLinkAboutPermit Building 1982-12-30
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INfORlIATION UNt I
726-3753
Sq. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add Alter Rep.
--Fence Demo Change/Use
Other- -
,
,
I IrlSPECTIOII 1I11E.
726-3769
Job Address
CITY Of SPRWGF I ElD
COIIBIIIATlON APPliCATION/PERMIT
E!lERGY SOURCES:
Heat
Hater Heater
Legal Description
1009 Main Street
17-03-35-41. TL 5600
Address
?~n Nn...+1,
Springfield,
d c::........oo...
Phone
ValUE .of Hork:
40.500.00
Buil~inq Pernlit Info: Describe Work{i.e.,
Familv Residence With Attached GaraQel
Build Single
Owner Sori ndfi el d lit.; li t.,v Rn~rrl
Oregon
97477
746-8451
Facilities Building
Construction lender
Address
DESIGN TEAll
{name}
Phone
(address)
flics.no.1
(exoires)
(ohone no.
Primary
'Desiqn Systems
PO 80x 3425. Euaene. Oreaon
683-6343
Structural
Electrical
f1echanical
CONTRACTORS
{name}
(address)
fl ics. no. 1
(exnirec;)
(nhone no.1
General Construction Manaqement
PO Box 3425. Euqene. Oreqon
683-6343
PlUllBlIlG
ElECTRICAl
~
".
MECHANICAl
Plllmhino
Electrical
~1echanical
Each single fixture
FfF '(HARr.F Nn FFF .cJJARG.E. NO.
Residence of furnace/burner to
SQ. FT. BTU's
FFL .J:HARGE.
',/
..JJQ.."
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Ouplex (1 bath) each
New circuits alts.
or extensions
Floor furnace
and vent
SERVICES
Recessed wall
Sn~rp hp~tpr ~nd vpnt
Stonn Sewer
Of
COI'if1. /lNO. FEEDERS
Install/alter/relocate
d;~trih. fppnprs
amps.
Appliance vent
spoaratp
Stationary evap.
cooler
Vent fan with
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Additional bath
Sewer
Temporary Construction
Change in existing
rps j qp.ncp
multifamily, camm. or
Industrial
~Iater service
Of
amps.
ISSUANCE OF PFRlllT
TOTAl CHARGES TOTAl CHARGES TOTAl CHARGES
WHERE STATE lAH REQUIRES that the Electrical work be done by an 'Electrical Contractor, the electrical portion of this penoit
shall not be valid until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXN1INED 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 Derformed 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 UO OCCUPAIKY 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 ORS 701.055 will be used on this project.
IIAl-IE(please print) /'./-I-Ji?/'7 ,19. .SmrR../ SlGrlATURE ~ ~
FO~ OFFICE USE OrllY
Sn. Ftg.
Sq. Ftg.
Sq. Ftg.
omJ..'t- .gO ~ \-
I.
Zone C-4
Tvpe/Const.
Bedrooms
Stories
5-N
NA
1
Units
Occy load
Occy Group
9820
x 4.12
Fire Zone NA
Flood Plain NO
B1
t1ain
Access
Other
x
Value
Value
Value
40.500.00
x
TOTAl VALUATION 40,500.00
BUIlDING PERfIlT
Charges an~
Surcharges
160 00 Plan Ck. Comm/lnd
. 65%/Bldo P~r Fpe
------------ Plan Ck. Res
6.40 30%lBl do Per Fee
Fence
104.00
syste.ms Development
Charoe (1.5~)
607.50
Plur4B ING PERMIT
Charges and
Surcha rges
Demo
ElECTRICAl PERI:IT
Cha rges and
Surcha rges
Sldewa 1 k I 7.00
I A/C Paving I Total Comb. Permi t
I Curb Cut I i
I L LTOTAL 884.90
MECHANICAl PERMIT
Charges and
Surcharges
~.
~
"~:r
COMBINATION APPlICATION/PERMIT (CAP)
.~:
I. Applicant to furnish
A. Job Address
B, legal Description
I. example- Tax lot 100, lane County Map Ref. I.fe
II oj 4J
2. example- lot I. Block 3, 2nd Addition to
~prlngtield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examole. heat/electrical ceiling/or forced
2. example- waterheater/electrical/or s~
E. Square footage or valuation, etc. - (
I. examole- 1250 sq. foot house, 500 sq. foot ~,
2. exa~le- if new project. check-nfw - if ad
check add. etc.
F. Building permit information: r
1. example - construct single family house wi ~n
attached gar"ge
2. exam~le - remodel existing garage into fam"
3. examole - convert single family residence
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of
Structural Specialty Code
H. DES I GN TEAI'I AND CONTRACTORS (',
To avoid design or construction delays, Buildir
Division Staff must be able to contact appropri
persons regarding design information or job sit
correct ions, etc. ..
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 l,
B. Full Plumbing, Mechanical, and Electrical Sched
are available at the Building Division
1. To conserve space on the permit form the sc: d.
have been abbreviated (
2. If the item(s) to be installed are not cove,
the abbreviated schedules you should consul~
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 deliverer
electrical contractor for signature by his elect
supervisor. The general contractor is.not authc
to sign the electrical label. ---
Applicant to sign and date
Whenever possible, the initial application will be u
a worksheet~Dnly. Where possible, Building Division
wi] r prepa re; a type writ ten copy and return it to th
applicant at the time the actual permit is issued for. nlS
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
payable when the permit is issued.
Ill.
V. FOR OFFICE USE ONlY
.
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CITY OF SPRINGFIELD
City Hall
Springflald, Oragon (t
Department 01 Public Works
OFFICIAL RECEIPT '
, No. B 60193!.
Date \~- :s() 1995:2- '. '
Rec'd Fr~m -!)~ '
AddressvO(C0 ~:300
~G.\~33
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Received For:
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Amount Received
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AUTlIORazEoSlGNATURE
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D~IGGD I"I'lINTIII'lS/LITHOGRAI"HE'UI, EUGENE, OREGON
Permit
Cl,d'J\A--
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
An additjonal plan and permit required for all electrical work to be done in this
buil di ng"
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name--Lnrn~ w Pl~~~
signature
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date
12-29-82