HomeMy WebLinkAboutPermit Miscellaneous 1984-2-28
12"0 M/J/N 5r
legal Oe<cription 17-C3-3:,-C{/ 1X>2<JJ3
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.i UirlSPECTIOrl L1IIE
[ "1726-3769
;
Job Address
Owner ~Gsc::ph
Address
i).
\?.&Q ''''r\,..,
S,"",,,'t'=' c.d},
Construction lender
Address
UESIGrI TEAI.I
lnamel
Primary
Structural
Electrical
Meehan; ca 1
CONTRACTORS
(name}
Genera 1
Plumbina
Electrical
Hechanical
PlUllBIIIG
NO.1
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
11 bath 1
Duplex (1 bath) each
Additional bath
Hater service
~15I'sewer
Istorm Sewer
I
I
I
-I
I
I
TOTAL CHARGES
WHERE STATE l~W REQUIRES
shall not be vali1 until the
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CITY OF SPRI;IGFIElD
COtIBI;IATIDN APPLlCATION/PERMIT
E!IERGY SOURCES:
Heat
Hater Heater
Ufir--r ·
~
~
~
~
ti
BAn 11 (',
INFORlIATION
726-3753
So. Ftg. 1.lain
~q. Ftg. Access.
Sq. Ftg. Other
Ilew Add A Iter ~ep.
Range -Fence Demo Change/Use
Valu.!. of Hork: -Other- -
"'@;o.e,o ~_ _.c.V
Builtiina Permit Info: Describe Work(i~e.. Build Single
Familv nesidence With Attached Garaael
^ A'
..1 "'" 1,)
Phone
0.::1 c.t."........
Q')-<ill
t.,..."" "t"'
:r."<;~\IA.h(,,
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sc........ c.--\
Phone
(address)
(l ;C5. no. \
'l{
"..
"
(ohane no.
(address'
(lir:~. no.'
(p){nirp~)
(ohonp nn )
ELECTRICAL
. <:ELI J:IlARG.J.1lo.....
MECHANICAL
I FEF I I':I-IARGF .JJO
I...EEL I
Residence of
furnace/burner to
BTU's
SQ. FT.
New circuits alts.
or extensions
I Floor furnace
and vent
I' Recessed wall
~n~rp kp~tpr ~nrl
I
v,:>"t
I SERVICES
I
I
I
I
:~
I I
I I I Install/alter/relocate
rli"trih fppopr"
I I IOf
I rl
I I I
I l I
3~ 0110 I TOTAL CHARGE5
that tile Electrical work be done by an, Electrical Contractor, the electrical [lortion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I Temporary' Construction
[Change in existing
TP-s-5dpnrp .
Imu1tifamily, COIl1l1. or
Tnnuc:t.rial
I App 1 i ance vent
c:poarate
I Stationary evap.
cooler
I Vent fan wi th
..inole duct
I Vent system apart from I
hea t i nq or A. C.
I Mechanical exhaust
hood and r1uct
I \'Sood stove/heater
i
I
I
Of
amps.]
COMfl./IND. FEEDER5
amps.1
IS5UANCE OF PFRllIT
TOTAL CHARGES
I HAVE CAREFUllY EXNlINED the completed apfllication 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 rw OCCUPAHCY 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 OP.S 7~1.055 will be used on this project.
IWIE(please print) 07',sfOj) h O.
QIQ^Oo.
S lc,rIATURE \\..0Ql)Ul,
FO~ OFFICE USE ~ - -
Sq, Ftg. l1ain
Sq. Ftg. Access
Sq, Ftg. Other
D.-9:r- ( _DATE~~ I
x Value
x Value
:x ValuE'
TOTAL VALUATION
Plan Ck.
____________ 65%/Bldo
Plan Ck.
30%/Bldo
____3$= 4C [ Fence
/. % I Demo
I.Sidewalk
lAIC Pavi ng
Zone
Fire Zone
Flood Plain
Tvpe/Const.
Bedrooms
Stories
BUIlOHlG PERHIT
Charges an~
Surcharges
PLur1BING PERMIT
Charges and
Surcha rges
ElECTRICAL PERI~IT
Charges and
Surcharges
rlECHAtlICAl PERMIT
Charges and
Surcharges
Units
Occy load
Occy Group
Conmll nd
Ppr Fpp
Res
Per Fee
Systems Development
Charoe (1.5~)
I
I
Total Comb. Permit
L I Curb Cut
I -----~~.=::---:-I --
1-
I'OTAL,
I. Applicant to furnish
A. Job Address
B. Legal Description
1. examole- Tax Lot 100. Lane County Map Reference (.
17 oj 43
2. exam~le- Lot 1. Block 3, 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examo 1 e- hea tie 1 ectri ca r ceil; nQ/or forced air c
2. examPle- waterheater/electrlcaf'tor solar '
E. Square footage or valuation, etc. - (
I. example- 1250 sq. foot house, 500 sq. foot garal .
2. example- if new project, check-new - if addition
check add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. exam~le - remodel "existing garage into family ra
3. examyle - conve~~ single family resjdence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEM4 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.
II. 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 adjacer ('
to the appropriate item(s) to. be installed
8. .Full Plumbing, Mechanical. and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedulE (
have been abbreviated
2. If the item(s) to be installed are not covered or. ~
the abbreviated schedules you should consult the
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND (, '
CHARGES ON THE SCHEDULES t
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. ---
Applicant 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 permit is issued for his
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.
.
COMBINATION APPLICATION/PE~~IT (CAP)
,
Ill.
V. FOR OFFICE USE ONLY
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Springtieil.i, v(8gon
Department 01 Public Works
OFFICIAL RECEIPT
No. B 62504
(
Date rt!EZ? -:? g, 19 ~ r
Rec'd From,. J. V t G,., <:7'> ,'n ( S f> /h.~,
AddressSl':;?S-6~e- &A"'.b-7 ,/F'P.
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Received For.
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2. -Y"S rr O~ ~/~
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4T /:< SCD m..4-//Y $/;
1-,8 -#:::. &4t'6/S~
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1.//6
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3h": $/.p
Amount Received
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.1111008 I"IIIINTlEIII8/LlTHOOIIIAI"HI:IIIS. lEUOlEHlE. OllllEOON
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Pennit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
5" pc. W,/< c..
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Pennit appl icant exempt from registrati on with the Bui 1 der' 5 Board because':
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n,,_.pAr-7,e-V r ~'/<~~-=-.- ~~ s-/r~ 1"A07~"'b~€~~-'r~:
PLANS REVIEWED BY:
Additional Project Infonnation: AlDr8: ~
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nameJ. ~r; j .!~ ,~~lgnature~" -'
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;27"" " date 2-:2..!!:-8V