HomeMy WebLinkAboutPermit Building 1980-11-24
lUFORtlATION LINt
726-3753
So. Ftq. I.'ain cr-O.:L.-
~q. Ftg. Access.
So. Ftg. Other
l .Uew Add Alter Rep.
RanQe '~Fence_Demo_Change/Use
Value of I./ork: 11" _Other
Owner ~j(,~,,,V 5CHA9,t/~vP' ! 'f?() - .
../.. / / <>~")" 'G~BUir~~nQ Permit tnfo: Oeser be Work{l",e.. Build Single
Address IYI~ IfJHr'.!f.NAl4. Phon~:r~,~ Family Residence 1.lith P.ttached r.araae)
I
I I
1/0.0-:1
I
I
I
/tJ.tJ.'7 I TOTAL CHARGES
Contractor. the electrical portion of this
and returned to the BUilding Division
I HAVE CAREFULLY EXN11NED the completed application for germit. and do hereby certify that all information hereon is true
and correct. and I further certify that any and all \lOrk oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Orel]on oertaining to the work described herein, and that llO 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 ons 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.
IW\E(please print) &"~'II!V ~Hh..cNf!;[r,II.~TURE~', ./~L
FO!!" bFFICE USE O;jL Y ,,- ,. ~ --
Units 'n. Ftg. rlain 503 x
Occy Load - Sq. Ft9. Access x
Occ'y Group M... I Sq. Ftg. Other x
/2-t<,..-""'~~
ISystems Development I
Charoe (1.5.,)
5 00 ) J-?4- 'i()
fJj},A::t 0B/ t =-Q
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I
CiTY UF SPRINGFIELD
COMBIiIATION APPLICATION/PERMIT
EllEReY SOURCES:
Heat
Hater Heater_
,
I WSPECTlON LIIIE
726-3769
Job Address /~~ S' (;JKrn A/AlR
Legal DmriPtion'.ot"Gq I }/(e
<T.
U III O:...CHL/
b
Construction Lender
1)&7.4 CHe..-D
Address
DES IGN TEArI
Phone
{address 1
(lics. no.)
(nameJ
Primary
";Je'~'7 ~Ah..v~......c/
~
Struct\..l:'"al
Electr:::ai
;~echanic3l
CG~HR;.CTG~S
Inal!1ei
(addrpss)
l1ir:~. no.)
Genera 1
A ftI AI ~-,e
?lur.:bina
, ::lectrlc3l
".~':!-.3.,i::~ 1
?U;lloUjG
ELECTRICAL
."}.!
I FE~ CHA.RGF
Nn I
I Residence of
SQ. FT.
New circuits alts.
or extensions
~t"t" 1 rUAPl~~ WL
f I'acn
single fixture
$." $.00
I~~ioca~ec oUllding
(new fix. 3~jitional)
S.r. ?esidence
(J bathl
Duplex (1 bath) each
SERVICES
Additional bath
ITempOrary Construction
IChange in existing
l'"p~ i q~n('~
multifamily. corron. or
Tnduc;trial
Water service
Sewer
Storm Sewer
Of i!mps,
S.Oo ICOr11".IIND. FEEDERS
I Install/alter/relocate
nidrih. fpprlpl'"C;
.I 10f 4 b /I- amp~
/ 7('V -.5, VI/rIj" Di"~I)
I
I
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TOTAL CHP.RGES //J ,(}rJ I TOTAL CHARGES
WHEP.E STATE L.'lj REQUIRES that tile Electrical work be done by an Electrical
shall not be valij until the label has been signed by an Electrical Surervisor
Zone [!- /
Fire Zone .-
Flood Plain AIIl
.~~d....
"
"II-lot
Type/Canst.
Bedrooms
Stories
I
BUILDING PERI.IIT
Charges anc
Surcharges
;:,'
Plan Ck.
dJC).t)O 65\/Bldo
------------ Plan Ck.
t 'if {) 30%/Bl do
:J{J ,00 I Fence
--------:~~-I Demo
______e\tJ, 00 I Sidewalk
,,?O I A/C Paving
I Curb Cut
,------------1
CorrrnlInd
Ppr Fpp
Res
Per Fee
PLU'1BlNG PERMIT
Charges and
Surcha rges
ELECTRICAL PERr~IT
Cha rges and
Surcharges
I1ECHANICAL PERMIT
Charges and
SurCharges
?]
-
-
...D
-..\
II
S"# <:.])
(exoires)
(phone no.
(pxoi rps)
(ohonp nn. \
MECHANICAL
~!='t"
nUIQf,~
furnace/burner to
BTU's
/
Floor furnace
and vent
Recessed wa 11
Snar:p hpatpr ann vpnt
I Appl iance vent
'iPDarate
I Stationary evap.
cooler
Vent fan with
sinole duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust
hood and duct
II-SOOd stove/heater
lSSUANCf OF PFPJ1IT
permit I
om~..a Y-"G'
Value
Value
Value
TOTAL VALUATION 1.000 =
Total Comb. rermit
I
I TOTAL
>P'taJ., ~ {)
it
-,
COMBINATION APPLICATION/PERMIT (CAP)
III.
t. Applicant to furnish
A. Job Address
B. legal Description
!. examole- Tax Lot 100, Lane COOl ~a
II 03 43
2. examole- Lot I. Block 3, 2nd Ac
~prlngtield Estates
C. Name. etc. of owner and constructio ~n,
D. Energy Sources
1. examole- heat/electrical ceil in
2. exa~~le- waterheater/electrical
E. Square footage or valuation. etc. ('
I. examo I e- 1250 sq. foot house, 51
2. example- if new project, check-r
cneclI; add. etc.
F. Btlilding pemit information: C Rec'd
1. exam~'e'" construct single 'fam; I ~,
dt7.C!.cneo garage
2. examole.. remodel existing garag
3. exali1~le - convert single family;
restaurant (change of use)
G. Value of work as defined in Section:
Structural Specialty Code
H. DES I GN TEA;.! MID CONTRACTORS r:
To avoid design or.construction delay Q.
Division Staff must be able to cantac
persons regarding design information
corrections. etc. (
II. Abbreviated ?lu:r.bing. r'lechanical, & Electl .,
A. :xce~t ~here blank soaces occur in thl
:~rtion of :r.e Mechanical and Electric
:ne a;:lplicant need fill-in only the Nc ,o^-
:0 tne a~pro~riate item{s) to be insta ~
B. Full Plumbing. :1echanical, and Electri
are available at the Building Division
1. To conserve space an the permit fo tn,
have been abbreviated \
2. If the item(s) to be installed are
the abbreviated schedules you shou'
full schedules
C. BUILDl1iG DIVISION STAFF WILL FILL OUT I (FF
CHARGES Oi; TIlE SCHEDULES
O. As noted on the CAP. the label must be
electrical contractor for signature by
suoervisor. The general contractor is.
to sian the electrical label. .
Applicant-to sian and date
Whenever possibie. the initial application \
a worr.sheet only. Where possible. Building
will preoare a type written copy and return
applicant at the time the actual permit is i
signature.
IV. Fees and Charges (
Plan check fees are due and payable at the t ,
application. and no plans will be processed ~~(r tnese
fees are paid. All other fees and charges are due and
payable when the pennit is. issued.
.
.
PERMIT VALIDATION
. ,
CITY OF
SPRINGFIELD
r
City Hall
Springfield. Oregan
Department af Public Warks
OffiCIAL RECEIPT
(
No. B
Date 12 ~ 3! l?~()
From ~~9Ox,-~?~t:.nt~
Address 14(.)~ u - 'yt-
55504("
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Received
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2C),OO
r 6,0
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\ a. Amount Received
(
~1--_ 4-Q CP-.
(i~ 8Y _"
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(I~"UD ..D.",U",
."l~TO"'TU"..::~~T::~'<T~.. . IlUOI..t:, Oil .'.01
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V. FOR OFFICE USE ONLY
. Permi t Cl erk
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PROJECT CONDITIONS.TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information: /~:. ~ ,p.I1' ~ ~LL."Y' ~~
if
~~. ~~_ c,.-/. 7"...1& -:,.7.,:......... M.-7""'u /,.,'.'fi; . ., --,A.
u v v
./v-gf,~tJ k M7-K4-/'d' __war. ~'!;'~'. ~ ~ ~, :
tJ . ;.v
~
PLANS REVIEWED BY:
name
signature
&,
date 11-;;<(,-8"0
~._....-