HomeMy WebLinkAboutPermit Building 1982-9-3
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I INSPECTION LIIIE. CITY Uf SPRWGfIELD
726-3769 CDrmWATION APPLICATION/PERMIT
J b Add '/0 r \" . C -II E!IERGY SOURCES:
o ress.,,:)() '-I I) "':1.\'),(, <,\)t,,,~ P!ll~ Heat
Legal Description 'I n~ 'd S '=) l (), 17J0 !Iater Heater
Ranqe_
ValuE of Hork:
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Address..:\ ()<I'O
y€,(I..c.J ~O()ht \4alr <;0[0'1
OI,\",u,C_ SD(I~~{t..\L Phone
Construction Lender
Address
UE5 I uN TENT
(name)
Phone
(address)
Primary
Structural
Electrical
11echan; ca 1
CONTRACTORS
, INFORlIATION LINE
726-37S3
Sq. Ftq. 1,Iain
~q. ~tg. Access.
So. Ftg. Other
New Add Alter Rep.
-Fence Demo Change/Use
Other- -
-
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Builolna Pernlit Info: Describe Work{i.e., Build Single
Family Residence With Attached Garaae)
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( ~.om ml" 'f ri (1,,1 Kp,m(Jcllf>-,
flies. no.)
(ohone no.l
(exoirf!sl
(address) (lies. no.)
10101.\ \lnoo/k ~f.\P"P" ICCl/d
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ELECTRICAL
FEF r.HI\Rr.F Nn~
S:'- Residence of
SQ. FT.
I New circuits alts.
or extensions
SERVICES
(name)
't4o.:t'f'Y A."hbclV'l'\
6c o-I.;", IJ, 't.-\ec+,(;C
+-,'re 5orl\\~\'Y
Genera 1
Plumbina
Electrica'l
f..lechanical
\-bl(()f'''-. -\- ~(-ic..p
PLUllBlIlG
riO,
I
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath)
each
Additional bath
(~xDir~s)
(ohnn~ nn.
;;,JiJg/){"!.,
34?'-S"~qo
MECHANICAL
~r:L...cH8.R.G.E. NO,
r:r:L..tliARG.E..
I
furnace/burner to
BTU's
I~-
Floor furnace
and vent
Recessed wall
~n~rp hp~tpr ~nrl vP~t
amps.
Appliance vent
seoarate
Stationary el/ap.
cooler
Vent fan with
sinale duct
Vent system apart from I
heating or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Hater service
Temporary Construction
Change in existing
res j deflCe
multifamlly, COJrnl. or
Industrial
Of
CO~1,/INO. FEEDERS
Install/alter/relocate
ni~trih_ fppdpr~
I
t: 0.. TOTAL CHARGES I~. - TOTAL CHARGES
that the Electrical work be done by an 'Electrical Contractor. the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
,
I HAVE CAREFULLY EXM11NED 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 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 NO OCCUPAUCY 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 701.055,Wiji be used on this project.
IWIE(please pr;nt)+bVY(! .It<.kltcvv\, SI(,!lATURE ~ /J-t{.t-uw/' DATE q-:s-!,'d"
FO~ OFFICE USE m.LY v
Sq, Ftg, flain
Sq. Ftg. Access
Sq. Ftg. Other
Sewer
Storm Sewer
Of
TOTAL CHARGES
WHEnE STATE L~W REQUIRES
shall not be valiJ until the
Zone
Type/Canst.
Bedrooms
Units
Occy Load
Occy Group
Fire Zone
Flood Plain
Stories
BUILDING PWIlT
Charges an~
Surcharges
/....... 0" Plan Ck, Co","/lnd
/"". 65%/81 do PPf Fpp
-------.-~~- Plan Ck, lies
-,' 30%/Bldo Per Fee
_____s;.~____ Fence
. ,,:/e> Demo '
PLU',IBING PERMIT
Cha rges and
Surcharges
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ELECTRICAL PERI:IT
Charges and
Surcharges
----/(;!>. -
. .yO
Sidewalk
A/C Paving
11ECHANICAL PERMIT
Charges and
SurCharges
Curb Cut
amps.
ISSUANCf OF PFRIIIT
Value
Value
Value
TOTAL VALUATION
x
x
x
b.St!:>
Systems Development
Charqe (1.5~)
Total Comb. rermit
7(;, . --
TOTAL
"3 2. ~o
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Oescription
I. examole- Tax Lot 100, Lane County Map Reference
1/ o.j 43
2. examp'le- Lot I. Block 3, 2nd Addition to
springtield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. exam21e~ heat/electrical ceilinqlor forced air (
2. examole- waterheater/eJectrical/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, 500 sq. foot gara!
2. example- if new project. check new - if additior
check add. etc.
F. Building permit information:
1. example - construct Single family house with an
attached garage
2. exam.ele - remodel existing garage into family rc
3. exam~le - convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM 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 adjacE
to the appropriate item(s) to be installed
8. Full P.lumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedul
have been abbreviated
2. If the item(s) to be installed are not covered c
the abbreviated schedules you should consult the
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
O. As noted on the CAP, the label must be delivered to
electrical contractor for signature by his electrica
supervisor. The general contractor is.not authorize
to sign the electrical label. ---
Ill. Applicant to sign and date
Whenever,possible. the initial application will be used
a worksheet only. Where possible, Building Division Sta
will prepare a type written copy and return it to the
applicant at the time the actual permit is issued for hi
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.
V. FOR OFFICE USE ONLY
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PERMIT VALIDATION
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CITY OF SPRINGFIELD
(
CllyHall
Sprlngllald. Oregon
Department 01 Public Works
OFFICIAL RECEIPT
, No. B 59694
Dat__~ ri- i. \519 8~ I
Rec:d~::;]i~~.ll\l~ C'~ I
Address \fJ\. 04 t~.A )-{l 1\ Q .tN
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Received For:
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, A )Q~,J) , c:::; '.00
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.40
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Amount Received
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.Rllla. PRINTER8/UTHOaRAPHIER.,IEUaI:NK, OREGON
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Permit
Clerk~~)
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit .applicant exempt from registration with the Builder's Board because:
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Additional Project Information:
PLANS REVIEWED BY:
name
signature
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