HomeMy WebLinkAboutPermit Building 1980-10-8
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726-3769
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Primary 7f;:::;:!.A~" .,!..I
(address)
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(lies. no.) (exolre'S'T
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Electrical
llechaniC.Jl
CO:ITR"CTORS
(",1me)
(address )
(lies. no,)
General
Plumbino
Electrical
I ~~~chan;ca 1
PLUllBlIIG
MECHANICAL
(exo~resj
- (ohane no, 1
ELECTRICAL
FEF I l':HARGE
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I-I-+- ~:w circuits, alts..mp~
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/ TOTAL CHARGES W' :;> ~'"'"
that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
label has been siqned by an Electrical Supervisor and returned to the Building Division.
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lEaCh single fixture
Relocated building
(new fix. additional)
NO I
I furnace/burner to
BTU's
Floor furnace
and vent
S.F. P.esidence
f1 bilthl
Duplex (I ~ath)
each
Recessed wall
__ . "~~~tP" ;lnri VPr'lt
I
I App1 iance vent
seo.ar,Hp
Stationarv eVdO.
cooler ~ "
Vent fan with
sino1e duct
Vent syste~ apart from
heatiM or A.C.
Mechanical exhaust
hood .lnd rlud
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I~!ater service I I
I Sewer l'iJoo '<€~. 'I.!b.~
~'lIStorm sewer~er""". ~
tc;~~ZplfoM"~I58~~
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I I I I
I III
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Addit10nal bath
WOOd stove/heater
ISSUAliCE OF PERtH!
TOTAL CHARGES
WHERE STATE LAW REOUIRES
shall not be valid until the
BaS-' I TOTAL CHARGES
I .
Res 1 dence of
F"
SQ. FT.
New circuits alts.
or extensions
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SERVICES
jTempOrary Construction
IChange in existing
rp~jrlpn("p
Imultifami ly, COrml. or
Tnrlll<:tr1.'l1
IOf
ICO:*l.fINO. FEEOERS
I Install/alter/relocate
di~trib" feedprs
amps.
I HAVE CAREF'lILL Y EXAf.lINED the camp 1 eted app 1 i ea t i on for pennit. and do hereby cert i fy that a 11 in fonna t i on hereon is true
and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Oregon pert.ainin9 to the work de.;tcribe herein, and t7Ja NO OCCUPArlCY will be made
of any structure without the permission of the BuildinQ Oivision. " J J I () I
NAI.IE(pleaseprint) '}}=J)Io;"/5 B l;.J&,)PAISIGNATURE .... e.1'I/JU/J ..t1A1..\!4{'& /O/'?I.G-',
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FOR OFFICE USE OIlLY
Zones Fz:tlr.MNP Flood Plain _ Bdrms _ Type Cnost.
Deey Load" Ol.:cy GrouD Stories IJrdt.. '"3Q.)(
--A-Ce U U jj T-"S'O iT,\(A~ R y
Plan Ck. Comm/lnd.
65r,/Bld~ Ppr Fpp
Plan Ck. Res
30Z/Bldo Per Fee
Sq Ftg. Value
"- "L- 'IdGld,/Q#lrV.'uC /S~, ~--
BUILOlllG PERI.IlT
Charges and
SurCharges
____~7L-:':._
1'-/.8<1
"'0 s: "...
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~'2 .20
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IS-: ~O
SOC
I TOTAL
I
<tillS"
I Other
I Other
Other
Total
PLU'.lBING PERliIT
Charges and
Surcharges
Fence
Spr"inkler System
I Demo.
Ale Pavi ng
ELECTR I CP.L PERllIT
Charges and
Surcharges
11ECHAN I CP.L PERI'IIT
Charges and
Surcharges
Curb" Cut
'. 00
!(),
~.'-'
Sidewalk6&'O
Storm Sewer Connec.
Comb. Permit I
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CO~BINATIOi~ APPLlCATlON/PERfIlT (CAP)
1.
, II.
Applicant to furnish
A. Job hddress
B. legal DescriPtion
1. examole- Tax lot 100. Lane County Map
II OJ 43
2. examnle- lot 1. Block 3. 2nd Addition
Sprlngfield Estates
C. Name. etc. of owner and construction lendel
O. Energy Sources (
1. exa:r.Dle- heat/electrical ceilinQ/or fOt -.
2. exa~Jle- waterheater/electrical/or s~
E. Square footage or valuation, etc. -
1. examD I e- 1250 sq. foot house. 500 sq. f '''9
2. exa~Dle- if new project. check-new - if ~~~
c::JeClo:. add. etc.
f. Building permit information:
1. example - construct single family house ~n
dtt::!ched gar~ge
2. exa~ole - remodel existing garage into
3. example - convert single famlly residen_
restaurant (change of use)
G. Value of work as defined in Section 303 (a)
Structural Specialty Code
H. OESIG:I TEA:-i ArlO COIITRACTORS
To avoid design or construction delays. Bull tY
Division Staff must be able to contact apprc ~t
persons regarding design information or job
corrections. etc.
Abbreviatea Plumbing. r'lechanical. & Electrical S ,du
A. Except \':here blank spaces occur in the descr \i(l'
porcion of the Mechanical and Electrical 5ch
the aoplicant need fill-in only the No. Boxe
to the appropriate item(s) to be installed I
B. Full Plumbing, l.lechanical. and Electrical Sci ~lf
are available at the Building Division
1. To conserve space on the permit form the
have been abbreviated .
2. If the item(s) to be installed are not c( {ec1
the abbreviated schedules you should con~
full schedules
C. BUILDI:IG OIVISrDN STAFF WILL FILL OUT ALL FEE
CHARGES 011 THE SCHEDULES
D. As noted on the CAP. the label must
electrical contractor for Signature
SUDerv i sor. .The genera 1 contractor
to sign the electrical label.
Applicant to sign and date
Whenever possible. the initial application will bl
a worksneet only. Where possible. Building Divis'
will ~reDare a type written copy and return it to ~~
applicant at the time the actual permit is issued
signature. f.-. _
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 I'lhen the permit is issued.
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be delive
by his 01
is not au
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IV.
V. FOR OFFICE USE O;~LY
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CITY OF
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SPRINGFIELD
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City Hall
Springfield, Oregon
Deportment of Public Works
OFFICIAL RECEIPT
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AddressqSn :-t-a i h ))1 ill} Qv
Received For:
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Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Additional Project Information:
PLANS REVIEWED BY:
na~e Lc:RNIfE /2e:-..::::;-:
signature
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