HomeMy WebLinkAboutPermit Building 4-11-1
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. Job' Addre;;- s-i:/ ~ ':Jj n :5"/"
Legal DescY'ftijO: '3671
/1()'L-"34<UJ
owner'r/?; ~ bard [J,R c;{ Y S
Address~")'~9 /h "./1 r, 5T .
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.TOTAL CHARGES laDO .1 TOTAL CHARGES
.\.JHERE .sTATE Ul~ REQUIRES ;thatthe' El ectri ca 1 work be .done by' ancEl ectri ca 1
shall not be va1H until trela,be1:has been"osigned by an. Electrical Supervisor
.. ,
'INSPECTION'LINE
7:::6-3769 . .
Construction 'Lende~
Address
DESIGN TEAr~
(name)
. Primary
Structural
Electrica.1
: Meehan i ea 1
. CONTRACTORS
Genera 1.
P1umbinq
Electrical
'~lechanical'
. PLUr.1BING
NO.1 . . FEE . CHARGE
Eaehsingle.fixtur~'
. Relocated building .
:(new fix. a'dditional)-
.171 Fba~~~ i dence
Dup1 ex (1 bath) each
Additional bath.
Iwater servi ce
Sewer
r
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I
'1
1000 .
Storm Sewer
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C1TY OF. SPRINGFIELD ,'- iNFOR'1ATrON"'LrNE-
COMBINATION APPLICATION/PERMIT' 726-3753 .
ENERGY SOURCES: Sq. Ftq. Main
'Heat-l;./l, G q oS ~q.Ftg. Access.
t~ater' Heater & q S Sq. Ftg. Other Jk1'A.
~..-f! ~lew-XAdd-,-A lter -,ll.ep. .
Ranq~, Fence . Demo Change/Use'
ValuE. of Hork:. O'~ -Other- _.
',z?d1 ._.r- . .
Bui1dina Pe.rnlit Info: Describe Work(Le., Build Single
Phone7~~>'~..J 1
7 //~ JJ Family Residence With Attached Garaoe
NOTIFIED'
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0'
~.-
Phone
(address)
I, () If_A (J.J/llrJ .P ~ a
" A (Ll1Y\..Lf2..,.e./f et/)f;;JrYj
~'I-I~N/l.1 e,JltJ~
.il ics.nci:)' Cexoiresl , (ohoneno. 1
(1 ics, no.)
. (exoires).
( ohone . no ,)
,r;:
-.:...-,7.......
.... ELECTRICAL
MECHANICAL
FFF' rH~Rr::d. NO.
FFF
rHARr::F
SQ . FT.
furnace/burner to
BTU's
. New circuits a1ts.
~ or extensions
. ~ OR MtJl21!.
/SERVICES
Floor furnace
. .and vent .
Recessed wall
Soace heater and vent
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Temporary Construction
Changein:ex.isti,ng'
res i denc'e .
multifamily; comm. .or
Industrial"'
Of amps.
ICOMM./IND. FEEDERS
Insta1l!a1ter/felocat~
distrib. feeders
Apo1iancevent
seoarat~
Stationarv'evaD~
coo'l er.. .
Vent fan with
sindleduct
Vent system apart from
'heabna or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
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8.. ()C7 .
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Of
J:-rlelt~:( "!lUrrJ rb>r.:1-
~DO
'amps.
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. ISSUANCE OF PF.RI1IT :5 00
ls~o TOTAL CHARGES <8fd!2
Contractor:, the. electrical .portion of this permit
andreturned:to the' Building Divis.ion
. I HAVE CAREFULLY EXA~1INED the.compl'eted appLication Jor flermit, and do her:eby certify that all information hereon is true
and correct,and r further .certifv. that any and all work oerfo'rmed shall ..be done in accordance'with the Ordinances of the City
of Soringfieldand.the Laws of the Stateof.Oregon oertaining.to the work described hereiri; and that NO OCCUPAr~CY will be made
of any structure without the permission of the Building Division.. I further certify. that. my registration with the.Builder's
Board ts.i n :fu 11: force and' efJectasrequi red by ORS 701.055 , that tfexempt the basis for exempti oni s noted hereon,. and that
only subcontractors:and>employees who are .incomoliance with ORS 701.055 will be used on this'flroject.' .
'Ilad~ e~/JYl, 13a-J6rr::NATURE 7AA,"~~'/1~7-/7
,. FOP-OFFICE .USE Oi.ILY .,~ . fl.
Units, I Sa. ,Ftg. ~1ain .
Occy Load Sq. Ftg.. Access'
OccyGroup R"" 3 Sq. Ftg. other
f~Ar'lE(please print)t1rf{.' ~
ZoneR-I.
. F.ire ZO(letIt
FloodPlain No
Tyoe!~onst.' V-Af
Bedrooms.'" . ,,-.
. 'Stories
I
x Value
x Value
llnA. x' , Val ue
~S(oo!'O
TOTAL VALUATION ~;1l)D~
BUILDINGPERmr
Charges and
Surcharges
r.., '. I P1 an .Ck.. Comml-Ind
:....:....~____~~~'b()f:L~~%/Blda Per Fef!
. .,. I Plan c'Ck. Res .
,q" JO%/B1dq'PerFee
ISystems Development "1.
Cha rqe 0.5%) .
10-7.1. I.
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PLur~B ING PERMIT
Charges:and: '. '.
Surcharges
_______~t~~
.lJ.tJ
____'-___L~!l1Z
"
.100
:.:.~______j.!_.l!Q
, ?>:t
ELECTRICAL PERMIT
Charges,and
Surcharges
t1ECHANICAL PERMIT.
. Charges and ~."
. Surcharges
~.~o
: Fence
D~Rlo .
'Sioewal k
A/C Paving
Total Comb. Permit
51.1.f
#5'J'.;Lg
J
Curb Cut
TOTAL
t
"';~fl"";';';'
~"\' pp
.A.Job Address
'B. Legal Description
example. Tax Lot 100, Lane County Map Reference
03 43 ..... .
example- Lot 1. Block 3, 2nd Addition to'
Springfield Estates
, etc. of owner and construction lender
Energy Sources
1. example- heat/electrical ceilinq/or forced air qas
examp]e- waterheater/electricalior solar .
footage or valuation, etc.
example- 1250 sq. foot house, 500 sq. foot garage
example- if new project, check new - if addition,
check add, etc.
Building permit .information:
1. example - construct single family house with an
attached garage
2. example - remodel existing garage into family room
3. example - 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 adjacent
to the appropriate item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on
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 the
electrical contractor for signature by his electrical
supervisor. The general contractor is not authorized
to sign the electrical label. ---
III. 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.
PERMIT VALIDATION
rv
OF
SPRINGFIELD
(J.
City Hall
Springfield, Oregon
Depa'rtment of Public Works
OFFICIAL RECEIPT
No. B 5 2 0 3 6 (',:
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For: tl(\\ ~ cDJ CO
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Received
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AUTHORI:Z'tt> SIGNATURE
SHELTON-TURNBULL PRINTERS. l::UGENE OR 97401
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V. FOR OFFICE USE ONLY
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
signature d~~
da te /~':3/-77