HomeMy WebLinkAboutPermit Building 1980-10-24 (2)
I IrISPECTIOIl LIIlE
726-3769
Job Addres~
Legal De~cription
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CiTY OF SPRIIlGFIELD
COIIBl;IATlON APPLICATION/PERMIT
E!lERGY SOURCES:
Heat =.,~.::.r r ,AI
~'!ater Heater 2C.cc. r .
Ranne H..4
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'10.'( L,.,....+: A. ,?)OO
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Address 10'" ~IW'! l.tt.Y' Phone
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B~lnQ Perm1t Info:
Family I'!.esidence I-lith
INFDRIIATIO~ L,"t
726-3753
Sq. Ftg. 1.1ain
~q. ::tg. Access.
Sa, Fto, Other
flew.. Add -0ilter ~ep, 0
--Fence Demo Change/Use
~her- ~ . Ii !'1
",gg \.UJIo'L ..IWJ.IUIl/ ~.J I
Describe \~orkti..e.. Build Single OQ
~.ttached Garaqe)
Construction Lender
Address
OI:.~llirl I ~/\1'
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(ohane no.)
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~2.=>""-~:')~
(name)
Phone
(address)
fexnires)
(lies. no.)
Primary AMu~,,~~ ~~
?~4"
Structural
Electrical
:1echanica 1
CO:~TRACTORS
~~.
"'.~..&I )~"'~" I
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{nar.:el
(address)
(Dhnnp nn.)
(lies. no.
(~xni re<;,)
General ~~MII.IJ' .. "'-'-~
P1IHl'.bi no AJA.
Electrical '1 WI/;,.,
".ch"ical ~V~.... ~M~.
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PLUIIB!1IG
ELECTRICAL
MECHA!1l C~.L
I !="Et" CHARr.E
Is,c-? 5. 09
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Residence of
~!="L I rl-l.1.Rr,!=" NO. I
I furnace/burner to
BTU's
I Floor furnace
ISq, (5.o~ and vent
I Recessed wall
SDnrp hPntpr non vpnt
I
I r"tor.> I
IE::n single fixture
T f;..;:..""
!Relocated ~uildino
l<new fix. addjtio~al)
IS,F. Residence
(1 bath)
Duplex (I bath) each
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TOTAL CH~.RGES 5. ();:' I TOTAL CHARGES
WHERE STATE L'\H REQUIRES that the Electrical work be done by an
shall not be valii until the label has been signed by an Electrical
/
Additional bath
~Jater servi ce
Sewer
Storm Sewer
SQ. FT.
New circuits alts.
1000""" or exte_nsions _
" -:;",.,', ...,-~.~..'.:.
SERVICES
Temporary Construction
Change in existing
rps i d_~nr:p
multifamily, comm. or
TnntJc;.trii'll
Appliance vent
seDarate
Stationary evap.
cooler
1 Vent fan with
sinale duct
I Vent s)/ster.l apart
heatina or A.C.
Mechanical exhaust
hoon and nllet
Wood stove/heater
1
14,-8 ';50
Of
from
amps.
COiRIIND, FEEDERS
Install/alter/relocate
dic;trih. fppdprc;.
amps.
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"':/..;..L,;....,'V'...a.X-,.~1:: .
ISSUANCF OF OFRrllT
/5: oS! TOTAL CHARGES
/0. 0:-
/1-/59
Electrical Contractor. the electrical portion of this ~ermit
Sunervisor and returned to the Building Division
I HAVE CAREFULLY EXArlINED the completed apnlication for permit, and do hereby certify that all infonnation 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 Spri ng f; e 1 d and the laws of the Sta te of Ore(]on perta i n i n9 to the work descri bed herei n, and tha t IlO OCCl!PArKY \'Ii 11 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 OP.S 701.055 will be used on this project.
Type/Canst., ::'~ \
Bedrooms
Stories
f,1 'nIT SIGiJATl!R"E ":6/'-?~...
FO~ OFFICE LISE OflLY
\ - Sq. Ftg. f1ain
Sq. Ftg. Access
Occy Grou" . '3 '2.... Sq, Ft9, Other
j;JkU'c/~...-...IJATE;(ih4 ~^
NA:.iE(please 'print))}]) LLlloLL~,IJ' (.;EIV;':J(At
Zone (' _ J
Fire Zone I
Flood Plain
BUILDIIIG PERI,IIT
Charges an':
Surcharges
PLUI.1BIIIG PERI~IT
Charges and
Surcharges
ELECTRICP.L PERIIIT
Charges and
Surcharges
/lECHANICAL PERMIT
Charges and
Surcharges
l~units
Occy Load
x Value
x Value
x Va 1 ue
TOTAL VALUATIO/1i"'~':)(']lqg
. L J/...i OC> . Plan Ck,
~T-J' - 65i:/Bldo
-- -:;:------~n Ck.
I, '_'0.. 30%/RldQ
__~:~_____J Fence
Comm/lnd
Ppr Fpe
Res
Per Fee
:<8,109"
Syste~sDevelopment
Charoe 0,51,)
.....,,::..
, -:0--
Demo
,.r.::-:::>O
-_/_,"=':.... =.- --- ---
Sidewalk
.-,
1/; l..'
A/C Paving
Total Comb.
1_-
111..'TAl
rermit
"jf) r
."/'0. 2.,c..
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Curb Cut
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COMBINATIO~ APPLICATION/PERMIT (CAP)
1. Applicant to furnish
A. Job Address '
B. Legal Description
1. examDle- Tax lot 100. lane County Map ~efercnce
1/ 03 03
2. examole- lot 1. Block 3. 2nd Addition to
Sprlngtield Estates
C. Name, etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ceilinq/or forced air oas
2. examale- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house. 500 sq. foot garage
2. exam~le- if new project, check new - if addition,
. c/1eck add. etc.
F. Building per;;l1t information:
1. exar:mJe - construct single family house \'Jith an
a t~2cr.ed garage
2. exa~aJe - remodel existing garage into family room
3. examDJe - 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, DESIGii TEA/.! ArlO 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 Plu~bing. Mechanical, & Electrical Schedules
A ~xceot where blank soaces Occur in the descriPtion
:crtion 07 :r.e ~echanical and Electrical Schedules.
:he appl icant need fill-in only the flo. Boxes adjacent
:0 the aporo~riate item(s) to be installed
-. Full Plu~binQ. ~ecnanical. and Electrical Schedules
are available at the BuildinQ Division
1. To conserVE space on the~permit form the schedules
nave been abbreviated
2. !f the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules
C. BUILOIi:G DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES 0;1 THE SCHEDULES
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 worksneet 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 wh~n the permit is issued.
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V, FOR OFFICE USE ONLY
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PERt'IIT VAll DATlml
'IlY OF SPRINGFIELD
City Hall
Springlield, Oregon
Department af Public Wark.
OFFICIAL RECEIPT
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Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
... I. _.. .. __ . _. . _.. .~.. .., ,.'" . _ . ...._ ....."..
PLANS REVIEWED BY:
name
signa ture .-:::;::-'A'L
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date 1{)-,2_U-/j~
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