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HomeMy WebLinkAboutPermit Signage 1980-11-6 (3) ~ '. I IrlSPECTIOrI LIIIE , 726-3769 Job Address ", III '-I ~'rd 0 (,( In 4-donJO - () I CITY OF SPRINGFIELD CO/IBHIATlON APPLICATION/PERMIT E!lERGY SOURCES: Hedt Hater Heater . IrlFORlIATlON UNe 726-3753 So, Ftq, 1,lain ~q. Ptg. Access. So, Ftq, Other Ue\;, Add .A.1ter P.ep. --Fence Demo Change/Use -Other - - B ~ Legal De~cription Address DeSIGN fEAl1 (name) Phone (address) Ranqe Valu, of Hork: /<) ,000,00 Builolna Pernlit Info: Describe Work(i~e., Build Single Famil v rtes i dence l'lith .A.t tached Garaae) S (~- (h (1 hi ~ 0 nil .l1l(L!'lL I ~.j/ dn,.JrtpA0--02.. 00-&..- I a I () /' I. Owner '1\\ 1'l1"tJ;:;) ~ 1\ \':".. Address (p n ~ ~V 0-n\ r/1 ~Hv.( ,,\....0 lU 11 n (;..1"7Y\) ConstrucrtLon Len~ U ~ C:rVl '") PhQ,. (1 ics. no.) (exoires) (ohone no. ) Primary 5:r.:ctura 1 ::l~ctrical :'~:;anical C::::-;;;"i:7QiiS (narr:e) (dddress 1 ~ ~ rv-{\___ ,'-.rl ~..,;""1\. Q '~ (1 iC5. no.) (~xolrp<:.:\ (ohnnf' nn UI I G-:?nera 1 '-f'(\(\ 1\ T I V\ t~ ^ f"\S: Plumblnc Electricai "~''":.:--3nica 1 PlmmlilG I I r:HARGF t Nn ElECRTCAL r.1ECHA!/ICAl :..~. i I rcE I Residence of ~~~ i lI;':'Rr.~ no. I I' furnace/burner to BTU's Floor furnace and vent I ~;!=" I rl./.dRr.~ ,- I tdCO IRelocatea building (new fix. dddition~l) IS.F. Residence (j bath) Duplex (1 bath) each single fixture SQ, FT, New circuits alts. or extensions SERVICES Recessed wa 11 ~nnr.P he~tpr ~nrl vpnt ~later service Temporary Construction Chanae in existing rp~idenLP multifamily. comm. or Tnrluc;tr;;d I App 1 i ance vent Sf'loaratf> Stationary evao. conler ~ . Vent fan with sinole duct Vent system apart from heatino or A.C. Mechanical exhaust honrl and dud Wood stove/heater Additional bath Sewer Storm Se\./er Of amps. I CO/1f1. lIND, FEEDERS Install/alter/relocate rlic;trih. fppdprc; Of amps. ISSUANC, OF rFR!lIT TOTAL CHARGES I TOTAL CHf,RGES TOTAL' CHARGES , WHEP-E STATE L"M REQUIRES that the Electrical \'lark be done by an 'Electrical Contractor, the electrical portion of this pemit . shall not be vali1 until the label has been signed by an Electrical Supervisor and returned to the Building Division Zone Fl re Zone I HAVE CAREFUllY EXN1WED 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 Derformed shall be done in accordance with the Ordinances of the City of Soringfield and the Laws of the State of Oregon pertaining tp the work described herein, and that riC OCCUPAHCY will be made of any structure without the permission of the BUilding Div1sion. I further certify that my registration with the Builder's Board 1S 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 emnloyees who are in comoliance with Or.S m1.055 n~ used on thiS. proJect, NA!.IE(please print) R,'" [, AA'";\ UYE (I. SIG;IATURE~" LNL/2,1 /1 D~TE 1I/r.,/10 Far. omCE USE O~L\;" /. 1 Sq. Ftg. Hain x Value Sq. Ft\:!. Access x Value Sq. Ftg. Other x Value Type/Canst. Bedrooms Units Occy Load Flood Plain Stories Dccy Group TOT^L VALUATIO!l BUILDING PERI,I!T Charges and Surcharges Plan Ck, Coom/Ind ____________ 65%/Bld(l Ppr Fpp Plan Ck. Res 30%/Bldq Per Fee Fence Systems Development Charoe (1.51,) PLU!1BING PERI11T Cha rges and Surcharges Demo I ~ J1~6/Y\' II 'IJ ?jLf.CO ELECTR[C~,L PERI~IT Chil roes and Surcharges 11ECHANICAL PERMIT Charges and Surcharges Sidewalk ------------ I AIC Paving ____________1 Curb Cut I Total Comb. Permit -- TOTAL I . jf 8'-/, ~ -~~.=..__. r= 'f' i ~ I ; ~ I j 1 j 1 j I L J ~ . COMBINATION APPLICATION/PEP~IT (CAP) I. ,I. Applicant to furnish A, Job Address B. Legal Description 1. examole- Tax lot 100. lane County Map Referenc 11 03 43 2. examDle- Lot 1, Block 3. 2nd Addition to )prlngtield Estates C. Name. etc. of owner and construction lender O. Energy Sources 1. examole. heat/electrical ceilin~/or forced air 2. examole- waterheater/electrlcal/or solar E. Square footage or valuation, etc. - 1. examole- 1250 sq, foot house, 500 sq. foot gal 2. examole- if new project. checknew - if add;t' check add. ete. F. Building perr.Ji", information: 1. examole - construct. single family house with attacned g:1rl;ge 2. exar:mle - remodel existing garage into famlly 3. examole - convert single family residence int restaurant (chanqe of use) G. Value of work as defined in Section 303 (a) of th Structurai Specialty Code H, OESIGN TEA;'I AllO CONTRACTORS To avoid design or construction delays. Building Division Staff must be able to contact appropriat persons re9arding design information or jOb site corrections. etc. Abbreviated Plurr.bing. ;.iechanical, & Electrical Schedl A. txceot "'there blank soaces occur in the descriptir .:lort ion 07' the :'lecnarll ca i and El ectr i ca 1 Schedu i I the applicant need fill-in only the No. Boxes ad, to the aporopriate item{s) to be installed B. Full ?lu~bln9, Mechanical, and Electrical Schedu are available at the Building Division 1. To conserve space on the permit form the sch have been abbreviated 2. If the item(s} to be installed are not cover the abbreviated schedules you should consult full schedules C. BUILOU:G DI'.'ISION SiAFF !HLL FILL OUT ALL FEES A CHARGES 0;1 THE SCHEDULES D. As noted on the CAP, the label must be deliverec electrical contractor for signature by his elect suoervisor. The general contractor is .not authe to sion the electrical label. --- Applicant.to sign and date Whenever possible. the initial application will be l a worksheet only. Where possible. Building Divisior will prepare a type written copy and return it to tl applicant at the time the actual permit is issued f( signa ture. Fees and Charges Plan check rees are due and payable at the time of application. and no plans will be processed until th. fees are paid. All other fees and charges are due and payable when the permit is issued. . PERMIT VALIDATION ( CITY OF SPRINGFIELD City Hall Springfield, Or~gan Department af Public Warks OFFICIAL RECEIPT (-" Ill. IV, V, FOR OFFICE USE ONLY (" . //_ b 19JONO. B 55113C Rec'd From fr/afltJ.n &In<-. Sf crn Address P p '_ &-y O((Yo q V Date (' Received For: /.. eu'(f' 0()~'1 &Con (,ilt.( s.:~ t [114 " ( U), t~) 1 3.(1) ("'+0 \I 'Il.y ,L) U 'fit'-. ROO ( Gu:L ll'll......"'. o (.Yi + II.A Y.tw ') - iJ 'R4 ' 00 ~ (IJ~ eJR.(f) ~ ( \, f [ed Amount ReceivedB~ 00 4 'at , ~q' ..f_=,J\.p ( fc ./ ~~ G A,UTHOIU%ED SIG"~TUIU! ..."LTO...TU.....Ull ....'..T".... [UG["I:. 0.. .7.0' sa.".a (... ( ~ 1 Permit Clerk I ,J PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: l Additional Project Information: - , I l J 1 I I' ",'.-. ... .1 PLANS REVIEWED BY: name signature date .r ..."....... .. ...,.... ,,- ..