HomeMy WebLinkAboutPermit Signage 1980-11-6 (4)
I IIISPECTIOrl LIIIE
726-3769
Job Address
".
1114
Legal De::;cription
Owner '--f'{\ (k,~ .tl' IV,
,\ddrcss (\J. (C'), ut&&f
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Construction lend~0' - I
Address
DES I GrI TEAll
(name)
Pri,nary
Stl'"t.ic~t.:ra 1
Elec:rical
:~e':nanical
,:':::TRAC7QRS
.
.
lIlfORIIATION liNt
726-3753
50, Ftg. I,Iain
~q. FtlJ. Access.
So, Ftg, Other
r~e\" Add A Her ~ep.
--Fence Demo Change/Use
-Other - -
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CITY UF SPRlrlGFIELD
CorlBI:IATIDN APPLICATION/PERMIT
E!lERGY SOURCES:
Heat
!-later Hea ter
~j\[)~ ~.~
r'J!)/o3_ Phone
f\\A 0 r~
~. \l
Phone
(address)
{!13.r::el
"-tY\ ()J\~n J~n\)~,
SC\.'((lQ j
General
;:l1:J2;,ina
Electricill
"~-:"~~ic~l
?lu:m I r:G
i~acn 5ingie fixture
!
i?elocatea building 1
I (new fix. additional)
I S.F. Residence
11 bath)
Duplex (1 bath) each
Additional bath
i~Jater service
I Sewer
Storm Sewer
(addr~5S )
::=;:-
i CHARr,F
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SERVICES
Ranoe
ValUE of Hark:
'1<00,00
Builc:ina Permit Info: Describe I-iork(i'.e., Build Single
Far:lilv npsidence Hith Attachf!d Gol"'aqe)
QLq-n -, (1 JLcJLt 1kohlRll(L1:,
\ Q('lQ~-ON, f\ I -v-.r,', , ..In.r 0,
I . Lho.2iJ .
(exo{res)
(lies. no.)
(ohone no.
tIn I
Residence of
New circuits alts.
or extensions
(1 ies. no.
(~xnirf'ls )
(nhonP no. )
ELE!:TRICAL
MECHANICAL
FFC
I fHt..Rr,;:
i rj..jt.Rr:~ ~
I
;-;0. i
I furnace/burner to
BTU's
I Floor furnace
and vent
Recessed wa 11
SOncP hPntpr nnn vpnt
I CCF
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sq, FT,
amrs.
Appliance vent
Sf"oarittf"
Stationary evao.
cooler ~ .
Vent fan with
sinale duct
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and rlur-t
Wood stove/heater
Temporary Construction
Change in existing
rp')inenrp
multifamily, CDllln. or
lnnuc;trial
Of
COMM,/IND. FEEDERS
Install/alter/relocate
cii<:trih. fpprlpr<;
Of
amps.
ISSUANC, OF PFRruT
TOTAL CHARGES TOTAL CHARGES
ImERE STATE L\H REQUIRES that the Electrical work be done by an
shall not be vali'J lIntil the label has been signed by an Electrical
TOTAL CHARGES
Electrical Contractor, the electrical portion of this permit
Supervisor and returned to the Building Division
I HAVE CAREFULLY EXArHNED the completed aprl ication 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 wi-th the Ordinances of the City
of Soringfield and the laws of the State of Orel]on pertaining to the \...ork described herein. and that tiC OCCUPA{~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 is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted ryereon, and that
only subcontractors and emnloyees who are in comoliance with ORS 7nl.055 will be used on this nroject.
IWIE(please pdnt) k! l~_c.. A,).f) {)7.)6, (f SIr,aATUREi2;L/i/ (J"Lp/'/ DATE/! 1r~(RD
FOr. OFFICE USE QilL1\. /
Zone Tyoe/Const. Units
Fire Zone Bedrooms Occy Load
Flood Plain Stories Occy Group
BUILDING PERI.IIT Plan Ck. Comm/lnd
Charges and ------------ 65%/Bldo D~.. ~pp
Surcharges Plan Ck, Res
30%/B1do Per Fee
PLU'1BING PERMIT Fence
Charges and ------------
: Surcha rges Demo
ELECTRICP.L PERI\lT 'Sidewalk
Cha rges and ------------
Surcharges A/C Paving
IIECHAN I CAL PERM IT Curb Cut
Charges and ------------
Surcharges
Sq. Ftg. t1ain
Sq. Ft~. Access
Sq, Fl9. Other
x
x'
Value
Value
Value
x
TOTAL VALUATION
SysteQs Development
Cha roe (1. 5")
S I rtr )
?? ,('{)
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[Total Comb. rermit
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TOTAL
'6.tD j
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COMBINATION APPLICATION/PE~1IT (CAP)
I.
PERMIT VALIDATIDN
,I.
Applicant to furnish
A, Job Address
B. Legal Description
1. examole- Tax Lot 100. lane County Map Ref~rer (
17 OJ 43
2. examDle- lot 1. Block 3, 2nd Addition to
springrield Estates
C. Name. etc. of owner and construction lender
O. Energy Sources
1. examole- heat/electrical ceilinq/or forced a"
2. exam~le- waterheater/electrical/or solar
E. Square footage or valuation. etc. - Co'
1. examole- 1250 sq, foot house. 500 sq. foot g;
2. example- if new project. check~~ - if add;"
cnecK add. ete.
.. :~iljinQ pe~it ~~farr.aticn: \'
1. exa~~le - construct single family house with
a t t~..:hed oarace
2.' ex~rr:ole - ~ re!Jodel existing garage into famil
3. e.\di':lole - ccnven single famlly residence ~n (
reSt~urant (chance or use)
G. Value of work as deflned in Section 303 (a) of t
Structural Specialty Code
H, DES I Gi: TE,~.; Aim CONTRACTORS ('
To avoid design or construction delays. Building \
Division Staff must be able to contact appropria
persons regarding design information or job site
corrections. etc.
;'bbrevtate~ Plur:;bing, j'lechanical, & Electrical Schec ,
A. :.xceot where blank seaees oecur in.the deserteti
::::r:ior. of the ;':echanical and Electrical Schedui
the applicant need fill-in only the No. Boxes de r'
:~ the 3oprooriate item(s) to be installed \
3. ~ul1 Plumbing, Mechanical. and Electrical Scheel
are av~ilable at the Building Division
1. To' conserve space on the permit form the scl (".
have been abbreviated
2. If the item{s) to be installed are not cove!
the abbreviated schedules you should consul'
full schedules
C, BUILDf1iG DI'IISIOii STAFF HILL FILL OUT ALL FEES, (
CHARGES Oil THE SCHEDULES
O. As noted on the CAP, the label must be delivere
electrical contractor for signature by his elec
supervisor. The General contractor is not auth
to sign the electrical label. -
Applicant to sign and date
Whenever possible. the initial application will be
a worksheet on~y. ~lhere possible, Building Divisio <fa' BV
will preoare c type written copy and return it to t
applicant at the time the actual permit is issued f
signature. .
Fees and Charges (
Plan cneck fees are due and payable at the time of
application, and no plans will be processed until ~~~
fees are paid. All other fees and charges are due and
payable when the permit is issued.
1
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CITY OF SPRINGFIELD
City Hall
Springfield, Oregan
Department of Public Works
OFFICIAL RECEIPT
(
(
C
B 55113(
No.
I I - ~ 1980
Rec'd From ma,7:Dh f?:utnc...
Address PO ,_f..A-y OKYo q
Dale
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'R4 ,00 a
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Received For:
5/(r' (1r;"J9 W, ('~,d,)
,')LCou-L1 n q r."h 'l '~ Jr )
SLem. lfll4
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G~ U.Y.l.J-I.
Q
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(..,... + IInlu ')
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III.
(er '''':1- 00
Amount R.~ceiveU_l..~ .
'<11
(' J\U k ./
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"UTHOI'IIZI:D 5IGN"TUI'II:
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FOR OFFICE USE ONLY
Permit Clerk
PRDJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~,
J Permit applicant exempt from registration with the Builder's Board because:
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Additional Project Information:
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_...~..~-, . ,- - -, ....
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PLANS REVIEWED BY:
name
signature
date
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