HomeMy WebLinkAboutPermit Building 1981-9-28
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lIrlSPECTlOl1 L1IIE CITY Of SPRINGFIELD INFOR/1ATION llrlt
726-3769 C0/1BIIIATION APPLICATION/PERMIT 726-3753
Job Address d(/ /)' ^~,_ ..(. 'I. EIIERGY SOURCES: So. Ftg. I.Iain
/ .......- I, v __ v \/ :e'Ll)" Heat ~q. Ftg. Access.
I 1 .. !'/ater Heater Sq. Ftg. Other
.e9a De,cnpt,on f1LJ! ;""-, LOT rt) EI'ilDf!4i.P }/.615_ ~Ilew Add Alter Eep.
Ranqe__=..___ Fence Demo Change/Use
/7-t:J~. 3<;:-/11 'T"L.35"00 Valu' of Hork: .,. Other--
Owner i=?(o:>~S'~t' Il\IA'1 '~VU V\ ,"1 P I.;J()U:..... _
/ rot Built;inQ Permit Info: Describe l'/ork.( Le.. Build Single
Address -l./- /,-., I (? I \i -., _ '\) . ,... I ..j ,_ ') -r-. PhO~f~.'"'::?~? ~ Fami 1 v nesidence Hi th .A.ttached Garaae \
i:? ""'WI ove (l~d ,('''''/D la I2p
*"C~."J -\'D HO~l..ce
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Construction lender
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Address
DESIGII TEAll
(name)
Phone
(address)
(lies. no.}
(exnires)
(phone no.
Primary
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Structural
Electrical
I~echanical
CONTRACTORS
Genera 1
1"- ,f3-.
(Dhon~ no. ) i
i 7;< 6'-JJJ7l
J
Plumbina
(name)
1c:V- n ?; '^ " N /I
Iii' 71 it
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IV 0 JUt-
AJ C)U;=
(address) Jli.,cs_ no.)
cIM.,J, C, J76~~~~^F!ut//-. /.f'1
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(exD;r~c;l
Electrical
~1echanical
PLUIIBIIIG
ELECTRICAL
MECHANICAL
NO,'
Each single fixture
, FFE I CHARGE ...llil.....J I U',L1...ClJARG.E. NO,'
Residence of furnace/burner to
SQ. FT. BTU's
I FFF rHI\RIif'~
,/ i
Relocated buildin9
(new fix. additional)
New circuits alts.
or extensions
Floor furnace
and vent
S.F. Residence
C1 bathl
Duplex (1 bath) each
Additional bath
I SERVICES
I
RecE:S:jed wall
Snace he~~ ~nrl vpnt
Sewer
ITempOrary Construction
IChange in existing
r~$jctencp
Imultifamily, camm. or
Tnrlll"tri~l
IOf amps
ICO~1./IND, FEEDERS
I Install/alter/relocate
rtic:trih. fppdprc;.
IOf amps.
I
I
I
Appliance vent
sfi!o~ritt~
Stationary evap.
cooler
Vent fan with
c;inole duct .
Vent system apart from
heatina or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Hater service
Storm Sewer
/
I
TOTAL CHARGES
WHEP.E STATE L~W REQUIRES
shall not be valiJ until the
TOTAL CHARGES
ISSUANCE OF PFRrlIT
TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical portion of this pemit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFUllY EXAtHNED the completed aprlication 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 with the Ordinances of the City
of Soringfield and the laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAHCY will be made
of any structure without the Dermission 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 sUbcontractor~a~~..._:PIOYeeS "ho ;re in compliance with ons ~n1.055 ,~l; be US~d on t~) prOjecft'"f
IlAI-lE(please print) I r" v' I' '-f ij kv'.; e. ( ( SIG;jATURF/~' I ,-{1.(A"P / : DATF9-;2f'-rl
/ For. OFFICE USE DIlLY ?
Tyoe/Const. 'Tl' -,</ Units / Sq, Ftg. liain
Bedrooms Occy Load Sq. Ftg, Access;l1.J7.Sh
Stories / Occy Group 1'4- / Sq. Ftg. Other
Zone
R-J
x
Value
Value
Value
Fire Zone ,.--,
Flood Plain ;LI/J
x
x
TOTAL VALUATION (dt'XJUJ
BUILDIIIG PERI.tIT
Charges an~
Surcharges
," Plan Ck.
_ _ __ __.Io{..'a'J 65~/Bld"
.J./d Plan Ck.
/?"n 30%/Bldo
I Fence
I Oemo
1 Sidewalk
I A/C Paving
COIT1l1/lnd
Ppr- FM'
Res
Per Fee
Systems Development
Charoe (1.5~)
PLUllBING PERMIT
Charges and
Surcharges
;1. i~:; t/t. a ~" 0
.......:: v'o,'.;,.....;;-(;/
1;,;,..-= 573.:>,<9
I
I
ELECTRICAL PERI~lT
Charges and
Surcharges
Irotal Comb. rermit
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
1
I TOTAL
~d.~i'-.I
IS'if' ,<.' //
.
/7 - 0 ':'!, -': <1 - ( ,?
It. 3:;'o()
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. legal Description
1. examole. Tax Lot 100. lane County Map Refe~~"~~
11 03 43
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 t-9
2. examole- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. ------
I, example' 1250 sq. foot house. 500 sq. foot
2. example- if new project. checknew - if add (on
check add. ete.
F. Building permit information: !
1. examole - construct single ~~mily house wit
attached garage
2. examole - remodel existing garage into (ami
3. examole - convert single family residenc~ ;,
restaurant (cha~ge of use)
{;. Value of work as defined in Section 303 (a) .'('If. (
Structural Specialty Code
H, OESIGN TEA~ AND CONTRACTORS
To avoid design or C('~:5truction delays. Buildin~
Division Staff must b., ~ble to contact appropric
persons regarding desiqf! infonnat';on or job 'site '.
corrections. etc.
Abbreviated Plumbing, Mechani~al. & Electrical Sched
A. Except where blank spaces uccur 'in the descripti ,'"
portion of the Mechanical and Electrical Schedul I.
the applican~ need fill-in only the No. Boxes ad
to the appropriate itelL1(s) to be installed
B. Full Plumbing. Mechailicz; I: and Electrical Schedu (
are available at the ~uilding 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, /I.'
the abbreviated schedules you should consult \
full schedules
C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES At
CHARGES ON THE SCHEDULES
D. As noted on the CAP. the label must be delivereci ..tr
electrical contractor for signature by his electr
supervisor. The general contractor is ,not author
to sign the electrical label. ---
III. Applicant to sign and date (
Whenever possible. the initial application will be us
a worksheet only. Where possible. Building Division
will prepare a type written copy and return it to the I
applicant at the time the actual permit is issued for ~
signature.
IV. Fees and Charges
Plan check fees are due and payable at the time of thl ,"
application, and no plans will be processed until the! f
fees are paid. All other fees and charges are due an(~'\'
payable when the permit is issued. .
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V, FOR OFFICE USE ONLY
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PERMIT VALIDATION
CITY OF SPRINGFIELD I
City Hall
Springfield, Oregon
O"parlment of Public Works I
OffiCIAL RECEIPT
. N~ B 57354,
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Dote .,.,-~~ 19C) 1 .
Rec'd From\n'-'\\\ I\. t)''),,~QCbL ,~
Address 8llo?D "tort ~ ~~
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If:
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ReceIved For:
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Amount
;:ceived L:-J .~h
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AUTt401llIZI:0 SIGNATURE
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Permi t 11 erk
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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:
.
PLANS REVIEWED BY:
name
signature
I
date 9-.2c/~%1
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