HomeMy WebLinkAboutPermit Building 1980-7-16
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. A:.~ CITY OF SPRINGFIEL!}J
" ""Cm1BliIATION APPLICATION/PERMIT
',E!JERGY SOURCES,'i,.
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Hater Heater
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Owner~c;~ (..)~
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Address A c: ..., ., n~,.. "
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constCcti on Lende~ ~,
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Address'
DES I Gr~ TEAr1
, Primary 1; I/J"
(name)
Vt".'-<q !..:-:::j'N\
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Phone
(address)
~G \0;;..... ('~ h~,;r c0 k~ ('~ 'Dv-. -
(phone no.)
, Structura 1 .
El~r.:t.riC?l
f1echanical
. CONTRACTORS
.~
INFORllATION LitH:
726-3753
Sq. Ftg. I.lain
~q. Ftg. Access.1riJ..J",
Sq; Ftg,. Other
.r~e\~ Add Alter Rep.
--Fence Demo Change/Use
p...Other -- --
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Range
ValuE. of Hork:
5002 , 40
Buil1;;ino Permit Info: Describe Hork( Le.,
'Family Residence With'Att~ched Ga~aqe)
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~~/~ 7:~ :~'i'iil .......,.....~.. ~-, "'"'"...L.I
....._~~.'-......._,'\I.~.r;t..;... j t .......,-
(lics. no. r
Build Single
(exnires)
7'17-'2,.3'/ I I
Il
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(name)
(address)
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'7/)/ ..o::-.:.?<:
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General r') L.l9Y\. of
Plumbinq
, Electrical'
, ~1echankal
PL Ufm I tlG
(1 ics. no.)
(expires)
(phone no. )
i
.~
. ELECTRICAL
MI'CH/l,NICAL
Each single fixture,
FEE CHARGE NO. I FFF CHARGf NO.
Residence of furnace/burner to
SQ. FT. BTU's
..
FFF CHARGF 1
rw.
Relocated building
(new fix, additional)
New circuits alts.
br extensioris .
S.F. P.esidence
, (1 bath)
Duplex (1 bath) 'each
ISERVICES
I
Floor furnace
and'vent
Recessed wall
Soace heater and vent
Apoliance vent
separate
Stationary evap.
I
,I
I
I
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I
~!a ter serv ice '
ITempOrary Construction
Change in existing
re~idence
multifamily, comm. or
Industrial
Ilnstall/alter/relocate
distrib. feeders
10f _ amps.1
I
I
I
Additional bath
Sewer
Storm Sewer
Of
COMM./IND, FEEDERS
," .~
I t~' 1
. i . "11
! \ / f i'-
c:)oler
amps.1
I
I
Vent fan with
sinale duct
Vent system apart
heating or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
from
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, 't' "
I' '..
Al . l'
.' " I ''-~
'ill \
.:!
./!
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/1/ / -/ "
ISSUANCE OF PF.Rr1IT
TOTAL CHARGES TOTAL CHARGES TOTAL CHARGES
WHERE STATE L~W REQUIRES th~t tile Electrical work be done by an Electrical Contractor, the electrical portion of this perQit
shall not be valiJ until the label has been signed 'by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXNlINED 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 performed shall be done in accordance with the Ordinances of the City'
of Springfield and the Laws of the State of Oregon oertaining to the work described herein, and that NO OCCUPArKY will be made
of any structure without the permission of the Building Division. I further certify that my registration ~Iith 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 hereon, and that
only subcontractors and employees who are in comDliance with ORS 701.055 will be used on this project.
rW1E(please print) ~O'~ ~ \' \\ ':'\.~ ('" L L'(:\~ ~\. SIGW\TURF. \'j",,,)C....fLl._ \ :'(v~ CJX'i..-".-,,-_
FOr. OFFICE USE O:~LY\. ~
Zone e-( , Tyoe/Const. V- M
Fi re Zone --L.U- Bedrooms
Flood Plain t...J (J Stories I
Units
Occy Load
Occy Group 1-1
BUILDING PERf.lIT
Charges and
Surcharges.
..., Plan Ck. CommlInd
__-'____:?y~€2.~ 65~I,/Bldo Per Fee
. . Plan Ck. Res'
!, (/4L 30%/Bldq Per Fee
.Ii' ,/;) I Fence
~r{77T.-------
D!:!mo
,\/ [~. 'ISidewalk
- -q;--, T-- ---
. .' I A/e Paving
-/~1,-------1 Cocb Cot
PLU/1B ING PERMIT
Charges and
Surcharges
ELECTRICAL PERr~IT
,Charaes and
. Surcha rges
MECHANICAL PERMIT
Charges and
Surcharges
DJl.TE-2//C /-kc'
/ /
So. Ftg. r1a in
Sq. Ft!J. Access~{~
Sq. Ftg. Other
x Value
x f .L\O Value C:;rCJ7... 40
x Value
TOTAL VALUATlON500z. 40
Systems Development
Cha roe (1. 5'1:)
JO,COO fo-ZC;-~:::SO
~'b32~R I
I. I
II
I Total Comb. rermit
I
, I, 1 TOTAL
;5~, 44
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OF SPRIN'GFIElD
City Hall
Springfield. Oregon
Department of Public Works
OFFICIAL RECEIPT
, - No. B
(
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1
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CITY
, ~'
II.
Applicant to furni~h
A.. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map RE
17 03 43'
2. example- Lot 1. Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceil inq/or forCE .::.:::..
2.' examDle- waterheater/electrical/or solar \.
E. Square footage or valuation, etc.
1. ~xample- 1250 sq. foot house,' 500 sq. foo
2. example- if new project, check--riew - if a (,.'
check add, etc.
F. Building permit information:
1. example - construct single family house w'
attached gc.rage
2. exc:r;wle - rentode'l existing gar'age ,into fan
3. example - convert single family residence
restaurant (change of use)
G. Value of work as defined in S~ction 303 (a) of
Structural Specialty Code (
H. DESIGN TENl AND CONTRACTORS
To avoid design or construction delays, Buildir
Division Staff must be able to contact appropri
persons regarding design information or job sit (
corrections, etc, '
Abbreviated Plumbing, Mechanical, & Electrical Sche
A. Except where blank spaces occur in the descript
portion of the Mechanical and Electrical Schedu (
the applicant need fill~in only the No. Boxes at
to the appropriate item(s) to be installed'
B. Full Plumbing, Mechanical, and Electrical SchedL
are available at the Building Division (
1. To conserv~ space on the permit form the .sch
have been abbreviated
2. If the item(s) to be installed are not cover
the abbreviated sched~les you should consult (
full schedules
C. BUILDIilG DIVISION STAFF WILL FILL OUT ALL FEES Ar
CHARGES ON THE SCHEDULES
D. .As noted on the CAP, the label must
electrical contractor for signature
supervisor. The general contractor
to sign the electrical label.
Applicant to s1go ~r.d dJte '
Whenever possible, the initial application will be US! \0
a worksheet only. Where possible, Building Division ~~
will prepare a type written copy and return it to the ' '
applicant at the time the actual permit is issued for his
signature.
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.
(
54006,.
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Date =s- 0 \ ,( \.,1' ,
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Received For: /,~ J d/!., .
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Receive ~
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, "UTHORIZED SIGNUUoRRE ,,'0' ...,,'. \,'
S~ELTON-TURN8ULL P~INTERS . EUGENE.
(
be de 1 i ver'ed
by his electr
is not author
(tn
. BY
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IV.
V. FOR OFFICE USE ONLY
Permit Clerk
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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
slgnature
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AfA,._ _~~.-___~
date 7-/.<::)-g-~
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