HomeMy WebLinkAboutPermit Building 1980-4-25 (2)
~~~~~i~;ION liNt "~I
So. Ftq. '.lain .
~q. Ftg. Access.
Sa, Ftg, Other0~_
_lIe,,_Add_Al ter ---,~ep,
_Fenc~ Demo_Change/Use Ir ,\
valu';f:}{)"'C/)cZJ I ~utner'") \.}'J
Bul1tino 4ien11it Info: Describe Hork( i ~e.. Sui ld Single ,'6
Famil v P-esidence (,Ii th Attached r.araae) I ()J
I< H1SPECT[01i" L lriF.
1726-3769
Jab Address /j( t1' 2..- /6" C'4/"
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CITY OF SPRiilGFIELD
COtlBI ,IATI ON APPLI CATION/ PERMIT
j E"ERr.y SOURCES:,
Heat
Ha ter Hea ter
Ranqe
~/A/<..'
u..(>,
legal Description
Owner~ / 1. L
Address ? ft i
/1.-1 tJt3R?
k ,1./ /1'''
Phone? t:/'2"IP
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Construction lender
A/Q"v-ir
)m~,~-,
'IL'J:JiAR1iE. ~I
I furnace/burner to
BTU's
I Floor furnace
and vent
Recessed wa 11
Sn~rp hp~tpr rlnrl vpnt
Address
Ut:S1Gil rEAH
Phone
(address 1
(name)
(lies. no.)
Primary
Structural
Electrical
l1echan; Cd 1
COIlTRACTORS (namel
(PO b
(address)
f1 its. no.)
-i-AM~S
/7"L::?P
Genera 1
Plumbina
Electrical
Ih c. u,lf> /J l',.c
c.. c.' /,/7',(' A'C. 7' Ck C',
I.:,?/:'" c /7.2/UJ (
~lechan; Cd 1
PLUIIBIIIG
ELECTRICAL
110.1
Each single fixture
, FEF . rHARr,F
~i_
I Residence of
SQ, FT.
INew circuits alts.
or extensions
ISERVICES
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115CD I
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Relocated building
(new fix. additional)
S.F. Residence
(1 bathl
Duplex (1 bath)
each
Additional bath
Temporary Construction
Change in existing
rp~_iqpn('p'
Imultifamily, corm!. or
Innllc;trial
IOf
ICO~1,/INO, FEEDERS
I Install/alter/relocate
r1ic;trih fppdprc;
~!a ter servi ce
Sewer
I Storm Sewer
amps.!
TOTAL CHARGES
WHERE STATE L1W REOUIRES
shall not be valiJ until the
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I TOTAL CHARGES
that tile Electrical work be done by an
label has been signed by an Electrical
amps.
Of
(exnires)
(ohone no_)
lexoirec;)
(ahonp no, )
'7',-7 ~(){}t
MECHANICAL
, ~~~
r"~
I Appliance vent
.;pn;\l"atp
I Stationary evap.
cooler
I Vent fan wi th
sinole duct
I Vent system apart from I
heatino or A.C.
I Mechanical exhaust
hood and du('t
I Uood stove/heater
I
ISSUANCf OF PFRilIT
TOTAL CHARGES
Electrical Contractor. the electrical portion of this permit
Surervisor and returned to the BUilding Division
I HAVE CAREFUllY EXN1INED the completed aprlication for ~ermit, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work nerformed 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 rlC OCCUPArKY 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 CRS 701.055, that if exempt the basis for exemotion is noted hereon, and that
only subcontractors and employees who are in com~liance with OP.S 7~1.055 will be used on this project.
1lAf.IE(please print) U-/1L/AH E, A-1.,~f-fr SIr,;I^TURE~a~~~~-4 DATEU~
Fm~ OFFICE USE OiIL Y
Zone Tyoe/Const. Units So, Ftg. riain x Value
Fire Zone Bedrooms Oooy Load Sq, Ft~, Access x Value
Flood Plain Stories Occ.y Group Sq, Ftg, Other x Value
BUILOlllG PER,IIT
Charges an~
Surcha rges
...-(. \U ~ Plan Ck.
-~---,y--:!- 65%/Rldo
C"~I , Plan Ck.
N) 30%/BldQ
Fence
COninlI nd
Ppr Fpp
R-es
Per Fee
PLU~BING PERMIT
Charges and
Surcharges
ELECTR!ttf PERI:IT
Cha r~ and
SurCr.farges
I D,;:mo
__l~-,-<?5?__J Sidewalk
. LoC ) I A/C Paving
I I Curb Cut
~-----------
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I1ECHArlICAL PERMIT
Charges and
. ,- ': . ! :",". ~ s
TOTAL VALUATION
Systems Development
Charoe (1.5<)
To'ta1 Comb. rermi t
I_,,~::
~
6o.l\()
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COflBINATION APPLICATION/PWIIT (CAP)
j, Applicant to furnish
A, Job Address
B, Legal Oescription
1. examole- Tax Lot 100. lane County Map Reference ~~
II oj 43
2, example- Lot I, Block 3, 2nd Addition to
Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air Qas
2. examole- waterheater/electricatjor solar
E. Square footage or valuation, etc. -
I. examole- 1250 sq. foot house. 500 sq, foot garage
2. examole- if new project, check-n€w - if addition,
check add, etc.
F. Building perr71it information:
1. examole - construct single family house with an
attached garage
2. examole - remodel existing garage into family room
3. examole - 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, OES I GN TEAI'I AilO 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 Plumbing, Mechanical. & Electrical Schedules
A. Except where blank spaces occur in the description
portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacent
to the appropriate item(s} to be installed
B. Full Plumbing. Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been 'abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
fu 11 schedu I es
C. BUILDING OIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEOULES
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.
Ill, Applicant to sign and date
Whenever possible. the initial application will be used as
a worksheet 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 when the permit is issued.
V. FOR OFFICE USE ONLY-
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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CITY OF
PERI1LT VALIDATION
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SPRINGFIELD
,;
City Hall
Springfield, Oregon
Department of Public Warks (
OFFICIAL RECEIPT
t No. B 5 3 3 3 2 ,
te 1..\..- <:95 19m
'dFrom~~ (
l'dress ,'?J,\ N\C\' ~ 0 St-....
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l:eived For:
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lOunt Received ~--.J.._ . '-\
&BS~,
5"f.:l~O"'~V"".U"L ~"'''~f.:.S ' o.:UC;;I[..[ O. .,.01
7"
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Permit Clerk
.1.. ..'"" ....
Permit applicant exempt from registration with the Builder's Board because:
Additi ona 1 Project Informati on:
PLANS REVIEWED BY:
name
signature
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date
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