HomeMy WebLinkAboutPermit Building 1997-1-1
1111SPECTIOII LIIIE
726-3769
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INFORlIATION LW, II
726-3753 ~
So. Ftq. '-lain
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Sq, Ftg. Other
lIew Add A Her Rep.
--Fence Demo ChangelUse
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CiH UF SPRUiGFIELD
CmlBlIlATION APPLICATIOu/PERMrT
-+- E!IERr,y SOURCES:
'Job Address I ZS'~ PIf/P5PAl ( Heat \
,- Legal Dmription 1.,ot -l'LBI,')(I,1! _, . NOR.#l(:AAtr.? \'Iater Heater ". ......
_Fii>--::f fr:Idtn6A.J in ,~#I. {}1?~ 1<6 R; r3 ~:~~: of Hark: 00
-Owner -....//I/I1f7S r z:Iz6RA- !leJJ!~ G::" 080. -
Address IC)SC/ P/~l'!sP.WI- Phone7<fI-iJ$/ ~~~l1:~nRe~;~~~~eInf~h
SDRf(..y.?,f7<,~tI /)R.,
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Constructlon lender AIoIJIl...
17<177
VDe.+Ftc.l?d
Describe Work(i.e'f Build Single
Attached GaraQe)
aFtPA~~
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Address
U,,!(;ll lOA11
Structural
rhlJhq
..../
Phone
(address)
C'
....'p.fl:te
(1 ics. no.)
(end res)
(ohane no.l
(name>
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Primary -...J IfMeS
Electrical
t1echanical
CONTRACTORS (name)
General JI7IV!~
If~N 4'l-/
---'
(address)
C
o-JlIlI1e.
(l ;r.s. no.)
(pxnired
(ohonp nn 1
Plumbino
'Electrical ~MI'S lIelJ/-ey
f.lechan; ca 1
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011111,,',
PLUIlBUIG
ELECTRICAL MECHANICAL
FEE CHAPr,E fin ~F rl-IARr.F t.JO. FFF rHARr.~
Residence of furnace/burner to
SQ, FT, BTU's
New circuits alts. Floor furnace
or extensions and vent
I SERV ICES - 1,.,.-0 , 1,:-' Recessed wall
-.. SD~CP h~~tpr ~nd vpnt
... I cO .......,.....~.
r10.
Each single fixture
IRelocated buildino
(new fix. additional)
Is.F. Residence
(] bath)
Duplex (1 bath) each
Hater service
I Sewer
I Storm Sewer
Of
amps.
Appliance vent
seoarate
Stationary evap.
cooler
Vent fan wi th
sinole duct
Vent system apart from I
heatino or A.C.
Mechanical exhaust
hood .lnd duct
Additional bath
Temporary Construction
Change in existing
res.i dpnce
multifamily, COrml. or
TndlJ,,-tri.ll
COlj/.L/IIID, FEEDERS
Install/alter/relocate
distrih. fpprlprs
Wood stove/heater
Of
amps.
TOTAL CHARGES
HHERE STATE L~H REOUIRES
shall not be vali] until the
~
TOTAL CHARGES
'r-
I
I I ISSUANCE OF PFR!IIT
/ c-~'.J I
_', _ TOTAL CHARGES
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....
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that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit
label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXAHHlED 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 oerformed shall be done in accordance with the Ordinances of the City
of 50ringfield and the Laws of the State of Orel]on pertaining to the.\oJork described herein, and that 1m OCCUPAUCY 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 ons 701.055. that if exemot the basis for exemption is noted hereon. and that
only subcontractors and emrloyees who are in compliance with ORS 701.055 will be used on this project.
IlAI-lE(please print)
Zone j"=\ Tyoe/Const. \1,\1
Fire Zone Bedrooms
Flood Plain - Stories \ -
Units
Occy Load
S 1r,IIATURE
FO~ OFFICE USE OIIL Y
Sq. Ftg. /lain
SQ, Ftg, Access (_.4(,
SQ, Ft9, Other
DATE
Occy Group \ I I
x Value
, qs"O value'! t,,,go, ,,<;0
x Va 1 ue
BUILDING PERI.IIT
Charges anc
Surcharges
4'() 00 I Plan Ck.
. . -- 65%/Rldn
-------0----
{fo ~ I ~6~~Bi~~
_____~.:__---_I Fence
I Demo
J5:00. Sidewalk
-- --.-------
, ,~.9 AIC 'Pavi ng
COIM1II nd
Ppr F~e
Res
Per Fee
TOTAL VALUATlOIi
I '1"'~<J'''iO Syste~s Development
.M-<'u-p -.JI" Charoe (I. sn
.:pI'), DE' ,;,#?-'S<
I QRLtLW)(,6 ro4
I
I
PLU'~BING PERMIT
Cha rges and
Surcharges
ELECTRIC~.L PERI:IT
Cha rges and
Surcharges
ITotal Comb. Permit
.1=)'740
II ,..b.-
';'S7-.ro
11ECHAIHCAL PERMIT
Charges and
Surcharges
Curb Cut
I
I TOTAL
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COMBINATION APPLICATION/PERMIT (CAP)
I.
PERMIT VALIDATION
II.
Applicant to furnish
A, Job Address
B, Legal Description
1. example- Tax Lot 100, Lane County Map Reference
II 03 43
2. example- Lot I, Block 3. 2nd Addition to
>prlngtield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. examole- heat/electrical ceilinq/or forced air qas
2. examole- waterheater/electrical/or solar
E. Square footage or valuation, etc. ------
I. examole- 1250 sq, foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
check add, etc.
F. Building permit information:
1. example - construct single family house w ~a(
attached garage
2. exam~le - remodel existing garage into far
3. examole - convert single family residence ('
restaurant (change of use)
G. Value of work as defined in Section 303 (a) 01
Structural Specialty Code
H, DES I G;I TEM,' AND COIITRACTORS
To avoid design or construction delays, Build;
Division Staff must be able to contact appropr
persons regarding design information or job si
corrections, etc. 'd F "
",e' Rec. rom
Abbreviated Plumbing, Mechanical, & Electrical 5ch ~
A. Except where blank spaces occur in the descrip
portion of the Mechanical and Electrical Sched
the applicant need fill-in only the No. Boxes,
to the aopropriate item(s) to be installed (
B. Full Plumbing, Mechanical. and Electrical Schel
are available at the Building Division
1. To conserve space on the permit form the s<
have been abbreviated (
2. If the item(s) to be installed are not COVE
the abbreviated schedules you should consul
full schedules
C. BUiLDIi;G DIVISION STAFF WILL FILL OUT ALL FEES
CHARGES ON THE SCHEDULES
O. As noted on the CAP, the label must
electrical contractor for signature
supervisor. The general contractor
to sign the electrical label.
Applicant to sign and date
Whenever possible, the initial application will be I
a ~'Iorksheet only. Where possible, Building DivisiOl (ell
will prepare a type written copy and return it to tl
appl i'cant at the time the actual 'permit is issued f(
Signature.
Fees and Charges (
Plan check rees are due and payable at the time of t
appli'cation, and no plans ~.1i11 be processed until th
fees are paid. All other fees and charges are due a
payable when the permit is' issued.
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CITY
(I
SPRINGfiELD
Of
City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
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No.
B
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Date 1/'
19,
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Received For:
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be delivere
by his elec
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( A~~~~ Received';' .-
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FOR OFFICE USE ON,Y
PROJECT CONDITIONS TO BE SATISFIED BEFORE
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AUTHOlll1:E;O 5IGN...TURE
....~LTON.TU......ULL ..."..t.... LUC'U.t"" .~.O'
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Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
PLANS REVIEWED BY:
name
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slgnature - /' .', ",',.1,".\'
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date
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