HomeMy WebLinkAboutPermit Building 1980-2-4
~~~~GftaU&~t\ c
Hater Heater Elitc tric
Range Electric
Valu, of Hark:
~ C~nst. Inc 42,627.00
..... .64.11cilnQ Pennit Info: Describe \1ork(Le.. Build Single
7::s02~~'j:6 HIl6tlilv ~esidence Hith Attached Garaae)
;in~le faillLlvwl att. ~arage
. llllSPECTIOtl LINE
726-3769
Job Address 73J Poltava
Legal Description Lot I/- 8
Uke Vil:bage
Owner Grell:' sElectric
Address 2787 OlvillDic
.
. ~ITY OF SPRINGFIELO
" COHBJilATION APPLICATION/PERMIT
.
Construction Lender.First Nat. Ba:lk
Address
Ut~Jl:irl II:AI.l
Phone
(address 1
(nameJ
flies. no.)
Primary Wes tern Desilp;n Ass.
492 E. 13th Eug.
Structural
Electrical
t1echanical
CONTRACTORS
(name)
(address)
f1 ics. no.)
General Greg I sElect. & COl-St.
2787 OlYillDic
N.2nd. Sp:rfr:.
[nc 2707 Olympic
8865
20- ~l~ .
20-28
Plumbind;nnr......;H~ r. 'P1UIJ1h.
Electrical GreR; I s Elec t .
20'58
& C:mst.
INFORlIATION lINl
726-3753
Sq. Ftg. 1.laln ~~go
~q. r:tg. Access.
Sq. Ftg. Other
X-'lew _Add _Alter -:qep.
Fence Demo Change/Use
-Other - -
~
I~
(exo;resl
(ohane no.)
688-2787
(pxoirpc;l
(ohonp nn.
6/23/8el
6/19/80
6/3J/80
726-6404
746-0220
726-6404
PLUIIBIIIG
ELECTRICAL
'Iechanical T?n.lf' Hp"";n,, ?lKh'" r.nsr. V"lpv 1,,,,.,,0,. Of'"r.P..... ?:1?4 \?/lS/Rn Q'I7-2F,RR
MECHANICAL
I
I
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I
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I ISSUANCE OF PFR!IIT /I?,P.n
TOTAL CHARGES .3~~oo TOTAL CHARGES 3S:tb TOTAL CHARGES ...?.!l. ~/)
WHERE STATE L\\/ REQUIRES that the Electrical work be done by an Electrical Contractor. the electrical portion of this permit
shall not be vali~ until the label has been signed by an Electrical Supervisor and returned to the Building Division
I HAVE CAREFULLY EXA~lINEO 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 oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Oregon pertaining to the work described herein. and that 1m OCCUPAfKY will be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builderls
Board is in full force and effect as required by ORS 701.055. that if exempt the basis for exemption ;s noted hereon, and that
only subcontractors and employe who are in comoliance with OP.S 7nl.055 will be used on this project.
......~Please ~ _ / _ d/ SIGilATURF .
I " ------ // ~.:.. .b" ~ FOr. OFF I CE USE OtlLY
Zone 2-/ TYD"/C~St. rl~JI Units I Sa. Ftg.
Fire Zone 111. Bedrooms...3 Occy Load Sq. FtlJ.
Flood PlainHO Stories I Occ.v Group R.3 Sq. Ftg.
Systems Development
Char~e (J.5~)
~ ID('IT I
I I
I
I
110.1
-----lEach single fixture
IRelocated building
(new fix. additional)
l--IS.F. Residence
(1 bath)
IDuplex (1 bath) each
/ IAdditional bath
I ~Jater service
I Sewer
rEF
fHARGE
/j(\
FFF
f"1UlGE. .J!.IL....
Residence of
.... ~nD
SQ. FT.
07s.lb
New circuits alts.
or extensions
~Se>O
SERVICES
ID.(Xj
=- -- ---", 1:--: --- .-'
/ ITemporary Construction ~~..
Change in existing
rps i d_pnc:p
ImUltifamily. COITlT1. or
Tndust.riil.l
Storm Sewer
10f
I COI~'I./I NO. FEEDERS
I Install/alter/relocate
dio;:,trih fpprfpro;:,
IOf
amps.
amps.
!\a i n Il.oo
Access~ff'
Other
BUILDING PERI.IIT
Charges an~
Surcharges
Plan Ck. Comm/Ind
65%/Bldo Ppr Fpp
Plan Ck. Res
30%/Blda Per Fee
__ __ u Jltz.~./1(J
1"./,,4/
PLUi~BING PERMIT
Cha rges and
Surcharges
2r Fence
_U____\~Q.Q
_ J .1J.fJ D~mo
__6J5~~ Sidewalk t,7..sf3
, .~~c Paving
_______~I Curb Cut IB I
Itt~1
J I.ff/}
~ rf*.~t.t
I TOTAL q ri.45 >>' ~~~~_
ELECTRICAL PERIIIT
Charges and
Surcharges
l,. 'lIP
Total Comb. rermit
IIECHANICAL PERMIT
Charges and
Surcharges
FFF
r"ARliE
furnace/burner to
BTU's
Floor furnace
and vent
Recessed wa 11
~nil.C:p hpil.tpr ~nrl vpnt
I
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I
19.1Jn
I
lv-so
I
I
.3
Appliance vent
~poariltp
Stationary evap.
cooler
Vent fan wi th
sinale duct
Vent system apart from I
heatina or A.C.
Mechanical exhaust
hood nnd durt.
I
Ig",o
I
Wood stove/heater
DATE
x -;)..I/.ZO
X_7.IJD
Value~ll.llll
Value~-;.~o
Value
x
TOTAL VALUATION 42..1,,1.1. ZO
t,3Cj .4/1
,-.c--'.
/e
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.
,
,-
COMBINATION APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. Lane County Map Reference
II U3 43
2. examp.le- Lot I. Block 3, 2nd Addition to
sprlngfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example- heat/electrical ceilinQ/or forced air Qas
2. exa~le- waterheater/electrlcal/or solar
E. Square footage or valuation, etc. -
I. example- 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.with an
attached garage
2. example - remodel existing garage into family room
3. example - 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. DESIGN TEM1 AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to contact appropriate
person~ 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
full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
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. ---
III. 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
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
I
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
signature
J)b-~
.Ii
j
I
PLANS REVIEWED BY:
name
date~-(/-Jl"1')
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