HomeMy WebLinkAboutPermit Building 1980-2-4 (2)
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~ 'I iNSPECT ION LINE
725-3769
Job Address 73) P:J1taV3.
legal De,eription r,Clt fi 8
lIke VUb;:e
O\'mer Grep;;'s Electri..c
Address 27.37. ")1 vnr-; i. e
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": .' - CITY OF SPRWGFIElD
. CDMBI;IATION APPLICATION/PERMIT
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- - - - 'EilERr;y. ..sp,uRCE~:.
Heat l:.l",.C v J. .C
. \iater Heater E1ee t:'~e
I Ranqe Eleqtri2-____
I Valu, of \iO;k~-
Ine 42.027.00
Pho ,...,,..., - ,.. 64,Q<;;nQ PerntH Info: Describe I'Jork(i .e., Build Single
r;::_-:c :1,131;0 hBat:"lv nesidence l'lith A.~.tached GaraQe)
birzLe fRmLlv wi DGt. ~Br&~e
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~~ C.Jt}sc.
Construction lender Fi.rs t 1'1,;1 t. Sa ":: k
Address
Ut>IGN TEN.
Structural
Primary':,'ieSi,ern Desi:!gr.. Ass.
(name} ___
Electr; ca 1
11echan; ca 1
CONTRACTORS
(name)
Phone
(address)
40.2 ~. 13th
(lies. no.)
i2,,'.lg.
Genera 1 G r e ~ 's E 1. e e t. .'1,. C").' st.
(address )
2757 :JlYITIl: ic
(lies. no.)
0.,855
Plumbind;")nt""'l(~t Pl:111b.
Electrical Gr;?g:'s T::lecc.
&. C "lnSG. [Lie
20'38 N.
2nd Svrfc.
2~)-1l4
20-<:8
~lechanica1 R..,lf' Pp'1'~in= )l....th:::; ,')sr, V.81ov f,'-~Y',t:>
c.?~7 '}L'ym~ie
f.:=- '.~ r. p~" -;. ");:"4
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rlO.
PlUlIBlIlG ElECTR I CAl
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(,l-lAQr.~i
"'."'r-r
~....~".v
FFF
rHARr,F
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(l bath!
Duplex (1 bath) each
!.---
! Additional bath
Water service
Sewer
I Storm Sewer
IdSOO
I
NO I
I Res i dence of
~ !/,..n.'J SQ. FT.
!New circuits alts.
or extensions
I SERVICES
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"I /D~CU --:- Temporary construction~' ' ... - ~
I Cha~ge in existing I
rp'l- ] dJ'nrp
I multifamily. COIll!!. or I ..
'ndlJ~trial .:
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3.s~O!? I TOTAL CHARGES
that the Electrical work be done by an
label has been signed by an Electrical
TOTAL CHARGES
WHERE STATE l~\i REQUIRES
shall not be va1iJ until the
IOf
I C0I1'-1. fIND. FEEDERS
Install/alter/relocate
d;~trih f~pdpr,
Of
amps.
amps.
lNFORllATlON liNt
725-3753
Sq. Ftq. I.1ain 1 ,:;.)~
~q. Ftg. Access!JC'O
So. Ftg. Other
Y.-11e"_Add_Al ter -,~ep.
__Fence__Demo__Change/Use
_Other
~
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V
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(exnires1
(ohone no.
6B8-~787
(exoirpc;)
(ohonp no 1______
7;:;)- ::.4:14
7'-15-0220
'7<: 6-54:)4
6/23/8B
5/1g/80
.-;" '/'-1)
'..:) ./...... '-"
1;:' /1 "'I,",) ("::;?-;:'';,''.F\
MECHAN I CAL
Itn I
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(,~AQr.~
furnace/burner to
BTlI's
Floor furnace
and vent ..
Recessed wa 11
SOnrp hp~tpr ~nrl vpnt
Appliance vent
<;.eoaratp
I Stationary evap.
cooler
I Vent fan wi th
sinole duct
Vent system apart
heatino or-A.C.
Mechanical exhaust
hnod nnd durt
I Hood stove/heater
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}.j~ -?-::')
from
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ISSUANCf OF PFRillT
I/}. t:U
_).~~~,~I TOTAL CHARGES
Electrical Contractor, the electrical portion of
Surervisor and returned to the Building Division
.J.g I .S"/)
this permit
I HAVE CAREFUllY EXN1INED 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 Spri ng fi e 1 d and the laws of the S ta te of Orel)on perta i n i ng to the work descrt bed here in, and tha t IW OCCUPAllCY \'Ii 11 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 exempt the basis for exemntion is noted hereon, and that
only subcontractors and employees \vho are in compliance with Or-!.S 7('Jl.055 will be used on this project.
IWIE(please print) S IG;IATURE
FOr.1irFlCE USE mil Y
Zone ..~'-.' Tvpe/Const. ~"'4 Units I Sq. Ftg. rlain /~.I)O
Fi re Zone 712 Bed roorlls .3 Occy load Sq. Ft~. Access .-;Z:-r'
Flood Plain ,'J"'.) Stories I Occy Group ;7/... ~ Sq. Ftg. Other
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BUILDING PERI.llT
Charges an~
Surcharges
PlUI1BlIIG PERMIT
Charges and
Surcharges
ELECTRICAL PERr~IT
Cha rges and
Surcha rges
flECHAN I CAL PERMIT
Charges and
Surcharges
)1 l Plan Ck. COlMlfInd
_______..:...!..!:L.{::! 65%1Bldo Ppr Fpp
Plan Ck. Res
'.... '.,:i 30%/BldQ Per Fee
-; ... ,.,.....,1 Fence
_ _ _ _ _ _ _~......~"l!"-= ~
, .J. .,~I D~mo
\ "',')o(}
_ _SlS~~=:.~ Sidewa 1 k 1~ 7..':8
I .(..;\-" ","":"", .__j -rqC Paving
,?~ <"~, Curb Cut j,q I
--- _ ____,~~"f!.
/Istl
DATE
x '_1.:.t.?..') Value ?~, i?!J.OCJ
x i,f)!) Value "~-.q",.?~
x Va 1 ue
TOTAL VAlUATIOII 41./..7.'1. z..J
Sys ter.:s Deve 1 opmen t I
Charoe (1.5')
L\C\ ID(I'J
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Total r.oMb. Permit / j ':!~ .~l!
ITOTAlQr14S ;}~~
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COMBINATION APPlICATION/PEffi~IT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100. lane County Map Reference
.J/ 03 43
2. examole- lot 1. Block 3. 2nd Addition to
Spr1ngfield Estates
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examele- heat/electrical ceil;nqlor forced air qas
2. examoJe- waterheater/electrical/or solar
E. Square footage or valuation, etc. -
1. examole- 1250 sq. foot house, 500 sq. foot garage
2. example- if new project. check-new - if addition,
check: add, etc.
F. Building pennit information:
1. example - construct single family house with an
attached garage
2. examele - 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 (aJ 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
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
8. Full Plumbing, Mechanical, and Electrical Schedules
are availabfe 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 prepa~e a type written copy and return it to the
applicant at the time the actual permit is issued for his
5 i goa ture.
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
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CITY OF SPRINGFIELD (
City Hall
Springfield, Oregan
Department of Public Work.
OFFICIAL RECEIPT
52939(
No. B
"e :~ - 3 - 1980
c'd From~"-.t> ri' rJo,r ,t-
Idress .lJ'l g ~ ~ rU-l / ~ :1/
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ceiv_ed For:
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r1:. 13115
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mp
49"
5-uJ d ('j_
S.o?
lount Received
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AUTHOll:I:lltO SIGNATUIU
SH~~TOH.TU"".U~~ ~,,,..TUls . ItUCItHIt, 0_ _7.0,
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Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit applicant exempt from registration with the Builder's Board because:
Additional Project Information:
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PLANS REVIEWED BY:
name
signature _ADu..-_
,'1
'V'
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to
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..'?'......~j_::.~~
date ,../-<'/--,<-""1
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