HomeMy WebLinkAboutPermit Building 1982-3-9 (2)
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I'NSP~CT'ON liNE
726-3769
I Job Addr..u
I legal Description
I
I Owner
I Addreu
I
I
I
I
.
.. CITY OF SPRINGFIELD
. COMBINATION APPLICATION/PERMIT
ENERGY SOURCES:
..
INFORMATION LINE
726-3753
phone
$10.000.00
Building Permit Info: Describe Work (i.e., Build Single
Fornil., Residence With Attached Goroqe)
Sq. Ftg. Main
Sq. Ftg. Accen.
Sq. Fig. Other
_New_Add_Alter_Rep.
_Fence_Demo_Changel Use
_Othe'
(Xl
N
o
I-'
'"
N
1166 South
17-03-.35-41
"A" Street
Tax Lot 6600
Heat
Water Heater
Range
Volue of Work:
S. Fleek iCathv Roberson)
Alterations
'I
Construction Lender People I 5 Ban k
Add,." 5th & "B" Streets
DESIGN TEAM (name)
phone
(address)
(lies. no.)
(expires)
(phone no.)
Primory Art.pm; n Pn 7
Structural Artemi 0 Paz
220 N. 5th Street
220 N. 5th Street
747-8823
747-RR?::l
Electrical
Ml'!chanicClI
CONTRACTORS
(nome)
(address)
(lies. no.)
{exoires}
{ohane no..
G.n.,al L 1 ovd Seamans
PlumbinQ Un known
Electrical Unknown
Mechanical Unknown
PLUMBING
, CHARGE! NO. I
ELECTRICAL
MECHANICAL
NO.
FEE
FEE
'CHARGE
NO. I
FEE
CHARGE
Each sin!=lle fixture
Relocated building
(new fix. additional)
S.F. Residence
(l bath)
sQ. ft.
New circuits, alterations
or extensions
15.00
furnace/burner to
BTU's
Appliance vent
separate
Stationary evap.
cooler
Vent fan with
single duct
Vent system apart from
heatinQ or A.C.
Mechanical exhaust
hood and duct
Residence of
2
SERVICES
Duplex (1 bath) each
Temporary Construction
Additional bath
Amps.
Water service
Sewer
Wood stove/heater
Storm Sewer
FEEDERS
Heat Pump
Air handler to
10,000 CFM
Air handler over
10.000 CFM
Ck disconnected
plumbing and
compressor lines
Amps,
15.00
ISSUANCE OF PERMIT
TOTAL CHARGES
15.00 TOTAL CHARGES
15.00 TOTAL CHARGES
WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall not be valid until a
label has been signed by an Electrical Contractor and attached to the eledricol panel.
I HAVE CAREFUllY EXAMINED 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
pertaining to the work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building .Division. I further
cert1fy that my registration with, the Builder's Boord is in full force and effect a s required by ORS 701.055, that if exempt the basis for exemption is noted
heron, and that only subcontroctors o~ employees who are in compliance with ORS 701.055 will be used on this project.
Basis for Builder's Board exemption: _f '/.t.,t-) y 6~!O;J
'IGNATURE_-:;"'" // -0'.'/~M____ TE79 c:.,
NAME (pl.a.. p<int" FOR ~FFlCE USE o:'yA 7 ~ ~.~ OA .J - -" <<-
Zone
C 4
Type/ Canst.
Bedrooms
(,torie"
V-N
Units
nccy Load
Occy Group
B2
Sq. Ftg. Main
Sq. Ftg, Accen
Sq. Ftg. Other
Value
x Value
Value
TOTAL VALUATlONJl n _nnn, nn
Fire Zone
Flood Plain
PLUMBING PERMIT
Charges and
Surcharges
#B~8157 I
Pd <-4-R<\_.c-$52.OD
\ 2.08
$15.00
.60
$15.0C
Plan Ck. Comm} Ind
65%/ Bid!:! Per Fee
Plan Ck. Res
30%} BldQ Per Fee
$33.80
Systems Development
Charroe (1,5%)
NA
BUILDING PERMIT
Chorges ond
Surcharges
Fence
Pl an ck fee
$
$
33.80
33.28
Demo
Totol Comb. Permit
ElECTRICAL PERMIT
Chorges and
Surcharges
Sidewalk
Fr: A/C Pavina
MECHANICAL PERMIT
Chorges ond
Surcharges
Curb Cut
TOTAL
$
67,08
COMBINATION APPlICATlON/.IT .P)
I. Applicant to furnish
A. Job Address
B. Legal Description
L example-tax lot 100, Lane County Map Reference 17 03 43
2. example-Lot L Block 3, 2nd Addition to Springfield EstDtes
C. Name, ete, of owner and construction lender.,
D. Energy Sources
1. example-heat/electrical ceiling/or forced air gas
2, examD,le-water heater/electrical/Dr solar
E. Square footage or valuation, etc.
1. example-1250 sq. foot house, 500 sq. foot garage
2. example-if new project, check new-if addition, check
add, ete,
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 TEAM AND CONTRACTORS
To avoid design or construction delays, Building ~ivision
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, MechDnical, and Electrical Schedules
are available at the Building DivisiDn
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 abbrevi-
ated schedules you should consult the full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
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 typewritten copy and return it to the applicant at
the time the actual permit is issued for his signature.
IV. Fees Dnd 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:
Additi,onClI Project Information:
PLANS REVIEWED BY:
name Dan Smi th
/I U.-7
--, /'
"ignaturo
- --
-. - ----- ---
.. .MIT VALIDATION
~
.,.'
Permit Clerk
~atF'
3-5-82
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