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HomeMy WebLinkAboutPermit Building 1982-3-9 (2) -~ 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 1