HomeMy WebLinkAboutPermit Building 1981-12-15
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17-03-35-41
CITY OF SPRINGfiELD
COMBINATION APPLICATION/PERMIT
I ENERGY SOURCES:
Heat
I Water Heater
_ Ran!=j8
Value of Work:
INFORMATION LINE
726-3753
INSPECTION LINE
726-3769
lego] Description
LLROOO
Sq. Ftg. Main
Sq. Ftg. Access. 5/60
Sq. ftg. Other
~ _New _X-Add_Alter _Rep.
_Fence_Demo_Changel Use
_Olhe
:P
~
:::>
:P
:n
.0
Job Address
1117 SouttL.".A" ,1'"",,1'
Owner
N;rol;d rnmn;tnv
1117 Snllth "A" ,1'"",,1'
Phone
7?"_1 Q71
$7 5..000. 00
Building Permit Info: Describe Work (i.e., Build Single
Fomilv Residence With Attached Gcrooe)
Address
~r";n3field> Oregon 97V7
Construction hnder None
-Ext"n~;n~ Of exis~;ng f~ log ~arehouse
4(' I x 144 I
I Addren
I
I
r
I
Phone
DESIGN TEAM
(nome)
(addren)
(Iics. no.)
(e:ltpires)
(phone no.)
Structural
AUGust Construction
.1nhn HI' r...; r.k
Comoanv
485-6961
Primary
Electrical
Mechanical
CONTRACTORS
(nome)
(addren)
(Iics. no.)
(expires)
(phone no,)
~'l
G~neral
Auoust Construction Comoan"
4RS-6961
Plumbinq
Electrical
Mechanical
I
I No.1
I
I-
I
I
I
I
PLUMBING
ELECTRICAL
MECHANICAL
FEE
I CHARGE
I
NO. I
FEE
J CHARGE
NO,
FEE
I CHARGE I
I
1
I
I
SERVICES
furnace/burner to
BTU's
Appliance vent
separate
Stationary evap.
cooler
Vent fan with
sin~le duct
Vent system apart from
heating or A.C.
Mechanital e:lthoust
hood and dutt
Residence of
Each sinqle fi:ltture
Relocated building
(new fix. additional)
S.f. Residence
(I bath)
Sq. ft.
New circuits, alterations
or extensions
Duplex (1 bath) each
Temporary Construction
Additional bath
Amps.
Water service
Sewer
Wood stove I heater
Storm Sewer
FEEDERS
Heat PUMP
Air handler to
10.000 CFM
Air handler over
10,000 CFM
Amps.
ISSUANCE OF PERMIT
TOTAL CHARGES
TOTAL CHARGES
TOT AL 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
'abe' has been signed by an Electrica' Contractor altd attached to the eleoct,ico' poltel.
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that 011 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
cerHfy that my registration with the Builder's Board is in full force and effect a s required by ORS 701.055, that if e:ltempt the basis for exemption is noted
heron, and that only subcontractors and employees who are in compliance with 01.055 will b{j)use this project.
Basis for Builder's Boord exemption- I
NAME(pl.a..p,;nt)Ye:"'N ./)"Oc,"''f . '. L 'k1-~ DATEa!~/R!
FOR OfFICE USE ONLY (
Zone _M _1
fire Zone
Flood Plain
Type/Canst.
Bedrooms
<:torie-
V-N SPKI 0 Uni..
n.'Cy Load -12
'Jccy Group_I--I1
Sq. Ftg. Main
Sq. Ftg. Access
Sq. Ftg. Other
5760
X '!alue
x n 02 Value $7'1,000 nn
x _Value
TOTAL VALUATION $7'1,000 00
BUILDING PERMIT Plan CIt. Comm/lnd
Charges and ____23Z-.'OO- 65%1 Bldo Per Fee ~1'i4 0'1 Pci
Surcharges Plan CIe:. Res
9.48 30%/ Bld~ Per Fee R'i7717
PLUMBING PERMIT
Charges and fence
Surcharges
Demo
elECTRICAL PERMIT
ChClrges and Sidewalk
Surcharges
AIC PaviM
MECHANICAL PERMIT
Charges and Curb Cut
Surcharges -------- I
Systems Development
Chortle (1.5%1
t~,125 00
Tolol Comb. Permit
~AL ''1
1 TOTAL
!J,371.48
'.; .-..-
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
,A. Jab Address
. B. legal Description
1. example-tax lot 100, lane County Map Reference
2, example-Lot 1, Black 3, 2nd Addition to Springfiel,.
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceiling/or forced air aas
~. example4water.heaterjelectrical/or 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, cheo
add, etc.
F. Building permit information:
1: example-construct single family house with an otto
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 Divisi
Staff must be able to contact appropriate persons rege
design information or job site corrections, etc.
"
II. Abbreviated Plumbing, Mechanical & Electrical.Schedules
A. Except where blank spaces occur in the description pOl
of the Mechanical and Electrical Schedules, the applicc
need fill-in only the No. Boxes adjacent to the appropr
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,
ated schedules you should consult the full schedules
C. BUILDING DIVISION STAFF WILL Fill OUT ALL FEES AN
CHARGES ON THE SCHEDULES
III. Applicant to sign and date
Whenever possible, the initial application will be used as d-
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 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
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City Hall
Springfield. Oregon
Department of Public Works
OFFICIAL RECEIPT
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57752(1
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Date r\O~,. \ C~ 19 F\\
( Rec'd Fr:m C\\\cnH l:'d- ~\:'\\1\.
Address\ \) ~ I~ 1lB oS )' H 0/
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Received For:
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Amount Receive~ _ ~ _~
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AUTHOR12:ED 5IGNATU~E ."n-. (..,
5...~TON.TU""N.U~~ ~""".TI!:"'5 . .UGI!:Nt, 0"" .'..0.
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Permit Clerk
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional permits are required for electrical. plumbinq, or meChanical work.
Additional Project Information:
PLANS REVIEWED BY,
/i
dt
name
n~n Smith
signature
.J"]te
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