HomeMy WebLinkAboutPermit Building 1982-3-4
INSPECTION LINE
726-3769
.
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
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INFORMATION LINE
726-3753
Sq. Ftg. Moin Y I {J{J
Sq. Ftg. Access.
Sq. Ftg. Other
_New_Add_X.Alter_Rep.
I_Fence_Demo_Chonge/use
_Other
Building Permit Info: Describe Work (i.e., Build Single
Fomily Residence With Altoched Garaoel
Job Add.." 308 N. "A" Street
L'901 D""'pHoo 1,~,3~.5.=.31 T I ._2.10(\
ENERGY .1iOl!~CES:
H.o' Kaal ant &
Woter Heoter _E-ter
N8
Elec
Ronge
Volue of Work:
Owner
City of 5orinofield
225 N. 5th Strppt
Phone 7?F.- <7~~
Remodel Old Lihrilrv into-1lffirp RILiJrlin~
Address
Construction Lender
City of Sorinafield
Address
225 N, 5th Strppt
Phone 7?F._ 17~~
(address)
DESIGN TEAM
(nome)
Primary
I orlJejl Pl p'lpr
??~ N ~th Street, Spfd OD
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
P.O, Box 717, Plpil,il~t Hil~R
(lics. no.)
.2"""01 Vanquard Const, Co,
Plumbina
EJectricol
Mechanical
PLUMBING ELECTRICAL
NO, FEE CHARGE NO.
Residence of
8 Each sinRle fixture 5,00 4(1(1(1 sq. ft.
Relocated building New circuits, alterations
(new fix. additional) ? or extensions
S.F. Residence
(I bath) SERVICES
Duplex (1 bath) each Temporary Construction
Additional both 1 Amps. 150
Water service
1 Sewer 10.00
Storm Sewer FEEDERS
2 Amps.
TOTAL CHARGES
50.00 TOTAL CHARGES
WHERE STATE LAW REQUIRES thot th. Electrical work b. done by th. Electrical Contractor, the electrical portion of this permit shall not be valid until a
label has b..n signed by an Electrical Contractor and attached to the el.drical panel.
Basis for Builder's Board exemptior"
~- -~'l.J" J?, ~~...s:-c::='PV
NAME (please print)~'
SIGNATURE
fOR OffiCE USE ONLY
PL
\I-N
Type/ Const.
Bedrooms
l;;torie,
Units
n "-:y Load
I"\ccy Group
Zone
Fire Zone
BZ
Flood Plain
(lics. no.)
fEE CHARGE NO.
, t:;. nn
3
15.00 1
I5.0r 30.00
cCI
9J
o
o
..t:..
"-0
(e)tpires)
(phone no.)
??1i-11i1i0
(e)tpires)
(phone no,)
MECHANICAL
FEE CHARGE
furnace/burner to
Il.TU'S
Appliance vent
separate
Stationary evap.
cooler
Vent fon with
single duct
Vent system apart from
heatinR or A.c.Sa una
Mechanical exhaust
hood and duct
3.00 9.00
4.50
Wood stove/ heater
Heat Pum"')
Air handler to
10.000 CFM
Air handler over
10,000 CFM
Relocation of
forced air Sl/S tell
6.00
ISSUANCE OF PERMIT
'0,00
70.00 TOTAL CHARGES
29.50
DATE3 / a/-B~
I
x
Value
Volue
Volue
$105.7?9.00
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 ond 011 work ~rformed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the Stote of Oregon
pertaining to the work described herin, and that NO OCCUPANCY will bOo made of ony structure without the perminion of the Building .Division. I further
eart7fy that my registration with, the Builder's Board is in full force and effect as required by ORS 701.055, that if e)tempt the basis for exemption is noted
heron, and thot only subcontractors and employees who ore in compliance with ORS 701.055 will be used on this project.
/? ~
~~
Sq. Fig. Main
Sq. Fig. Accen
Sq. Ftg. Other
x
,
TOTAL VALUATION
BUILDING PERMIT $296.00 Plan Ck. Camm/lnd $192.40 Systems Development
Chorges and 65%/ Bldg Per fee Charae CT .5%' N A
Surcharges 11.84 Plan Ck. Res
30%/ BldR Per Fee Plan r:hprk Fpp lO? 11(1
PLUMBING PERMIT
Charges and ~00(1 Fence
Surcharges 504.20
? ,0(1 Demo Totol Comb. Permit
ELECTRICAL PERMIT
Charges ond 70,00 Sidewalk 174' ?ORR
Surcharges
?R(1 AI C Pavina
MECHANICAL PERMIT t{) 'G~~.
Charges and _____-.19,50 Curb Cut
Surcharges TOTAL
L lR Fnrrn;:trhmj:lnt (?O 00 I $696,60
\
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COMBINATION APPLlCA T10N/PEIlMI.AP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example-tax lot 100, Lone County Mop Reference 17 03 43
2. example-Lot 1. Block 3, 2nd Addition to Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceilinq/or forced air gas
2." example~woter heater/electrical/or solar
E. Square footage or valuation, etc.
1. example-1250 sq. foot house, 500 sq. foot go rage
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 (0) of the
Structural Specialty Code
H. DESIGN TEAM 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
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 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 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
PROJECT CONDITIC!lNS TO BE SATISFIED BEFORE OCCUPANCY:
Additi,onal Project Information:
.I
PLANS REVIEWED BY,
. Lorne W. Pleger
namf'
~,ighatur'"
eRMIT VALIDATION
Permit CierI--
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