HomeMy WebLinkAboutPermit Building 1982-3-4 (2)
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I INSPECTION LINE
726.3769
Legol Description 17-0.1-.1fi-.11 T
?100
I ENERGY ':;O~~CES,
H.ol Ka'll ant &
Water Heater E 1 ~r.
Ron.. NA'
Value of Work:
Elec
INFORMATION LINE
7U-3753
Sq. Ftg. ~ajn ~ 1 ()()
Sq. Fig. Accen.
Sq. Fig. Other
_New_Add_XAlter_Rep.
_Fence_Cema_ChangefUse
_Other
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CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
Job Add,... 308 N. "A" Street
Address
City of Sorinafield
??~ N, ~th Strppt
phone 7?h_A7~~
Building Permit Info: Describe Work (i.e., Build Single
Fornil", Residence With Attached GoroQe)
Owner
Remade 1 01 rl I H,r~rv i ntfl Offi rQ R"i 1 <Ii n9
Addre"
22~ N,
City of Sorinafield
Sth StY'Ppt Phone
7?h_R7<:'l
(address)
(lies. no.)
(expires)
(phone no.)
Cl)nstruction lender
DESIGN TEAM
(name)
Primary
Lornp W. Plpppr
??~ N ~th ,t~AQt 'n~~
I?Ii-1lilin
Structural
Electrical
Mechanicol
CONTRACTORS
(nome)
(address)
(lies. no.)
(eX.,!res)
(phone no.)
G.n.,,,1 Vanaua.rrl COn5t, CO.
p,o RflX 717, Plp"~"~t Hill, OR
Plumbinq
Electriccl
Mechanical
PLUMBING ElECTRICAL MECHANICAL
NO, FEE CHARGE NO, FEE CHARGE NO, FEE I CHARGE
Residence of furnace/burner to
8 Each sin~le fixture ~,(1n an,nn stl.ft. BTU's
Relocated building New circuits, alterations Applionce vent
(new fix. additional) ? or extensions ,~ nn separate
S.F. Residence Stationary nap.
(1 bath) SERVICES cooler
Vent fan with
Duplex (1 bath) eoeh Temporary Construction 3 sinRle duct 3.00 <l.00
1 150 1 Vent system apart from
Additional bath Amps. 15,00 heatinR or A.c.Saunn ,.~O
Mechanical exhaust
Water service hood and duct
1 Sewer lO.OO Wood stove/heater
Storm Sewer FEEDERS Heat Pump
2 Air handler to
Amps. 15.0( 30.00 10.000 CFM
Air handler over
10,000 CFM
Relocation of
forced air svstell 6.00
ISSUANCE OF PERMIT
lr.,OO
29.50
TOTAL CHARGES
50.00, TOTAL CHARGES
70.00 TOTAL CHARGES
WHERE STATE LAW REQUIRES Ihal Ihe Electrical work be done by the Electrical Conlrador, the electrical porlion of Ihis permit sholl not be valid until a
label has been signed by an Electrical Contractor and attached to th. electrical panel.
I HA VE CAREfUllY EXAMINED the completed application for permit, and do hereby certify thai all information ~ereon is true and COrrecl, and I furlher
certify thai any and 011 work performed sholl be done in accordance with Ihe Ordinances of the City of Springfield and Ihe laws of the State of Oregon
pertaining to the work described herin, and thot NO OCCUPANCY will be made of any structure withoul the permission of the Building .Division. I further
certlfy that my registration wit" the Builder's Board is in full force and eiffect os required by ORS 701.055, that if exempl the basis for exemption is noted
heron, and that only subconlractors and employees who are in compliance with ORS 701.055 will be used on this project.
Basis for Builder's Boord exemption: --::?-.", ......... ..A"'~
NAME(pl.o..p"nt)~~~ J? C;;~'.::--'PV <IGNATURE ~~-YA~
DATE~ / ~e.~
FOR OfFICE USE ONLY
Zone
Fire Zone
Flood Plain
PI
Type/Canst.~
Bedrooms
c:.tori."
Units
O,;cy load
Occy Group
T
B2
Sq. Fig. Main
Sq. Ftg. Access
Sq. ftg. Other
.
Value
Value
x Valul
TOTAL VALUATION ~~ 1 O~, '?,?9. on
BUILDING PERMIT $296.00 Plan Ck. Ccmm/lnd $192.40 Syslems Development
Chorges and 65%/ Bldq Per Fep Charne fl.5% \ 1\1 A
Surchorges 11.84 Plan Ck. Res
30%/ Bldq Per Fee Pl~n rhpl'k ;-pp 10? I1n
PLUMBING PERMIT
Charges and ~n.nn Fence
Surcharges 504.20
? .00 Demo Total Comb. Permit
ElECTRICAL PERMIT
Charges and 70.00 Sidewalk 174' 2('l,RR
Surcharges ? Rn AI C Pavina
MECHANICAL PERMIT ~'C~~.
Charges and _____..19.50 Curb Cui
SurchQrges TOTAL -
T. 1$1 i:'nrV",,:ar!-'monf- (?n nn $696,60
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applica nt to furnish
A. Job Address
B. Legal Description
1. example-tax lot 100, Lane County Map Reference.
2. example~Lot 1. Block 3, 2nd Addition to Springfielc
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceiling/or forced air gas
2.' example-water heater/electrical/or solar
E. Square footage or valuation, etc.
1, example-1250 sq, foot house, 500 sq, foot garage
2. examole-if new project, check new-if addition, chec
add, elc,
F. Building permit information:
1. example-construct single family house' with an attae
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 Cade
H, DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Oivisio
Staff must be able to contact appropriate persons regal
d_esign information or job site .corrections, etc.
H. Abbreviated Plumbing, Mechanical & Electrical'Schedules
A. Except where blank spaces occur in the description port
of the Mechanical and Electrical Schedules, the applicar
need fill-in only the No. Boxes adjacent to the appropri,
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 01
ated sohedules you should consult the full schedules
C, 8UILDING DIVISION STAFF Will FILL OUT ALL FEES AND
CHARGES 01'1 THE SCHEDULES
III, Applicant to sign and date
Whenever possible, the initial application will be used as a
worksheet only. Where possible, 8uilding 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 applij....-
and no plans will ge processed until these fees are paid. All
other fees and charges ore' due and payable when the permit
is issued.
. . . . ~, ,'. .
V: FOR OFFICE USE ONLY
PROJECT CONDITI0NS TO BE SATISFIED BEFORE OCCUPANCY,
...;.:.;,':_....:..':-.-..
Additional Project Information:
PLANS REVIEWED 8Y,
. Lorne W. Pleger
nom"'"
"ignaturf"
PERMIT VALIDATION
City Hall
Springfield, Oregan
Department of Public Wark.
OFFICIAL RECEIPT
No. B
Dote~ 4- 19~/L
Rec'd FroU(lJ""S.roJ\fR Q ~-1-\ II
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~-22-82