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HomeMy WebLinkAboutPermit Building 1982-5-24 .' ',' f'---'~ -, " "::." _:,:: .'~'-' ..-.<' ,;-,.~.~'.i-~t-1,~~~~;d:~>~~~:~~~~~,~~I\,:i::;.,~,-~~':',".' ' INSPECTION LINE' 726-3769 Job Address n19~C~ntennail RL~d 17 -01-n -41.--.I...J 111QO CITY OF SPRINGFIELD COMBINATION APPLICATION/ PERMIT ENERGY SOURCES: Heat Water 'Heater Range Value of Work: INFORMATION LINE 726-3753 Add;ess Spi-1 ilgf+c 1 j ,OR Phone $1.000.00 Building Permit ,Info: Describe Work (i,e" 'Build Single Family Residence With Attached Garage) Sq. Ftg. Main Sq. Ftg. Acce ss. Sq, Ftg. Other _New~Add_Alter _Rep. _Fence_Demo_Change/ Use _Other 00 N o (J"J N l.O , legal, Description -- Ow-rier .' H5 i'l t t 'B..r.o..:t /1 p rc:: Address ,Phone R,uilrl 1D' nUl waLl Li'lr into bat~ plumb- I ing for new sink. Place 6 elec pluq out- Ilets. Construction lender DESIGN TEAM (name), (address) (Iics. no.) (expires) (phone no,) Primary Structural 'Electrical Mechonical CONTRACTORS (name) (address) (Iics, no.) (expires) (phone no.) General Plumbing Electrical Mechanical PLUMBING ElECTRICAL MECHANICAL NO. FEE I CHARGE NO. FEE I CHARGE I NO. I I 'FEE I CHARGE ~ '.,;d.o'.o' I I furnace/ burner to , I 2 Each single fixture sq. ft. BTU', I Relocated building , ,-,- New circ~its, alterations ) r~-l) I Appliance vent I I (new fix, additional)' X or extenSlons2 n r mn r ' nn separate I S,F, Residence I I I I I Stationary evap. I I (1 bath) SERVICES cooler I I I I I I I Vent fan with I I Duplex (1 bath) each Temporary Construction single duct I I I I I I I Vent system apart from I I Additional bath Amps, heating or A,C. I I I I I I I Mechanical exhaust I I Water service hood and duct I Sewer I I I , I I Wood stove/heater I I I Storm Sewer , I I I FEEDERS I I Heat Pump I .;/ I r I I / I Air handler to I Amps. 10,000 CFM I I I I I Air handler over, , 10,000 CFM I I I I I I I I I I I I I I I I I I I I I I I ISSUANCE OF PERMIT TOT Al CHARGES <<l;lO_n~ TOTAL CHARGES $15.00 TOTAL CHARGES WHERE STATE lAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical ,portion of this permit shall not be valid until a label has been signed by an Electrical Contractor and attached to the electrical panel. I HAVE CAREFUllY EXAMINED the completed application far permit, and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Oreg~n pertaining to the work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building ,Division, I further cerHfy that my registration with, the Builder', Board is in full force and effect a, required by ORS 701.055, that if exempt the basis far exemption is noted heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used an this project. Basis far Builder's Board exemption: NAME (please print)f!a-YfJ Jd if/. g/};C l' SIGNATUR~~df>l~/ld- DATEI ~-~tj-:?2... FOR OFFICE USE ONLY, Zone --C=? Fire Zone Flood Plain Type/Canst. V-N ,Spr Bedro,ams 1 Units nccy load 0ccy' Group ---B 2 "q. Ftg. M"in C;q"Ftg, Access Sq. Ftg. Other le.a.s P '( Value x Value 'pi'lr.P RE'lllo,deJ Value TOTAL VALUATION 13$ S'f 0 g 'f I Syste,ms Development 6.50 Pd 5-20~oo.rge (1.5%) I I !Lggg~ gg <:'torie" BUILDING PERMIT Charges and Surcharges ___~JlD~O .40 _~__JlO.JJO _40 ____-.$15.JJ0 .nO Plan Ck, Comm/lnd 65%/ Bldg Per Fee Plan Ck. Res 30%/ Bldg Per Fee Demo II Total Comb. Permit I I I I ~1r;,4n PLUMBING PERMIT Charges and Surcharges Fence ElECTRICAL PERMIT Charges and Surcharges MECHANICAL rERMIT Ch':Hges and Surcharges Curb Cut I I I ,r TOTAL Sidewalk I A/ C Pavinq $36.40 .~----_.---.--------- _:......._- ----- ...-' , , ..." " -""" '''''''''I" ~.__-' . - '. -".... . . ~ ~~. :. ~~. ~~~ f.j.'"~~i;t;:a...t;I,);......j.;,~~~,\>rif~-ifi~,'ii_;~~1r:~~~ ~~~ ~~~':~~ ~.., :. ',. ~ ~ ':.. ",~ Hi.. r "':~~"~lu, ,:::;. "4:\ ':'~~"~~~~H.:({itJ~' ':qi11 _I:;; '" <,- .;. ~'i)ff~~~t -( ). ',' .,' ':...~ ".. ~'~'~'\"~':"L"';;,~?:~f,r}~Wj~~,.:;,r'JfJ~t~p:~J~ii:~df!t1.'rl;;: . ~ - r' ~'\', ~. t! I.. .: ~4~lf.,; ~.':' ~ .':.-: ;:~ .~ .,;.s.t",,,.:"~l::'~":-:_':-'-~ ~~nl~" .rriJ'~ .t~!..~t:4?j': ~CC~ -Jp . ' -l:~'14(#g,t7 /" <;lgnatur;;t/"!-/rJ '-'<"~iT- " v COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. legal Description 1. example-tax lot 100, lane County Map 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 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. 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 CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: PLANS REVIEWED BY: nam'" Lorne Pleger PERMIT VALIDATION ::t- g t;Cj () OJ 2- ':1p )0,00 ,yO 490 pp L/9D IO.CO . YO' JL.p IS-.CO .(nO Ll90 "1CJt1i L- j~. Ll6 / Permit Clerk- r ^-n (Leu r~t~ 5-24-82