HomeMy WebLinkAboutPermit Building 1981-7-7
INSPECTION LINE
72~769
CITY OF SPRINGfiELD
COMBINATION APPLICATION / PERMIT
Job Add,m~Sb UAlrFAJV,JL ~l vf'>
legal Desc,iation /7..c3- -u; - V'I, .r:~. P::!> 300.
ENERGY SOURCES:
Heat W 1\ \...1- 4 ~ A ~p~
Owner
~^~O L.~D ....l/'Ol-A-
SA t.v1 if...
,,<:"k' I> /'? J"'I, A 1_
.~ - - ~ ,_ I.. . - ~
Water Heater
Range -
I Value o~'k: C 3
VSOOO.
INFORMATION LINE
72~753
_I
Sq, Ftg, Moon
Sq, ftg, Access.
Sq, Ftg, Other I'll./- l27'
_Ne.... \){.Add _Alter _Rep,
_,_fence_Demo_Changei U,e
_Otner
~
()
~
~
Address
Pnone
Building Permit Info: Describe WorK (i.e., Build Single
Fami:v Rp'5idpnC'~ With Atta.ched Garaae\
ADD IT I G ^-J 10 r;-A,/rR Y AJ..!t.fJ D/..uIAJ C,..
Con.truction lender Oi..J4J ~Q.. J:J A.iA tU~
Add,ess Pnone
DESIGN TEAM
(name;
(address)
(lies, no,)
Primary
'f<otJALD PARR.
it
11>2/ -S-
~ lJ 1",,- (" .11~ A Al.DJ2 ;
- . .
Structural
Electrical
(I
Mechanical
(name)
( address)
1 ~ j <; ('...cR P.A l. tJ k.
(lics. no,)
COI'lTRACTORS
\( ovA. l..D ~ 14. t>.-
~/A
Kr Dvuv~ f?
,
4'21 )-
General
Plumbing
Electrical
Me<:hQnicol
PlUMBING
~
1
ELECTRICAL
NO_ I
CHARGE i NO,
FEE
I CHARGE' NO,
I
/$.00 I
Residence of
:L...
sq: ft,
New circuits. alterations
or ex tensions :Z6ilirM~
Eoen lingle fixture
R~lacared building
(ne.... fix. additial>al)
S,f, Re.,den~e
(1 batn)
SERVICES
Duolex (1 bathl eocn
Temporary Construction
Additional batn
Amps.
Water ser.ice
Sewer
I
~ U] :
I V I - I
I
I
I
I
Amp.,
Stor,m Sewer
FEED ERS
(expire.)
(phone no,)
~/J.hJ-
, /
/'1'-~9) ')
(expires)
(ohone 1>0,)
tjl)1;L
.> iC-if?? ~
MECHANICAL
FEE
!CHARGE
I
furnacel burner" to
~TU's
Apt'liance vent
separate
Stationary evop.
cooler
Vent fan witn
single duct
Vent system aport from
heating or A,C.
Mechanical exhaust
hood and duct
Wood stave/heoter
Heat Puma
Air handler to
10,000 CFM
Ai, handler ove'
10,000 CFM
" /,~
(V -it!" I
TOTAL CHARGES
TOTAL CHARGES
ISSU-ANCE OF,PERMIT
/S.OO I TOTAL CHARGES
WHERE SiATE LAW REQUIRES tnat the Electrical work be done by the E!ertrical ContraClO?, the electrical porlian of this permit shall not be valid until a
label has b...n signed by an Electrical Contractor and attached to the electrical panel.
I HAVE CAREFULLY EXAMINED tn. completed application far permit, and do hereby certify that all information he,ean is true and correct, and I further
certify that any and all work pe,farmed sholl be done in accordance ....ith the O,dinances of the City of Springfield and the laws of tne Stole af O'egon
pertaining to tn. wa,k descriDed ne,in, and Ihat NO OCCUPANCY will be mode of any sl,uclure without Ihe permission of the Building Division, I fu,lner
,",rtify that my ,egistration wit;' Ihe Builder's Boa,d is in full fo,ce and effect as ,equired by ORS 701.055, thai if exempt Ihe basis for exemption is noted.
heron, and that only subcontractors and employees who are in compliance wilh ORS 701.055 will be used on Ihis p,oject.
Basis for Builder's Boord exemption:
NAME (plea.e print;\;?,t;fo.> 1\ \...b
'\IGNATURE~",",~ 0..~
__J - - --.-'
IJ , t01\1't...R..
FOR OFFICE USE ONLY
Zone
R-I
'"r;t -N
I
'\q. fig. M"in
<;q. fig, Acces'
Sq. Ftg. Other-1..!i.!:l
Type/ Canst,
8ed,aoms
C::torie'.
fire Zone
Flood Plain
-
Units
,... ccy load
nccy Group
...Q - 3
I
DATE
b/3O, ) 'If /
'(.. Value
x Value
x .3cJ. '1"- Value
TOTAL VALUATION
.s. ooa, "'0
S.~o'f!!J
.-
Pion Ck, Comm/lnd
65~~1 Bldq Per Fee
Plan Ck, Re.
30%/ Bldq Per Fee
I Systems Development
Cnorae (1,5%)
~.€C ~~"
I EL&::. LA t'JS 1..
BUILDING P~RMIT
Cna'ge. and
Surcha'ge.
_____~oo
1.:U;
'_____~E)O-'
,€.tO I
Demo
PLUMBING PERMIT
Charges and
Surcharges
Fence
elECTRICAL PERMIT
Cha'ges and
Su,cna'ge.
Side....alk
",I C Pavina
MECHANICAL PERMIT
Cnarge. and
Svrcha'ges
Curb Cut
I TOTAL
Total Comb, P~rmit
.Yl
~.fI"
LC 0<3
~--;-~~
-'<-".~._. .. ---...._,~. .
COMBINA TlON APPlICA TI~
I. Applica~ 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: electricol/or solor
E. Square footage or valuation, etc.
1. examole- J 250 sq. foot house, 500 sq. foot garage
2. examoie-if new project, check ~-if addition, ched
add, erc.
F, Building permit information:
1. example-construct single family house with an attac
garage
2. exam ole-remodel existing garage into family room
3. example-convert single famiiy residence into
restaurant (change of use)
G. Yalue ot work os defined in Section 303 (a) of the
Structural Specialty Cede
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Divisic (
Slaff must be able to contact appropriate persons regc
design information or job site correctiens, etc.
II. Abbr'evioted Plumbing, Mechanical & Electrical Schedules (
A. Except where blenk spaces occur in the description po
oi the Mechanical and Electrical Schedules, the applice
need fill-in only the No. Boxes adjacent to the approp ,e
item(s) to be installed
B. Full Plumoing, Mechanical, and Electrical Schedules '
are available at the Building Division
1. To conserve space on the permit form the schedule
have been abbreviated
2, If the item(s) to be installed are not covered on the
aled schedules you should consult the fuil schedul!
C. BUILDING DIVISION STAFF WILL Fill OUT ALL FEES A
CHARGES ON THE SCHEDULES
ERMIT (CAP)
PERMIT VALIDATION
CITY OF SPRINGFIELD
City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
56867
. (
Received
cQ])
F~_J\ rl t1'i ~ 7""y - "",\
'~)(/~ ~/\ ' / ~~)J "
J f), P>.-l- T-,6 / 18'CJ
_>LQ~L\ \ c::: CO
49); ~ )((f) ,\,
,'6J()'
III. Applicant to sign and dote (
Whenever possible. the initial application will be used a
worksheet only. Where possible, Building Division Staff '
prepare a typewritten copy and return it to the applican (
the time the actual permit is issued for his signaturE'.. . Amount Received
IY. Fees and Charges
Plan check fees are due and payable at the time of the I
and no plans will be processed until these fees are paid
other fees and charges are due and payable when the I
is issued,
(
(
.<lit
" BY
.Im)
AUTHORIZED SIGNA.TUR~~
SHELTON-TURNBULL PRINTERS. EUGENE OR 97.01
...". (
V. FOR OFFICE USE ONLY
+-
~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~
...
-:
Additionc/ Project Information:
PLANS REVIEWED BY:
namp'
-ignaturp
A!1:.
-iale 7-J- ~ /