HomeMy WebLinkAboutPermit Building 1980-12-29
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CITY Of SPRINGFIELD INFORMATION LINE
COMBINATION APPLICATION/PERMIT 726-3753
ENERGY SOURCES _ J / 1 liff fig Meon t""')OU
Ht'cl-hL..alf2:!f1!-/:J - UQ'C~'t;q Ftg Atten
Waler Heater _4dtJ-fn/ .1 Sq Fig Other
~-"~!_~"~-'.'--.-J 7-- Q.:7 ,.:JoC.. - -3d -'_ '000' _Uru:J.KLC__ _'/N.w_Add_AIt"_R.p
.. ~ .......- ~ 7 ---~ -- ~~-:;flr. ~_Fe"ce_Demo_Chonge/Use
--.Jf\x-Co_L..37.C>u___ -_____ ____ 7 006 a~ ,.JI''o'h"
0__, ~f~ln,;}1 ~u~"e.. j - -
I ...dd,." ,~CC- -C~~~ '" ,;., - ~ho"" '~-8& -, ~~~~;~jR~~~:~tc~n~,th ~~:~~l:eed ~~rr~~'~~ Budd Single
I -----.- q -== - _C.0:"'RIZ-/;OI!L-DJ' le4.s-L :y=.C(1'
Co..,trun.n.. 1.1'd., - J6....... (")'.t Fr; tf
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INSPECTION LINE
7'26-3769
Add.e..
Pl'1Q".
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11
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CESIGN TEAM
("0"'.'
food'f'ul
(I,es no)
(expIres)
(phone no )
Pumo..,
5bn
c:::.,~..." I?,
~c... c h~"'l Cl'\d"l'~
~t,u(lv'ol
El..,',,(al
M~'''o''''oJ
CONr~ACTO~S
1I'lomel
:oaorllHI
(lIes no)
(exPires)
(ahone no l
G"n~rol
KONC.,.,..() ~,0)E\.o
OO'n L.~",< IS
&.b G~~....d
M~......->",~\\~
,';) NQ"~ C.lb<.:">
~D5 ~ S4f!j.
</IZ LIYlf,,)r1-
..q I '" I "E" 5tw:a.t-
4/ b /81
14\0 -3b~ '-
7210-0/</7
342.-ZllofS
747-7445
Plvmbonq
Ellllctneal
Mechan,cal
Plu....eING
ElECTRICAl
MECHANICAL
1"/0
13
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6=~~
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fEE I C!-lARGE I NO FEE I CHARGE I
I I fvrncce/bvrncr to I
_BTU~
/50() ApplIance venl I,
seporote
StatIonary evap I .
cooler I
II Vent fan wIth 13001
srnqle duct
I Vent system apart from I I
heotrn~ or A C
I Meenanrcol exhaust I I
heod and duel
I Wood stove/heeler
1/ I Heat Pump d, OC!
I I AIr handler fa
10,000 CFM
I AIr handler over
10000 CFM
Duol...: (I hoth) each
I rEE I C'"lARGE ,
L'l ()I) 1/.5: o-J
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,
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NO
Each I,"qle f'.'ure
a.locared bUlld,ng
{nlllw fli( ada,honoll
5 F R"I,de"ce
(1 barh)
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.z!
I
Relldenc~ 0
___sqrt
New C"CO,jlrl <Iltero"on~
or elllenllon~
SE?VICES
Temporary Conurucl,on
Add,honol bOln
Amps
Wof..r Il11rY'Ce
Sewer
Storm Sewer
FEEDERS
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I TOTAL CHARGES
I
Amps
ISSUANCE OF PERMIT
/O~O
/9.00
/ S LJO I
TOTAL CHARGES
/:J. 00
TOTAl CHARGES
WHERE SlATE lAW REQUIRES that the ElectrICal work be done by the Electrical Contractor, the electrICol portIon of thIS permit sholl not be valid until a
lobel hOI beon SIgned by on Elocf"col Contractor and attached to the electrical panel
I HAVE CAREFUlLY EXAMINED the completeCl applICatIon for permIt, and do hereby certify fhat 011 mformatlon hereon II true and correct and I further
cerflfy that any and all war!.; pertormed sholl be done In act;Ordance WIth the Ord,nances of the Crty of Sptl"gfreld and the Laws of the State of Oregon
pertalMlng to Ihe work. descnbed herm and that NO OCCUPANCY Will be mode of any structure Without the permiSSion of the BuddIng D,vlslon I further
certlfy that my reglstrahon With the BUilder's Board IS m full force and eoffect as reqUIred by ORS 701055, Ihot If exempt the baSIS for exemption II noted
heron, and that only subcontractors and employees who ore In compliance WIth ORS 701 055 WIll be used on thIS project
SoSI$ for Budder's Boord exemphon
NAME (please print) G~).r'1
f?"2- clUP.
~
,,",0 N t1 U)
%NATURE ~'-'+' ~~
FOR OFFICE USE ONLY -J
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DATE i)ec Cc f!0,
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Zon-
Fife Zone
Flood PlaIn NO
Typel Const
Bedrooms
Cito"e-
rL-~-HK.
lnlh
f"lecy Load
Oecy Group
~
e;-~
Sq Ftg Marn
Sq Ftg Access
Sq Ftg Other
9:'00
x
"alue
Value _ ___
7,<,,<'10.=
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x
x
Value
7.oot:J /Y)I
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TOTAL VALUATION
BUilDING PERMIT L//J,(Y) plan Ck Comm/lnd
Charges ond 65~o/ Bldq Per Fee
Surcharges J,{dJ Pion Ck Res
30%1 B!dq Per Fee
PLUMBING PERMIT /5.00
Charges and Fence
Surcharges ,f#O
Demo
ElEORICAl PERMIT -
Chorges and 15"00 Sidewalk
Surcharges
. {., () Air POVIO'"
MECHANICAL PERMIT
Charges C1nd _____L3!fXl Curb CuI
Surcharges 1'1l..2
11'-?Z~'Q
..., I 0 0 'tr ),vtems Development
0'\. \,C> - ~~ ~l-orqe (J 590l
Tolal Comb PermIt
I TOTAL
# 9:Z.S~
-"
COMBINATION APPliCATION/PERMIT (CAP)
Appilcant'\fO furnish
A Job Add ress
8 legal Descnptlon
1 examole-tox lot 10Q, lane County Map Reference
2 example.Lot 1 Block 3, 2nd Addition to Sprlng!lel.
e Name, efe of owner and constructIon lender
o Energy Sources
1 example~heat/electncal ceding/or forced aIr qas
2 example~water heater/electrical/or solar
E Sq-uare footage or valuatton, efe -
1 example.1250 sq foot house, 500 sq foot garage
2 example-If new prolect, check -;ew.lf addition, ChE
add, efe
F Budding permit information
1 examole.construct Single family house Will'- an aft
garage
2 example remodel eXisting garage mto family rool
3 example-convert single family residence mto
restaurant (change of use)
G Value ot work as defined In SectIon 303 (0) of the
Structural Specialty Code
H DESIGN TEAM AND CONTRACTORS
To ovoId deSign or construction delays, Budding 0'/1
Staff must be able to contact appropriate persons reI
deSIgn lnfOrmCitlon or lob site corrections, etc
11 Abbrf"vlated Plumbing Mechonlcal & Electrical SchedulE
A Except where blank spaces occur In the descnptlon p
of the Mechanical and ElectrIcal Schedules, the apph
need fill-in only the No Boxes od1acent to the appro
Item(s) to be ,"stalled
B Full PlumbIng, Mechanical. and Electrical Schedules
ore available at the Budding D,vlslon
1 To conserve space on the permit form the schedul
hove been abbreViated
2 If the Item(s) to be Installed are not covered on t~
ated schedUles you should consult the full schecu
C BUILDING DIVISION STAFF WILL FILL OUT ALL FEES I
CHARGES ON ThE SCHEDULES
III Apohcant to sign ana date
Whenever pOSSible, the initial application will be used I
worksheet only Where pOSSible. BUIlding DIVISIon Staff
prepare a typewritten copy and return It to the appllea
the time the actual permit IS Issued for hiS signature
IV Fees and Charges
Plan chec~ fees are due and payable at the time of the~
and no plans will be processed untIl these fees are paid All
other Tees and charges ore due and payable when the permit
1$ ISSUed
V FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY
.......PERh"r VALIDATION
sto CITY OF SPRINGFIELD
(I
City Hall
SpringfIeld, Oregan
Department af Public Warks (
OFFICIAL RECEIPT
( No. B S 5 4 72(
Dote /7 - 1..-9 19'60
tee Rec'd From t nrV) ~ rl) f!:L1L{ ti Q tsS
Address I S -----n 117 ) 0. , V--
( -(
Received For
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Amount
Received q / . F) (f'J C P
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I .....THORIZED SIGN"TU.-E
SMI:LTO" TU.....""- ~..,..TE..S "UGE..E 0.. ~7"O'
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Permit Cler~
PR.OV/J)L' 1- :U;- R,J;l.E/) F/J?E /:;<7/)/(;, LJ/SHLY~ ro BF /"co4T.ED NE/?/i:
FRONT C7..'1VA/TIE-e
Addltlonol Prolect Information
PLANS REVIEWED BY
nom,:
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