HomeMy WebLinkAboutPermit Building 1981-5-28
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INSPECTION LINE Westt'IVI "OtJYt:6 CITY OF SPRINGFIELD
726-3169 72vtJ1I1/AJ.. A J i .tfl JIll"" J COMBINA.TlON APPLlCAflON/pERMIT
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INFORMATION LINE
726-31 S3
I ENERGY SOURCES:
Heat . rJ... r L I u..
I Water Heater iJ.~ r - -
Ranqe
-r7 ::.;4 ao I Vcjre of Work: __Fence_Dema_Changel Use
. I Y:P 0 nCO _O,h"
I Own" I+l.L1t::rJ. l/l/i'fJ:bnfijp':-.. ___ ~._... ...... .....J?....... ............ .__um_
P~/~ A~ Building Permit Info: Describe Work (i.e., Build Single
Ao'd;;!,',' . _ _ ~ 1 Phon. iTJT m;lv R,,'d,n,. With Atto,h.d Go,aa.'
'7f11?!JUMTliJ CLUfiJ?J> P;:JPTITiON MIA-l.lh I f./
I Can.t,u:on~ ~1rIJJf-? .W./lt,D/UIA k,
I Add,... Phone'- C.OMPl.~PS (l?/JS~ 5PA-l';cF'
I DESIGN TEAM
I Primory
I StrucTural
Job Add".JL'7 U, 61rrF IMLLcx.}j:?
i 7- ()3 -,;;):;? - d Atvt nf
Legal Description
Sq. ftg. Main
Sq. Fig. Accen.
Sq. Ftg. Other
_New_Add..XAlter_Rep.
ilil..+>~1
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QF/2jt:'^-I
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(oddreu)
pc.; .f!t2X ':?4-?E RbBJt3 "774tY~
(lies. no.)
(eJtpires)
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~4
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(pnonf; ;lC'.)
(name)
Electric,,1
Mechanical
CONT1~ACl'ORS
fZ(j/~_~bJEt"'~
4m!t}~:E-.!IJ/t:id!;r{
_ .1i11:JJ:ILJ-!Y .fJ:Li L I~
(nClme)
(oddreu)
(1irs. no.)
(expires)
General
A:.6---.M30vtr.
Plvmblnq
x
NtiW d~r;;\J:t:. I"llteraliv"s
or e;;jen5~lJr.s
/~-
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J
fur.'a~a/bu~ner to
__._Blll's
J,ppliCIllCi. \'an~
~oparats
5totionary evop.
cooler
-:1
,
!
-----,
-~.' "'
~-' ~c~_'-1
F,,!; CH"'~'."I' I
-- ''''''1
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---j--J
Eleetrice:!
etEL~~___..
Mechanical
:'l'JMcn..:O
ELECTF:!CAl
T
MECHN~i<":AI.
Nci'~~=':::-~__ _._i FEE
rCH.\~-i;F.
Is-:<>~
J
;~O.
_....:..!!"L ..':HARGE
NO.
_J --:.. _ Eccll ~inQle fj;.:ture
P.Illocorcd Luilding
(ne...... fj,;. ad~.i;-iO:Kn_..
S,F. llesidence
(1 bgt},)
ResiGE-:-lct} of
~q: ft.
-:=1
_._ _ S~.V!CE$ ,___.__. ___ __.. _ _~._.
Duoln (1 bolh) each
"e~n})Orr!i'j.' Cm;sfllldiuOi
Vent fan with
single duct
Vent system apart from
. heotin!:! af A.C.
Mechcmicol exhoust
hood a...d duct
Additior'tol both
Amp.'.
Woler service
Sewer
I
I
I
FEEDERS
Heot Puma
I Air handler to
10.000 CFM
Slor", Sewer
Amp,.
. 1__..
-----I___L......-___ _._'
TOTAL CHARGES
z;: .~
TO'!..\l CHARGES
WHERE STATE -LAW REQUIRES thut the f.ledrical wodl"bv c!ano by thlQ Elc~licor"e:on'ractCll, tbl! .l..drjcal.il.,;-~l,,:, o~ ,hi: Pllrmit Sh3U noJ b. '~lid until ~
label has bHn signed by an Eledricaf Contradl:r ane.!.aNochcd to' tho .!:!id,icc;;1 panel.
I HAVE CAREFULLY EXAMINED the ~mpleted opplicgtion For permit; and do'hereby certify" that gll infarmgtion heron" j!'i :rue one! corre~, and I further
certify thQt any Qnd 011 war!:. performed shall be done in accordance with the Ordinances of the Cil)' of Sprillgfield one! ~he laws of the ,State of Dregorl
pertaining to the work described herin, and that NO OCCUPANCY wiiJ b~ ,..1ade' of ony structure without the permission of the Building .~visioll. I further I'
certify that my registration with the Builder's Board is in full force and e-ffect as required by ORS 701.055, that if exempt the bosis fa," exemptiC'n is noted
heron, and thot only subcontractors and employees who are in complionce with ORS 701.05.5 will.~e usad on this proi.ect. ~.
.a.i. fa, .ulld.... Boa,d ...mp-!ia'" '../ / ~ ; .'
NAME (pl.o," p'in,? hL//.'7A-1 ,/ b..:>A'/ ,-~,"" <IGNATUR< ~ ~ /~.<TE:' <;--,7.5"-;Y J
-,. - ::;-...-:~==-_~r."-!./~-:::_~_.....!.."";;:"!::.-.V__'_","~--"-_7T'
FOR OfFICE USE ONLY ,
Zone ,:,,:,---Lf Type/Canst.~/;f;i?
Fire Zone~"":"""-'-Bedroams _
flood Plain Ne:> C:~ari.. I
-~---""'J7/c., -
Units Sq. Ftg. j.~ain
"'ccy load __// Sq. Ftg. Accel'
Occy Graup...22:-_~"",---Sq. F~g. 0Ih"'r_---..:..._
x
.--:--Val::-'~!'"ao, ""'-'c
x ','alue --:-
x _. V-:.lue
TOTJo.L VALUAT~ON ..1.J~.. ~~
BUilDING PERMIT 2&', 0<> Plan C!:. Comm/lnd
Chorges and -------- 65%/ BIde Per Fee
Surcharges f 'f":'co (./< Plan Ck. Rei
30%1 BldCl Per Fee
PLUMBING PERMIT s-: ~..
Charges and Fence
Surcharges :20
Demo
ELECTRICAL PERMIT 15,""0
Charges and Sidewolk
Surchorgll. ..;;'~
AI C PaviM
MECHANICAL PERMIT (/ ""'"
Chorges and 0' Curb Cut
Surcharges ------7 '(
,0
, \h,ID?1
<;:,\oCQ ~€;
Systems Development
ChorQo (1.5%l
L
5"2, S"<::S
;",..\q
Total Comb. Permit
r.;~. 5'6
I TOTAL
1/1,CJ<O
I. Applicant to furnish
A. Job Address
B. legal Description
1. examole-tox 101 100, lane County Map Reference 17 03 43
2, exam pie-lot 1. Block 3. 2nd Addition 10 Springfield Estates
C. Name, etc. of owner and construction iender ..'; C I T Y
D. Energy Sources
1. example.heat/electrical ceiling/or forced air gas
2. exomole.wofer heater/electrical/or solar
E. Square footage or valuation, etc. . (
1. examole-1250 sq. fool house. 500 sq. foot garag.
2. example-if new project, check new-if addition, ch
add.. etc.
F. Building permit information:
1. exam ole-construct single family house with an at.
~~c ~~
2. examole-remodel existing goragt; into family roo (
3. exompie-converr single family residence into
restou~ant (change of use)
G. Volue of work as defined in Section 303 (a) of Ihe
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction delays, Building Divi: .
Stoff must be able to contact appropriate persons re~ (~i'
design information or i,ob site corrections. etc.
COMBINA nON APPlICA nON/PE"T
(CAP)
II. Abbreviated Plumbing. Mechanical ~ Electrical Sched~le
A. [;~"t!pr where blcnk spaces occur' in rhe descriprion pI
ot rhe Me.:hanical and Electrical Schedules, the opplit
need fill.in or.ly rhe No. Boxes adjacenr ro the.opprol
item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
ore available or the Building Division ,
1. To conserve space on rhe permit form rhe schedulE
have been abbreviated
2. If rhe item{s} to be installed are not covered on thf:
ated schedules you should consult the full schedul.
C. BUilDING DIVISION STAFF Will Fill OUT All FEES AI
CHARGES ON THE SCHEDULES
III. Applicanr to sign ana date
Whenever possible. rhe initiol applicarion will be used os
worksheer only. Where possible. Building Division Stoff 'I
prepare a typewritten copy and return it to the applicant
rhe rime rhe acruol permir is issued for ~is signarurE.
IV. Fees and Charges
Plan check fees are due ond payable at the time of the a
and no plans will be processed until rhese fees are paid. .
orher fees and charges are due and poyable when the Plt-
is issued.
v. FOR OFFICE USE ONLY
/ .,
· PERMIT VALIDATION
OF SPRINGFIELD
City Hall
Springfield. Oregon
Deportment of Public Works
OFFICIAL RECEIPT
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f\\( f'yJ" No. B 56606
Dale ,\\1\t).--Q.{\19~ \
From \.~1('Y\\ ~ >{,\\Q~ (
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Address \,>,\). ~ <.~~.\ 0 ~11
Received For: b~cr\.1[t, <:Do ,cP \.
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AUH401'llZED SIGNATURE
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...UTON.TU.....Ull ~",..T[.. . [UCI:NI, 0" 11"01
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Permil Cler~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
j- FiRe: OC:P7. /,v-Si<>6c7/':;'--" /rd tr:&-<P"j'c,,-'-~
Additional Projecr Information:
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PLANS REVIEWED BY:
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Lo/?N;;:' h~c-c:~
",ignaru~1'"
name
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