HomeMy WebLinkAboutPermit Building 1981-1-27
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INSPECTION LINE
726-3769
,
CITY OF SPRINGFiElD
COMBINATION APPLICATION/PERMIT
,
INFORMATION LINE
726.3753
109
ENERGY SOURCES: Sq. fig. Main
Heat 'f, . G,_ Sq. fig. Acceu.
Water Healer ,". J 'l Sq. FIg. Other
Ronae ',' i ...., _Ne....._Add_Alter_Rep.
Volve of Work~ /_Fence_oomO_Change/U5lP
7t9t>~ _Olher.
Building Permit Info: Describe Work (i.e.. Build Single
Familv Residenu Wi,h Alloched GOfCII)1I1
~
Job Address
'5{1t,;,. c.J, NJiWiEvJ l:>-RiIJl:::
1.07/ AI/;./ /7-{)~~,}.?-:>'i
DIlGw>OPtlc? PA/2t( n 100
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Legal Oeicription
Owner
.Address
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:........:.:.:. .. -:' ._. __, ..1...___..____
Phone
DESIGN TEAM
("nme)
tf)fIIAI(;1'
(addren)
(lic5. no.)
(....pires)
(phone no.)
Primary
Structural
~=tri..al
M..ct'-:l,,;,ol
cmn~J.CTOItS
,I G.n.,ol '
Plumbinc::
(r:CITIII)
fAoAlt::t? .
(address)
(lie,. no.)
(exDiresj
{ohon" no,l
Ele('l~if'(11
Mecl'o:,';i':-'JI
PLUMBING
ELECTRICAL
--
MECHANICAL
fEE I CHARGE NO, fEE
I furnoco/burner to
a,TU',
I Appliance ven~
separate
I I 5Iationory....ap. I,
cooler
I Vent fon with I
si"!=Ile duct
I Vent system aport from I
heotinq or .A.C.
-I Mechanic::!1 .,:h"u~! I
hood and d..rct
Wood ,.oye/hooter
-'
rNGT'
fEE
CHARGE I t-IO.
CHARGe
I
i
i
I. Each lil:~le fixturt:
ReJocaled bu;J"~'19
(nl!!W fix. ad:Htiona!)
S.F. Residence
(1 bOlh)
Residence of
_~D: ft
-,
New,circuits, alterations
or extensions
I SERVICES
I Temporary Construction
.--t Amp.,
I ,
1
!
I
I
I
,-
.'
Duplex (I both) each
~~!.!.:onal both
I Wall.:r le,...;,e
I Sewer
Storm Sewer
FEEDERS
Amps. I
I
I
I
I
I
0 TOTAL CHARGES
Heat Purno
Ai, handler to
10,000 CfM
Air handler over
10.000 CfM
I
r
I TOTAL CHARGES
I
ISSUANCE Of PERMIT
o
TOTAL CHARGES
<0
WHERE $TATE lAW REQUIRES that the Electrical work be done by the Electrical Contractor, the olectrical portion of this permit .hall not b. valid until a
label has b..n signed by an Electrical Contractor and attached to th. electrical panel.
I HAVE CA,REfULl Y EXAMINED the completed application for permit, and do hereby certify' that 011 information hereon i. true, and correct, and I furth.r
certify that any and 011 work performed shall be Gone in ac~rdonce with the Ordinances of the City of Springfield and the laws of the Stato of Orogon
pertaining to the work described herin, and that NO OCCUPANCY will b. mode of any structure without the permission of tho Building Division. I further
certify thot my regiSfTotion with the Builder's Soard is in full force and Ill'ffect os required by ORS 701.05.5, that if exempt the bosis for exemption -is noted
heron. and that only subcontractors ond employees who ore in compliance. with ORS 70JI.O~55 will be2'.d ~n this project. ,
Basis for Builder's Boord ellemption: _ Oof.c--....An_
NAME (pl.a,. pdnll DON d.';flQ ",,,^, 'IGNATURE , _ DATE / t ?/~, ,
fOR OFFICE USE ONLY I
r;>b,.
Type! Coni'.
Bedrooms
C,tori..
V l'
'Jnits
"'ccy load.
^ccy Group
--
Sq. ftg. Main
Sq. Ftg. Access
Sq. Ftg. Other
.
ValulI
"alulI
Zone
Fire Zone
Flood Plain
u
x Valu~
TOTAL VALUATION .2ZQO, O~
BUILDING PERMIT
Charses and
Surcharges
7.00
----;-.;l,~---
Plan Ck. Comm/lnd
65%1 Blda Per fee
Plan Ck. Res
30%1 Sldn Pe, fee
PLUMBING PERMIT
Charges and
Surcharges
._-Q---
Fence
I Systems Cevlllcpment
CharAe (1.5%\
..~:lOPD lj'21-~J
lu/ EEt,,<l')
I Tatol Comb. Permit
I
I
i TOTAL
2..&
T.
Cema
elECTRICAL PERMIT
Charges and
Surcharge.
o
Sidewalk
.Ir o,....;,,~
MECHANICAL PERMIT
Charges and
. Su!~~~rges "'__'
C)
Curb C~t
4l 1: ?B
,.,,': ,~....-~.-
, "
~~.:?"'.~~~~~~_::.;~<,:~> :
~..... .....&'~..,U.:;;...'&tii,,~
,'. .
-" ~ .
Ill. Appiicant to si'::.ln and oate
Whenever possible, the initial application will be USE (s.
worksheet only. Where possible. Building Division Stl--
prepare a typewritten copy and return it to the applicant QI . -
the time the actual permit is issued for his signature.
. "I"'.::.t,.
. . .' ."'. . ~ .~' . .
COMBINATION
APPLICATION/PERf (CAP)
I. Applicant IQ furnish
A. Jab Address
B. legal Description
1. example-tax lot 100. Lane County Mop Reference
2. example-lot 1. Block 3, 2nd Addition to Springfield
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceilinq/or for'ced air gas
2. examole-water heater/electrical/or solar
E.: Square footage or valuation, etc. -
1. example.1250 sq, faat hause, 500 sq, foet garoge
2. exaroole-if new project, check new-if addition, che
add, etc.
F. Building permit information:
1. example-construct single family house with an aft
garage
2. example-remodel existing garage into family roo
3. exampie.convert single family residence into
restcuront (change ~f use)
G. Value of work as defined in Section 303 (o) of the
. Structural Specialty Code
H, DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Div
Staff must be clbleto contact appropriate persons"
design informction or job site corrections, etc.
II, 'Abbreviated Plumbing, Mechanical & Electricol'Schedu
A. Except where blank spaces occur in the description
or the Mechonical and Electrical Schedules, the apF
need fill-in only the No. Boxes adjacent to the appl
item(s) to be installed
B, Full Plumbing, Mechanical. and Electrical Schedule
ore available at the Building Division
1. To conserve space on the permit form the sehee
nave been abbreviated
2. If :he it~m(s) to be installed are not covered on
cted schedules you should consult the full sehe
C, BUilDING DIVISION STAFF Will Fill OUT All FEE
CHARGES ON THE SCHEDULES
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<,_.//,./'....1' , PERMIT VALIDATION
CITY OF SP'RINGF"ELD
Clly Hall
Springfield, Oregan
Department af Public Work.
OFFICIAL-RECEIPT
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Date (-5 1931No. B 55755(1
( Rec'd From ()?YlJ:1:ertlYlQt) .
Address ~ 7 to w ,:+(1 J )1, ( l..i.u Jl' !,
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Received For:
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Amount Received
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IV, Fees ond Charges
Plan check fees ore due and payable at *e time of the appljcation,
. 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
Permit CierI-
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
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PLANS REVIEWED BY:
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name ""t:)"'~ S'n.!I\"'-'Cf"' ""'-
signatur'"
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