HomeMy WebLinkAboutPermit Building 1981-8-21
INSPECTION LINE
726-3769
.
CITY OF SPRINGFIELD
COM8lNArlCN APPlICArlON/PERMIT
.
INFORMAtiON LINE
726-J7,SJ
ltl'Jol De,c,ip,ion
w fQ,'rVlel"J s~.Q)
,_I 1-O~-77-3 i
, rJ2;.O J
Gr-<>l""" ,) Ct,.,nr~l)
0-3'1 t,.j) Fo irv; "'.- ,-'
'.c?o
0,) I
Cc rf)()~T
ENERGY SOURCES:
I Sq. Fig. Main
I Sq. ftg. ActUI.
Sq. Fig. Q,tllltr
_New AAdd _A h., _Rep,
_n _Fonn_Oemo_Chango i ui.
_Dlk.,
~,
-....:,
()
V)
'\J
.......
Job Add,e"
Hear
Wale' Heater
Addren
Phon, 74(0'/ a:J.1...
Ronqtt _
Value of WOtl: .....!~t-".":' :.:....0
L/iJ (i~'
8uildinq Pet.:nillnfa: Oe~ctibe Wark (i.e., Build Sing I.
Famih Rf!lidltnc,", With 4.tta{h"d Gataae.
(~a.:r 60(=-1:
I
O_nflt
Canuruclian lltnder
Addre"
Phane
O::SIGN TEAM
(name;
(oddreul
(Iics. no,)
(expirel)
(phone no.)
Primary
mun or
S,ructural
~Iectrical
Mechal'lical
(ONT~"CTCi!S
(I'lamf'l
(addresd
(lics. no.)
(expires)
(pnc.l'le l'laJ
]
]
Gl'nerai
1'0~ n Ii/'
Plumbinq
El,.clricol
I" MeChanical
?LUMBING
ElECTRICAL
MECHANICAl
NO. .
P:l:
CHARGE NO.
FEE
CHARGE NO.
FEE ! CHARGF
Residenc. aF
iurnaceiburner ta
DTU's
Appliance vont
seporoto
Statianar}' oyap.
coaler
Vent fan with
linqio duct
Vent system apart from
heati~q or A,C.
M.chanical exhaust
hood and duct
cacn ~;nqle fill.lure
Rotlacaled building
(new ti.. additianal!
S,F. i!'!I.den~e
{1 balhl
U~: ft.
New circuits. alteratiaus
ar extensions
SERVICES
Dualeoc II balhl fOOen
Temporary Construction
Additional bOlh
Amps.
Wot." len;ce
Sewer
Wood slove/h.oler
I
I
I
I
I
I
\rf"
1),.'
~I
TOTAL CHARGES
}
Slot.m Se.....r
FEEDERS
Heat Puma
Air handl.r to
10,000 CFM
Air handler oy.r
10,000 CFM
Amps.
ISSUANCE OF PERMIT
TOTAL CHARGES
TOTAL CHARGES
WHERE STATE LAW REQUIRES Ihat Ih. El.ctrical Worle b. dene by the Elel'tricol Contranor, the .lectrical portion of thil permit Ihall nol b. valid unlil 0
label ha. b.." ,i9ned by on Electrical Contractor and attached to tho electrical panel.
NAME (please print)
I HAVE CAREFULLY EXAMINED tne completed application for permit, and do h.reby certify that 011 information h.reon is true and correct, and I further
certify that any and all work poe-rformed shall be dan. in accordance with the Ordinanc.s of the City of Springfield and the low. of thll State of Oregon
pertaining to the worle delCribed herin, ond Ihat NO OCCUPANCY will b. mad. of any structure without the perminion of tne Building Division. I further
certify that my re-gisfl'"otion with the Builder's Boord is in full forCll and effect os required by ORS 701.055, thot if uempt th." bods for uemption is noted
heron, and that only ,ubcontrClctars and employees who or. in compliance- with ORS 701.0.55 will bo usod on this projoct.
<IGNATURE J:i;.., .P9~<"'~ 2 ~h/Y>D
FOR OFFICE USE ONLY (/ (I U
Ba.is for Builder', Boord exemption:
/)
bl'ea
.J
c'n", ,..,..J)
DATE ~;;:j/
Value
TOTAL VALUATION
,:1,:-,'0:). =<'--"
~=?~:).~O I
I
I
I
I
I
I
I
I
Floo~ Plain
.'i~
Typel Canst, :~~. /1tI'
Bedrooms ---
<torie' ( I
"-..-/
Units
n<:cy lood
Occy Group
I'YI}"/
Sq. Ftg. Main
c-q. Fig. Accen
Sq. Ftg. Other
,t."7:"~'':.{ 'i~
x
Volue
~-.-:~
- , - -; ~ Value
i?_ ~.
Zone . '" /'!"
Fire Zone ....,.....;
BUILDING PERMIT
Chorges and
Surcharge.
"--;> ,.0:::"
-6-
~,.:-.
Plan Ck, Comml/nd
65'l~1 Blda Per Fee
Pion Ck. Res
:30~ol aldq Per Fee
...,
...:).
,1~"O /':"0
. :!!--::<I'~I
Syslems Development
ChorQ. (1.5~~1
I.
" .~
, ~...
PLUMBING PERMIT
Charge, and
Surcharges
Fence
Domo
Totol Comb. Permit
",:::?"?_/"2.
ELECTRICAL PERMIT
Chorges ond
Surcharges
Sidewalk
AIC Povino
TOTAL
I
~~,/:z'
1
MECHANICAL PERMIT
Chorges and
Surcharge.
Clolrb Cut
I. Applica~ to furnish
A. Job Address
B. legal Description
1. examole-'ax lot 100. lane Caunty Map Reference 170343
2. exampie-lot 1. Block 3. 2nd Additian to Springfield Estates
C. Nome, etc. of owner and construction lender
D. Energy Sources
1. examole~heat/electricol ceiling/or forced air g.
2. exomole-worer heater/electrical/or solar
E. Square footage or valuation, etc.
1. examole-1250 sq, foot house. 500 sq. foot gara \,
2. examPle-if new project, check new.if addition,
odd. etc.
F. Building permit information:
1. examole.construct single family house wit,h an I ~._l
garage
.2. examole-remodel existing garagE; into family rc
3. example-convert single family residence into (
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Dj'
Stoff must be able to contact'appropriate persons " ....
design info:rmatian or job site corrections. etc.
COMBINATION
APPLlCA TIO.ERMIT
(CAP)
,-
PERMIT VALIDATION
CITY
OF
SPRINGFIELD
(
City Hall
Springfield, Oregan
Department af Public Warks
OFFICIAL RECEIPT
No. B
Dote ?? - 8 I 19 2f
Reed From ~((->C1fJn ~ (~~ (
Address ~ 3C\ Y.D. .to. udJl V 11
r:;7'1 ':;8
"',_.... (
Received For:
II. Abbreviated Plumbing, Mechanical & Electrical Sched~; ~g.OO
A: Except where.blank spaces occur in the description j ,"" -b () (
, of the Mechanical and Electrical Schedules, the appl -' T 49" J. I:J/
need fill.in only the No. Boxes adjacent to the apprl
item(s) '0 be inslalled (
B. Full Plumbing, Me<:hanical, and Electrical Schedules (
are available ot the Building Division
1. To conserve. space on the permit form the schedu (
have been abbreviated ,
2. If the item{s) to be installed are not covered on t~ \, '
ated schedules you shauld consult the full schedu
C. BUilDING DIVISION STAFF Will Fill OUT All FEES J ,
(. .
CHARGES ON THE SCHEDULES
III.
Applicant to sign and date
Whenever possible. the initial applicotion will be used c
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 signafUr&.
Fees and Charges
Plan check fees are due and payable at the time of the c
and no pions will be processed until these fees are paid.
other fee. and charges are due and payable when the p ~i'
is issued. t- .
IV.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Addi(ionol Project Information:
PLANS REVIEWED BY:
/ ..... -= ":;:? ,5>.:;:....~:"
nam.... t-.-.y-./N~ /" ~ .~/ ) signaturo
,
"
Amount Received cOLLi. l -;:j., ('b l\ Q~ '
('~dA~ J
~
(
AUTHo"ru:o SIGN"TURI:
S"ILTO...Tl,'''''"I,1LL ..100'111.' lUGII..II:. 0" .,_g.
..111.1 (,
(
"
Permit Cieri.
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