HomeMy WebLinkAboutPermit Building 1982-7-12 (2)
Sq. Ftg. Main lOUt>
Sq. Ftg. Aecen. ~'i2
Sq. Fig. Other.--3..3..6
UNew _Add _Aher _Rep.
1___Fence_DemO_ChangefUse
_Other
I
Bvildi.,g Permit Info: Describe Work ii,e., Build Single
familv Residence With Attoched Gorcee)
t --
l\ .
. u..SPECTION LINE
72~769
.
CITY OF SPRINGFiElD
COM81NAJlCN APPlICATIONJPERMIf
Job Addren
4395 Forsythia _
Lot 27 ,
ENERGY SOURCES:
H.a' -E,1 "rtrir F II
Water Heoter Fl er:tri c
Ronqe _ElerTV'; ('
I Value of Work:
Legal Description
R~venwood Subdivision
Owner .l~<:.c::. R _ 8..rookc::.
Addren P n Rt"'l y 11 Fi
Sorinafie1d, Oreaon
Construction lender O. D. V. A.
$64.967.00
Phan. 747- 5009
.
INFORMArtON LINE
776-J7SJ
oa
......
o
U'1
.....
.....
Sinale Fnmi1v with attacbed Garane
w/woodstove
I
I
r
I TOTAL CHARGES
I WHERE SlATE LAW REQUIRES that th. Electrical work b. done by the Eler'ricol Contracfor, the electrical portion of this permit sholl. not b. valid until 0
lobel has been ,i9ned by an Electrical Contractor and attached to the electri,ol panel.
I HAVE CAREfULLY EXAMINED the compleled application for permit, and do hereby certify that all information hereon is true and correct, arId I further
certify that any and all work perfornw=d shall be done in actordonce with the Ordinances of the City of Springfield and th.e laws of the Stat. of Oregan
pertaining to the work described herin, and thot NO OCCUPANCY will bl) made of any slructure without the permission of the Building Division. I further
certify that my registration with the Builder's Boord is in full force and effect os required by ORS 701.055, that if eX,empt the basis for exemption is noted
heron, ond that only subcontractors and employees who are in complianC& with ORS 701.055 will be used on this project.
,?
~~
Addreu
DESIGN TEAM
Phone
(nome)
(address)
(liu. no.)
Primary
Structural
Electrical
MechaniwJ
CONTRACTORS
(nome)
(address)
(lies. 'no.)
Gon"al Jess R. Brooks
P.O. Box 116
;1 1 fiR 8nJiJ::a n te
PO Rox 2.3
. ,_lliJ. p;.~ ....ili:e..e.L_.~,__
J . ElECTR leAL
FEE 1 CHARGE NO.
8537
2Blllil
?h~44
25790
.....!Iurnbinq Oan Mprnpr
Electrical nrtVpC; Flpr.trir
Mechanicol Mi! rc:;, hi! 11 S
, PLUMBING
_.~_.A .__...._._
NO. i
FEE CHARGE
x
Each linqle fixture
R~located building
(new fix. odditional)
S.F. R'Hiden~e
(1 bath)
25.00
Duolex (1 both) each
10.00
1
Additional balh
Water lllrvice
1
Sewer
Stor.m Sewer
35.00
. (e}(pires)
(phone no.)
I
I
I
I
I
7.A.5-..56Ml I
.. '__ .l4? ;J41L.J
MECHANICAL I
~'---_. '-"-'-"'.-FEE CHARGE I
I fnm:~M~;~., 6.00 I
I Appliance vent 3 ./00 I
separate
, I
(upires)
(ohone no,)
1-5-82
fi-29-M
h-10.=..8?
_1.2-(1-81
747-5009
hR9-499?
1
1
Stationary tlVap.
cooler
3
Vent fan with
sinqle duct
Vent system aport ftom
heatinq or A.C.
Mechanical exhaust
hood and d~ct
I Wood sloyel heater
I 4.50 I
I 5.00 I
I
I
3.00 9.00
1
1
Heat Pumc
Air handler to
to,OOO CFM
Air handler over
10,000 CFM
ISSUANCE OF PERMIT
10.001
37.501
TorAL CHARGES
I ECc;
NAME (please print) ~ / ~
dlfoolrc,
,#~:
-;:'/;J. -~-
x 1<; 10 ~alu.$5.6...69] 8(\
x 10 00 Va'u. 5,5?0.00
. '" '''-I,;;;;l~; i
TOTAL VALUATION
I Systems De,,;'opment I $ 974 51
Choroe (1.5.0) .
65.10 Pd 8-21-81 #57135
Temo Elec Label O?:FllR .20
Bosis for Builder's Boord exemption:
SIGNATURE
FOR OFFICE USE gNlY
1
Zone
R
Typel Const....)1 =- N
Bedrooms 1
?
Sq. Ftg. Main .-1...6.0.6
Sq. Ftg. Access -5..5./
Sq. Fig. Other---3..3.fi.
Fire Zone
Flood Ploin
"',torieA
Units
/""'lecy Load
nccy G,ouP~
BUILDING PERMIT $217.00 Plan Ck. Cammllnd
Charges and 65~ol Blda Per Fee
Surchorgel Plan Ck. Res
8.68 30%/ Bldq Per Fee
PLUMBING PERMIT
Charges and 55.00 Fence
Surcharges
?,?O Demo
elECTRICAL PERMIT
Charges and 1<;.00 Sidewalk SO'
Surcharges
." AI C Povino
MECHANICAL PERMIT
ChorCles and ,_____37.50 Curb Cut IS'
Sutch-orges
1. 50
9.60
14.16
DATE
TOlal Comb. Permil .182.04
TOTAL
$ 1 ;35&. 75
.
COMBINATION APPLICATION/PERMIT (CAP)
'I. Applica,,! ta furnish
A. Job Address
B. legal Description
1. examole'tax lot 100, lane County Map Reference 1
2. examole,lol 1. Block 3, 2nd Addition 10 Springfield I
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceilinq/or forced air gas
2. exomole.woter heater/electrical/or solar
E. Square footage or valuation, etc.
1. example,1250 sq. foot house, 500 sq. faol garage
2. example-if new project. check r:;ew.if addition, check
odd, etc.
F. Building permit information:
1. examole-construct single family house with an cttad
garage
2. example-remodel existing 90r09& into faniily rDom
3. example-convert single family residence into
restaurant (change of use)
G. Value of work as defined in Sectic.n 303 (a) of the
Struclural Specialty Code
H. DESIGN TEAM AND'C.ONTRACTORS
To avoid design or construction delays, Building Division
Stoff must be able to contact appropriate persons regorc
design infor.mafion or job site corrections, etc.
II.. Abbrevi9ted Plumbing, Mechanical & Electrical Sched~les
. A. Except w;,ere blenk spaces occur in the description portie
of the Mechanical and Electrical Schedules, th~ applicant
need fill-in only the No. Boxes adjacent to the appropria
item(s) to be installed
B, Full Plumbing, Me<:hanical, and Electrical Schedules .
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the ifem(s} to be insfalled ore not covered on the ab
aled schedules you should consult the full schedules
C. BUilDING DIVISION STAFF Will Fill OUT All FEES AND
CHARGES ON THE SCHEDULES
III. Applicant to sign and date
Whenever possible. the initial application will be used as a
worksheet only. Where possible; Building Division Staff will
prepare a typewritten copy and return it to the applicant at
the time the octuol permit is issued for his signaturE.
IV. Fees and Charges
Plan check fees are due and payable at the time of the appli<
and no plans will be processed until these fees are paid. All
other fees and charges ore due and payable when the permit
is inued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
'..
Additional Project Information:
PLANS REVIEWED BY,
,-'
I
CI~F SP'RINGFIELD
City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
\ No. B
Dat~,\~~'" \0-19~Q.-
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PRIGOS I'RINTlEAS/LITHOGRA"HlERS. EUGENI:. OR[OON
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BRIGOS PRINTERllI/LITMOGRAPHlERS, EUGENE. OREGON
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