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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.- ( Rec'd Fro~\ \d j"-y';) ~ ~ .l1.. 1 ,.. AddreS&~P(\)~CJC \\\c\ ~O..c_ I I, Received For. '~\D'i.:J\1 , \. ),..D.\ f\ r1' 6) \\ 0 (.) () ~/l' 1'; .10'b t\ ) ~"r-. 'C 00 I: M ~ ~ '\U ) ~"'" _1, dp5}n /J.6lc.J ';2<' Cf5 ( C.J-J . ( ,0/) '8,1.. "7--.0 ( I :56 rO 3-> .r'f (f) (I _ q_()4 ,~(, I()SS0L :~ AlrrHORIZEDSIGNATURE ( '1 ( ( 59408 , (I ,.-, I, 'I ( (' ( \: 0 '\LsLrl M?J() ( vJ\~ ~ tJ'"'\ c 4.-~) [)~ ~ ""):4 (t' r-y-\r ( I', Amount Received - ~I BY.' ( -\ \ "" (I PRIGOS I'RINTlEAS/LITHOGRA"HlERS. EUGENI:. OR[OON . ' . ~ No. B 094U~(t ( Date~ W \t19gt \, ( Rec'dFro~ ~Df) D,'\~~~vj' 0 Addre~ ~_)~ \.0;:... or\.) , G~ C. -Received For. ~ \ () S""\ 1 ," '"" ([: ( .' (l; ,~( ,',\ , ~ Q V ( \~'-'\ '\ ~ CF ( . (L c- tfr; ( ".' ) ~-= ",>, ~ (~ ,,"' " L ('? , Amount Received !!- AUTHORIZED SIGNATURE ( BRIGOS PRINTERllI/LITMOGRAPHlERS, EUGENE. OREGON -'- :f:~ ';'.. ..J~ :'i~ ~ Q ~, i ~ -,ignature \y\ f\ ~~ tm JLh(~. dale . ~CO name (\~~Q-?i ~\ ~ I