HomeMy WebLinkAboutPermit Building 1981-7-1
!INSPECTlON LINE
726-3769
I Job Addren
I legal Description
I
I Owner
I Addreu
I
I Com,,",';on Lond.. -t5 JJA'fL,;-IJ;~n::'id' ~/'
I Add.... P. tJ, f51UL -'lilt,.:; rf";""N'-z Phono,3-1.;;-!.::133
I DESIGN TEAM - '(nomo) - ~ -,'- . -+?~,
I Pdmo'y ~7-t ..' As6:: .
I Structural
I Electricol
I Mechanical
I
I General
.
CITY OF SPRINGFIELD
COMBINATION APPlICAflON/PERMIT
..
INFORMATION LINE
72~7SJ
I~ I
.....
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~ERGY SOURCES:
I Heat
Water Heate,
Ronqe _
Value of Work:
,/;'/inyifjJ: 0/ Al .k...,M~jfk.dl",:"y:
f.- tI - -
, ,-,,;::<.5 - 71-J h' v{f: Phono
;9, 1/3/ ao
I Building' P~r-;;t-I-"-io;' 'De,-c-;ibe Wo~k-(i.e.. Build Single I
Family Residence With Att,:,~h'!1 0aroge}
(fa.u-ta:"q -+- .o:;t.4-i4n /UW-UJ .L.'tutr...eL~4
1/
Sq. Ftg. Main
Sq. Fig. Aceen.
Sq. Ftg. Other
_New_Add._Aller _Rep.
___Fence_Demo_Chonglll Us.
_Other
.!??XL) CJ.CLvL~ 'y?j ,
l$'DZfl.:>~.I=z._ r.e... LJq"<)
(oddre,,)
(lies. no.)
(expires)
(phone no.)
CONTRACTORS
H.siH4C
(name)
(address)
(lies. no.)
(expires)
(chane no.)
J7AVa.~
Plumbinq
Electrical
Mechanical
PLUM81NG
ELECTRICAL
MECHANICAL
NO. i
FEE
CHARGE
NO,
FEE
I CHARGE I NO.
I I
I -I
I
I
I
I
I
FEE
CHARGE
Residence of
furnace/burner to
ltTU',
Appliance vent ~--
separate
Stationary evap.
caa/er
Vent fan with
sinqle dud
Vent system aport from
. heotinq or A.C.
Mechanical e.xhaust
hood and duct
Each sinqle fixture
Relocated building
(new fix. odditional)
S.F. Residence
(1 both)
Sq: ft.
New drcuih. alterations
or extensions
Sewer
Wood stove/heater
I
I
I
.1
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I
I
I
I
I
I
I
Vg'&>' S'o',m Sowo' ID.~~(,I.r'. ~.-I
S12:RM :"Je~ ~ /if).....
I
I
I
SERVICES
DuoleIC (1 both) each
Temporary Construction
Additional bath
Amps.
Water service
FEEDERS
Heat PumD
Air hand/.r to
10.000 CFM
Air handler over
10.000 CFM
I
Amps.
TOTAL CHARGES
30. ..,
TOTAL CHARGES
ISSUANCE OF PERMIT
I TOTAL CHARGES
WHERE STATE lAW REQUIRES Ihat the Electrical worlc b. done by the Elct~ical ControClor, the electrical portion of this permit shall not be yalid until a
lobet has b_n signed by an Elecfrical Contractor and attached 10 Ihe .1.Clricol pan.l.
I HAVE CAREfUllY EXAMINED the campleted application for permit, ond do hereby certify thot 011 information hereon is true and correct. and I further
certify that any and all work perfor,,",d sholl be done in accordance with the Ordinances of Ihe City of Springfield and the Laws of the Stat. of Oregon
pertaining to the work. described herin, and that NO OCCUPANCY will b. made of any strvcture without the permission of the Building Division. I fvrther
certify that my registration .....itb the Builder's Board is in full force and effect a' required by QRS 701-.055, that if exempt the basis for exemption is noted
heron, Gnd that only subcontroctan. and employee, who are in compliance with ORS 701.055 will be used on this project.
FOR OFFICE USE ONLY
r-Y~~-e~
\ '
DATE ~/;/P/
Basis for 8uilder's Board exemption:
NAME (pleo.o pdnl) _Re hc;e ~ V t 11.1 ,Tnr~ ,b~j;+o.. g <S,GNATURE
Zone_~'" .
fir. Zone
Flood Plain
Type/ Const.
Bedrooms
C,tori.~
Unih
""ccy Load
""ccy Group
C... Ftg. Main
c". Ftg. Access
Sq.Ftg.~
, ~VIN&,
.
Value
Value
.
x . Value
TOTAL VALUATION r9/ q::v i _Do
BUILDING PERMIT
Charges and
SutCha'gn
Plan Clt. Comm/lnd
6S~O/ Blda Per Fee
Plan Ck. Res
30%/8Jdq Per Fee
5""7. S~
I Systems Development
Cha,qe (1.5%1
PLUMBING PERMIT
Charges and
Surcharges
~.-
I. ';Ie>
Fence
Demo
I Totol Comb. Permit
123, <0
AIC PovinD
"'72.~
I
I
I
I TOTAL
II /83. -..,.
ElECTRICAL PERMIT
Charges and
Surcharges
Sidewalk
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
c-
, COMBINATION APPlICA TION/pttllT
(CAP)
'I, Applica~ to furnish
A. Job Address
B. Legal Description
1. examole,.ox lot 100, Lane County Map Reference 17 0,
2. example,Lot 1. Block 3, 2nd Additian to Springfield Estat,
C. Name, etc. of owner and construction lender
D.. Energy Sources
1. example-heat/electrical ceiling/or forced oir gas
2. exomole-water heoterielectrical/or ~
E. Square footage or valuation, etc.
1. exam,ole,1250 sq, foot house. 500 sq, foot garage
2. example.if new project, check new-if addition. check
. add, etc.
F. Building permit information:
1. exomoJe-construct single family house with an attached
go rage
2. example.remodel existing garagE: into faniily room
3. exampie-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 ovoid design or construction delays, Building Division
Staff must be able to contact appropriate persons regardinf
design informction or job site corrections, etc.
II. Abbrevioted Plumbing, Mechanical 8, Electrical Sched~les
A. Except where blank spaces occur in the description portion
of the Mechanical and Electrical Schedules, the applicant
need fill-in only the No. Boxes adjacent to the appropriate
item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules '
___.h_.. are ovoiloble at the Building Division ...' _._-~--"_.__.-
1. To conserve space on the permit form the schedules
hove been abbreviated
2. If the item(s) to be installed ore not covered on the abbr.
oted schedules you should consult the full schedules
C. BUILDING DIVISION STAFF WILL Fill OUT ALL FEES AND
CHARGES ON THE SCHEDULES
t--,
III. Appiicant to sign ond 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 actual permit is issued for his signatur~.
IV. Fees and Charges
Plan check fees are due and payable at the time of the application,
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
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
~.
,
Additianal Project Information:
PLANS REVIEWED BY:
name
_signaturp'
(
CjY
SPRINGFIELD
OF
City Hall
Springfield, Oregan
.Department af Public Works
OFFICIAL RECEIPT
,
...
No. B S 6 8 3 :
19 SI
Reed Fram ~~ ~ 'f?tVIIV ~
Address ?:CJ. ~ 7o~.s-, C L.f;.e""A' ~
Date
Joc.....,. /,
(
(
Received Far:
,,-
-,
1)t:iB# frlolf3?
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30.-'"
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5'9. St:>
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V AUTHORIZED SIGNATURE ~ '
SHHTO"'TU"".UH .......T["!I" [UGENE. 0" .'''0' se.".,. \,
Amount Received
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Permit CierI-
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