HomeMy WebLinkAboutPermit Building 1981-1-5
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INSPECTION LINE
726-3769
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
. INfORMATION LINE,
72603753
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I ENERGY SOURCES,
Heat Baseboard
I Wale. r Heater N~
Ranqe NA
I Volue of Work:
, ' 1,100
Sq. Ftg. Main
Sq. Ftg. Aceon.
Sq; Ftg. Other 240
_New_AddlLAlter_Rtlp.
..:...-Fence_Dllmo_Chonge/ U..
_Other
CD
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Job Addre~.
931 Kelly Boulevard
Legal Description
17 03 34 11
TL 4800
Owne,
Kathleen D. Tanaka
Add,... 931 kelly Boulevard
Springfield, OR 97477
Phon. 746-7541
Building Permit Info: Doscrib. Work (i.e., Build Singr.
Family Residence With Attached Goroqll)
Rennovate storaae area into f~m;lv rnnm
Construction lender
Address
Phone
DESIGN TEAM
Pdma'y Owner
(nomel
(address)
(tics. no.)
(expires)
(phone no.)
- If any questions call Darrell Justus at 747-8145,
Structural
Electrical
Mechanical
CONTRACTORS
(nome)
(address)
(Iics. no.)
(exaires)
(ahane no.)
General
Owner
PlumbinQ
Electrical
Mechanical
PLUMBING
ELECTRICAL
MECHANICAL
NO.
FEE
CHARGE NO.
FEE
CHARGE NO.
FEE
CHARGE
Each sinRle fixture
Relocated building
(new fix. additional)
S.F. Residence
(I both)
0". ft.
New circuits, alterations
?4. or extensions
I ~ERVICES
l5.00
furnace/burner to
~TU's
Appliance vont
separate
. Stationary evap.
caoler
Vent fan with
sinQle dud
Vent system aport from
heating or A.C.
Mechanical exhaust
hood and duct
Residence of
Duplex (1 both) each
Temporary Construction
. Additional both
Amps.
Water service
Sewer
Wood stove/ healer
Storm Sewer
FEEDERS
Heat Puma
Air handler to
10.000 CfM
Air handler ovor
10.000 CFM
Amps.
ISSUANCE Of PERMIT
TOTAL CHARGES
TOTAL CHARGES
IS. nn TOTAL CHARGES
WHERE .STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of Ihis permil Ihall nol be valid until a
label has been signed by an Electrical Contractor _ and attached 10 Ihe electrical panel.
I HAVE CAREFULLY EXAMINED the campleted application for permit, and do hereby certify that 011 information hereon is true and correct, and I further
certify that any and 011 work performed shall be done in accordance with the Ordinances of the City of Springfield and the lows of the State of Oregon
pertaining 10 the worle described herin, and that NO OCCUPANCY will be mode of any structure without the permission of the BuildIng Division. I further
c:ertHy that my registration with the Builder's Boord is in full force and .;ffeel as required by ORS 701.055, that if exempt the hasis for exemption Is no led
heron, and that only subcontractors and employees who or. in compliance- with ORS 701.055 will be used on this project.
Basis for Builder', Board exemptio",'
NAME (please print)
P TNt';.c /\/7AN4~A
SIGNATURE
I
~ a-U..L:", -
~TE /-Y-8L
fOR OffiCE USE ONLY
R-l
Type/Canst
Bedrooms
Ctori.-
V-N
Zon.
Fir. Zone
Flood Plain -N':'
1
I ~nih
"ccy Load
"''leey Group
x
R-3
Sq. Ftg. Main
Sq. ftg. Acce!'
Sq. Ftg. Other
Value
'Value
Value
TOTAL VALUATION 1.10^
x
.44
plan CIe. Comm/lnd
~%/ Bldq Per Fee
Plan Ck. Res
30%/ Bldq Per Fee
Systems Development
Chota. (1,5%1
BUILDING PERMIT
Charges and
Surcharges
11.00
3.30 PD 12-22-!0
PLUMBING PERMIT
Charges and
Surcharges
Fence
Demo
I Total Comb. Permit
')7 nA
ElECTRICAL PERMIT
Charges and
Surcharges
I
I
~ ,'.
--------
~ . .
15_00
.60
Sidewalle
I a~O\Lq
I
I
I TOTAL
2.0
AI C Pavina
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
:"~~r:~;'i~::
-. ..~..'
27~4
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicantta furnish
A. Jab Address
B. Legal Oescriptian
1. example-tax lat 100, Lane Caunty Map ReferenCl
2,.. example-Lot 1. Block 3, 2nd Addition to Springfiel
. C. Name, etc. 'of owner and construction lender
D. Et'lergy Saurces
1. example.heat/electrical ceiling/or forced air qas
. :.::;~., example:'water,heater/electrical/or solar -.
E. Square footage or valuation, etc.
'1. example-1250 sq. foot house, 500 sq. foat garage
2. example-if new project, check new-if addition, chI
add, etc.
F. Building permit information: . ,
'1: example-co'nstruct single family house with a-n aU
garage
. 2. example.remodel existing gorage into family rOOI
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 Oivi
Staff must be able to contact appropriate persons re~
design information or job site corrections, etc.
II. Abbreviated Plumbing, Mechanical & Electrical Schedule
A. Except where blank spaces occur in the description p
af the Mechonical and Electrical Schedules, the appli
need fill-in only the No. Boxes adiacent to the appro
item(s) to be installed ~
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division ..
1. To conserve space on the permit form the schedul
hove been abbreviated
2. If the item(s) to be installed are not covered on th
ated schedules you should consult the full schedul
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES I-
CHARGES ON THE SCHEDULES
Ill. Applicantta sign and date
Whenever possible, the initial application will be used a
warksheet only. Where possible, Building Division Staff
prepare a typewritten copy and return it to the appliear
the time the actual permit is issued for his signature.
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PERMIT VALIDATION
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CITY
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n.'. .,' .
OF
SPRINGFIELD
(I
(
City Hall
Springfield, Oregan
Department af Public Warks
OFFICIAL RECEIPT
(,
( No. B 55514( ,
Octet cr \\ .r:, 19nO
C' Rec'd F q<~ \ Q.Q_" \{{) ',\\('{:, \{ ("\,j r"
Address C\ '?l \ ~'L ~lh''fs'-~~.YJ
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Received For:
C 0liC\(\ \\ 00 (.
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Amount
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AUTHORI:U:D SIGNATUIU;
S',,:uo...n,l"".ULL ~"r..tll"S . IlUGI..Il. 0" 'HO,
..sn.. C.
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IV. Fees and Charges l-
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 CONDI,TIONS TO BE SATISFIED BEFORE OCCUPANCY:
,-
..
Additional Proiect Information:
Il~ 0 I'/nfl: Iy
PLANS REVIEWED BY:
Permit Clery
~.:i
.....
.....
. TOM SHBIBBoN
na~"," .,..
Signatur~ A v\/"\ 1~ ~ tJ, kt0'Y\ -'J(j (1 date
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1-3-81