HomeMy WebLinkAboutPermit Building 1981-7-1
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INSPECTION LINE
726-3769
Job Address
1925 .Laura
Legal Description
17032710 02900
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INFORMATION LINE
726-3753
CITY OF SPRINGfiElD
COMBINATION APPLICATION/PERMIT
Own.. Springfield Utility Board
Add,... PO Box 300
S~rinQfjelrl, O~F.GON
Construction Lender
Address
DESIGN TEAM
(name)
Primary
CH2M Hill
Structural
Electrical
Mechanical
CONTRACTORS
(name)
0.."..;"1 B.A. (.h.amh~!,s
Plumbin!:! Vas Plumbing
flectrical Builders Electric
Mechanical
PLUMBING
NO
t Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 both)
Duplu (l both) each
Additional both
l W~ter service tap
. Sewer
200'
Storm Sewer
TOTAL CHARGES
Phon.746-8451
Phone
(address)
(address)
FEE I CHARGE
NO. ~
375
ENERGY SO~i'e'~'t.
Heat
Water Heater
Ranqe
I Value of Work:
Sq. Ftg. Main
Sq. hg. Accen.
Sq. ftg. Other
. New_Add_Alter_Rep.
_Fence_Demo_Chonge/Ule
_Other
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Residence of
17,677 . 00
Building Permit Info: Describe Work (Lo., Build Single
Famib Residence With Attached Garaae'
Sut>statioll "ont.rol ~~", inrlllclin"
foundation, plumbing, electrical and
mechanical for steel pre-fab bld~.
(licI. no.)
(expires)
(phone no.)
(lies. no.)
(expires)
(Dhone no..
CHARGE
\.00 9.00
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"GNATURE .RI ~
FOR OFfiCE USE ONLY .,
ELECTRICAL
MECHANICAL
I FEE
--- '.'FEE
I CHARGE
NO. ~
6.00
10.00
25.00
WHERE STATE LAW REQUIRES that the Eledrical work be done by the Electrical Contrador, th. el.ctrical portio" of fhi, permit .hall not b. valid until a
label has been ligned by an Electrical Contractor and attached to th. electrical panel.
I HA VE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true and correct, and I further
,ertify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon
pertaining to the work delcribed herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I further
certlfy that my regiltration with the Builder's Board is in full force and effect os required by ORS 701.0.5.5, that if exempt the basil for exemption II noted
heron, and that only subcontractors and employees who are in compliance with ORS 701.0.5.5 will be used on this project.
Basis for Builder', Boord exempticll1'.
NAME (please print) G'A~ 4
RA
'rype/Const.
8edrooms
C::torie,
Zone
Fire Zon~
Flood Plain
3
furnace/burner to
A,TU's
Appliance yent
separate
Stationary evap.
cooler
Vent fan with
sinple duct
Vent system aport from
heating or A.C.
Mechanical exhaust
hood and duct
I:;, '10 11:;, An
SQ. ft.
New circuits, alterations
or extensions
SERVICES
Temporary Construction
1 Amps. SO
5.00
'20.00
I
FEEDERS
Amps.
40.00, TOTAL CHARGES
II-N
Units
f'lccy load
,",ccy Group
1
BUilDING PERMIT 84.00 Plan Ck. Comm/lnd
Charges and 65%/6Id~ Per Fee
Surcharges Plan Ck. Res
3.36 30%/6Id~ Per Fee
PLUMBING PERMIT 40.00
Charges and Fence
Surcharges 1. 60
Demo
ElECTRICAL PERMIT
Charges and 105.00 Sidewalk
Surcharges .60 AIC Payina
MECHANICAL PERMIT 25.00
Charges and Curb Cut
Surcharges --------
1.00
15.00
Wood stoye'heater
".
Heat PumD
Ai, handler to
10.000 CFM
Air hondler oyer
10.000 CFM
1 Unit Heater
I
ISSUANCE OF PERMIT
15.00 I TOTAL CHARGES
DATE 7-/ J Ql
ilL
Sq. Ftg. Mllin
Sq. Ft9. Access
Sq. Ftg. Othe,
375
x
Value
Value
Value
x
x
TOTAL VALUATION
54.60
System. Denlopment
Chorc'e fl.S%\
2605.16
845.75
San. Sew. Assesm.
Total Comb. Permit
TOTAL'
1. 336. 07
17.677.
17.677.
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III. Applicant ta sign and date
Whenever possible, the initial application will be used as ('~
warksheet anly. Where pcssible, Building Divisian Staff "
prepare a typewritten copy and return it to the applicant
the time the actual permit is issued for his signature.
IV. Fees and Charges .
Plan check fees are due and payable at the time af the aJ"pI,callan; .,.
. and na plans will be precessed until these fees are paid. All
'.. ather fees and charges are due and payable when the permit
'is issued.
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant ta furnish
A. Jab Address
B. Legal Descriptian
1. example.tax lat 100, Lane Caunty Map Reference
2. example-Lat 1. Black 3, 2nd Additian ta Springfield
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example.heat/electrical ceilin9/ar forced oir gas
2.. example-water heater/electrical/or solar
E. Square footage or valuation, etc.
1. example.1250 sq. foat house, 500 sq. foat garage
2. example-if new project, check newwif ~ddition, che.
add, etc.
F. Building permit information:
1. example-construct single family house with an atto
garage
2. example-remodel existing garage into family room
3. example-convert single family residence into
restaurant (change of use)
G. Value af wark as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Oivisi
Staff must be able to contact appropriate persons reg<<
design information or job site corrections, etc.
II. Abbreviated Plumbing, Mechanical & Electrical 'Schedules
A. Except where blank spaces occur in the description po t~
of. the Mechanical and Electrical Schedules,.the applicl.
need fill-in only the No. Boxes adjacent to the approp
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 schedule!
have been abbreviated
'. 2. If the item{s) ta be installed are not covered an the'
ated schedules you should consult the full schedule
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES M
CHARGES ON THE SCHEDULES .
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Additio'nClI Project Information:
PLANS REVIEWED BY:
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"ignatur~
PERMIT VALIDATION
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CITY OF
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SPRINGFIELD
City Hall
Springfield, Oregan
Department af Public Works
OFFICIAL RECEIPT
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56834(1
(~ No. B
Datet \~'6 \ 19 R\
C Rec'd Ira L'\1 D _ (I
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( Amount Received~ ,?l!:\l .02 f) (\ x:...J CI
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