HomeMy WebLinkAboutPermit Building 1982-5-4
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INSPECTION LINE
72W769
Job Add".. 2080 Laura Street
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
INFORMATION LINE
726-3753
I
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"lillistrilll> (KOR!')!
Phon.747-5673
legal Oescription
17-03-27-13. Tax Lot 10900
Owner
Tn~~ntinon~~l
Addre"
2080 Laura Street
Snri~fipln, Or~~
Construction lend.,
Address
DESIGN TEAM
(name)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(name)
Gonorol
Owner
Plumbinq
Electrical
Mechanical
PLUMBING
1"0,
I
I
I
.I
Each sini:d. fixture
Relocated building
(n...... fix. additional)
S.F. R.sidence
n both)
Duolu (1 both) each
Additional both
Water service
Se.....er
Storm Sewe,
TOTAL CHARGES
Q7Al.7
Phone
(addren)
(oddren)
FEE
CHARGE NO.
Sq. Ftg. Main
Sq. Ftg. ACUln.
Sq. Ftg. Other
_New_Add_Alter_Rep.
I_FencO_Dema_Olano., Use
_Other
$7,500.00
Building P.rmit Info: Describe Work (i.... Build Single
Family Residence With Attached Gara't.\
ENERGY SOURCES;
Heat
Water ,Heater -NI-.A.
Ranjle
Value of Work:
Sattelite receive only antenpo
Parabo'ic 12' diam~~~~
(lies. no.)
(phone no.)
))
~.
.r;
~
~
FEE I CHARGE
WHERE STATE LAW REQUIRES that the Electrical worle be done by the Eledrical Contrador, th. electrical portion of this permit .hall not be valid until a
label has been .igned by an Electrical Contractor and attached to th.: ."drical panel.
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true and carreet. and I furth.r
certify that any and all worlt performed .hall be don. in accordance with the Ordinances of the City of Springfield and the Lows of the State of Oregon.
pertaining to the work described herin, ond that NO OCCUPANCY will; be made of any structure without the perminion of the Building Division. I further
cartrfy that my registration with the Builder'. Board is in full force ond .ffect a. required by oas 701.055. that if exempt the basis for exemption Is noted
heron, and that only subcontrac~rs and employees who are in compliance with oas 7Q.1.055 will be used on this project.
Basi. for Builder's Board exemption'
NAME (please print)
5 +e. -?-hs,'~
Zone
Fire Zone
Flood Plain
M-R
Type/Canst
~ adroom'
C.toriet
BUILDING PERMIT
Charges and
Surcharges
44.00
1. 76
PLUMBING PERMIT
Charges and
Surcharg..
Re.idence of
(expires)
*
(lies. no.)
bhane no.)
{expires}
ELECTRICAL
MECHANICAL
FEE . CHARGE "0,'
furnace/burnor to
A,TU's
Appliance vent
"parate
Stationary ovap.
cooler
Vent fan with
sinqle duct
Vent system apart from
heating or A.C.
Mechanical exhau.t
hood and duct
'9' ft.
New circuits~ alterations
or extensions
SERVICES
Temporary Construction
Amps.
FEEDERS
Amos.
TOTAL CHARGES
i3.a..tr f.o V"
Wood stove/heater
Heat Pumo
Air handlor to
10.000 CFM
Air handl.r over
10.000 CFM
ISSUANCE OF PERMIT
TOTAL CHARGES
t~
DATE
SI,//'l2
ISIG"ATURE ~'-"--
FOR OFFICE USE ONLY'
Ilnits
occy Load
Occy Group
Plan Ck. Camm/lnd
65%/ BldQ Per Fe. I
Plan Ck. Res i
30%/ Bldp Per Fee I
Fence
o.mo
ELECTRICAL PERMIT
Charge. and Sid.walk
~u~~~:~:~____ ___J_______..______ ~!S_!~vif'~
';"_u'
M-l
Sq. Ftg. Main
Sq. Fig. Access
Sq. Ftg. Other
Value
Value
Vol~
x
x
TOTAL VALUATION
Systems Develapmont
CharCle (1.5%\
Total Comb. Permit
-I
7.500.00
"
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COMBINATION APPLICATION/PERMIT (CAP)
I, . Applicant to furnish
A. Jab Address
B, legal Description
1. example-tax lot 100, lane County Map Reference 17 03 43
2. example-lot 1, Black 3, 2nd Addition to Springfield Estates
C. Name, etc. of owner and construction len"der
"D. Energy Sources
1. example-heat/electrical ceiling/or forced air gas
2. example.,water heater/electrical/or solar
E. Square footage or valuation, etc. . .
1. example-1250 sq, foot house, 500sq, foot garage (
2. exomple.if new project, check new-if addition, chec
add, etc,
F. Building permit information: ,,"
1. example-construct single family house with an otta. \"
garage
2. eXQmple~remodel existing garage into family room
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 Divisic
Staff must be able to contact appropriate persons regc ("
design information or job site corrections, etc.
II, Abbreviated Plumbing, Mechonical & Electrical'Schedules
A. Except where blank spaces occur in the description par ~
of the Mechanical and Electrical Schedules, the applicc '
need fill-in only the No, Boxes adjacent to the apprcpr
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 schedules
have been abbreviated (
2, If the item(s) to be installed are not covered on the
ated schedules you should consult the full schedule,
C, BUILDING DIVISION STAFF Will Fill OUT All FEES A~ "
CHARGES ON THE SCHEDULES
1//./. '1"'~'-'"
_ " "'::::l.'~~___ ~__
III, Applicant to sign and date
Whenever possible, the initial application will be used as
worksheet only. Where possible, Building Division Staff w
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 of the aF
and no plans will be processed until these fees are paid. )
other fees and charges are due and payable when the pe
is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
PLANS REVIEWED BY:
,.... .... ::"-..: ....
"
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PERMIT VALIDATION
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CITY OF SPRINGFIELD
(I
City Hall
Springlleld, Oregon
Departmant of Public Works ct
OFFICIAL RECEIPT
No. B 58987/f
Da~i14 19DA '
Rec'd Fro~R~KLb ~~ Q
Addres.AJ8D dn.LU('\ ~:L.
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Received For.
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AUTHOR/lfO-liCGNATURE
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waoa PRINTl:RS'UTHOGRAPHERS, EuaENL OREGON
Permit Cieri.
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