HomeMy WebLinkAboutPermit Building 1981-6-5
INSPECTION LINE
726-.3769
.
Job Addren ()"~ I j.,..r { J dl(eJ.'1
legal Description L.. '"f: ;.l- iA fc<..Jr" .'i'
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Addren 4"":t':f.L..b.;._ ,('!L..LA \
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Construction lender 1/ A,
Address
DESIGN TEAM
(nome)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
(nome)
G~ner"1
1-1,,/.,.)
I
II" /., )
j
(fy r J':"i..1'
1'1./, /
ft,,!.1
Plumbinq
Electrical
Mechanical
If,J.ru.L -1:JJI L /
I
PLUMBING
NO,j
fEE
Each fin~le fillture
Relacored building
(ne..,' fill, odditionalJ
S,F. Residence
(1 both)
I
I
I
I
I
I
I
I
I
I
r'
I TOTAL CHARGES
I
D:.Jolu (1 bOlh) each
Additionol both
Woter lervice
Sewer
Stor.m Sewer
'';.;\''';!..'it CoNlil,CnOtJ
u~'.:.-.S 1'HP:f.J 1M ;:f:LT
jr'l.09 IO..J
4; I ().of?
WHERE STATE LAW REQUIRES thai tho Electrical work be done by the Eler~ical Contracto,. tho electrical portion of thi.. permit shall not b. .:tllid until a
label hos been signed by an Electrical Contractor and clttached to the .lectrical pan.l.
CHARGE
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CITY OF SPRINGFiElD .
COMBINATION APPlICAflON/PERMIT '
INFORMATION LINE
726-.3753
JLJ
o.
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(jJ
ff a,,,,..
ENER~WU'l5=:-Eh~/-r1 ,I" "'+-t
Heat~
Wolf!lr Heal.r ~
Range _
Value of Work:
Sq, Fig, Mainl-?Jlr...
Sq, ftg, Acceu,
Sq. Ftg. Other
_New _Add _Alter _Rf!lp.
___Fence_Demo_Change/ U se
_Olh.r
Phone 7QL'IJe,,',"J.
'Z- q :l?:>q ! C6
Building Permit Info: Describe Work (i,e" Build Single
FOm~l;~,:n~r; With"~_t_t~f"_~,:,d Gar..ne\
r\nl,hPo 111)( ClP J rflt-t
7-4 'K ~() -~ pH :r~o~
I BIAL.-B PeJN.CG$.UXX:O;i:O~-
Phone
(oddreu)
(upiTes)
(pho~e no,)
"*'
...
(lics, no,)
-'
(address)
(lies, no,)
(phono no,)
(upires)
11'.,... <
/t:1'f r" ~
:~44-~,A:::t~
~140 Gl'ldH1Vl;iJ8/u.d,
)1,." .' ,.
l' -~
.----.----.r---r---.'~-..---
ELECTRICAL
MECHANICAL
---FEE. I CHARGil,
NO.
FEE
CHARGE
NO,
Residence of
furnace/burner to
~TU's
lq: ft,
N...... circuits. olterotions
or elltensions
SERVICES
Applionc~ vent
seporote
Stolionory evap,
cooler
V.nt fan wilh
single dud
Vent system aport from
. hf!loting or A,C,
Mechonkol e)(hoult
hood and duct
I
,.
Temporary Construction
Amps,
r-OQ1L~ MOM'C-. 'E,UP'f"l..l(
pt PIsr1lC.
MOe!!.~ h(:~~.
~~r~V(L~
10.0.9
J I), oy
I
/O,og.
10.'::'
Wood stove/heater
5.~3
5,03
/
Heat Pump
Air handler to
10,000 CFM
Air handler over
10,000 CFM
FEEDERS
Amp"
ISSUANCE OF PERMIT
/o,o!:
/5,og
TOTAL CHARGES
.$ ~D,03.
1>
TOTAL CHARGES
I HAVE CAREFUllY EXAMINED the compl.ted opplication for permit. and do hereby certify thai .all informatio!" h.r.on is true and correct, and I further
certify that ony and all work performed shall be done in accordonce .....ith the Ordinances of'the City of Springfield and the lows of the State of Or.gon
pertaining to the .....ork delcribed herin. and that NO OCCUPANCY will b. made of ony structure without the permission of the 8uilding Division, I further
certify that my rltgistTotion with the Builder's Boord is in full force and effect as requir.d by ORS. 701,055, that if ellempt the basi. for .llemption is nateel
heron. and thai o!lly subcontractors and .mployees who ar. in compliance .....ith ORS 701.055 will be used on this project.
Basis for Builder's Boord ellemption:
NAME (please print)'f. 1/:''''"<1, / ,I, &vrl,'.. ~
Zo,. (l1 t\ ~
Fire Zone -
Flood Plain ~ 0
Type/Const.rt1:il
Il.drooms "2-
c;.torie' I
BUilDING PERMIT I
Charges ~ bf)\.I~t'JlIIlf.
f '...:. 5 Sf....U?
40.00
-e-
IO,o,5?
D,+9
PLUMBING PERMIT
Charge, and
Surchorge.
ElEGRICAl PERMIT
Chorg.s and
Surcharges
~o 00
/. .-
O,'i:>,5?
( ~ ocr
~,
--------
o,bjt
,MECHANICAL PERMIT
Charges and
Surcharges
':'~_'_"l_.,
"
SIGNATURE"- 1C,P 1--
FOR OFFICE USE' ON~Y'; r
ol.,,;_u~
o:f, C;/~/pl
Units
nccy load
f1ccy Group _Ii( - :2:.
Sq. Ftg. Main
t:lq. Ftg. Access
Sq_ Ftg. Other
.
TOTAL VALUATION ?Cf ,I~ 00 I
441o,D.1
.
.
Value
Value
Value
Pion Ck, Comm/lnd
65%/ BldCl Per Fee
Plan Ck, Res 5u~pp"Std<J
30%/ Bldq Per Fee
System. Development
Charqe (l,5~:'\
,30,a:-
Fence
~
Demo
100'
Sidewalk
Totol Comb, Permit
''P-=: ~
, - I I'
liD. oC? ::"'Ar,
A/ C Povino
,.z.'
Curb Cut
':: ~-~
, -
512,61
TOTAL
...--""'.
_~.::o-..:t_::::.",..
;~.....-,.
COMBINATION
.
APPLICATION/PERMIT (CAP)
.
PERMIT VALIDATION
'I. Applicant to furnish
A. Jab Address
B. legal Oeser; ption
1. example-fox lat 100, Lone County Mop Reference
2. exampie-lat 1. Block 3, 2nd Addition to Springfiel,
Nome, etc. of owner and construction lender.
Energy Sources
1. example-heat/electrical ceiling/or forced oir gas
2. example.woter 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, ch
odd, etc.
F. Building permit information:
1. examole.construct single family house with an at
garage
2. example-remodel existing garage into faniily roc
3. example-convert single family residence into
restaurant (chonge of use)
G. Volue of work os defined in Section 303 (0) of the
Structural Speciolty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Div
Staff must be able to contact appropriate persons fE
design information or job site corrections, etc.
':.
((
C.
D..
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S6672
,..
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Received ~
IY\~ .
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l,
(~d
pp
, lOOn
4pJI') L\ ()
?n .C'/)
95()
, h~~{y)
3no{)
/6,01
Received 51.7 ~gr.J( ~
rp -
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II. Abbreviated Plumbing, Mechanical & Electrical Schedu'
A. Except where blank spaces occur in the description
of fhe Mechanical ond Electricol Schedules, the cpp
need fill.in only the No. Boxes adjacent to the appr
item(s) ta be instolled
B. full Plumbing, Mechonical, ond Electrical Schedule,
are available at the Building Division
'1. To conserve space on the permit form the sched'
have been abbreviated
2. If the item{s) to be installed are not covered on
ated schedules you should consult the full sched
C, BUILDING DIVISION STAff WILL fiLL OUT ALL.fEES
,CHARGES ON THE SCHEDULES
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III. Applicont to sign ond date "
~'
Whenever possible, the initial application will be usee ".0 ~
, worksheet only. Where possible, Building Division 5ta
prepare a typewritten copy and return it to the applic
the time the actual permit is issued for his signaturE_ (
"
AU,fHOIIIIZIEO SIGNATURE
...llrc....'TlJ"...lJLl ~'''''Tr.... tlJGr"r, 0.. ....0.
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IV, fees and Chorges l-..
Plan check fees are due and payable at the time of the application,
and no plans will be processed until these fees ore paid. All
other fees and charges are due and payable when the permit
is issued.
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.,
V, fOR OffiCE USE ONLY
Permit Cieri,
PROJECT CONDITIONS TO BE SATISfIED BEFORE OCCUPANCY:
,
Additional Project Information:
,I
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PLANS REVIEWED BY,
name -rt;"w. ShP;Y'ooJ..,.
signalu
~are
to. +-19bl
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