HomeMy WebLinkAboutPermit Building 1981-8-31
legal De1Cfiption I OJ:ha~pn MH5-_,,-
INSPECTION LINE
n~3769
Job Addr"n
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INFORMATION LINE I"
716-3753
CITY Of SPRINGfiELD
,COMBINATION APPLICATION/PERMIT
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aS1 Loehaven
I ENERGY SOURCES:
Heat NA
I Water Healer
Range _
Valve of War..:
00
......
O'
lJ1
'"
00
i 5q, Fig, Main
I Sq, fIg, Accen,
I Sq. ftg, Other
I _New __Add _Alter _Rep,
_.. _fence._ Demo_Change i U' 5e
_Other
R1k ~ lot?
Owner Brown
Add",. 881 lochaven
CanHrvclion lender
Addreu
DESIGN TEAM
Primar., ~
Slructural
Electrical
M~chanical
I CONT~ACTO~S
G..mHol
I plumbina
I EIf~ctrical
l Mechanical
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I TOTAL CHARGES
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NO.
~1Qnn. nn
Buildinq Permit Info: -DelCribe Work (i,e.. Build Single
Fomil.. R,Hid"nce With Attached Goroae)
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'1
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1
Phone
Attached carnnrt
Phone
(nome;
(oddren)
(lies, no,)
{expired
(phone no.) .'
688-6~
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R.r:a..uI'r
15425
?U3/R?
W6.h M;nnC'.le"'+~
{nome}
(address)
(\ics, no,)
(phone no.)
(expires;
PLUMBING
ELECTRICAL
MECHANICAL
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~ CHARGF i
1
!
\_~
f::=
CHARGE
FE!:
. CHARGE
NO.
FEE
NO,
Residence of
furnace/burner !o
Il,TU's
Appliance vent
separate
Stotionor}' evop,
cooler
Vent fall with
singie dud
Vent system aport from
heati~CI or A,C.
Mechanical e;llhavst
hood and duct
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Ro!localed builciing
{new tix. odciirional)
S,f, ~o!uden~e
(l both)
Stl: ft,
New circuits. olteratiolls
or eXlensions
Eocn ,;nfllt! f;ltlure
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SERVICES
Temporary Construction
Additional bOlh
Duolel!: t1 both) "otn
Amps,
Water service
Sewer
Stor.m Sewer
Wood stove/ healer
fEEDERS
Heat Puma
Air handler to
JO,OOO Cf,l,\
Air handler o.,..r
10,000 CfM
Amps,
NA
>JA
WHERE STATE lAW REQUIRES that the Electtital work be don. by the Ele..t~icol Contractor, the
label has been signed by an Electrical Contrador and attached to the electrical panel,
I TOTAL CHARGES
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.1.",I'al p."lan af ,hi. p.,ml' .hall n.. b. valid .n,1I a .1
ISSUANCE OF PERMIT'
I TOTAL CHARGES
I HAVE CJ\,REFUllY EXAMINED the completed application for permit, and do hereby certify that 011 information hereon is true and correct, and I furthor
certify that any and all work performed sholl be done in acwrdance with the Ordinanus of the City of Springfield and thllt lows of the Starlit of Oregon
pertaining to the war.. cew;ibea herin. and that NO OCCUPANCY will b. made of any structure without the permission of the Building Division. I further
certify that my registration wiln the Builder's Soord is in full forca and ~ffect os required by ORS 101.055. thot if exempt the basis for e;llemptian is noted
heron, and Ihot only svbco':'tractors and employees who ore in compliance with ORS 701.0" will be usod on this project,
Basis for Builder's Board exe~ptiofl.
NAME (please printlLA-a.., ~ ~
ZOM --!11-1'
Fire Zone
Flood Plain
BUILDING P!:RMIT
Charges and
Surcharges
PLUMBING PERMIT
Charges and
Surcharges
ElECTRICAL PERMlT
Charges and
Surchargu
MECHANICAL PERMIT
Charges and
Surcharges
<IGN~TURE,o~)c ~
FOR OffiCE USE ONLY ,
,
-"'""""W6_',
DATE
Type/Const,~
:!,edroams
(toriel
Voiue
Val.. $3900 0('
Sq. Fig. Main
Sq, ftg, Acceu -1.B..C'
Sq, Ftg, Other
Units
I"Iccy Load
Occy Group M 1
x ? 00
x
Valve
TOTAl VAlUATION $1Qnn nn
Plan ell., Comm/lnd
_-,-__J2B....DD-_ ~"/Blda PO' F..
Plan elr., Res
1 _ 1 2 30%/ Bldq Per Fee
I Systems Development
CharM / 1,5~:'1
~R 4n Pn R_?t_Ql ~~717n
FenCl!
Demo
Talal Comb, F'-ermit
Sidewalk
,,/e: ;>"vino
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I TOTAl
$29,12
l~______
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Curb Cut
'.... ,~
'COMBINATION APPLlCATlONiPl1IT
(CAP)
I. Applica~ to furnish
A. Job Address
B. Legal.Description
1. examole-tax lot 100, lane County Map Referenc
2. exampie.lot 1. Block 3, 2nd Addition to Springfie
C. Name. etc. of owner and construction lender
D.. Energy Sources
1. example-heat/electrical ceiling/or forced air gas
2. examcle.water heater/electrical/or solar
E. Square footage or valuation, etc.
1, exom"le-1250 sq. foot house. 500 sq. foot garag
2. exompie-if new project, check ~.if addition, d
add. elc.
F. Building permit information:
1. examole.construct single family house with an oj
garage
2. example.remodel existing garag~ into faniily roc
3. example-convert single fomily residence into
restaurant (change of use)
G. Volue of work as defined in Section 303 (a) of the
Structural Specialty Cede
H, DESIGN TEAM AND CONTRACTORS
To ovoid design or const~uction delays. B0i1ding Div
Stoff must be aole to contact appropriate persons re., ,.....
design inf~rmotion or job site corrections, etc. \
II. Abbreviated Plumbing, Mechanical & Electrical Sched~1
A: Except where.blank spaces occur in the description,
or the Mechanical and Electrical Schedules, the appl
need fill-in only the No. Boxes adjacent to the apprc
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 schedu
hove been abbreviated
2. If the item(s) to be installed ore not covered on H
ated schedules you shouid consult the full sched.
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES,
CHARGES ON THE SCHEDULES
I · PERMIT VALIDATION
CITY OF SPRINGFIELD
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City Hall
Springfield, Oregon
Deportment of Public Works
OFFICIAL RECEIPT
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No. B
t\lt'\OI19t91
Rec'd Froa\t_ ~() J J J-...
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Addresrf)()l (( I f) ffiJ..n f\Q.~ ,
1:;7106
\J ..L. -..J ('
Date
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Received For:
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\:~ctQ_ ._ ~_CU
- (l.19Q l. I Z-
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Receive~ (.r0
rhllV'J
AUTHOIltI'ZED SlONATUIltE (
IMlLTO...TU''''.Ull ~IIIIMr(JII' lUOItMl. 0111 .'.0' .....'. ~"
Amount
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III. Applicant to sign and dote (
Whenever possible. the initial application will be used, Q
worksheet only. Where possible, Building Division StaH ",
prepare a typewritten copy and return it to the applicar,.;_.
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 pIons 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:
Additional Project Information:
PLANS REVIEWED BY,
naml""
~ignatur""
Permit CierI-
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