HomeMy WebLinkAboutPermit Building 1981-9-2
CITY OF SPRINGFIELD
J7 ~ 03-2. 7-,:)::(/ () 7~19!BINATlON APPliCATION/PERMIT
/ ENERGY SOURCES:
1025 Lochaven Avenue / It / / I H.at elect! wonrl
I Water Heater
l'9al D'''';Pt;~~_Lp_L8_,_BJJLC.k 2, Kel1=.Ra.)'...P..a.rk Rano.
S>I ndrCL
Arno 1 d/~, .J(;hri stensell
1025 Lochaven AvenUI!I>an.747-3729
Sorinqfield, Oreqon 97477
Conllruction Lender S ta te __ _V~.__
I INSPECTION LINE
726-3769
.
job Address
Owner
Addreu
Addren
Fllopne
(nome)
Phon. F"RIi-774F.
(addr.,,)
DESIGN TEAM
Primary
Jon Vahala
988 N. 63rd St.
746-7719
(name) (address) Wes. no.) (expires) ('lhone no.)
Jon Vahala 988 N. Ii::!rrl St. 74F._7710
Q"lCQR Elect. 4F.? F llth S~, *" ~q2 2Hl!
"
Structural
Electrical
Mechanical
CONTRACTORS
General
plumbing
Electrical
Mechanical
PLUMBING
NO,
FEE CHARGE NO.
Residence of
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(I both)
sq. ft.
New circuits. alterations
or extensions
2+
seRVICES
Duplex (I both) each
Temporary Construction
Additional both
10.OC 10.0C
Amps.
Wahlr service
Sewer
Storm Sewe,
FEEDERS
1 ,relocate rain drain
5.0C
Amp..
TOTAL CHARGES
15. OC ' TOTAL CHARGES
','
~OTlFlED 6/9/81 bv Mail
. INFORMATION LINE
726--3753
Sq. Ftg_ Main ~J '(
c;. to..v.e.. Sq. FIg. Accen. 2?R
Sq. ftg_ Other
_New.XMdd_Alter_Rep.
_Fence_Demo_Chongel U511
_Other
00
~
a
w
......
cr,
I Value of Work:
$16,755.00
Building Permit Info: Describa Work (i.e., Build Sing I..
Fomil., Residence With Attached Garage)
Residential lIddition=family rnom.
hnth, n1~n nnnitinn tn garagP
hpdroom
(lies. no.)
(phone no.)
(expires)
ELECTRICAL
MECHANICAL
FEE
CHARGE NO, 1
I furnace/burner to
9TU',
Appliance vent
15 _ 00 separate
Stationary ....ap.
cooler
Vent fon with . ~.:.n
singl. duct
Vent systein aport from
hooting 'or A.C.
Mechenicol exhaust
hood and duct
CHARGE
I FEE
15.
Wood Itovel heahtr
5.00
,
Heat Pump
Air handler to
10.000 CFM
Air handler o....r
10,000 CFM
ISSUANCE OF PERMIT
10.00
15.00
15. 00 TOTAL CHARGES
WHERE STATE lAW REQUIRE.i that the Electrical work b. done by the Electrical Contractor, tho el.ctrical portion of this permit shall n~i b. valid until a
lob.1 has b..n signed by an Electrical Contractor and attached to the electrical panel.
I HAVE CA~EFULLY EXAMINED the completed application for permit. and do hereby certify that 011 information hereon is true and correct, ond I further
.:ertify that any and 011 wark perfarmed Ihall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon
pertaining to the work described herin, and that NO OCCUPANCY will be mad. of any structure without the permission of the Building ~ivision. I further
certify that my registration with the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted
heron, and that only subcontractors and employees who ore in compliance with ORS 701.055 will be used on this project.
@.U~DATE 9-2-f'1
Basis for Builder's Board exemption:
c-.~f'r..r..l<;~SIGNATUREG'~
NAME (please print) A/~ tVt,L{) p,.
R1
fOR OffiCE USE ONLY
x
Value
Value
Value
Type/ Canst.
Iledroams 1
in
\/t\J Units 1
;:trl1i tionccy load __-=-_~JJ1
"'"leey Group R3 +M I
Zone
~ Fire Zone
Flood Plain
<:'tori.-
I plan Ck. Comm/lnd
BUILDING PERMIT 80.00
Charges and -------- 65%1 Bide Per Fee
Surcharges 3.20 Plan CIt. Res
30%1 Bldo Per Fee
PLUMBING PERMIT 15.00
Charges and F~"'ce
Surcharges .60
Demo
elECTRICAL PERMIT 15.00
Charges and Sidewalk
Surcharge, .60
AI C Pavino
MECHANICAL PERMIT 10 add. feet
Ch:uges and ____l.?",QQ.._ Curb Cut
Surcharges .60
MECHANICAL PERMIT ~___l.?~~ _ 110 add. feet
Ch~rges and Curb Cut
Surcharges
<:''11. Ftg. Moin
Sq. ftg. Acces.
Sq. Ftg. Otha,
x
x
TOTAL VALUATION $1 F., 7~~ nn
I'
Systems Development
Charae 11.5%\
i24.00 pd 6/4/81
~E::5~
Total Comb. Permit
S:141,nn
11.00
141.00
TOTAL
11.00
I
I TOTAL
141. 00
r-,\ '4>--- --:... /---, ..- -:. ~. .~..:;:: '.. .
..,.-/. ." "" '- "
~/ - .
, ,
B. legal Description
1. example-tax lot 100, Lone County Map Reference 17 03 43
2. example. Lot I.,Black 3. 2nd Addition to Springfie!.'
C. Nome, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceiling/or forced air ,9as
2. example-water heater/electrical/or.~ :.
E. Square footage or valuation, etc.
1. example.12S0 sq, foot house, 500 sq, foot garage
2. example-if new project, check new-if addition, chI (
add, eic.
F. Building permit information:
. 1. example-construct single family house with an aft
garage (
2. example. remodel existing garage into family roor
3. example-convert single family residence into
restaurant (change of use)
G. Value of work os defined in Section 303 (a) of the
Structural Specialty Code
H.. DESIGN TEAM AND CONTRACTOR'S
To avoid design or construction delays, Building Divi! (
Staff must be able to contact appropriate persons re~
design information or job site corrections, etc.
i~t~,1 vr. r:1\O\;~j C~T~rrr.~;
COMBINATION APPLICATION/PERMIT (CAP)
I, Applicant to furnish
A. Job Address
II. Abbrevioted Plumbing, Mechonicol & Electrical Schedule
A. Except where blank spaces occur in the description pi
of the Mechanical and Electrical Schedules. the applic
need fill.in only the No, Boxes adjacent to the approl
item(s) to be installed
B. Full Plumbing. Mechanical, and Electri,cal Schedules
ore available at the Building Division
1. To conserve space on the permit form the sched,:,l<<
have been abbreviated
2. If the item(s) to be installed are not covered on thl
ated schedules you should consult the full schedul
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES A
CHARGES ON THE SCHEDULES
III. Applicant to sign and date
, Whenever possible, the initial application will b~ used 0
worksheet only. Where possible, Building Division Staff '
prepare a typewritten copy and return it to the appliean
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, ~i~
and no plans will be processed until these fees ore paid.+-: tl
other fees and charges are due and payable when the pen,)t
isissu~. .
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
"
. -~ .
-- .....~
PERMIT VALIDATION
,,-
.
CITY OF
(l
SPRINGFIELD
(
City Hall
Springfield, Oregon
Deportment of Public Work.
OFFICIAL RECEIPT
(I
("
N B r-71"\15
,0. oJ , c.. -'- 'll
19 J-1 '
Rec'd From Yx-Lt1r,Lrf7 ,/Ii ,(!hr~C""+':>IJ3.ia1
Address! C-A) ~[/7(/ ,r{/iJ at..,l(?
.c:....~, r/~I /-, /.1 n 71 (....~--'
I .....' 11,"- I I I I
Received For:
Dote
9-2
,~1
/;)0
YO. CO
3, :J,()
/5, ()O
,(/i()
l-tf,()()
, l1()
/ ":T ,({)
,h()
/ /, (){)
(',
'0
L.f'1~!
(I
(
;.2.-0
/ f
q7~\
(I
tIe J-1.']
f
(I
//C.'
I' 7[.
(. '-1'lI AJ
." . - f
(I
--4 tjtJ
Il-Ll+
c
(iU.1j,.
(
(I
j <-1/. (Y) (7//17 (Ie
(!,( >-)(:[; 1.J
Amount Received
(
~,I
(I
/JoUT..OltrtI!:D .'GHATU.u;
"
c
S"t:~TO""U'U'.U~1. ...,..,,,,,.. . 1:1101:..(_ 0" ".0'
",,,..
SI
. ~-
Permit Cieri.
~1
'I
,
I
I
~- -
PLANS REVIEWEO BY:
name
. l"; ,,,,':". f_:
, signatur"':
-late
.:,.;::'.'";1