HomeMy WebLinkAboutPermit Building 1981-4-21
... ,.~ -
_... ..,\~ . ."~"\'f'".<.,.'
.' ..,': ~.'
I INSPECTION LINE
726-3769
I Job Address
Itegal Description
.:..';-"~
"""'J"'lr."
.".~'"'
.
CITY Of SPRINGFIELD
COMB1NATlON APPliCATION/PERMIT
.
INFORMATION LINE
.726-3753
1119 Lochaven
17 -0,3-27 -22
lax..Lo.LI5.31
ENERGY SOURCES:
Heat pl p('tY'ir
Water Heater_electrJc_
Range
I Varu~ of Work:
10,000.00
Sq. Fig. Main
Sq. FIg. Access. --44-C'
Sq. FIg. Other
_New_X-Add_Alter_Rep.
_Fence_Demo_Changel Use
_Othe'
00
~
Construction lender
Dale Naro
1119 Lochaven
Sorinafield.
none
phon. 7 41i-2 9R2
Ore"nn 97477
Building Permit Info: Describe Work (Le., Build Single
Family Residence With Attached Gorope)
o
N
'"
W
Owner
.1 Address
I
I
I
Room add-on to house
Woodstove-Firedrum #2
Addreu
Phone
DESIGN TEAM (nome)
Primary Ken Naaao
Structural owner
(address)
(lies. no.)
(expires)
(phone no,)
Electrical owner
'*
,
1;1'\0_01;1111
Mechanical
CONTRACTORS {nome}
(address)
(lies. no.)
(expires)
(ohone no.)
PJumbinQ
owner
Hall & Son Plumbino
6766 "E" Street
747-9258
G..neral
Electrical
owner
Mechanical
PLUMBING ELECTRICAL . MECHANICAL
NO, FEE ' CHARGE NO, , FEE I CHARGE NO, , I FEE I CHARGE
1 5.00 Residence of furnace/burner to
Each sin~le fixture "1. ft. BTU's
Relocated building 2 New circuits, alterations 15.00 Appliance vent
(new fix. additional) or extensions separate
S.F. Residence Stationary evap.
(1 both) SERVICES cooler
2 Vent fan with
Duplex (1 both) each Temporary Construction single duct 3.00 6.00
1 10.00 Vent system apart from I
Additional bath Amps. heating or A.C.
Mechanical exhaust I
Water service hood and duct
",
Sewer 1 Wood stovel heater 5.00
Storm Sewer FEEDERS 1 Heat Pump 6.00
I Air handler to
Amps. 10.000 CFM
I Air handler over
10.000 CFM
I
"
ISSUANCE OF PERMIT 10.00
TOTAL CHARGES 15.00 TOT At CHARGES 15.00 TOTAL CHARGES 27.00
WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall no' b. valid until a
label has bMn signed by an Electrical Contractor and attached to the eledrical 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
certify thot any and all work performed shall be done in accordonce 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 made of any structure without the permission of the Building Division. I further
certlfy that my registration witt. 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 emp'loyees who are in compliance with ORS 701.055 will be used on this project.
Bosis far Builder'tBoard exemption:
NAME (please prinV fl..:::;/~
.4.
4~n
SIGNATUR~--&f'...-.:::::Z- ~~
DATE j/- ;;";-1'/
Zone
Fire Zone
/'
.If-1
FOR OffiCE USE ONLY
Type/ Canst. --.J/-N
Bedroom~
1
Sq. Ftg. M~in
Sq. Ftg. Access
Sq. Fig. Other
x
x
Value
Value
Value
Flood Plain no
C::tori~~
1
Units
nccy Load
I'1ccy Group~i
TOT At VALUATION 1 n . 1)00 00
BUilDING PERMIT 52.00 Plan Ck. Comm/lnd
Charges and 65%1 BldCl Per Fee
Surcharges 2.08 Plan Ck. Res
30%/BldQ Per Fee
PLUMBING PERMIT 15.00
Charges and Fence
Surcharges
.60 Demo
ELECTRICAL PERMIT
Charges and 15.00 Sidewalk'
Surcharges
~n AI C Pavina
MECHANICAL PERMIT
Charges ond ._~_ ..z.LJllL Curb Cut
Surcharges
1 nR
Systems Development
Charae tl.5%1
lo.bU palQ q-It-~I
receiot #Sfi::109
Total Comb. Permit
11 ~ ~I;
TOTAL
1-' -- -
I 113.36
\; .t.~ ~,'~?;:~,~~/
'0:_~
. ~.-",
COMBINATION APPLlCATION/P.IT (CAP),
I. Applicant to furnish , '.,
A. Jab Address' "
:',,,..,:,,,.
B. legal Description I
1. example.tax'lat 100. Lane County Map Reference 17 03 43 '
2. example.Lat 1, Block 3, 2nd Addition to Springfield Estates
C. Name, etc. of owner and construction' lender '. ;
D. Energy Sources ,
1. example-heat/electrical ceiling/or forced air gas
2. example-water heater/electriccil/or.s'olar.
E. Square footage or valuation, etc.
1. exomple.1250 sq. fooi house,500~q:foOt"garage
2. example-if new project, check new-if addition, check
odd, etc, ( . ,
F. Building permit information:
1. example-construct single family house with an attached
garage
2. example-remodel existing garage into family room
3. example-convert single family residence into
restaurant (change of use)
G, Volue 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 Division.
.. Staff must be 'able to contact appropriate persons regarding
design information or job site corrections, etc.
'l"
.J< _
II, Abbrevioted Plumbing, Mechanical & Electrical Schedules
A. Except where blank spaces occur in the description portion
of the Mechanical and Electrical Schedules, the applicant
need fill.in only the No, Boxes adjacent to the appropriate
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 ;tem(s) to be installed are not covered on the abbrevi-
ated schedules you should consult the full schedules
C. BUILDING DIVISION STAFF w'ILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
III. Applicant to sign and date
Whenever possible, the initial application will be used as a
. worksheet only. Where possible, Building Division Staff will
prepare a typewritten copy and return it to the applicant at
. . the time the actual permit is issue'd for his signature.
IV. Fees and Charges
Plan check fees are due and payable at the time of the application,
and no plans will be processed until these fees are paid. All
other fees and charges are due and payable when the permit
isissu~. ~ .
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
AdditionClI Project Information:
:.'
,
,.f .\..
PLANS REVIEWED BY:
,
\
'"
nam-:-
.,.-. I.
Dan Smith
o;ignatur-:-
.",-,',
"",.-' '
-'!I:,:, "
,...,-.'....,....''''f '~-~
,. -- > ~~\
, ,
~ ..~-
\1
."
PERMIT VALIDATION. ,
.,.', ._.... ..J ~ r t";
""s Co 3~l\!
:i
Cl.'.;':"'.:\ ...\?:- V \
I. ,~. .... ~)
. :... : ~
'''".' n
;-':, "
. :',
" ,
...1,.
Permit Cler~./.1 v-.....
\
\
\
'~at-
4/20/81