HomeMy WebLinkAboutPermit Building 1981-4-17
I INSPECTION LINE
726-3769
I Job Add'en
"
.
INfORMATION LINE
726.3751
cA
CITY OF SPRINGFIELD
COMBINAlION APPLICATION/PERMIT
~-j..ql./
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f.r;"ir-;....U
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Sq. ftg. Main
Sq. FIg. Aceen. ~
Sq. FIg. Other
_Ne..... .)i.Add_Alter _Rep.
_ _Fence __Cema_Chongel U,e
_Other.
WHERE SlArE LAW REQUIRES that th. Elect,itol work be done by .h. Elutricol Contractor. the .Iectrical portion of thi. p.,mi. .hall not b. valid until a I.
label hall b..n signed by on Electrical Contractor and attached to the .Iedrical panet.
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify Ihot all information hereon iI true and corred, and I further
,o,rify that ony and all worlt performed shall be done in accordance with the Ordinances of the ~ity of Springfield and Ih. laWI of the State of Oregon
pertoining to the work d.'Ctibed herin, ond thot NO OCCUPANCY will be mod. of any strumr. without the permission of the Building Di"i.ion. I further
canfty that my r.gistrotion with the Builder'. Boord is in full force and effect as required by ORS 701.055. thot if uempt the basi. for exemption i." noted.
heron, and that only subcontractors ond employees who are in compliance with ORS 701.055 will b" used on this project,
SIGNATURE ~ ,;(,;/ c~~
I Systems O."elopment
~ 9.~ PrDa4~'I() -~i
t:;~ - L_
- I /.fP c= 40
Total Comb. Petrmit , c:;x:). ~
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~/::x..f Fee. 1::, I
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L~R-
23
Legal DelCriptio~_I'!J;}
t,(/ it t f1"eLJM
Add,...~ r;) 'i;;2 L,A f~' B ,eel
1/--"".".1-,... ~~
Owner
a.+I2.Y
Building Permit Info: D."ribeo Work (i.... Build Singl.
Familv Re,jd.nc. Wilh A"acned Garaq.l
tf~rMrrXurJW>' /0)
1-1-CLtY\ Lt.e 1, (J'tOlf\m
(lies. no.) 1
I ConlrruClion l.nder
I Addre..
I DESIGN TEAM (nom.) /{/'r.k:.
Primary
I Structur.,1
I El.ctrical
M.chanical
Pnon"
t'.t/Gt:~
(address)
(expirel)
CONTRACTORS
l,
(nom.)
J~ ,~r,:,~
-,
//,/ /?l.::17J1V'
iV" Jlffcs. no.)
)
J::J.31"ii1
~..
{address}
(expires)
I G~n.ral
I Plumbinq
I Electrical
I Mecnanical
I
I NO, I
12.
r>.rrJ::
r"",~"Sj- 7::/'IC
17>'9 e(j:~j;y
OJ(
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YY"'.tJ '"
. ELECTRICAL
PLUMBING
MECHANICAL
I fEE CHARGE
1 lOPS /(\,02
CHARGE
NO.
feE
NO.
Residence of
furnace/burner to
llTU',
Appliance vent
separate
Stationary e"op.
cool.r
Vllnt fan witn
single duct
Vent system apart from.
heating or A.C.
Mechanical lI,l{noust
hood and duct
ICl:ft.
New circuils, ohert::Itions
or extensions
/
Eacn linql. fixtute
Relocoled building
(new fix. additional)
S.F. R.sidenm
(1 botn)
SERVICES o-fAN&E
./5.CE /503
ID,c:e /D.09
2t"
I
Duol.. (I boln) eacn
Temporary Construction
Addilional both
Amps.
Wat., ,ervice
Sewer
Wood "o"./nllater
Storm Sew,,"r
FEEDERS
Heat Pump
Air handler to
10.000 CFM
Air handl.r over
10,000 CFM
Amps.
ISSUANce Of PERMIT
TOTAL CHARGES
.if I D,c>E. TOTAL CHARGES
-# 'JC;:OO
r..._.-
TOTAL CHARGES
Basi. for Builder's Boord eXllmprion:
NAME (pleasll prinl~ IJ
/jFiid/
FOR OfFICE USE ONLY
Zone l'!--4
Fir. Zone
Flood Ploin ~b
T,p./Can.t.~ ~\
:!,edrooms -
c;lorie,
I
t"'\ccy load -. \ C
....'Y Group_P'-;(
Sq. Ft9. Main
Sq. Ftg. Access
Sq. Ftg. O'ner
Units
Valu.
Volue
'alue
TOTAL VALUATION
.
BUilDING PERMIT
Charges and
Surchorgu
...3~.D.E2 I
/,28 I
/0.0.5::- I
--- Q,"i!: ---I
I/~.::.)
( l 05:/
. '-r-8~
---:- 6,73- ---I
I
I
~jLC
Plqn Ck. Comm/lnd
65~~1 Bldq Per Fe.
Plan Clt. RII,
30%1 BldCl Per Fe.
PlUMBING PERMIT
Charges and
Surcharges
fence
O.mo
ELECTRICAL PERMIT
Charge. and
Surcnarge.
Sidewalk
I
I
I
I TOTAL
A C PCI"in-
MI:CHANICAl PERMIT
Charg.. and
S~.nh.ree.
-
Curb Cut
'.. ,. ~~;,<~..'.:.~.
"~._~,;.,""';
<"~..~
....>,-"".j\;:;.,~-..~.;....
~
o
~
(':J
(pnone no.)
(pha"fl no.)
hJ'9-.:;J7::>/
FEE ! CHARGE
1
.,~~ 500
5.~-15.0E'
I I
I I
I I
I
10,0.2
-II; 8,O'z
DA;E{/JYJ7~/
I
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COMBINATION
APPlICATION/~IT
(CAP)
I, Applican{ la furnish
A, Jab Address
B. legal Description
1, examele.lax lal 100, lane Caunty Map Refe'
2, examele,let 1, Black 3, 2nd Addition to Sprin
C. Nome. etC. of owner and construction lender
D. Energy Sources' . .
1. example.heat,l electrical ceiling/or forced air
2. cxomOle-woter heater/electrical/or solar
E. Square footage or valuation, etc.
I. exomale-1250 sq. foal house, 500 sa. fool gal
2. examcle-if new project; check new~if additior:
odd. elc.
F. Building permit information:
1. example-construct single family house with or
garage
. . 2. example-remodel existing garage into family
3. ~xamoje.convert single family residence into
resrouront (change of use)
G, Value of werk as defined in Seclian 303 (a) af Ih,
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction delays, Building [
Stoff must be able to contact appropriate persons
design informction or job site corrections, etc.
II. Aborcvicted Plumbing, Mechanical & Electrical Sehec
A. E;a:ccol where biank spoces occur in the descriotio
of Ihoe Mechanical and Electrical Schedules, th~ aF
n'!ed fill.in only the No. Boxes adjacent to the OPI
itemi'sl to be installed
3. Full Plumbing, Meehanical, and Electrical Scheaul,
ore available at the Building Division
1 : To conserve space on the permit form the sche!
hove been abbreviated
2. If the ilemls) to be installed arc not covered on
aled scheduies you should consult the full schet
C. BUILDING DIVISION STAFF Will Fill OUT All FEE~
CHARGES ON THE SCHEDULES
III. Applicant to sign and dote
Whenever possible. the initial application will be usee
worksheet oniy. Where possible, Building Division Sto
pr~PQre 0 typewritten copy and return it to the applic
the lime rhe actual permit is issued for his signature.
.CiTYOF SPRIN,GFIELD
City Hall
SprIngfield, Oregan
Departmenl of Public Warks
OFFICIAL RECEIPT
Dale,q- 1 18ro. B 56326(
(0 'ocd "JltJw,QJ::L'r)/\ (11J'l$:;f
Address Il~ fl.kQlJJ D V'
tv~~ ~\
Received Far: 1
.
PERMIT VALIDATION
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c.16 Ii)
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~7._ 00
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C Amaunt Received ~% ,eta C'_~
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AUTHOIllIZIED SIGNATUIU:
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IV. Feus and Charges 0 (
Plan check fees are due and payable at the time of th -4'"
and no pIons will be processed until these fees are paid. ,..11
other fees and charges ore due and payable when the permit
j, issued.
V. FOR OFFICE USE ONLY
I
Permil Cler~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Addirional Project Information:
-
PLANS REVIEWED BY,
I
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