HomeMy WebLinkAboutPermit Building 1981-2-25
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INSPECTION LINE
726-3769
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CITY OF SPRINGfielD
COMBINATION APPLICATION/PERMIT
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INFORMATION LINE
726-3753
Job Add,." ":lj2l_<;ATGIN~)>, Loop
legal Description Lt'JT 3~~~Pd5r ~~/c>AI Ronqe
.B1pr 0,", /.'t... Z&;Og, MAP 17-o~-z~ -7 Volu, of Wo,"
. ' He
Ow,,, ~D,D<r' W4-rGR /""v~7'~~- U&!.::>&O ..-
-e:iiding ~ermit--I"fQ: Describe Work (Le.. Build Single
Addr." ~O)( /~ .P~one ,~8S'" '1,1!!3 Family Residence With Attached Gor('l"'",~ _ _ ___
.<;77t;y~C:<.D u(l?Miz;>t' ) ~.IY<' r&uC::r CtJ::rvC~ j;''-'/c..D~
ConSfruction lender a...v~~ I L.I"r-AL ~'!CP.NA<:...r' J?4VEJ? ~k.i'~.
---= r. - I
ENERGY SOURCES, ~
H.ol tS'~c..T. #6f.,. p
Water Heater _~(F< 7.
tCLE<7.
Sq. Ftg. Main ~.~~
Sq. Ftg. Acc,us.
Sq. ftg. Other
_New__Add_Alter_Rcp.
__Fence _Demo_Change I Use
_Other
~.
C)
~
~
~
Addr"n
Phone
DESIGN TEAM (nome)
Pdmo,y ~AG.Il?4-5r.~-. "
(address)
~~/""~.
. .
(lies. no.)
(expires)
(phone no.)
38:B#/&N _V-)' C'-"6Y&
(jg,r-R~ ':?
StruCi'Jrol
Elect:kd
Mecnanicol
I NO. I
1/z.
I
1
I
I
CONTRACTORS (nome) (nddreu) (lics. na.l (expires) (anOM noJ
G_""ol ,&($ M. ~.,.,~/-,.c~. 3:'8 w. //lb...4y~ B-c.G;;,IG.~...,"8,:57'82 '7BS-:'it;?S'~1
, , .
Plumb;,q5".....-....... &..'-~.N",,\: /299 ac~.r E'<:,' E', ~ 2C- 'J/ PE ~..B/ ~87-(_~<:;"/
EI"I.;'ol~Cu::cJ: R413ex '2~S"_~~ti=N~ ~a-/<:. r Ue/.' 6Bb-861:i,
M"ho,;,ql ~s,... <9' h;<e, <a'S'" #~6~'" WA~ eGo~~,~7? /dl~/. ? 5'&-/~;;U
I ELECTRICAL . I
I FEE I CHARGE I NO. FEE I[ CHARGE I NO. I
ls:" 10..-1 ~:~:;.::.:-~_:9: ft. furnace/burne~;~,s
r I
I
PLUMBING
MECHANICAL
1
I
ICHARGE I
I
/1
I
I~,- ".--1
I
/' J
I
::i'l. ..,
I Each linqle fixture
Relocated building
(new fijl(. additionoll
S.F. Residence
(1 both)
I FEE
Notw circuits, alterations
or extensionl
Appliance vent
separote
SERVICES
Stationory evap.
cooler
Duplex {1 batt,} eoch
j
I
Temporary Construction
:z
Vent fan with
sin"le dud
I Vent system apart from
heatinq or A.C.
I Mechanical exhavst
hood and dud
I'wood slove/hlttlter
I Heat Puma
Air handler to
." 10.000 CFM
,t,-
;co.
I
,
78'j
,
l~r
. I
,
I
Additional bath
Water UIf;;;..../ 1
Sewer. //004 I.
I~ -//~ I, ,.
Slorm Sewer ,/_1..,..
Amps.
q.~
I/). .0
!.:s.).
I
::z
Amps.
'2 ;Z S"'
I
I
It{
zs:- sa-I
I I
I I
I I
I
.1
Air handler over
10,000 CFM
s:-
,/tJ.-
,
:itJ. ...
FEEDERS
I
I
I
r'
I TOTAL CHARGES
I
9'.):-
TOTAL CHARGES
ISSUANCE OF PERMIT
9..5': GO 1 TOTAL CHARGES
10,-
'10. .....
I
WHERE STATE LAW REQUIRES tho I Ihe Electrical work b. done by the. Electrical Contractot, the .Iectrical portion of this permit shall not b. valid until a
label has been si9ned by an Elec:trical Contractor and attached to the elecrrical panel.
I HAVE CAREFUllY EXAMINED Ihe completed application for permit, and do hereby certify thot all information hereon is trve and correct, and I further
cerrify that any and aU work pedormed shall be done in accordance with the Ordinances of the City of Sp,in9field and the Laws of the Stole- of Oregon
pertaining to the worlc. described herin, and that NO OCCUPANCY will b. mode of any structvre withovt the permission of the Bvilding Division. I further
certify that my r&ghtrotion with the Bvilder'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 t!-lat only subconfractars and employees w!-lo are in compliance with ORS 701.055 will be used an this project.
PLUMBING PERMIT
Charges and
Surcharges
Fence
1:;,</2, S'S-
lIP S~<9
I .. ""-en
Systems Development
Chorae /1.5%1
DATE~,
I
"olu. ::z ~"r C::><:SC::>':J
x Value - _
x Value ~~ C)C:IlC).
TOTAL VALUATION~_Ot::::c>.oot
- ,
,
I
I
Ji'a3.S8 I
I
I
..-.'--_...
x
Basis for Builder's Boord exemption:
NAME (pl,o.. P';oIl-F~. -\ S'" 1 'If:ie[
SIGNATURE
~m~
FOR OFFICE USE ONLY
zo,~~~:ic::::,~..v
Fire Zone --- Bedrooml -
. Flood Plain _N~ e'ori.' /
Units
I"Itcy Load .
l"Ir;cy Group.....lf-2.
Sq. Ftg. Main
Sq. Ftg. Accen -
Sq. Ftg. Other ~Y~H<"
5"~~
-
BUILDING PERMIT
Charges and
Surcharges
5/~. So
~O.78
9S". 00
3.80
~ 00. I Sidewalk /"D'
----- -!_j- .'"
s.sa ' 'I A/c POV;'"
'I t:J. 0110 Curb 'Cut :2 'I '
----/~ ~i'-I
I Plan CIt. Camm/lnd
65%/ Bldq Per Fee
I Plan Ck. Res
30%/ BldQ Per Fee
3'9t:Ir:P,
00
Demo
I Total Comb. Permit
elECTRICAL PERMIT
Chorgel and
Surcharges
10. -
'32.-
12. VO
MECHANICAL PERMIT
Charges and
Surcharges
I TOrAL
,l\1~~3~
_-.-..... - ~~....
III. 'Applicant ta sign and date
Whenever possible, the initial application will be used as a (
worksheet only. Where possible, Building Division ~taff wi'+.-
prepare a typewritten copy and return it to the applicant at
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 application,
and no plans will be processed until these fees are paid. All
other fees and charges are due and payable when the permit
is issued.
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COMBINATION
APPlICATION/P.T (CAP)
I. Applicant,!\> furnish
A. Jab Address
B. Legal Description
1. example, tax lot 100, Lane Caunty Map Reference r
2. example-Lat 1. Black 3, 2nd Additian ta Springfield E
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceiling/or forced air qas
2. examole.water heater/electrical/or solar
E. Square footage or valuation, etc.
1, example-1250 sq. foat hause, 500 sq. foot garage
2. exampie.if new project, check new-if addition, check
add, etc.
F. Building permit information:
1. examole-construct single family house with an cttad
garage
2. example-remodel existing garage into family room
J. example-convert single family residence into
resfaurant (change of use)
G, Value af wark as deficed in Sectian 303 (a) af the
Structural Specialty C-=-dr.:
H.' DESIGN TEAM AND CO,'iTRACTORS
To ovoid design or construction delays, BuilJing Divisiol
Stoff must be able '0 contact appropriate persons regar
-:esign informf"JtiOil or job site corrections, etc.
11. Abbreviated Plurnb;ng. Mecho~ical & Electrical Schedules
A. Except where blank spaces occur in the description porti
of the Me<.:hanical and Electrical Schedules, the appliear
need fill-in only the No. Boxes adjacent to the appropric
item{s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
ore available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item{s) to be installed are not covered on the a
ated schedules you should <,:onsult the full schedules
C. BUILDING DIVISION STAFF WILl: FILL OUT ALL FEES AN,
CHARGES ON THE SCHEDULES
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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CITY
DCDl\AIT \1411n4Tlnl\J
OF SPRINGFIELD
1.3.
City Hall
Springfield, Oregan
Department of Public Works
OFFICIAL RECEIPT
No. B 55912
Dote~ h, ~ S 19?:-\ '
Rec'dF~~9.\'{\~'::JW, (
Addressa.~9-- I LJ U"\-f\ k~.
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Received For: '~_
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\ 40/0
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If' J~O\f\Or- 0;:) cO
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Amaunt Received U fl t3'?1.,<6~ Q,L
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5'(:\ ,"50
rm 1'b
q~pD
~,80
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4UTIolOIUZI:O SIGNATURE
....l'O...TU~".U\.L ~"'NTI'" . (UGI"I[ 0"'17"01
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Permit Cler~
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J=?R~ U~7".R-J<lA~"'~NCS^",
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Additional Project Inf.ormation:
PLANS REVIEWED BY:
name L..e:.7?/SI' ~
rignatur...
,""off"
<>-'24-'2 /
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