HomeMy WebLinkAboutPermit Building 1981-3-16
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CITY OF SPRINGFIELD
COMBINATION APPlICATION/pERMIT
IJAJ IT
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INFORMATION LINE
726-3753
Sq. Ftg. Main '-f' ;.~
Sq. Ftg. Acc.n. (,,41 '('
Sq. Ftg. Olher
ANew _Add _Altllr_Rep.
1__Fence_Oemo_Chonge' Use
I.): '\ 3"J5'~S'(.,9 _O.h..
_ / _ ,Building Permit Info~ Describe Work (i.... Build Single
Phone 7f/w-~ V7.J'Fomilv Il,,-,n,.nn. Wirh AttoC"l,.d C;oroc>el
"...~6 u.n:J:o rAf.47T t:oA-i?
j::, 2i!.. "i.AcE
WHERE STATE LAW REQUIRES that the Electrical work b. done by the Electricol Contrador. the electrical portion of thi. permit ,hall not b. VQlid until. a
'Iabol has b_n .ig.,.d by an Elernical Contractor and attached to the electricol panel.
I HAVE CAREFUllY EXAMINED the completed application for permit. and do hereby certify that all informotion hereon il Irue' and co"ect, and I furtf1er
certify that any and all work JMrformed .hall b. done in accordance with the Ordinancel of the City of Springfield and the lowl of the Stat. of Orogan
pertaining to the work described herin, and that NO OCCUPANCY will bo made of any structure without the perminion of the Building Divilion. I further
certify that my rll'9istration with the Builde"s 800rd is )n full force and .FIect os required by ORS 701.055. that if uempt the bOlh for ex.mption i. noted
heron, and that only subcontrac1otl and .mploy..s who or. in compliance with ORS 701.055 will d on this project.
Ba.il for Builder'. Board exemption"
NAME (plec:lse print) c;?k" (f), 17~~-r--
I INSPECTION LINE
726-3169
I Job Addten
I legal Om.;..on ..~/~- /" ~ ~. ., ?t/ .;7.
IUA/IT'.;.' 'jJ.!i)I:.PI./M/'.5.. /..07;# /lJ
I Own.. ~_ ~ ~ al'~
I Add,." d'I7PtJ ~~
I
ENERGY SOURCES, ~
Heat P L!;;l- , a U.
Water Heater E:...c.<':";
Ranqe ":L...t?c..
Value of WadI:
~'"f7f
4~
2.1
A, f
HIt:..
. Construction lender
Add.." ~: <
DESIGN TEA
~."... f-
..:&i!-,,-p
bu<
,~
Phonll
,c../..~ V
(add,e,,) ~....__.....-:'~.. / (Iin. no.)
(expirel)
(nome)
Primary
Structural
Electrical
Mechanical
CONTRACTORS
G"neral ' ~
(name) Q""/'7>
1'!rl..Ab-.:Z::r-Coddmol d~.fd' .IfU~
~'1
(upir..)
:r;- - ,
(Iics. no.)
/.2.. -=-
Plumbinq ~,,~,
Electrical ~/ _-
Mechanical C~./...I- .......
PLUMBING
ElECTRICAL
MECHANICAL
NO.
fEE
CHARGE
fEE
I furnace/burner to
yo---- o.TU's
Appliance vent
s.patato
Stationary evap.
cooler
CHARGE
NO.
NO.
1/
ResiDence of
9' ~"'l- '':f: ft.
New circuits, alterotionl
or extensionl
/5. CXJ
.>
Each linql. fixture
RelocaTed building
(new fix. additional)
S.F. Reliden~e
(I both)
SERVICES
I
I
;zl
I
;?S,OC i
I
I
I
/t.CCi I
I
I
Duolu (1 bath) .ach
Temoorory Construction
/(;,o-J
Vent fan. with.
sinqle duct
Vent Iyi"tem aport from
heatinq or A.C.
I Mechanical exhaust
I hood and duct
Additional bath
Ampl.
c:J.cO
/
I
Water service
~ . Wood slave I heat.r
Sewer
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I
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ISSUANce OF PERMIT
FEEDERS
Heat Pumg
I Air'hondler to
10.000 CFM
I' Air handler o.er
10,000 CFM
Storm S.wer
AmPI.
TOTAL CHARGES
I
I
I
[
3S:od
TOTAL CHARGES
/i5.co TOTAL CHARGES
I
Type/Canst. '--).J... - IV
l.edraams pi..
/
SIGNATY!'C '\
FOR OFFICE USE ONLY
Units / Sq. Ftg. Main c.,-I.~
nccy load,' Sq. Fig. ACCIII1-L""J'~
I1"y Group K-"'~ Sq. Ftg. Othor
I
. :;z,:":>;:',(1Volu. ?,O 3{~1
. q."'t:Volu.-4-'S~
.x Value
TOTAL VALUATION ~..:S::lS. (P(l
Zon. L.J. .:l. V U D
Fir. Zone -
Flood Plain A/ 0
(Crod.r
BUilDING PERMIT
Charg.. and
Surd1argu
II / ~ I Plan Ck. Camm/lnd
.___-'.J.'Ji.,OlJ 6S%/Sldq Per Fu.
~ q~l Plcn Ck. Rei
V ~ ....J 30%1 Bldq Per Fee
I
I At/CD
I System, De.elopment
Chortle (1,5%)
"'5lr-0731 I
3-17-.P/
li:.-dYk.>~ I
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I
PLUMBING PERMIT
Chargol and
Surcharges
_~___~~{]C Fence
ELECTRICAL PfRMIf
Charge, ond
Surcharges
,I.tfo O.mo
~S:col Sld.wolk
/ ,fJD Ale Pavinn
Total Comb. Permit
MECHANICAL PERMIT
Charges and
Surd1arg.,
(Th.
.........
()
,-,
CD
-C)
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,
(=hon. nO.l7r/~1
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FEE I CHARGE I
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3&0 I ~oa I
I
I 4.5'0
I I
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(phone no.)
b:
/O.a:::;
dO ,56
DATE
,3-1" -rf
S '17. ig
..:20
.;2:?l'1.t.q
I TOTAL
#735. 7~
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_____--f).O.:::O Cu,b CuI
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..........
COMBINATION APPLlCATION/paIT {CAP}
I. Applico~ to furnish
A. Job 'Address
B. legol Description
1. exomple.tox lot 100, lone County Mop Reference
2. exomple-lot 1. Block 3, 2nd Addition, to Springfield
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceiling/or forced air Qas
2. exampleawoter heater/electrical/or solar
. E. Square footage or valuation, etc.
1. exomple.1250 sq. foot house, 500 sq. foot goroge
2. example-if new project, check new-if addition, ehec
add. etc.
F. Building permit information:
1. example-construct single family house with an ottoe
garage
2. example-remodel existing garage into family room
3. example-convert single family residence into
restaurant (change of use)
G. Volue of work os defined in Section 303 (oj of the
S~ructural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Oivisio
Stoff must .be able to. contact appropriate persons regar
design information or job site corrections, etc.
II. Abbrevioted Plumbing, Mechonicol & Electricol Schedules
A. Except where blank spaces occur in the description porti
of the Mechonicol ond Electricol Schedules, the opplicon
need fill.in only the No. Boxes adjacent to the appropric
item{s) to be instolled
B. Full Plumbing, Mechonicol, ond Electricol Schedules '
are available at the Building Division
1. To conserve space on the permit form the schedules
haye been abbreviated
2. If the item(s)to be installed are not covered on the ai
oted schedules you should consult the full schedules
C. BUILDING DIVISION STAFF Will FILL OUT All FEES AND
CHARGES ON THE SCHEDULES
III. Applicontto sign ond date
Whenever possible, the initial application will be used os 0
worksheet only. Where possible, Building Division Stoff will
prepare a typewritten copy and return it to the applicant at
the time the actual permit is issued for his signature.
.
PERMIT VALIDATION .
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CITY OF SPRINGFIELD n
City Hall
Springfield, Oregon
Department of Public Works n
OFFICIAL RECEIPT
No. B 56266(1
Date ~~\)., \D 19<6\
Rec'd From O&O~Q ~ oort, ~\J' (/
Address \~ \ \ () ffi~ ~ Ii '"It:..
Received For: P\~h\. '\1r1> pU
'" lJ DfIn ~C:p... II
\. DU\\b ~'S 00
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Amount Received t'\.~:).T)Z-
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IV. Fees and Chorges j,... 'I'
Pion check fees ore due ond poyo\)le ot the time of the opplicotion,
ond no pions will be processed until these fees ore poid. All
other fees and charges are due and payable when the permit ....
is issued~
\,
V. FOR OFFICE USE ONLY Permit Cler~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Additional Project Informotion: .../ .
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PLANS REVIEWED BY:
nom-
signatur....
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AIL
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