HomeMy WebLinkAboutPermit Building 1981-3-16
/J/I/ /1 H
INSPECTION LINE
72~769
CITY OF SPRINGFiElD
COMBINATION APPLICATION/PERMIT
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INFORMATION LINE
726-.:1753
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I ENERGY SOURCES, n /
.5f7? )(-~ 2~( It. f H J (., H.or t:: /I:;L '-OEH.
"/ 17 __ I ~. '/~' ./~-'. I Wor., He'!!1' l::"j-BL
legal Description .~~~...... , /.. ;. ...., r 'Jt---. / Ronqe _ri LEG.
~p.,L Dt.:, JI.1li/. (13 I l-oT ,0{ I Valu. of S~ {.,
Ow.., <:7.;:_ .~/-k- 9~ (,L', 3G,) . ()
~ ~ _ / _ BUIldIng Permit Info: Describe Worll (i e.. BUIld Single
Address d'~,,-lJ ~~ Phone 7<1'w-~ V7_ 'Family Re~jde""" woIh 6.t1ached Garoqttl
Job Addre"
I Sq. fig_ Main 'i/7-
Sq. Fig. Ace.1t ,'...."V
Sq. FIg. Orh.r
~N.w_Add _Ah., _Rep.
__Fence_Demo_Changel U.e
_Other
\b'
-
\:)
........
~
CondruClion Lend.,
Add,eu ~.."
DESIGN TEAw/.,I
';::'L#"-a~...:f-
fl~-
(nome I ...~
44-(1
~.::, f?r;e:." 47r6/J-if.
1=\ eE. Pt..HGF,
-......
phone
,<./_~V
(oddress) C"~..--/?rf....~ (Ii~. no.) (upit.')
(phone no,)
Primory
Structural
Electritol
Mechanical
CONTRACTORS
GltnenJI'~
(name) (e}I/~
rL-C'l ~_z,<-(odd,...) dCt:.1' .J~:"
(Iin. no.) ~'/ (eKcires}"";[;..-
(phone no.l ?r/~:S1t
/.2..~
Plumbino /2,."k_ _ ~
Electrical ~ a~
M!,ho.;,ol cf:t:v- "
NO. I
.>1
I
FEE
I
I CHARGE I NO. I
I-
ELECTRICAL
MECHANICAL
FEE 1 CHARGE NO. , FEE i CHARGE I
15.O:J furnac.Jburner to
.--- DTU's
Appliance vent I .. I
sepora te
Slationary evap. I
coolor
2- Vent fan with
h'J,a1 sin91e d~ct . l\.M (",lIll
Vent syi"tem aport from I
healing or A.C.
I Mechanical exhoust I <<...-d
hood and duct
J I I
~ . Wood slave I heotet
Heal Puma I
Air handler to I
10.000 CFM
Air handler ovet I
10,000 CFM
I
1
I
PLUM81NG
Each sinClle fiKtute
Relocated building
(new fi.... additional)
S.F. Reside~ce
(1 bal;,)
ResiLIence of .
9'i"l- .,: ft.
New circuits, ahetations
at eJ(tensions
Ouol.... (1 bOlh) each
",,"S.co .I.
I
I
I
lIMn I
I
SERV!CES
I
Temp,orary Construction
Additional bath
Amps. c:::2. 00
/
I
Water service
Sewer
Storm Sower
FEEDERS
Amps.
t.
I TOT At CHARGES
I WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor,
iob.1 ha, been signed by an Electrical Contractor and attached to the .I.ctrical panel.
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I
35, a:::; I
TOTAL CHARGES
ISSUANCE Of PERMIT
oI'J'<:a~1 TOTAL CHARGES
v'
the elecrricol portion of thi, permit .hall not b. vcdid until. a
If). rn
,.)n,{'n
I HAVE CAREfULLY EXAMINED the completed application for permit, and do hereby certify that ~II information hereon is true Qnd correct, and I further
certify Ihat any ana 011 work performed sholl be done in accordance with the Ordinances af the City of Springfield and the law. of rhe Stat. of Oregon
pertaining to the work de.cribed herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building Divhion. I further
Glrtrfy that my re-gistrotion with the Builder'. Boord i. in full force and rffect as required by ORS 701.055, that if ....empt th. basi. for exemption h noted
heron, and that only subcontractors and employees who ore in complionClt with OR$ 101.055 will d on this project.
Basis for Builder', Soard e.xemption:
NAME (please pr;nt) ~# 1')..
17..:>~.,r-
~IGNA.TY.B.C
n~
(
Sq. Ftg. Main 9/2.
Sq. fIg. A.CceSl_(';,~g-
Sq. ftg. Other
.~
1ATE
3-1(;, -11
, ,
fOR OfFICE USE ONLY
BUILDING PERMIT
Charges and
Surcharges
Plan Ck. Comm/lnd
65%/Blda Per Fee.
~ 9 Plan Ck. Res
u. ,.1 30%/ Bldq Per Fee
_____3S: aJl Fe.,e
;.1,101 Demo
_____;{5'.001 S;dewolk
;,00 AIC P..vi"",
'l{). <~,.,
~ ~~ Curb Cut
.--- . ~ ~-'+
Systems Development
Chor<:1e IT .5~\
x3~.~o Volu. ~.~<;'~J.l
x _9. ~() Value r..-~,.s-~"an
.
x Valu. .
TOTAL VALUATION ~I S'c:I5; ~D !
.sv7, ~'I' I
I
Zan. p.'., ~''2--Ty.eICo....Y=,1f
fire Zone - III-droom'..:t
Flood Plain -d./') Il\tori.- J
/
Units
"'cc:y Load
I"Icc:y Group
R"-~
____J!i!co
/-RID
3'17-);/
I
I
, 1a-;L'~,.,w
I Totol Comb. Petmit
I
I
I
I TOTAL
. :UJ
:J ~ 7,1~iI
ee.c It
f1w07~
PLUMBING" PERMIT
Chorges and
Surcharges
ELECTRICAL PERMIT
Charges and
Surcharges
MECHANICAL PERMIT
Chorge. and
Surcharge.
>P" 7f!S'. I:<'
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~. ... .-..'
..'..~ '
. "'~ ....-,. '-
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._' _~,..:....:":'::_ _._ ....0-:........... "._.~~':.:..'._
. _..
III, Applicant to sign and dnte
Whenever possible, the initiol applieo"tion wilrbe used os 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 issued for his signature.
IV. Fee. and Charge., _ '''' " . ,1,-
Plan check fees ore due and payabl..ariliii'time 6Etne application; " "
and no pions will be processed untit these fees are paid. All
other fees and charges ore due and payable when the permit
is issued.
COMBINATION APPLICATION/pea (CAP)
I. Applicaru to furnish,
A, Job Address
B, legal Description
1. example-tax lot 100, lone County Map Reference 1
2, exomple,lot 1, Block 3, 2nd Addition to Springfield E
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceiling/or forced air Qas
2. example-water heater/electrical/or solar
E. Square footage or valuation, etc. -
1. example,1250 sq, foot house, 500 sq, foot garage
2. example-if new project, check new-if addition, check
add, etc.
F. Building permit information:
1. example~construct single family house with an attach
garage
2. example~remodel existing garage into family room
3. example-convert single family residence into
restaurant (change of use)
G, Value of work os defined in Section 303 (0) of the
Structural Specialty Code
H, DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Division
Stoff must be able to. contact appropriate persons regard
design information or job site corrections, etc.
II, Abbreviated Plumbing, Mechanical & Electrical Schedules
A. Except where blank.spaces occur in the description portiol
of the Mechanical and Electrical Schedules, the applicant
need filJ~in only the No. Boxes adjacent to the appropriatl
item(s) to be installed
B, Full Plumbing, Me<:hanical, and Electrical Schedules .
ore available at the Building Division
1. To conserve space on the permit form the schedules
heve been abbreviated
2. If the item(s) to be installed are not covered on the ab~
ated schedules you should consult the full schedule.
C, BUILDING DIViSION STAFF Will Fill OUT ALL FEES AND
CHARGES ON THE SCHEDULES
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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PERMIT VALIDATION
CITY OF SPRINGFIELD
City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
Received
For:I;~
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...UTHOIIIIU:O 5IGN"'TUIIIE:
SHllTO...TU"".Ull ~"".TIItS " IEUOIMIE" Q" .'.&01
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Permit CierI--
Informatian:.jM.J. ~ A.L.4~~ ~p~ /~
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a-t.< /~.",e? -,-d2.
Additi?nal Project
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PLANS REVIEWED BY:
d
name
,signatur....
~at..;-2~-$(
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