HomeMy WebLinkAboutPermit Building 1981-4-8
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\ INSPECTION LINE CITY OF SPRINGfiELD INFORMATION LINE
726-3769 . COMBINATION APPLlCAT10NfpERM1T 726-03753
I Job Address
I legal D.lcription
44/i Main Strppt
Sq. Fig. Main
Sq. Ftg. Accen.
Sx Fig. Other .
_N.w_Add_AI~,_Rltp.
I_Fonce_DemO_Changel U'8
FDN ONLY 6997.92 _Olh"
Building Permit Info: O.Icrib. Work (i.e., Build Single
Fornil" Residence With Attached Garaa.}
ENERGY SOURCES;
Heat ~, ~rt
Water Heater -&1 ect
Ran_9_
Value of Work:
lYllS
Owner
17-D3-3~ 11, !L-Z80n
Lot 7. Block 35. Sorinofiel~~dition
D()r()th~a Sf'tera
310 North 2nd Street Apt ~on. 747-3753
Springfield, Oreqon 97477
co
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Add,eu
Construction lender
FOUNDATION, SLAB & UNDERSLAB PLUMBING
FOR NEW COSTUME SBnp
Addren
Phone
DESIGN TEAM
(nome)
(addreu)
(lics. no.) (expires)
*'
~
(phone no.~
Primary
StPve..-M~rl<pn
l;Q rnnlll"9 Rn~rl
68 Z=..QZ Q1
Structurol
Electricol
Mechanical
rONTRACTORS
fnome\
(oddress)
(lies. no.)
(exoires'
(nh'.'n~ nn.l
G.n.,ol Walts Concrete 4105 ,JasDPr Road. Snrinof"ie.lcI
P1umb;no Rpp<nn Plllmning 41]0 M~ij'l Str"&..--Sprin~fie-1-d
746-3637. 747-3~~~
ZA.7 -43QO
Electrical
Mechanical
PLUMBING
ELECTRICAL
MECHANICAL
NO.
fEE "CHARGE NO.
fEE . CHARGE NO.'
fEE 'CHARGE
SERVICES
furnace/burner to
lTU's
Appliance vent
separate
Statianary evap.
cooler
Vent fan with
sinAle duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and dud
Residence of
Each sinAle fixture
Relocated building
(new fix. additional)
S.f. Residence
(1 both)
'9. ft.
New circuits, alterations _
or extensions
Duplex (I both) each
Temporary Construction
Additional bath
Amps.
Water service
x
Sower
10.00
Wood stovel heater
Storm $ewer
FEEDJ;:RS
Heat Puma
Air handler to
10.000 CfM
Air hondler over
10.000 CFM
Amps.
ISSUANCE Of PERMIT
TOTAL CHARGES
10.00
TOTAL CHARGES
TOTAL CHARGES
WHERE STATE LAW REQUIRES tho' the Electrical worlr: be dona by the EI.ctrical Contractor, the electrical portion of this permit shall not b. valid until a
label hal b..n signed by an Electrical Contractor and attached to Ih. electrical 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 that any and 011 work performed sholl be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Oregon
pertaining to Ihe work described herin. and that NO OCCUPANCY will be made of any structure without the permiuion of the Building Division. I further
alrtlfy that my registration with the Builder's Board is in full force and effect a s required by ORS 701.055, that if exempt the basis for exemption is noted
heron, and that only subcontractors and employees who ore in compliance with ORS 701.055 will be used on this project.
NAME (pl.o.. pdntlLD.() fJrn:t! Et:! C; ETFP, )::)
SIGNATURE~ t;) )(,p:;t:;)-
fOR OFfiCE USE ONLY
OATr!-~ ~ 8" L
~ Basis for Builder's Boord exemption:
.'1
Zone CN~
fire Zone
flood Plain NU
'rype/Const.
ll,edroom~
V-N
Units
nccy Load 56
nccy Group--B=.?
Sq. Ftg. Mo;n 2928X 23.00 X 1.0%
<:". Ftg. Access
Sq. Ftg. Other
(10% Of TOTAL)
x
Volu. 6.9.9.L...9?
Vohu
"tori.'.
1
LJNDERSLAR
40.00
1. tJu
PIJIMRTNr:: ONI V
Plan Ck. Comm/lnd
65%/Bldq Per Fee
Plan Ck. Rei
30%/ Bldg Per Fee
,- Value
TOTAL VALUATION 6997.92
BUILDING PERMIT
Charges and
Surcharges
FOUNDATION &
I
Systems Development
Charqe (1.5%)
104.97
PLUMBING PERMIT
Chargos and
Surcharges
10.00
.'1U
Fence
Demo
Totol Comb. Permit
52.00
ELECTRICAL PERMIT
Chargos ond
Surcharges
Sidewalk
AIC PavinCl
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL
156.97
Curb Cut
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicont to furnish
A. Job Address
B. Legol Description
1. example-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. exomple-heot/electricol ceilinll/ar forced oir gas
2. example-water-heater/electrica1!or solar." .
E. Square footage or valuation, e~c..:
1. example-1250 sq. foot house, 500 sq. foot garoge
2. example-if new project, check new-if addition, che.
odd, etc.
F. Building permit information:
1.' example-construct single family house wi!h an attc
garage
2. example-remodel existing garage into family roon
3. example-convert single family residence into
restaurant (change of use)
G. Value of work os defined in Section 303 (0) of the
Structural Sp.eciolty Code
.H. DESIGN TEAM AND CONTRACTORS ".
:' To avC?id design or construction delays, Building Oi,vis
. Staff must be able to contact appropriate pe'rsons reg
design information or job site corrections, etc.
II. Abbreviated Plumbing, Mechonicol & Electrical Schedule,
A. Except where blank spoces occur in the description pc
of the Mechonical and Electrical Schedules, the opplic
need fill-in only the No. Boxes odjocent to the approF
item(s) to be instolled
B. Full Plumbing, Mechanical, ond Electricol Schedules
are available at the Building Division
1. To conserve space on the permit form the scheduh
have been abbreviated
2. If the item(s) to be installed ore not covered on th,
ated schedules you should consult the full schedul, (;
'.
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES A
. CHARGES ON THE SCHEDULES
III. Applicant to sign and dote
Whenever possible, the initial application will be used a
worksheet only. Where possible, Building Division Stoff .
prepare a typewritten copy and return it to the appliea" {
the time the actual permit is issued for his signature. '.
I,--
PERMIT V ALIDA liON
(
CITY OF
n
SPRI NGFI ELD
(
City Hall
Springfield, Oregon
Department of Public Work.
OFFICIAL RECEIPT
(I
( 4 _ D. _ (J {No. B 562 51 (I
Dote 7 t 1971
C. Rec'd From r f)V()tl1t ~ ~<;P jpy-a ,
Address 4-1.4- 'YY\n-irY\ ..sf,
(
Received For:t\4 b ffi(ll AI) ,,:51-,
f) ~ LJ...O .00
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Amount
Receive~ ~ q:J (' J:::..,
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'"lLTO"'TU"".U~~ "lOt..,,;.. . &UQc.... 0" "40' ..."., '.
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IV. Fees and Charges
Plan check fees ore due and payable ot the time of the application,
and no plans will be processed until these fees ore poid. All
other fees ond chorges are due and payoble when the permit
is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE .OCCUPANCY:
Permit Cler~
1. THIS PERMIT IS FOR THE FOUNDATION AND UDNERSLAB WORK ONI Y.
ADDITIONAL PERMITS REQUIRED FOR ALL WORK BEYOND THE FOlJNOATTON
Addili.onal. Project Information:..
r ".
PLANS REVIEWED BY:
'''LORNE PLEGER
nom....
,i9natur~
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"'ate
4-6-81
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