HomeMy WebLinkAboutPermit Building 1981-5-21
INSPEcrlON liNE
726-J169
.. CITY Of S'IINC"UD t'
rCOMftlNATION A"LICATION/rIIMIf '
IN'OIMATlON LINE
72....,153
tNUGY SOURCES:
Al Beckett & Associates
Add",. 977 Main Street
Sprinqfield. Oreoon 97477
3,500.00
,
I Sq. fig. Mo,n
Sq, F'9. Acc.u.
Sq. fIg. Olh.r
~_.New _ Add . ~.Art.r _Rep.
X Fl!nc..__SI(il!'mp ._chonge/ul.
__Other ta 1 rway
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Job Add,... 977 Main Street
1'901 D.""p.o" 17 03 35 42, TL 6500
Heal
Waler Heater _____
Runq.
Value of Work:
Owner
Phone
726-1813
Building Permit Info: Describe Work (i.e., B'Jild S,ngl.
Familv Residence With Attoched GoroclC~)
Construct stairway, correct items per
Occupancy inspection of 9-4-81
Construction lender
DESIGN TEAM
(name)
(oddress)
(liel. no.)
(expire,)
(phone no.)
I"
Address
phone
Primary Owner
*
Structural
Electrical
Mechanical
CONTRACTORS
(nome)
(address)
(lies. nc.)
(expirOl)
(phane no.)
General
IrvinJladrfny <;4n WP~t ?4th Str~~t. EUgene~l'e90r
344-8643
Plumbing
Electrical
Mechanical
PLUMBING
ELECTRICAL
MECHANICAL
NO. I
FEE I CHARGE NO.
FEE ~ CHARGE NO.
FEE I CHARGE
Residence of
furnace/ burner to
~TU's
Appliance vent
separate
Stationary evap.
cooler
Vent fan with
single duct
Vent system aport from
heati"g or A.C.
Mechanical exhaust
hood and duct
Each sinQle fixture
Relocated building
(new fix. additional)
S.F. Residence
II bath)
O'q.ft.
New circuits, alterations
or extensions
SERVICES
Duplex (l both) eo:h
Temporary Canltruction
Additional both
Amps.
Water service
Sewer
Wood Itove/heater
Storm Sewer
FEEDERS
Heat Pump
Air handler to
10,000 CFM
Air handl.r over
10,000 CFM
Amps.
,
ISSUANce OF PERMIT
TOTAL CHARGES
TOTAL CHARGES
TOTAL CHARGES
WHERE :sTATE LAW REQUIRES that the Electrical work be don. by hthe Ellltctrical conltractor, the electrical portion of this permit shall not b. valid until a I.
label hOI been signed by an. Electrical Contractor and attach.d to t . e ectricol pane.
~
I HAVe 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 worlt performed shall be done in accar nce with the Ordinances of the City of Springfield and the lows of the Stote of Oregon
pertaining to the work described herin, and1hat. NO OCCU will be mode of any structure without the .perminion of the Building Divilion. I further
cerUfy that my registration with the Buil~e1'ri ~n I fa and effect a s required by ORS 701.055. that if exempt the basis for exemption is notod
heron, and that only subcontractors t:l'Iid ~OYllOs;1'o o/ln .~p~a~~ with, ORS 701.055 will be used on this project.
Basis for Builder's Boord exemption: ( .((// /' k'f ,e;(!'"Z...z-.
. \:D /
NAME (please Pri~t) xl', TJ ~ ~J/ ~:li:1t'*: &..77
SIGNATURE
DATE S~I Ai
I '
FOR OffiCe USE ONLY
Zone
Fire Zone
Flood Plain
C-4
Typel Canst. ~N
:a.edraoms
C,tori,..
Units
""ccy load
,",ccy Group
B-2
~q. Ftg. Main
Sq. Ftg. Access
Sq. Ftg. Other
x
x
Value
Value
Volu
3.500.00
TOTAL VALUATION
BUilDING PERMIT
Charges and
Surcharges
28.00
1.12
plan ek. Comm/lnd
65%1 Blda Per Fee
Plan Ck. Res
30%/ BId.. Pp.. Fee
Systems Development
Chor..e (1.50/,,\
lR.?n pn ~_ll_Rl
PLUMBING PERMIT
. Charge. and
Surcharges
Fence
Oema
Total Comb. Permit
29.12
ElEORICAl PERMIT
Charges and
Surcharges
Sidewalk
AIC Pavinn
".
MECHANICAL PERMIT
Charge. and
Svu:;harges
Curb Cut
.-
TOTAL
..~-
. . . .....,..29.12
.,
:\\
COMBINATION APPLICATION/PERMIT (CAPr'
4.";
I. Applicant to furnish
A. Jab Address
B. legal Description
1. example-tax lot 100, lane County Map Reference'
2. example-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 Ras
2. 'example-wafer 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, che,
add, etc.
F. Building permit information:
1. example-construct single family,house with an afte
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 (a) of the
c.. Struc.tural Specialty Code
H. . DESIGN TEAM AND CONTRACTORS "',',
To avoid design or construction delays, Building Divis
Staff must be able to contact appropriate persons reg
design informo.tion or job site corrections, etc.
II. Abbreviated Plumbing, Mechanical & Electricol'Schedule,
A. Except where blank spaces occur in the description pc
of the Mechanical and Electrical Schedules, the applic
, need fill-in only the No. Boxes adjacent to the appro!
item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical 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 are 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
PERMIT VALIDATION
~'
CITY OF SPRINGFIELD
cr,
c
City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
f
No, B 56547<1
19 PI
(d Rec'd Fr~." 111 - Ap c.../c.e;:t;h-
Address Cf77 Y/7~
;S r 7/-6:::/
Received For: \.
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Date
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Amount Received-d~/;;2.
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III. Applicant to sign and date
Whenever possible, the initial application will be used a,
worksheet only. Where possible, Building Division Staff <
prepare 0 typewritten copy and return it to the appliear J '.-7.1
the time the actual permit is issued for his signature. /" '--
'Fees and Charges , ."
Plan check fees are due and payable at the time of the applicatic
and no plans will be processed until these fees ore paid, All
~t~er fees and charges are due and payable when the permit
.. 1$ ISSUed.
IV.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
PLANS REVIEWED BY:
~'.
A,UTIo40lUZED SIC"'ATUIIII: C' -5
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Permit CierI-
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nam""
TOM SHEIRBON
.ignatur~1-VVJ ,lh 11)) hm~ ~/f!fJ
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5-18-81