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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 co - o N o - 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: \. ( 5-d/ Date (I ( CI (, (I / " hD I Lj70 d?,f,OO' f.ld. (I c (i (' ( €b c. ( ( Amount Received-d~/;;2. (1f 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 ,.",.. ,",.,"" ."'."... '"0'" .."... ...", .' f I - . ~J' . Permit CierI- I \ I> nam"" TOM SHEIRBON .ignatur~1-VVJ ,lh 11)) hm~ ~/f!fJ dot.... 5-18-81