HomeMy WebLinkAboutPermit Building 1981-9-18
INSPECTION LINE
72&-3769
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CITY Of SPRINGfiELD
COMBINAflCN APPLlCAflONJPERMIT
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INfORMATION LINE
716-.3753
ENERCY SOURCES:
i Sq. ftg. Main
ISq. fIg. Accon.
Sq. fIg. Other
_Ne....._Add _Alter_Rep.
_.. _fence_Demo_Changei Ule
_Olher
00
.....
o
U'1
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Job Addreu
402 Main
Heat
Water Heater
Ronqe _
Volue of Work:
l.,ol D.",;.t;O" 17-03-35-31, T.L. 7300
O_"er
Tom Whiteley
540 N. 8th Street
So,cirmfipld OR 97477
Pho"e
747-1634
$8,000
Buildi"q Permit I"fo: Delcribe Work (i.l!.. Bllild Single
fomi]., Residence With Attached Corace)
~nnstructio" le"der
Ranqe hood for Tom's Po~1-Hall
747-9294 Busines~
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Addreu
Addren
Phone
CONTJ:ACTCRS
("ame)
(addren)
((jes. no.l
(uoiro51
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DESIGN TEAM
(nome;
(address)
(lies. no.)
,...",~..- "'.
Primory
Owner
Structural
EleClricol
Mechanical
(;,,",uol fl..Inpr
Plumbinq Own~r
!;I~ctrical Own~r
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'-T
MECHANICAL
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t.\echonieoIOwner.
PLUMBING
ELECTRICAL
Residence of
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-1-;"-'~_.--'-...-FETlc~';:'~Gr'
I fur"ac..!burner to I
a.TU's
I Appliance VO"t 1
separate
Stationary evap.
cooler
Vent fon wilh
lingle dud
Vent syslem apart fr('lm
heati~g or A.C.
Mecl1anical O)lhaust
hood and d~ct
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NO. I
F=~
j CHARGE i NO.
FEE
CHARGE I NO.
cock ,inctle fill;lure
R.locof.d building
(ne_ till;. additior'tall
S.F. il:'uide"~e
(1 bolh)
oq:ft.
New circuits. alleralia..s
or extensions
SERVICES
Ouoll'1l; {1 borh} ,"ocn
Temporary Conltructian
Sewer
Wood stou/ heahrr
J
14, <;nJ
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1
]
Additional both
Ampl.
Woter 'e",ice
Slor.m Sew.r
FEEDERS
Heat Pump
Air handler to
10.000 CfM
Air handle, aYe'
10.000 CFM
Amps.
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I TOTAL CHARGES
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14.50 I
WHERE STATE LAW REQUIRES that the Elect,ical Worle be done by the Ele"'ricol Contractor.. the .Iectrical portion of this permit sholl not b. valid until a .1
label has been si9nod by on Electrical Contractor and attached to the electricol paneJ. _
I HAVE CJ\.REfUllY EXAMINED the completed opplication for permit. and do hereby certify that all information hereon i. true and ca".cl. and I further
certify that any and all work performed sholl b. done in accordance with the Ordinance. of the City of Springfield and the laws of the State of Oregon
pertaining to the work del(ribeci herin, and that NO OCCUPANCY will be mode of any structure without ,he permission of the Building Division. I further
certify that my regisrtation wilh the Builder's Boord is in full farce and effect as requited by ORS 701.055. that if uempt the basi. far exemption is noted
heron, and that only subcontractors and employ..s who ore in ccrmpliance with ORS 701.0.:55 will b. used on this project.
ISSUANCE Of PERMIT "
TOTAL CHARGES
I TOTAL CHAR"OfS
Basi. f~r Builder's Boord exemption:
NAME (please print) 7tel #I. A \"'
,}. 0!.~k:}/
SIGNATURE
r
~nk /9~OArjdr/
fOR OFFICE USE ONLY
Zone --.C-3
fire Zone
flood Ploin
Type/Can!t.J T T -, HR
:!,edroams
(Iarie'
Unih
l'1ccy load
"'ccy GraupJ?
Sq. Ftg. Main
Sq. Ftg. Acc.n
Sq. Ftg. Other
)I Value
x Vol"
x Voluo
TOTAL VAlUAJlor'
BUilDING P=RMIT
Charges and
Surchargu
"Plan CJr.. Camm/lnd
65~:.1 Bldo Per Fee
Plan C!t. Rei
JO~:.J BId" Per fee
SYlt"ms Development
Chorae 11.5%\
PLUMBING PERMIT
Chorges and
Surc;,orge,
Fence
Demo
I Total Comb. Permit
ElECTRICAL PERMIT
Charges and
Surcharge.
Sidewalk
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1 TOTAL
~l~ OR
Ale Pa...in..
MECHANICAL PERMIT
Chargel and
Surcharges
__ _~4....5.0.__
.58
Curb Cut
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COMBINA TION APPlICA T10NiPII!IT
(CAP)
I. Applica~ to furnish
A. Job Address
B. legal Description ,
1. examole-Iox lot 100, lone County Mop Reference Ii
2. exam pie-Lot 1. Block 3. 2nd Addition to Springfield E:
C. Name. etc. of owner and construction lender
D. Energy Sources
1. examole-heot/electric;ol ceiling/or forced oir gas
2. ~xomole-water heater/electrical/or solar
E. Square footage or valuation, etc.
1. exomole-1250 sq, foot house. 500 sq, foot garage
2. exompie-if new project. check new-if addition, check
add. etc.
F. Building permit information:
1. exomoJe-construct single family house with an attoe"
garage
2. exomole.remodel existing garage:, into faniily room
J. exompie.convert single family residence into
restaurant (change of use)
G. Value of work os defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Divisior
Staff must be able to contact appropriate persons regar.
design inf~rmotion or job site corrections, etc.
II. Abbreviated Plumbing, Mechanical & Electrical Sched~les
A~ Except where.blank spaces occur in the description porti
of the Mechanical and Electrical Schedules, the applican
need fill-in only the No. Boxes adjacent to the appropric
item{s) to be insralled
B. Full Plumbing, Mechanical. and Electrical Schedules '
Qre available at the Building Division .
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the jtem{s) to be installed are not covered on the a
ated schedules you should consult the full schedules
C. BUILDING DIVISION STAFF Will Fill OUT All FEES ANC
'CHARGES ON THE SCHEDULES
III. Applicant to sign and date
Whenever possible. the initial applicotion will be used as a
worksheet only. Where possible. Building Division Staff wil
prepare a typewritten copy and return it to the applicant 0
the time the actual permit is issued for his signaturE.
IV.
Fees and Charges
Plan check fees are due and payable at the time of the ap~__,._...
and no plans will be processed untit these fees are paid. All
other fees and charges ore due and payable when the permit
is issued.
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PERMIT VALIDATION
t,es
CITY OF SPRINGfiELD
'City Hall
Springfield, Oregon
Department of Public Work.
OFFICIAL RECEIPT
No. B 57321,
Date :'<: \,t. \ C;;" IF:.. \ . ,
Rec'd From ,\f~"\"\ \ _\ \\:\ -\~ Q, ,~,\( ,f
Address ~0 ,\\(\ ~ \\ 22\-'~~'
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Received For:
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Amount Received ,U, j I..~ \ '\
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iUTHORIU:O SIGNATUIU:
."llTO"'TU"".Ull ..,,,..t[III'. l!:u(J[.n, 0111 .7.0,
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V. FOR OFFICE USE ONLY Permit CierI-
r PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
PLANS REVIEWED BY,
name
.si9natur~
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date
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