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HomeMy WebLinkAboutPermit Building 1981-9-18 INSPECTION LINE 72&-3769 . CITY Of SPRINGfiELD COMBINAflCN APPLlCAflONJPERMIT . 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 W W 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~ I -, Addreu Addren Phone CONTJ:ACTCRS ("ame) (addren) ((jes. no.l (uoiro51 (pho"e "0.1 ~ -i , -I ,.~ '~I 'i ~I DESIGN TEAM (nome; (address) (lies. no.) ,...",~..- "'. Primory Owner Structural EleClricol Mechanical (;,,",uol fl..Inpr Plumbinq Own~r !;I~ctrical Own~r ,r '-T MECHANICAL .J I i --''', i t.\echonieoIOwner. PLUMBING ELECTRICAL Residence of I I I I. I -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 I I I I J 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 I I 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. I I I I ( I TOTAL CHARGES I , ]().OO i 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 I I 1 TOTAL ~l~ OR Ale Pa...in.. MECHANICAL PERMIT Chargel and Surcharges __ _~4....5.0.__ .58 Curb Cut ~\ . ~ 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. . 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\-'~~' ( <" ( I, Received For: ( ( \\\~, f',~ '\~' l~'.'; 4,;{l , ~~, ./ .1 ( ", I c (I / f,... :,1 c \'-- C <., A V Amount Received ,U, j I..~ \ '\ ,--I--.. \ ! 'lP' ( J '!-..9-,'L/ d ( I ~., ...". (, iUTHORIU:O SIGNATUIU: ."llTO"'TU"".Ull ..,,,..t[III'. l!:u(J[.n, 0111 .7.0, ( ~ , I V. FOR OFFICE USE ONLY Permit CierI- r PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: PLANS REVIEWED BY, name .si9natur~ , ~_.I I j II , date " 'i.;. j . .}