HomeMy WebLinkAboutPermit Board of Appeals 1982-4-22
~':-...~~~,.tj.'~~;L~~', ..--' ,;;.,~ ~.
\
. \
I
I
.,.
~
. ,
tl"-
INSPECTION LINE
72~769
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
I ENERGY SOURCES:
H.a,..HoUater
Water Heat.r Ga c-
Ranae
I Value of ~ork:
Jab Add,o.. :U5? Tntprniltin.naLl:o"rt
l.gaIOn,,;p.;an 1 7~~_ 1 ~ _ '?utherly r"~+i,,n 'Jf Tax
Lnt 1lO.2...-P~rrpl "~" nf M P-9So.
Own., MOTFI Ii. Tor
Add,... 51 Hitc:hrnck WilV Phan.~~9~~1i1i1i
. .'.~ u: ~. "~""':"'," __.' ..: \~''''.'''''':''~ .: :'"'. ~
~ ~.,"':;.;,... ~,\.2.:.:;~,;;'~...~;~:;::,_~""'....:...~..; :.h "
INFORMATION LINE
726-3753
I Sq, fig. Main
Sq. ftg. Accen.
Sq. FIg. Other
~New_Add_Alter_R.p.
_fence_Dema_Change/UIe
_Oth.r
CD
'"
o
'"
.....
\0
$1.329.631.00
Building Per";it Info: Describe Work (i.... Build Single
familv Residence With Attached Garaae)
~~~ta Rarbar~, rA Q110~_QQQn
Construction Lender Owne r
r'1.l1S.t.oJr-t npw-131 rnnlD..JI1nto 1
Add...,. See abOlip
DESIGN TEAM (name) .
P,;ma,,_Alfrprl H. rrnnrli~.lJi~t
Phone
(address)
(Iics. no.)
11?? - ~th Avp ~pattle. WA 981~~
Structural
Electrical
Mechanical
rnNTRACTORS
(name)
(address)
(lies. no.)
Gono,al To be determi npd
PlumbiM Tn h.:l rI.:ltQ.Y"n"I; nor4
EI.",;,al To be detenni ned
M.d.anl",! To be determi ned
PLUMBING
ElECTllICAl
I HO.
1421
FEE CHARGE HO,
fEE CHARGE NO.
Residence of
5.00 2105.110
~.ft.
New c:ircuits, alterations
or extensions
Each sin~le fixture
Relocated building
(n.w fix. additional)
S.F. Re.idence
(I bath)
SERVICES
Duol.x (1 both) .ach
T.mperarv Construction
Additional bath
Amp" 1 ?OO
l;l; on
I
1571
;05
Water service
S.w.r
10.01 ~O,OII
10,0 10.01 , FEEDERS
1 Amps. 3D
8 200 Amos
1 400 Amo~
2 60 Amos
10.0110.00
15,OI'120.0r
Storm Sewer
{expir.s}
(phone no.)
(206)682-2690
(expir..)
(phone no. \
MECHANICAL
fEE I ~HARGE
135
furnace/burn.r ta
"TU'.
Appliance vent
leparate
Stationary evap.
cooler
Vent fan with
sinf2le duct
Vent sy.t.m apart from
heatinp or A.C.
Mechanical exhaust
hood and duct
4, ~l
1 00 Ii 10 0 ,I
1
Wood stove/heater
H.at Pump
Air hondl.r to
ID.OOO CFM
Air handler a....r
10.000 CFM
~ lllOJal' C('no
10.0J 20.0( 6 Gas nllt.lpt~
4 . ~ 0_ .63O...lllji
~ o~
.1
TOTAL CHARGES
;>1 Q~. f.(fOTAl CHARGES
240 . 0[. TOTAL CHARGES
ISSUANCE OF PERMIT
10.01'
1052.51
WHERE STATE LAW REQUIRES that tM Electrical work be done by the Electrical Contrador, the electrical portion of this permit .hall not be valid until a
label has been IiBMld by an Electrical Contrador and attached to tM electrical panel.
I HA VE CAREfULLY EXAMINED the completed applicatian for permit, and do her.by c.rtify that all information h.reon is true and correct. and I further
certify that any and all work performed shall be don. in accordance with the Ordinance. of the City of Springfi.ld and the laws of the State af Oregon
pertaining to the work d.scribed herin. and that NO OCCUPANCY will be mad. of any structure without the permission of the Building DI...I.ian. I further
c:ertlfy that my registration with the Builder's Board is in full force and effect a s required by ORS 701.055, that if ex.mpt the basis for exemption Is noted
heron, and that only subcontractors and .mploy..s who are in compliance with ORS 701.0.5' wj!l be used on Ihis proj.ct.
:J\O ~r" Boa~;:m.Pt~ ~'cu.Q
NAME (please p~
J\Clrl. ~J~E~ 1'1'(h.Q. i:dft.
FOR OFFICE USE ONLY
r 4
UnH, 134
ntcy Load
neey Gro.up R 1
~. Ftg. Main ::\4 I hRn
Sq. fig. Access
Sq. Ftg. Other
Type/Canst. Jl::l..HR
Bedrooms 133
?
Zone
fire Zon"
flood Plain
Ctori.r
OATE1j~8Q
x ~ll ~fl~Valuo~1.32Q,~11
x Value
or
I
"alue
TOTAL VALUATION ~l .32Q ,631 or
BUILDING PERMIT
Charges and
Surcharges
Plan Ck. Comm/lnd
65%/Bldp P.r f.e
Plan Ck. R.s
30%/Bldq P.r Fee
',1>lllb.UO)
$ 3 16 _bstems De....lapm.nt
1.160.69 - -:>2I,a,.o(l.5%'
#B58217 (Mailed rcpt 3-16-82\
plan cnecK
OveroaVfl1Q.nt "n
___JI...21LDfl
~R"~R
"__.JL19.5..,00
87,RO
____L~'O"illL
9.60
PLUMBING PERMIT
Charges and
Surcharg.s
fence
ua...oo
D.mo
ELECTRICAL PERMIT
Charges and
Surcharge,
Sidewalk ~nD I
$1i0 0(1
Alc Pavinl1
MECHANICAL PERMIT
Charg.s and
Surchorg.s
82'
~33.84
___jL!15~.5D Cu,b CuI
4? ~(',
.~-_......._,,_..............~-". .........,,--.---
-~
1Q"Q44.4i
44.64
Total Comb. P.rmit
$
:'-::10.5:
TOTAL
$
25,424.3!
.
-
signature-Ll4:b
~~ ,. "
\
".
J
I
.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant ta furnish
A. Jab Address
B, legal Descriptian .
1. example-tax lot 100, lane County Mop Referenc
2, example-lot 1, Block 3, 2nd Addition ta Springfie
C. Name, etc. of owner and construction lender
D, Energy Sources
1. example-heat/electrical ceiling/or forced air qas
2. example-water heater/electrical/or solar
E. Square-footage or valuation, etc.
1. example-1250 sq, foat hause, 500 sq, foat garage
2. exam ole-if new project, check new-if addition, chE
add, eic, .
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 wark as defined in Section 303 (a) of the
; Structural Specialty Code
H, DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Divisi,
Staff must be able to contact appropriate persons rege
design information or job site corrections, etc.
II, Abbreviated Plumbing, Mechanical & Electrical'Schedules
A. Except where blank spaces occur in the description por
af the Mechanical and Electrical Schedules, the applica
need fill,in only the No, Boxes adjacent to the appropr,
item(s) to be ,i.nstalled .
B, Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
....1. To conserve space on the permit form the schedules
have been abbreviated
2, If the item(s) to be installed are not covered on the,
ated schedules yau should cansult the full schedules
C, BUilDING DIVISION STAFF Will Fill OUT All FEES AN
."CHARGESON THE SCHEDULES
"
III, Applicant to sign and date
Whenever possible, the initial application will be used as (
. worksheet anly, Where possible, Building Division Staff wi
prepare a typewritten copy and return it to the applicant c
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 apl
and na plans will be processed until these fees are paid, A
other fees and charges are due and payable when the per
is issued.
V, FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE'SATISFIED BEFORE OCCUPAN
. "
",'
",.
. <.
Additional Project Infarmation:
PLANS REVIEWED BY:
name
n~n-5mitr
. '. -' ..~.-. -'--_.';'.'
... . . .....':~.r......:_.".,...
.. ~'-- . ~'.:.:,,,.~,....,,:_- ..:.- '. '. .:,. .
CITY OF SP'RINGFIELD '
City Hall
Sprlnglield. Oregon
Department 01 Public Worka
OFFICIAL RECEIPT ~""a1 9
No. B ~O.;... (
(7
Date _~~;, ~ tJq 180,
C Rec'd FrOIl:! ~r-h ~ LP
""\ '\\: \A"'(\""~ r \ l D.,. -
Address,', \ ~')l,\ v, ,... . !\..-
( - .
-R"ecelved For: ~ Mffi \ C\, ;V)
c ,\.~\r\ f\ \) ~~;'6
. .~ L\C/h CI
,~ \ ct\ t\ ~" \~~'.~
. ~, rJl (I
F~ ~~(\ c9L\(},OD
. L\ ,\00 (]
\ ,\)C:)8 ' '2J:)
W)"') L\,!:) _ I 0 (I
\ is ~ \\f\ Q \ ~ ~,
(_ JtY\<\ ~ l t Y\ \) ~ - \rf2 ~
Amount Received ' ~ ~g:[1JJl <AJ~.L
~)
. Sfi--
"",rHORlZ SICiNA.ruRE
t-
(
(
(
- \. I
(
, I
'I
(
(
\.\Sh
~'~
\\\\~~~
(
-
, '
\.
/
-
~..
(
\
......
illlllG08 ..1Il1..T.IIlS/LITHOGR.....H."S. .UGIINII. OIllIEGON
...... .
.. ,....'
..' OFFiciAL RECEIPT
( . No. B 58920~
Date. ~\i.~M 1M
( Rec'd FrolT\ ffir+Q ~ lo , If
Address :t:1L ~\(\~~O~ 'L \~~1'
C-t
Recelv~d FOr::!! ~()~ I q
( ~~-, \\}~ !"{bC\\C\-\ll.1 . .
.0 U \ 'N' \. r-\- ~~~
(
1
I
I
(
gLt
(
.... C')L\,{\tP f(\ \ \~ \ "p,) . ,
( '. '.' C) (\ ~ro'D9 \ QQl\L1.47 I..
~ .J
c
'( I
. -;:- Q. 0 [l["I (\ M r\~ -+ {nr- oLtJ\
~ ..-ff <1+ tm. "':'11JQty
Amount Received \ U\. 0"=\3. \pL 0 L
': \ ~ ~\lIt.2R' \,
c '. BRIGGS ..RINTIIRS/UTHOG"A...HIIIIlS. .UGIEN.. OIllIlGON
(
(
.('
('
'.
dalQl
3-29-82
J
-"'-- L __ '"-