HomeMy WebLinkAboutPermit Building 1980-10-06rE^ l/'
TION IINE
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legol De 99^e.-. -,Volr ol Worl:
1 2 ,000. 00
(503)
n Lender
(phone:exprre!)loddress)ilic:. no.i
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Pho nc
Phone
(nomei
S tructurol
{i.c., 8uild Singlc
ceilin t
7783753
DESIGN TEA}*
Rc ridcncc Arochod
el ectrical ,
I umb in
f19. Moin
ttg. Accert.
Owner
Address
Addre rs
Con
INSPECIION UNE
72C3769
Add Alter-ReP.
Demo-Chonge/ Use
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Othar
crIY ot sPrlNGrlEto
coMllNAroN APPUCAIIONI PEtAllr
TNTRGY SOURC€S:
x.o' . El ect --- -;:;. ;.:;,;: Et eia _
L7 0? 33 4 Tax Lot 600
5499 Main Street
ng Pcrmit ln{o: Dortribr WorL
H.V.A.C.,
- Chi I dren's Store
frg. Cthcr
Vancouver, Washington
B uildi
Fo m il'
S'l ab,
Et<tel
l'{echonicol
C.E. John Construction 7?.23 NE Hazel Dell ' Vanc.,WA
CONTRACTORS
223-OL J0HN C 347LF 283-55
nono-
Schmi dt P1 umb'ing 7500-c NE 16th Avenue,Vanc.,l,lA 694-8535
Plumbinq
Erecricor 3-WaY El ectri c 4739 7 46-97 43Ma'in Street,1 'tnqf eld, 0R
Mcchoniol DUf bi n Heati ng P.0. Box 1042, Euqene, 0R 343-1412
MECHANICALETECTRICATPLUMBING
FEE CHARGEFEECHARGENO.FEE CHARGE NO.No. r
furnoce/ burner lo
--BTU'S
15. 00
Residence of
--sq.
ftEoch sinqle fixture 5. 003
Applionce vent
sepsrq re
New circuils, olterotions
or extensions
Relocqted building
(new fix. oddirionol)
Stotionory evop.
coolerSERVICES
5.F. Residence
(l borh)
3. 00Vent fon with
sinqle duci1Temporory ConslruclionDuplex (l both) eoch
Venl system oport from
heoting or A.C.Am psAddirionol both
Mechonicol exhousl
hood ond duclWoler rervice
Wood stove/ heoterSewer
Heot PumpFEEDERSSlorm Sewer
15. 00 Air hondler to
10,000 cFMAmpr. 2001
Air hondler over
r0,000 cfM
6. 0013 ton HVAC
ISSUANCE OF PERMIT 10. OO
TOTAT CHARGES 19. 00TOTAT CIiARGES 15.00TOTAT CHARGES 15 -00
WHERE STAIE tAW REQUIRES thor rhe Electricol work be done by the Electricql Contractor, tha elactricol porlion of this permit shsll not be vqlid until o
lobel hoc bcen signed by on Electricol Controctor ond ottochad lo the eleclricol ponel.
I HAVE CAREFUUY EXAMINED the ompleted opplicotion for permit, ond do hereby certify thot oll informotion hereon is lrue qnd correct, ond I further
<erfify thot ony ond oll work performed sholl be done in qccordonce with the Ordinonces of lhe City of Springfield ond the Lows of the Stote of Oregon
pertoining to the work described herin. ond thot NO OCCUPANCY will be mode of ony structure without lhe permission of the Building Division. I furiher-
ertlfy thot my registrotion with the Builder's Boord is in full fore ond e{fecf os required by ORS 701.055, thot if exempt the boris for exemption is noted
heron, ond thot only subconiroctors ond employees who ore in complionce with ORS 7O1.055 will be u:ed on lhis proiect.
oerc/4-4-'ioSIGNATUREBrr/ Alt//a
Bosis for Builder'r Boord exemption:
NAME (pleose print)
FOR OFFICE UsE ONTY
x
--=-Yoluex
-Volue
x
-Volue
V.NType/ Conrr.
TorAr. yAruATlep 'l 2 ,000 - 00
Bedrooms
C.4 II n ilsZone Ftg. Moin
Ftg. Access
Group
Lood
Flood Ploin
Fire Zone
Sq. Ftg. Other-
5[Tptems Development-CXorqe (1.5%)39.00 PD L0-27-Plqn Ck. Comm/lnd
65%/Blds Per Fee
BUII.DING PER,IV\IT
Chorges ond
Surchorge:KLL 33UbO
60.00-----2i0-
Plon Ck. Res
3o7oi Blds Per Fee
Fence
Totol Comb. Permit
PtUMEING PERMIT
Chorges ond
Surrhorger
i5. 00
60 Demo
Sidewolk
ETECTRICAL PERMIT
Chorges ond
Surchorger
15. 00
.60 A/C Pqvino
Cvrb Cut
MECHANICAT PERMIT
Chorgor ond
Surchorgo r
19.00
.76
I
iI
TOTAT 113.36
1 So-
a
I
$
coMBtNATION AppLtcATtoN/pERMtT (C,Ap)
l. Appliconr to furnish
A. Job Address
B. Legol Description
l. exomple-toxlot 100, Lone County Mop Refere2. exomple-Lot l. Block 3, 2nd Addirion to SpringlC. Nome, etc. of owner ond construclion lender
D. Energy Sources
lectricol ceil or forced oir gc
2.eo ect oriolEi
E. Squore footoge or voluotion, etc.
PERMIT VALIDATION
OF SPRINGFIELD
CirY Holl
Springfield, Oregon
Deportment of Public Works
OFFICIAT RECEIPT
l{0. B 551"00
19
'1LLb fuE {1251
lae
?
r
(
fi
r
CITY
From
I. exomple-l 250 sq. foot house, 500 so. foot ooro,2. exEmElE-iT-new proieo, checkiEi-ii oddirion,l -{,
odd, etc.
F. Builciing permit informotion:
l. exomple-construct single fomily house with on o (h,goroge
2. exomple-remodel existing goroge into fomily ro,3. exfiFl-e-converl single fomily residence into ,resi6lront (chonge of use) {.
G. Volue of work os defined in Section 303 (q) of the
Slructurol Speciolty Code
H. DESIGN TEAM AND CONTRACTORS {.
To ovoid design or construction deloys, Building Div
Stoff must be oble to contocl oppropriote persons re
design informotion or iob site corrections, etc. (
ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedulr
A. Except where blonk spoces occur in the description p
of the Mechonicol ond Elecrricol Schedules, rhe oppii
need fill-in only the No. Boxes odiocent to the oppro
item(s) ro be instolled
B. Full Plumbing, Mechonicol, ond Electricol Schedules
ore ovoiloble ot the Building Division
'I . To conserve spoce on the permit form the schedule
hove been obbrevioted
2. lf the item(s) to be instolled ore not covered on the
oted schedules you should consult the full schedule
C. BUILDING DIVISION STAFF WILL FII-L OUT ALL FEES AI
CHARGES ON THE SCHEDULES
lll. Applicont to sign ond dote
Whenever possible, the initiol opplicotion will be used os
worksheet only. Where possible, Building Division Stoff $
prepore o lypewritten copy ond relurn it to the opplicont
the time the octuol permit is issued for his signotuie.
lV. Fees ond Chorges
Dole
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Amou nl Received
BY
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ORIZED gIGNATURE
3HEltoR.TUlx6uLL aFIXTERS EUC'XE Ol 9"o1 BA5l1 6
Permit Clerk
(
Plon check fees ore due ond poyoble ol the time of the op1
ond no plons will be processed until these fees ore poid. AiI. other fees ond chorges ore due ond poyoble when lhe permit
is issued.
V. FOR OFFICE USE ONLY
c(L
PROJECT CONDITIONS TO BE SAIISFIED BEFORE OCCUPANCY:
Additional Proiect lnformotion:
PTANS REVIEWED BY:
DAN SMITH 10-31-80nomesignoturedote