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Home My WebLink AboutPermit Building 1981-03-05INSPECIION IINE 7263769 CIIY OF SPRINGTIEID COA{BINAIION APPI.ICAIION / PER''1IT INFORIAATIO}I lINE 7?e3753 ENERGY SOURCES: Heot - -New-Add -Alter-ReP.--Fence-Demo-Chon ge/ UseVolue of Work: Woter Heoter -Other 5q. ftg. Aloin 5q. ttg. Orher Sq. ttg. Accets.S+ lDe rn t I Addrerr IZO -D o Pheddrer -.)Building Permil lnfo: Describe Work (i.e., Build Single Fomily Residence With Attoched Gotog9)- -) )ae-n< -I Consiruciion Lendar PhoneAddresr (nome)(oddrers)(lics. no.)(expires)(phone no.)DESIGN TEAM Primory S tructuro I Electricol Mechonicol (o ddre:s)(lics. no.)(expires)(phone no.)CONTRACTORS (nome) Generol Plumbinq Electricol lvlechonicol MECHANICALETECTRICALPTUMBING FEE I CHARGECHAR,GE NO.I rEE CHARGE No. INo. i i FEE Residence of -sq. ft furnoce/burner to --BTU'T Eoch rinqle fixture Applionce vent sepo rote New circuits, ollerotions or extensions Relocoted building (new fix. odditionol) Stoiionory evop. coolerSERVICES| 5.F. Reridence | (l both) Vent fon with sinqle ductTemporory ConslruciionDuplex (l both) coch Venl system cport from heotinq or A.C,Amps.Additionol both Mechqnicol exhousl hood ond ductWoler rcrYice Wood stove/heolerSewer Heot PumpFEEDERSSlorm Scwer Air hondler lo 10.000 CF,.lAmpr. Air hondler over 10,000 cFl,( ISSUANCE OF PERIAIT TOTAI, CHARGES WHERE STAIE fAW REOUTRES rhor rhe Electricol work be done by the Electricol Conlroclor, tha alectritol portion of this permit sholl not be vnlid vniil o lobel hor been rigned by on Etectricol Conlrqctor and artoched to the electricol ponel. TOTAT CHARGESTOTAL CHARGES IHAVE CAREFULLY EXAMINED the completed opplicotion for permit, ond do hereby cerlify thoi oll informotion hereon is lrue ond correcl, ond I further certify thot ony ond oll work performed sholl be done in ocordonce with the Ordinonces of lhe City of Springfield ond the Lowr of the Stqte of Oregon pertoining to rire work dercribed herin, ond thot NO OCCUPANCY will be mode of ony struclure withoul the permission of the Building Division. I further certlfy ih;t my regirtrotion wirh the Builder's Boord is in full fore ond effecl os required by ORS 70I.055. thot if exempt the bosis {or exemption is noled heron, ond thot Jnly rub€ontroctors ond employees who ore in omplione wirh ORS 701.055 will be used on thit Proiect. DATESIGNATURE ,^14 etCVt Bosir for Buildar's Boord exemption: NAME (pleose print)Dnvro rq, FOR OTFICE UsE ONIY Fire Zone-Bedrooms occy lood Sq- Ftg' Access x Volue x -Vqlue x -Vqlue TOTAT VAI.UATION Flood Ploin -5torie:-Occy Group-Sq. Ftg. Other- nils --Sq. Ftg. ^\oinZone -Typei Const. Syslems Development Chorqe ( I .5",'") Pton Ck. Comm/lndBUITDING PERMIT Per Fee Plon Ck. Res Per Fee Chorges ond Surchorger Totol Comb. Permit PI.UMBING PERMIT De rno Chorges ond Surchorges ELECTRICAL PERMIT Sidewqlk c Chorger ond Surchorger tl.Lo TOTAT $,[[.rcMECHANICAT PERMIT Chorges ond Surchorger Curb Cut I t ru Fe nce COMBINATION APPLICATION/PF{MIT (CAP) l. Applicoru. ro furnish A. Job Address B. Legol DescriptionI. exomple-rox lot 100, Lone County Mop Reference2. exomple-Lot l. Block 3, 2nd Addition ro Springfielr sto C. Nome, etc. of owner ond construction lender D, Energy Sources ectricol cei / or f orced oir gos 2 oter rt ial ./'or solor E. Squore footoge or voluqtion, etc.l. exomple-1250 sq. foor house,500 sq. foot goroge2. exEmEG-iFnEw proiecr, check new-ii oddition, cir odd, etc. F. Building permit informorion: l. exomple-construct single fomily house with on oil {rer goroge 2. exomple-remodel existing goroge into fomily roor3. exompG-convert single fomily residence inlo restouront (chonge of use) G. Volue of work os defirred in Section 303 (o) of the Structurol Speciolty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction deloys, Building Divi Stoff mus, be oble to contoc, oppropriote o.r.on, ,. design informotion or iob site corrections, etc. ll. Abbrevioted Plumbing, Mechonicol & Elecrricol Schedul, A. Except where blonk spoces occur in the description p of the Mechonicol ond Electricol Schedules, the oppi need fill-in oniy the No. Boxes odiocent to the oppr< item(s) to be insrolled B. Full Plumbing, Mechonicol, ond Electricol Schedules ore ovoiloble ot the Building Division I. To conserve spoce on the permit form the schedu hove been obbrevioted 2. lf rhe item(s) to be instolled ore not covered on t. oted schedules you should consuit the full schedr C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES CHARGES ON THE SCHEDULES lll. Applicont lo sign ond dote Whenever possible, the initiol opplicotion will be used worksheet only. Where possible, Building Division Stof prepore o typewritten copy ond re.turn it to the opplicc;_ the time fhe octuol permit is issued for his signoture. qr PERMIT VATIDATION OF SPRINOFIEID$ .ci?i.H'on i" 1',''; - - - CITY dF Spriagfie{d" Oregon Deporfmelrt'oi prbli. WorksOFFICIAT RECEIPT 'b ,t{0. B 55978 (l Do 9 Received For: ( ( (' Amount R ecei ved AY SHEITON.TUIXEU!f, Fi!NTERS SIGNATURE EUGE{E OR 97'OI 6r lV. Fees ond Chorges Plon check fees ore due ond poyoble ot lhe time of the opplicotion, ond no plons will be processed until these fees ore poid. All other fees ond chorges ore due ond poyoble when ihe permit is issued. V. FOR OFFICE USE ONIY Permit Clerk Additionol Proiect lnformotion: nome signoture dote PLANS REVIEWED BY I ( ( (.: PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: