HomeMy WebLinkAboutPermit 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: