HomeMy WebLinkAboutPermit Building 1982-03-05INSPECTION IINE
726.3769
CITY OT SPRINGTIETD
COMBINATION APPTICATION / PENTAII
INFONIIAIION TINE
7263753
Woter Heoler
Ronge
ENERGY SOURCES:
Heot
-
-New-Add-Alter
XRep,
-Fence-Demo-Chongc/
Ure
-Orher
-
Sq. Ftg. Other
Sq. Ftg. Moin
Sq. Flg. Acce
Volue of Work:
$2 , ooo. oo
Fomily Residence With Attoched Goroqe)
Building Permit lnfor Describe Work (i.e., Build Single
PhoneAddress
Providinq two enclosed offices. conferenc
room and reception area in an existinqConslruclion Lender
office buildinq.
@N)o
(o
16
PhoneAddress
DESIGN TEAM (nome)(oddress)(licr. no.)(expires)(phone no.)
Electricol
.lllechonicoI
CONTRACTORS (nome)(oddress)(lics. no.)(expires)(phone no.)
344-3044
Electricol Ourn o r^
lr{echonicol
EIECTRICAtPTUMBING MECHANICAT
NO FEE CHARGE NO.FEE CHA.RGE NO FEE CHARGE
Eoch sinqle fixture
Residence of
-rq.
f+.
furnoce/burner lo
-BTU'I
Relocoted building
(new fix. oddifionol)2
New circuits, olterqtions
or extensions 15-0n
.Applionce vent
seporo te
S.F. Residenc
(l borh)SERVICES
Slolionory evop.
cooler
Duplex (l both) eoch Temporory Conslruction 1
Vent fon with
single duct 3. 00
Additionol both Amps.
Vent syslem opori from
heotinq or A.C.
Wolar cervice
Mechonicol exhousl
hood ond duct
Sewer Wood slove/heoter
Slorm Sewer TEEDERS Heol Pump
Ampr.
Air hondler to
I0,000 crrrt
Air hondler over
I0,000 cFA^
Extend ducts 4.50
rssuANcE oF PERMTT 10.00
TOTAT CHARGES NA TOTAT CHARGES 15.00 TOTAT CHARGES 17 .50
WHERE STATE LAw nEoUlREs rhot the Ehctricol work be donc by thc Elecrricsl contractor, thr ctcctricol portion of this permit shqll not bc volid untit qlobel hcs becn rigned by an Electricot Controctor and ottochad to thc clectricol ponel.
DATE ISIGNA'NAilE (pleose prinr)\-I4h\ trR
Springfield ond
lhe permission
H VEA YCAREFUTT'theEXAMINED for ondcompletad do ollthotopplicotionpermit,cerlifyhereby hereoninformolion
tho t ollond work shoony il donebe nt1 rdqnocco ce rh Ordinoncesthecertifyperformed theof ofCity
ihe worklopertoi described ond NOthot Y willningherin,OCCUPAN,C be ofmo de itructureony wilhoutthotrhewithcerll[y registrolion BoordBuilder's tnt5 forefull effectond omy I lhotrequired.055,it exem pt
nd thotheron,ond3ubcontroctors who lnoreonly ORSirh willemployeesomplionce onused ihis
Bosis for Euilder's Boord exemption:
s lrue ond correct, ond I furlher
ihe lowr of the Stote of Oregon
of the Building Division. I further
the bosis for exemption is noted
x Volue
x Volue
a
-!sls6
TOTAT VATUATION,
Typu/const. V-N unir,
$2.000:oo -
lood
-So.
G.orp 82 ,-.
Ftg. Access
Ftg. Other
Occv
Zoae
Fire Zone
sq. ffmoi.
Flood Ploin Stories-Occy
Plon Ck. Comm/lnd
65%/Bldq Per Fee Pd NA
Plon Ck. Res
30%/Bldq Per Fee #8581 55
Fence
PTUMBING PERMIT
80
___JBUITDING PERMIT
Chorges ond
Surchorger
Chorges ond
Surchorges
Demo Totol Comb. Permit $ s+. oo
SidewolkChorges ond
Surchorges
PERMIT __$
A/C Povinq
Curb Cut
MECHANICAT PERMIT
Chorges ond
Surchorger
17. 50_$_
7n
TOTAI.
Job Addre..200 Snrrth Mi I I (lrapf
Lesol Descriptio^ 17-03- ?5-12
owner ,lnhn Amrrnrlsnn
(nri nnf i oI d nP O7 0.77
FOR OFFICE USE
Systems Development
Choraa /l 5o,/^'l
60
( qa. Rn
coMBTNATTON APPLTCATION/PERMrr (CAP)
l. Applicont to furnish
A. Job Address
B. Legol Description
PERMIT VALIDATION
CITY OF SPRINGFIELD
City Holl
Springfield, Oregon
Deporlment of Public Work;
OFFICIAT RECEIPT
l. exomple-tox lot 100, Lone County Mop Reference
2. exEmFG-Lot I. Block 3, 2nd Addition to Springfiel< (ro
Nome, etc. of owner ond construction lender
Energy SourcesI. exomple-heot/electricol ceiling/or forced oir gos
2. e x 6 mFlE - w o r e r TreEr ":r761-e c r r i co I / o r g
Squore footoge or voluotion, etc.I. exomple-1250 sq. fool house,500 sq. foot goroge
2. eTomFTE-iTTEw proiect, check-new-if oddition; che
odd, etc.
Building permit informotion:l. exomple-construcl single fomily house with on otlc
goroge
'l
c
D
I
E.
F.
('
'ed
No. B 58161
OO
o
fl
0
(l
CI
fl
fl
il
(t
(l
(t
Ddte
Received
2. exomple-remodel exisling goroge into fomily roon
3. exomple-convert single fomily residence inlo
i6lTouront (chonge of use)
G. Volue of work os defined in Section 303 (o) of the
Slruclurol Speciolty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction deloys, Building Divisi
Stoff must be oble to contoct oppropriote persons reg,
design informolion or iob site correclions, etc.
ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedules
A. Except where blonk spoces occur in the description po
of the Mechonicol ond Electricql Schedules, the opplic,
need filt-in only the No. Boxes odiocent to the opprop
item(s) to be instolled
B. Full Plumbing, Mechonicol, ond Electricol Schedules
qre ovoiloble ot the Building Division
I. To conserve spoce on the permit form the schedule
hove been obbrevioted
2. lf rhe item(s) to be instolled ore nol covered on the
oted sc,hedules you should consull the full schedule' C. BUILDING DIVISION STAFF WILL FILL OUT ALt FEES A}
CHARGES ON THE SCHEDULES
tll. Appliconl to sign ond dote
Whenever possible, rhe initiol opplicotion will be used os
worksheet only. Where possible, Building Division Stoff \^
prepore o typewritten coPy ond reJurn it to the oppliconl
ihe'time the octuol permil is issued for his signolure'
lV. Fees ond Chorges
sxELtoN-YUlilluLL PRriltER3 EUOEXE OR 9rao! 56tll 6
Permit Clerk
G'
(
(.,.
Amounl Received
BY-1I
Plon check fees ore due ond poyoble ot the time of the o[-
ond no plons will be processed until lhese fees ore poid' All .- . ' other fees ond chorges ore due ond poyoble when the permit
is issued.
V. FOR OFFICE USE ONLY
\\
piorrCr CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
I
I
t/!tff.,3 t)Avl a
Addilional Pro[ect lnformotion:
PTANS REVIEWED BY:
Dan Smi th signoturenome dote 3-4-82