HomeMy WebLinkAboutPermit Building 1981-07-09CIIY OT SPRINGFIETD
COMBINAIION APPIICAIION/ PERAAlT
INfORIAAIION IINE
72(-37s3INSPEC?ION TINE
72(-376i
SOURC ES:Elect
GasWoter Heoter
ENERGY
Heot
Part of TL 10100, lrlap 17
1216 lttohar*k BlvdJob Addrrrr
-l.sgl Dc !criptio n 03 25 33
Volue of Work,
40, 000. o0
-New
--Add--}[lter-Rep.
-tence-Demo-Chonge/ Use
Orhe'
---
LJ+ L'Sq. ttg. Moin
Sq. Ftg. Accerr.
Sq. Ftg. Other
ownar F1eek, Wayne E.
Building Permit lnfo: Describe Work (i-e., Build Single
Fomily Residence With Attoched Goroqe)Addrerr 1335 l*larket Street Phone 7 26-7880
Remodeling lease space for ChineseSpringfie1d, Oregon 97477
Restariiant
Conslruclion Lender
@tsoF
N)
U.l
PhoneAddress
(nome)(oddress)(lics. no.)(expires)(phone no.)DESIGN TEAM
Brodie HotelPri
Struclurql
Electricol
Mechqnicol
e1
RS
Plumbino
Electricol
Mechonicol
MECHANICATEI.ECTRICATPTUMBING
FEE CHARGENO.FEE CHARGE NO.NO.FEE CHARGE
Residence of
fr.
furnoce/burner to
-BTU'S
9 Eoch sinqle fixture 5. 00 4s. 00
TE 15-OO
Applionce vent
sepqrotex
New circuits, olteroiions
or exlensions 2 Of m<
Relocqted buiiding
(new fix. odditionol)
Stotionory evop.
coolerSERVtCES
S.F. Residence
(l boih)
2 Vent fon with
sinqle duct 3. 00 6.00Temporory ConslruclionDuplex (l bolh) eoch
Vent syslem oport from
heotinq or A.C.Amps.Additionol both
onn2
Mechqnicol exhqusl
hbod ond duct 4. -qoWoler service
Wood slove/heoterSewer
Heot PumpFEEDERSSlorm Sewer
Air hondler to
r0,000 cFMAmpr.
Air hondler over
r0,000 cFM
m 6- OnAlter HVAC Svste
2.OOGas Pipins
rssuANcE oF PERMTT 10.00
TOTAL CHARGES 35. 00
15.00
IOTAT CHARGESTOTAL CHARGES 45.00
WHERE STAIE fAW REQUIRES rhqr lho Elcclricol work be dona by rhe Electricol Conttqctor, rh. Gh.lricol Portioir of lhis parmit sholl not bc volid until c
lobel hcs bean signed by on Elcctrical Contrsctor ond ottochad lo lhc clectricol poncl.
I HAVE CAREFULTY EXAMINED the completed opplicotion for permit, ond do hereby certify thot oll informotion hereon is true ond correcl, ond I further
;ertify thot ony ond oll work performed sholl be done in occordonce with the Ordinonces of rhe City of Springfield ond lhe Lows of ihe Stote of Oregon
pertolning to rle work described herin, ond thot NO OCCUPANCY will be mode of ony.slructure withoul the permission of the Building 'Division. I further
ertlfy th-ot my registrotion with, the Builder's Boord is in full fore ond effect os required by ORS 701.055, lhot if exempl lhe bosis for exemplion is noted
heron, ond thot only subconlroctors ond employees who ore in complionce wilh ORS 701.055 will be used on ihis proiect.
fl1-.-Ci-le-uNcr
DATE xWrPtBosis for Builder's Boord exemplion:
NA.ME (pleose print)
LeuLrq
SIGNATURE
TOR OFFICE USE ONIY
1--!6lsg
1-!6lss
IOTAT VAI.UATION
Ftg. Moin x
--volr.
40, 000 . O0
flood Ploin 40,000. 00
194 2
Lood Flg. Access
Sq. Frg. Other
Zone Const.
Fire Zone-Bedrooms
(1.50h\
DevelopmentSystems
6horoe1n? n( Dr\ a 1<
Plon Ck. Comm/lnd
65%/Bldg Per Fee JT
Plon Ck. Res
3o7o/Blds Per Fee
Fence
)60 noTotol Comb. Pff.ll-Demo
157. 00
----6.28-
PTUMBING PERMIT
Chorges ond
Surchorges
45. 00
----1;&0-
BUII,DING PERMIT
Chorges ond
Surchorges
Sidewolk
A/C Povino
Chorges ond
Surcho rges
15. 00
-- '6U
ELECTRICAL PERMIT
Curb Cut
MECHANICAT PERMIT
Chorger ond
Surchorge:
33. 00
----T.52-
260. 00
TOTAI.i-
(nome)(sddress)(lics. no.)(expires)(phone no.)
L-Z I I I-]HR
coMBTNATION AppLtCATtON/pERMrr (CAp)
l. Applicont to furnish
A. Job Address
B. Legol Description
l. exomple-lox lot I00, Lone County Mop Reference
2. exomple-Lot I. Block 3,2nd Addition to Springfield
C. Nome, elc. of owner ond construction lender
D. Energy Sources
PERMIT VATIDATION
G, ctTY oF SPRINGFIEID (l
Ciry Holl
Springfield, Oregon
Deportment of Public Works
OFFICIAL RECEIPT
No. B 568E0 fl
l9nrCnev fl
Address /-151 S
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l. exomple-heot/electricol ceiling/or forced oir gos
2. e xo mFIE-w o te r TETET6G-cI ri co I / o @----
'l . exomple-1250 sq. foot house, 500 sq. foot goroge
2. exomple-if new proiect, check new-if oddition, cher
odd, etc.
F. Building permit informotion:
l. exomple-conslrucl single fomily house with on olto
goroge
2. exomple-remodel existing goroge into fomily roorr
3. exffipfe-convert single fomily residence inlo
reEtoiT6nt (chonge of use)
G. Volue of work os defined in Section 303 (q) of the
Structurol Speciolty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction deloys, Building Divisi
Stoff must be oble lo conlocl oppropriole persons reg(
design informotion or iob site correclions, elc.
ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedules
A. Except where blonk spoces occur in the descriplion po
of the Mechonicol ond Electricol Schedules, the opplicr
need fill-in only the No. Boxes odiocent to the opprop
item(s) to be instolled
B. Full Plumbing, Mechqnicol, ond Electricol Schedules
ore ovoiloble ot the Building Division
l. 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 schedules you should consult the full schedule
C. BUILDING DIVISION STAFF WILL FILL OUT ALt 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 n
prepore o typewritten copy ond return it to the opplicont
the time the octuol permit is issued for his signolure.
U
Received For:
3
Amount Received
F
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fl
fl
fl
il
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0
lV. Fees ond Chorges f-
Plon check fees ore due ond poyoble ot lhe time of the opplicotion,
ond no plons will be processed unlil these fees ore poid. All
other fees ond chorges ore due ond poyoble when the permit
is issued.
V. FOR OFFICE USE ONLY Permit Clerk
PROJECT CONDITIONS TO BE SAIISFIED BEFORE OCCUPANCY:
Additional Proiect lnformotion: Adciitional plan-s required for lightin*, EPu{a HVAC system
changes required to suitethe new tenant
PLANS REVIEWED BY:
... I' . LOPNE PLEGER 7-9-81signolurenomedote
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