HomeMy WebLinkAboutPermit Building 1984-03-26I'i9IlttED
CITY Of SPRINGFIEID
coMBtNATloN lppt tcartox / pelmtr
TNFORIAAIION LINE
726.37StlNs?tcroN lrNE
,2t-3r69
713 Water Street
Ro
SOURCES;
BE
ENERGY
Heo t
17 03 35 ?2TL 1040i,LcAol
Volue of Work,
6 ,000. 00
- Fence - Demo-Chonge/ Use
Other
-Other
-Rap.
ad.l X ^t.-,
Sq. Ftg. Accesr'
Sq- Ffg. Moin
Sq. Frg.
X N"*
Robert & Can ace Steele
Residence
Euilding Permit lnfo: Describe Work (i.e., Euild Single
Phone 343-5159Addre rr L977 }ak Street
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DESIGN TEAM res)(lics. no.)(nome)
I
E
Electrico I
Mechonicol
PTUMBING ETECTRICAT MECHANICAL
FEE CHARGE NO.FEE CHARGE
Eoch fixture 1 TI,25. 00
furnoce/burner lo
--BTU'S
Relocoted buildinq
f ix.
New circuits, olterotions
or exlensions 1
Applionce vent
rq le 3. 00
1 I
S.F. Residence 00 SERVICES
Stotionory evop,
cooler
I eoch Conslruclion 2
Vent fon with
le duct 6. 00
1 Additionol both 0. 00 rt fromVent syslem o
heoti or
Wqler rervice
Mechonicol exhousl
hood
Sewer
Storm Sewer FEEDERS
Air hondler to
Air hondler over
CFM
rssuANcE OF PERA,ilT 10. 0
TOTAI. CHARGES TOTAL CHARGES 25. 00 TOTAL CH.ARGES 19.00
WHERE STATE LAw nEeUtRES lhot rh. Etedricot worklc donc by rhelqb:l hos beon signed by on Electricol Controcto, ond>ottoched to-the
Elactricol contr6cto?. ,he .lcctricol portion of thir permit rhall not bo votid until oclectricol ponel.
I HAVE cAREFUttY EXAMINED lhe completed opplicotion for permit, ond do hereby <eriify thot oll informotion hereon is true ond correct ond I furthercertify thot ony ond oll work performed sholl bo done in ociordonce with the oidinoncs of the city oi Springfield ond the r.o-r-or the Stota of oregonpertoining to the work described herin, ond lhot No occUPANcY will be mode of ony structure wit'hou, tie iermission.i tf,. irifai.g,Division. lfurther@rtlfy thot my registrotion with' the Builder's Boord is in full fore ond effect os requirej by oRS 701.055, rhor'if .r"-pr ir," r"Jr'r", exomption is notedheron, ond thot only subconfroqlors ond employees who ore in complionce with ohs 7Ol.Ot5 wiu be used on ihis proiect.
Eorir for Builder's Boord exemptioni
3' zq5{eel<_R" 6 erf SIGNA DA'
NAI{E (pleose
TOR OFFICE USE ONI.Y
.Typ./Conrr. V-N Unirs 1 Sq. Frg.
^toin
x Volue
x
-[sls6
x
-Volue
R-1
Sq. Ftg. OthetGroup
Otv Iood
P
So Ftg. Access
Flood Ploin
Zone
TOTAT VATUATION
Fire Zone-Bedrooms
Plon Ck. Comm/lnd DevelopmenlBUITDING PERMIT
Chorges ond
Surchorges
36.00----Tnq-Plon Ck, Res
Per fee 0.50 PD 3-16_8
Label Fee .20
PI.UMBING PERMIT
Chorger ond
Surchorger
35. 00
----T.40-
Demo Totol Comb. Permii
Sidewolk
PERMIT
Chorger ond
Surchorger
25.00----T.Uo-
Curb Cut rrq wMECHANICAT PERry{lT
Chorges ond
Surchorger
19.00
T6-TOTAT
l
Woter Heorerf-J gct==-=--
Owner
?Occv
,rd 2 J ;i8l
tlji!- i-.'.
1'"j
., . .3 ili y_r
CoMBINATION APPUCATION/PERMIT (CAP)
l. Appliconl to furnish
A. Job Address
B. Legol Description
I.-exomple-tox lol 100, Lone County Mop-Refere-nce-
, 2. ero-ph--tot I. Block 3, 2nd Addition to Springfield
C. Nome, etc. of owner ond construclion lender
D. Energy Sources
or forced oir osIexoe-heot electricol ceil
2.or
PERMIT VATIDATION
CITY OF SPRINGFIETD
Cily Holl
Springfield, Oregon
Deporlment of Public Works
OFFICIAT RECEIPT
{
No. B 56148 (
I
/T
1l
Received For
(
f:
(
{
E. sq
l.
SBS:CiI
uore ri
foot go
o elc. iF. Building inf ormotion:
l. exomple-conslrucl single fomily house with on ollo(
goroge
2. exomple-remodel existing goroge inlo fomily room
3. exomFG-converl single fomily residence into
i6IIEuTiint (chonge of use)
G. Volue of work os defined in Section 303 (o) of the
Slructurol Speciolty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or conslruclion deloys, Building Divisi<
Sloff musl be oble lo conlocl oppropriote Persons rego
design informotion or iob site correclions. etc.
tt. Abbrevioted Plumbing, Mechonicol & Electricol Schedules
A. Except where blonk spoces occur in the description por
of the Mechonicol ond Electricol Schedules, the opplico
need fill-in only the No. Boxes odiocent lo the oppropr
item(s) to be instolled
B. Full Plumbing, Mechonicol, ond Electricol Schedules
ore ovoiloble ot the Building Division
l. To conserve sPoce on the permit form the schedules
hove been obbrevioted
2. lf rhe item(s) to be instolled ore nol covered 9n the
oted schedules you should consult the full schedule:
C. BUILDING DIVISION STAFF WIIL FILL OUT ALL FEES AN
CHARGES ON THE SCHEDULES Amounr Received tlq ?\o ( K-
C
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lll. Applicont to sign ond dote
Whenever possible, rhe initiol opplicorion will be used--os (
worksheel only. Where possible, Building Division Stoff w
prepore o typewritten coPy ond relurn it to the opplicont '
ih"'ti.. the octuol permit is issued for his signoture' (
IV. Fees ond Chorges !-
Plon check fees ore due ond poyoble ot the time of the.oPPlico'ion'
ond no plons will be processed until these.fee3 ore poid' All
.
other fels ond chorges ore due ond poyoble when the permit
is issued.
V. IOR OFFICE USE ONIY
BY
TXORIZEO SIGNATURE
(
Permit Clerk
INSURE THAT IT COPIPLIES TO APPLICABLE CODES.
Addilional Proiect lnformotion:
3-1 9-81
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