HomeMy WebLinkAboutPermit Building 1981-03-09INSPECIION IINE
72&3769
CIIY OF SPRINGFIETD
COMBINATION APPTICAIION/PENMIT
INFORMA'ION I.INE
7283753
rob Addresr 962 North 6th Street
Lesor De:criprio" Tax Lot 800 Map 17 03 35 2l
ETeaT
*.Ft
-El ect
ENERGY sOU
Heot
Woter Heoler
Ronqe
Volue of Work:
48,094. 90
Sq. Ftq. Moin IJSJ
-
sq. Ftl. Access. 3?O
-Add-Alter-Rep., Fence-Demo-Chorge/Use
Other
ln. Ftg.A N"*
Other
Larry Di I beckOwner
Building Permit lnfo: Dercribe Work (i.e., Build Single
Fomily Residence With Attoched Goroge)Ph""" 747-6011Address 4015 B Main Street
Sinqle Family Residence; att qarSorinqfield. 0reqon 97477
Conslruclion Lender rlreplace
co
lJo
HFOr
Addresr
(oddress) (lics. no.) (expire:) (phone no.)DESIGN TEAM (nome)
Primory
Structurol
Electricol
Mechonicol
(nome)(oddrers)(lic:. no.)(expirel)(phone no.)CONTRACTORS
7 47 -60t1ek
V & M Plumbing
La
Erectricor Daves El ectri c 20-9SC
itachonicol Laf fy Di I beCk
ETECTRICAL MECHANICALPTUMBING
FEE CHARGEFEECHARGENO.CHARGE NO.NO.FEE
6. 0025. 00 1 rtOS:0001;;,,
x
*"flT5"t
,0. r,.Eoch rinqle fixture
Applionce vent
seporo le
New circuits, ollerdtions
or exlensions
Relocoted building
(new fix. odditionol)
Stotionory evop
coo le rSERVICES25. 00X
S.f. Residence
(l both)
Vent fon with
sinqle duct 2.00 9. 00tftoe3TemSorory ConslructionDuplex (f both) eoch
Vent syslem oport from
heoting or A.C.10.00 Amps.1 Additionol both
Mechonicol exhoust
hood ond duct 4.501Wqler rervite
Wood stove/heoteri0.001Sewer
Heot PumpFE EDERSSlorm Sewer
Air hondler to
r0.000 cFMAmpr.
Air hondler over
10,000 cFM
tssuANcE oF PERMTT 10. 00
29.50
TOTAT CHARGESTOTAI. CHARGES 45.0045. 00TOTAT CHARGES
WHERE STATE tAW REQUIRES rhot rhc Etedricol work be done by rhe Electrical ControGlor, the elcttricol portion of this permit rholl not bc volid until o
lobcl hos becn signed by on Electricol ContrEctor ond ottached to lhc electricol ponel.
I HAVE CAREFUIY EXAMINED rhe complered opplicotion for permit, ond do hereby ceriify lhot oll informotion hereon is lrue ond correcl, ond I further
certify thot ony ond oll work pe.formej sholl be done in qcordonce with the ordinonces of the City of Springfield ond the Lows of the Stote of Oregon
p".roining to tire work described herin, ond thot NO OCCUPANCY will be mode of ony:truciure without the permission of the Building Division. I further
cerrrfy $-ot my regiilrorion wirh rhe Bullder's Boord is in full force ond effect os required by ORS 701.055, thot if exempt the bosis for exemption is noted
heron, ond thof Jnly subcontroctors ond employees who ore in omplione wirh OR570I.055 will be used on this proiect.
qV
DATE
(Bo sis
NFOR OFFICE USEI
:-3&f&Y:i::
a
-!6196
TOTAT YATUATION
1 353-_TZV
4U, Uy4. vUFlood Ploin
Fire Zone
Zone fype/ Conrt
Bedrooms
45,054.90
3 ,040 - oonits 1 Sq' Ftg.
Grorp R-3 Sq. Fts. other-
lood -----_-Sq. Ftg. Access
Systems Development
Chorqe (1.57o)
Plon Ck. Commi lnd
6595/Bldq Per Fee
55. 20
^-,1n nn
Plon Ck. Res
307o/Bldq Per fee
BUILDING PERMIT 184.00
7.36
Chorge: ond
Surchorges
8.10Plan Check Due--8-.T0'-oue
Fe nce
305.24Totol Comb. PermitDemo
Chorges ond
Surchorges
45.00
---T:A0--
PTUMBING PERMIT
15.00---rtr--ICAL PERMIT
SidewolkChorges ond
Surchorges
1A
Curb Cut
MECHANICAT PERMIT
Chorges ond
Surchorger
29.50
1. 18
TOTAT
TZ,
Phone
NAME (pleose print)
exemplionr
A/C Povino
ff ::1:-"rl
COMBINATION APPLICATION/PERMIT (CAP)
e.:c r
l. Applicont. to f urnish
A. Job Address
B. Legol Description
lot I00, Lone County Mop Reference I7 03 43
PERMIT VALIDATION
OF SPRINGFIETD
City Holl
Springfield, Oregon
Deportment of Public Works
OFFICIAL RECEIPT
No. B 559'$6
.r9
I. exomple-lox
2. exomple-Lot l. Block 3,2nd Addition lo Snrina{icl'l E"+^+^'
C. Nome, etc. of owner ond construction lenc (CITY (
l
D. En
I
2.
E. Squore footoge or voluotion, elc.
I
2
ergy Sources
exo mple-heot/electricol ceiling /or forc,
exo mple-woter heoter /electricol z' or sol
exomole-I250 s
exomple-if new
odd, etc. ),
q. foot house,
proiect, check
500 sg. fr
new-if or
F. Building permil informotion:
l. exomple-conslrucl single fomily house r
,. :::1t;"-remodel existins eorose into I (ir'
3. exornpl-e-convert single fomily residencr
iEJEu?E'nt (chonge of use)
G. Volue of work os defined in Section 303 (cr {tt.- Structurol Speciolty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or conslruclion deloys, Bui {rS
Stoff must be oble lo contoct oppropriote p -
design informolion or iob site correclions, e
ll. Abbrevioted Plumbing, Mechonicol & Electrico
A. Except where blonk spoces occur in the des
of the Mechonicol ond Electricol Schedules,
need fill-in only the No. Boxes odiocent to I
. item(s) to be instolled' B. Full Plumbing, Mechonicol, ond Electricol Sr
ore ovoiloble ot the Building Division
I. To conserve spoce on the permit form th
hove been obbrevioted
2. lf rhe item(s) to be instolled ore nol cove
_ oled schedules you should consr${re'fu
C. BUILDING DIVISION STAFF WILL FILL OUT A
CHARGES ON THE SCHEDULES
lll. Appliconl to sign ond dote
Whenever possible, the initiol opplicotion will I
worksheel only. Where possible, Building Divisi
prepore o typewrilten (oPy ond relurn it to the
the time the octuol permit is issued for his sign<
(
(
()
AUIHORIZED STGNATURE
PiTNIERS _ EUGENE OF 97'Ol 'a'll
a
t
(fe
f'(
(
BY
6.
lrl.
{
lJ,
Amounl Received
SHEL
(
(lV. Fees ond Chorges
Plon check fees ore due ond poyoble ot the tim
ond no plons will be processed unlil these fees ,
other fees ond chorges ore due ond poyoble w[=
is issued.
V. FOR OFFICE USE ONLY
rf l,
Permit Clerk
PROJECT CONDIIIONS TO BE SAIISFIED BEFORE OCCUPANCY:t)
Additionol Proiect lnformolion:
D
a
PLANS REVIEWED BY:
3-6.tLsignolure
q
dote
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