HomeMy WebLinkAboutPermit Building 1981-07-22INSPECTION TINE
l?b3769
CIIY OF SPRINGTIETD
COA{BIi I AIION APPTTCATION / PENMII
ENERGY SOURCES:
r'leo I
INFORIAATION LINE
72b3r53
Sq.tt9. Moin
5q.Ftg. Accest.
Sq. ttg' Other
-New-Add -Altcr-ReP'
, /0rg 50ut L
Job
Voluc of Work:
Building Permit lnfo:O"*;b. Work (i.e., Euild
Fomi With Arto Go
-Demo-Chong.irlJ
re
fle,<4tl tloU-
7fiLegol Dercription
Addre !3
Owner 4, //" L>raL C^ s&al-.,.
Addrers
'?.a J
m
c
PhoneAddrerr
(lic. no.)(oddre:r)DESIGN IEAM (nomci no.)(e
Electrico I
a E WtYp 20 -t7l C t gt ras:r*r,fc s306
ETECTRICAT
CHAFGEFEECHARGE
--l
MECHANICAI.
Mcchonicol
PTUMBING
NONOI FEENO. r t r?r I cl4lqE
furnoce/ burner io
--BTU'T
Eoch ringla fixture
Applionce vent
sepqrole
fr.
Residence of
New circuilr. olterolionl
or extensionr--fRJ*,.d| (new fix.
building
odditionui
Slolionory er.op
coolerSERV ICES
S.f. Reridence
(l both)Vent fon with
sinqle ductDuolex (l bothl coch
Vent 5yrlem oport from
heoting or A.C.Aciditionol both
woiel rerYi(a
Wood rtove/ heoter
Mechonicol exhourt
Temporory Conslruclion
_4,"er. __ _
Scwcr
I
I
Heot Pump8+rEED ER5Sewcr Air hondler to
10,000 cr^{4oAmpr.
Air hondler over
r0,000 cfM
tsst *NcE oFrPERrrllT
TOTAT CHARGEsTOTAT CHARGESTOIAT CHARGEs
DATE.TURE
lhis notrholl untilbovqlidrlactricolthcofConlrocror,parmiiporliortthcElertri <olworkdoneberhotIRESElclhc(lrico by5tWHERELAWAIEEUR nel.thc elestri coltoqndConlroGlol PqottothcdcolonEla.trihorlobclbarnignedby
nd ond furthercotollhereoninformotion,ruort o t tecl,do thoforondcertifyherebyiedt,YEFU tI INEXAM theED opplicotion permiIVEHA'CAR comple td theond ofLows Slolethe ofofcitheof OregonncethewithOrdinoncestySpringfiebetndoneqcordoshollondIthotpcrformedcerlifyDivision.furtherofnrhethedemoofwithoutrlructureBuildingwillPANCYbeonYpermirriondNOthstoccuqherin,Ce:criixdwork
ny
theiongpertoini bo It notedforlls70ORSrtlhotrheexemptionoeffect.055,PteremIInforceullondrequiredbyt58uiBoordlder'slhcwirhihotetti{y regi rtrotionmy 701 will.055 usadbe thironRS@mowith proiccl.owho tnre plionceondndthotempioyee:rubontrqclor:onlyheron,
Borir for Builder'r Boord exemption:
NAME (plsorq prinr)
I
FOR OFFICE U5E ONTY
Sysrem! DeveloPment
Choroc ( I .5?'o)
Flood Ploin storier Occy Group-Sq' Ftg' Other
nils
So Ftg. Acce3r
x ------Volue
a Vo lua
a
--Volue
TOTAT VATUATION
Ftg, MoinTone
-TYPe/Const.
FirE Zone-Eedroomr occY Lood
Plon Ck. Comm/lnd
6|ttlgld a Pet Fee T#ffiHCPlon Ck. Res
30",/./Bldq Per Fee
BUILDING PERMIT
Chorge: ond
S urcho rge r
I
Fence ffi)Totol Comb. PermitDemo
PLUMBING PERMIT
Chorger ond
Surchorges
__ro
Sidewolk
ELECTRICAT
Chorger ond
S ur cho rg er
Curb Cut obnTOTAL
MECHANICAT PERMIT
Chorgc: ond
S ur cho rEe r
.l/,t
q0
----r&,m
coMBrNATroN AppLlc,A,TtoN/pERlil-T (cAp)
l. Applicoru ro furnish
A. Job Address
B. tegol DescriptionI. exomple-tox lot 100, Lone County Mop Reference I7 03 43
2. exompie-tot I. Block 3, 2nd Addition to Springfield Estotes
C. Nome, etc. of owner ond construclion lender
D- Energy Sources
PERMIT VALIDATION
I. exomole-heol/electricol ceilinq/or forced oir gos
Z. exomole-woter heoter. electricolz'or solor
E. Squore footoge or voluq;ie6, .1..l. exomole-12!9 .q.foot house, 599 tq.foot goroge
2. effiFi6-i?;;^/ proiect, cte.[iEi-ii oddirion, Jheck
odd, etc.
F. Building permit informotion:
l. exomole-construct single fomily house with on ottoched
goroge
2. exomple-remodel existing goroge inlo fomily room
3. exomFG-converr single fomily residence into
res?ouronl (chonge of use)
G. Volue of work os defined in Section 303 (o) of the
Structurol Speciolty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction deloys, Building Division
Stoff mus, be oble to contoci oppropriote persons regording
design informotion or iob site corrections, etc.
ll. Abtrrevioted Plumbing, Mechonicol & Electricol Schedules
A. Except where blcnk spoces occur in the description portion
of the Mechonicol ond Electricol Schedules, the opplicont
need fill-in only the No. Boxes odiocent to the oppropriote
. item(s) to be insrolled
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 the irem(s) to be instolled ore not covered on the obbrevi-. ored schedules you should consult the full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
lll. Applicont to siEn ond dote
Whenever possible, the iniiiol opplicotion will be used os o
worksheet only. Where possible, Building Division Sroff will
prepore o ,ypewritten copy ond return it lo the oppliconf of
the time the octuol permit is issued for his signoture.
lV. Feet ond Chorges
Plon check fees ore due ond poyoble ot the time of the opplicolion,
ond no plons will be processed until these fees qre poid. All
other fees ond chorges ore due ond poyoble when the perrnitit issued.
V. FOR OFFICE UsE ONIY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Permit Clerk
Additionol Proiect tnformorion:
nome signolure dote
PLANS REVIEWED BY:
:,1;
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CIIY OF SPRINGTIETD
COMSINA'ICN APPI'ICATION / PERMII
INfONMAITON TINE
72(F3753lN5PtciloN t,tNt726{r69
/Crg Street
togol Ocr<rrorioa
Volue oi Work;
Bvilding Permit lnfo:
Fomr Rerrden<c
te
Goro
H
EN€RGY SOURCES:
l)v
ef
z
LLrt(,
Dcrcrrbe Wori ii.e., Suild SinE
nce
-
rh Atto
5q. Flg. Accerr..leo t
Sq. Frg. Olher
-New--Add -Altcr-ReP'
J
m
o
Addrcr Phone
(expirer)(licr. no.)(oddrerr)OESIGN lEAM
(phone(nomr)
E Pa'rL Dt eo-i7t I t ss66-gitcs3(4Electri co I
'tw
EIECTR ICAT
CHARGEFEECHARGE
Merhonicol
A^ECHAN ICAL
NO. r
PTUMBING
__]=Fi!_No, IC!.IARGEII F:E
furnoce/burner io
-BTU'T
Eoch rinqla fixtura
Applionce vent
!ePqlo te
Residence oi --'t.
-Jq
"'
Ncw <ircuils. qlterolion:
or exlenti.niRelocoted building
(ncw fix. odditionol)
Slolionory evop.
ccolerSERV ICE S
S,f. Reridcncc
(l borh)Vent fon with
sinqie CuctDuolcr (l bolh) coch
I
I
Vent syrlem oporl from
heoiinq or A.C.Aciditionol borh
Woter rervice
Wood slove/ heoter
hood ond duct
Mechonicol exhourl
Temporory.
i-r-:.--
Conrtruction
I
I Scwcr
Heot PumpFEEDERS*+Slclm Scwcr
Air hondler to
I0,000 CFA{/" t)Ampr.I
Air hqndler over
r0,000 cFM
lssur.NcE ofrPERMtr
wxERE SIAIE tAW REOUTRES thor thc Elactricol worl bo donc by thc Elcaricol conlrscroz, tha clcctricol portiort of this pcrmit lhsll not bo volid unlil o
I HAVE CAREfUtty EXAMINED rhc completed opplicotion for petmit, ond do hereby cerlify thot. otl, infomotion hereon ir lrue ond correct, ond I further
.crriiy'rhor-o^y o^d oll sork prfor^.i rholl be done in qcordonca wirh ,he Ordinoncer of rhe City of Springficld ond tha Lows of the Stote of oregon
pertoining ro rio wort dercriir<i horin, ond ihot No 9CCUPANCY will be moda of ony slruclvrc without the permirsion of tha Building Divirion. I further
orrify rhot my regirrorion with rhc guildc/t Boord ir in fvll {orce ond effe<t os rcquireri by ORS 701.055, thol if exempt rhc bcsis for cxcmption ir noted
hrron, ond rhor only rvbonrrocto.r ond cmpioyeer who ore in omplionce with ORS 701.055 will be ured on ihis proiact.
DATE
i
RE
lobrt hor brro dgnod by on flocricol Controslor onci ottochsd lo lha clccrricol ponel'
Bodr lor luildc/r Eoord crcmption:
NAr\t€ (pboro prinr)
TOTAT CHARGESIOTAT CHARGESTOTAI CH^RGES
FOR OTFICE UsE ONTY
Zonr
-fype/Conrr.-Unitr -Sq.
Flg' /rtoin
f irr Zoar-Scdroomr occy Lood Sq. Ftg. Accar:
FloodPloinslo.iet-ocnGtov9-Sq.ftg.other-
x --------Voluc
x Volue
x
-.-VoluE
TOTAI. VATUATION
-
Sysiemr Developmenl
Chorqc ( l.5i6)ffi(T%*EUITOING PERMIT
Chorgrr ond
5 urcho rgr r
Plon Ck. Comm/lnd
BId Per fec
Plon Cl. Rer
Per Fee30:'.I
ffiTolol Comb. Permit
PTUMBING PERMIT _lo Fence
Demo
Chorgcr ond
Surchorgcr
t
I
lsETECTRICAT PERMIT
SidewolkChorger ond
Surchorgc r
TOIAL 0bffi
A^ECHANICAI PERT^IT
Curb CutChorgar ond
Svrchorge r
./
I
q0
a/c PovinqI
Additionol Proiect lnformorion
nqme signoture dote
PTANS REVIEWED BY:
coMElNAT|ON AppLtcATloNz/pERMtT (CAp)
l. Applicoru ro furnish
A. Job Address
B. tegol Descriptionl. exomple-tox lot .l00, Lone County Mop Referr2. eEiir"-tor l. Block 3, 2nd Addiiion to Spriig
C. Nome, etc. of owner ond construction lender
D. Energy Sources
l. exomole-heot/'electricol ceili /or forced oir g2. eE---i-G-worer eo ter/.ect r co or solor
E.
PERMIT VALIDATION
clTY OF SPRINGFIELD c,
CltY Holl
Sprlngfield, Oregon
o"poi."it of Public works C
OFFICIAT RECEIPT
No. B 56949r
1-l9
Rec'5
Sguore footoge or voluotion, etc.I. exomole-1250 sq. foot house, 500 so2. e xEEr r-E-'?l& p ro i ect, cneck
-new-i
f
odd, erc.
ti
I
{
foot gorc
oddition,
F. Building permit informorion:
l. exomole-construct single fomily house wilh on r
goroge
2. exomole-remodel existing goroge into fomily rc3. ex#E]-e-convert single fomily rlsidence into
resrouronl (chonge of use)
G- Volue of work os defined in Seciion 303 (o) of the
Structurol Soeciolty Code
H. DESIGN TEAM AND CONTR.ACTORS
To ovoid design or consrruction deloys, Building DirSloff must be oble lo contocl oppropriote persons r(design informsrion or iob site corrections, etc.
It. Abhiev;oted Plumbing, Mechonicol & Electricol Schedul
A. Except where blcnk spoces occur in the descriplion Iof the Mechonicol ond Electricol Schedules, the oppi
need fill-in only rhe No. Boxes od[ocenf to the opprc. iiem(s) to be instolled
B. Full Plumbing, Mechonicol, ond Electricol Schedules
ore ovoiloble ot rhe Building DivisionI. To conserve spoce on ,he permil form the schedul
hove been obbrevioted
2. lf ,he item(s) to be instolled ore not covered on th. oted scheduler you should consult ,he full schedul
C. BUITDING DIVISION STAFF WILL FILt OUT ALL FEES.A
CHARGES ON THE SCHEOULES
llt. .Applicont to sign onci dore
Whenever possible, the iniriol opplicotion will be used osworksheet only. Where possible, Building Division Stdff vprepore o typewrirten cop), ond return it to the opplicontthe time rhe oouol permit is issued for his signotuie.
tV. Feet ond Chorges
AUTXORIZED
sH!!loi.Tult!u!! tRIiYERS CUGEXE Ol 97'Ol !6 !r t.a
f.rs
Recei ved For:
/1V Ltr
A mounl Received
Permit Clerk
(
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(00
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0
C'O
BY
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Plon check fees ore due and poyoble or the time of the opplicorion,ond no plons will be orocessed until these fees ore poid. .lllother feer ond chorges ore due ond poyoble wh"n ihe permiti: issued.
V. FOR OFFICE USE ONLY
(
PROJECT CCNDIIIONS TO 8E SATISFIED BEFORE OCCUPANCY:
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