HomeMy WebLinkAboutPermit Building 1981-03-30a
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CIIY Of SPRtNGTIEID
COMBINA IION APPT.TCAIION /PEI,I/tIT
INSPECIION TINE
7263769
]NFORMATION I.tNE
7263753
289ta North 16th Street
t7 03 36 24, TL 8300tegol
ENERGY
toveHeot
Rqn
Woler Heoler - ----
rowner Hen f Ba z
Volue oI Work:
5q. Ftg. Access.
Sq. Ft9. Other
-New-Add
Aher_Rep.
--Fence-Demo_Chonge/ Use
-Other
Sq. Ftg. Moin
9% North 16th Street ?h"^. 7 47 -7L73Addres:ng Permit info:
Fomil Go
Describe Work (i.e., Build Single
Springfield, Oregon 91477 Addition to istin I ivi
Address Phone
@
ol\)Fr
!
(nome)dress)DESIGN TEAM (lics. no.)
.M. Sl usher 8082 4 Lost Creek Road - Dexter 937-2
Mechonicol
CONIRACTORS
L.M. Slusher 80824 Lost Creek Road
Plumbi
Moore El ctri 747-0671Electrico I
Mechqnicol
AAECHANICALEI.ECTRICA!PIUMBING
FEE CHARGE NO.FEE CHARGE NO
furnoce/burner loResidence of
fr.Eoch {ixture
5.00 te
New circuilr, olteroiions
or extensions2+Relocoled building
(nerv fix. oddifionq
Stotionory evop.
coolerSERVICES
S.F. Residence
both)
Yent fon wilh
sl ductConstruclionTemeschxI
Vent system oport from
or A.C.AmAdditionol bolh
/r\echanicol exhoust
Woler service
001
Sewer
FE EDERSStorm Sewer
Air hondler to
t.
Air hondler over
I CFM
ISSUANCE OF PERMIT
15.00TOIAT CHARGESTOTAT CHARGES 15.00TOTAT CHARGES
notsholl valid untilclsctricoltheofb.Cotlt]oclor,permilportionrheElaclricolbeworkdomWHEREthdrElcctricolbyth.STATE lAw
electricolthelolobclConlrsclot ponel.ottochodondhosbeenonElecricolby:igned
DATESIGNATURE
CAREFUTTY EXAMINED the comPleled
oll work performed sholl City of
without
70r'.055,
oll hereoninformstion lruets ond ond furtherdoondhlhotcorrect,ereby certifyfort,HA opplicotion PermrVE of the ofStsteondtheLowsoflheSpringfieldwithnceerhOrdinoncestndoneq cco rdqbetho t<crtify ondsny Oregon
furtherolSSlOnthe,Division.BuildingrhebedeofstructureperminylltholondoccuNOPANCYp.r rheto describedwork heritoining n,notedifthotthet5forbosisoRsexcmptexemptionoeffectredll1vondbyrequlforcetheBocrdBuilder's tntsrhotortlfywithregistrotionmy thisirh701oR5.055 belt u:edqrewhoomplio nceondIt.on,thot ctorssubcontro ond employeesonly
.{a}^E (pleore print)
lorir for Euilder,s Boord exemplion:
FOR OTFICE UsE
3 ,975. 00
s Developmenl
( I .5",/.)
Sysiem
Chqrqe___28-00__
t.L2
Plon Ck. Comm/lnd
Fee
Plon Ck. Res
Fee
REC 56158
60. 32Totol Comb. PermitDemo
---15.g0-.60 c
Sidewolk
Curb Cut GO,3LTOTAL15. 00
ni ls
Group R.Sq. Ftg. Other---
TOTAT YATUATION
(-
Applionce vent
rhisN,EOUIRES
8.40 PD 3-25-8
coMBlNATloN APPLICATION/PERMlr (cAP)
l. Applicont to furnish
A. Job ,Address
B. tegol DescriPtion
i.=.*o-pt"-lox lot 100, Lone County MopX'eferencg.t-Z.Of f3
Z. "ffif-Lot I. Block 3, 2nd Addition to Springfield Estotes
C. NornE "t. of owner ond construction lender
D. Energy Sources
l. ei'omple'h"orlq!t!Ilg!.l!'g,/o.r forc.ed oir gos \
2. exq m tE-wote rT-51-GiGlEf-ri co l,'""oI " t
-,ry Holl
springfield, Oregon
Department of Public Works
OFFICIAT RECEIPT
No. B
r9
PERMIT VALIDATION
JTIELD
.L
(1
I
it
fl
fl
(l
(l
E. sq
l.
2.
foot ho
roiect, cl
uore footoge or voluotion, elc.56235exomle-1250 sq.
exom new p
use,500 sq. foot
heck ne*-if oddi
goroge /-
lion, cher
etc.
F. Building permit informolion:
I. exomple-construct single fomily house with on ollo
goroge
2. exomple-remodel existing goroge into fomily roon
3. Exampl-e-converl single fomily residence inlo
ElIEIront (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 conslruclion deloys, Building Divis
Stoff must be oble lo conlocl oppropriote Persons reg
design informorion or iob site corrections, etc.
ll. Abbrevioted Plumbing, Mechonicol & Electricol Scheduler
A. Except where blonk spoces occur in the description pc
of the Mechonicol ond Electricol Schedules, rhe opplic' need fill-in only the No. Boxes odiocent to the oPProF
item(s) to be instolled
B. Full Plumbing, Mechonicol, ond Electricol Schedules
ore 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 not covered on tht
qted schedules you should consult the full scheduk
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES A
CHARGES ON THE SCHEDULES
lll. Applicont to sign qnd dote
G
(
(
F
For:
Ll1,li
47",h0
il
(l
O ,r
i)('
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, Whenever possible, the initiol opplicotion will be used o' I
worksheet only. Where possible, Building Division Stoff ' \ -::-*
prepore o typewritten copy ond return iito the opplicon {ihe'ti-e the octuol permii is issued for his signolure. ,
t.
lV. Fees ond Chorges
Plon check fees ore due ond poyoble ot lhe lime of the dp-...--..-..,
ond no plons will be processed until lhese fees ore poid. All
other fees ond chorges ore due ond poyoble when lhe permit
is issued.
V. FOR OFFICE UsE ONLY
Amounl Received
Permit Clerk
AUTHORIZED SIGNATURE
SHELTON.TURilEULL PRIilTEFS EUGENE OR 974OI
I,l
A
i
PROJECT CONDITIONS IO BE SATISFIED BEFORE OCCUPANCY:
Additional Proiect lnformotion:
4. i-
f
PLANS REVIEWED BY:
TOM SHEIRBON 3-30-81nomesrgnolure
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