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Home My WebLink AboutPermit Building 1982-03-05CITY OF SPRINGTIELD COAIBINAIION APPLICAT'ON I PERIT'T Lood -.----Sq'croup 82 sq. TNFORIAAIION TINE 72&3753TNSPECT]ON lINE 72&.3769 tne t42 od Ploin .IDING PERMIT ,rges ond horges IBTNG PERMIT Ies ond drges ICAI PERMIT :i ond tges NICAT PERMIT r ond ,es WHERE STAIE TAW REOUIRES that thr Elecfticol work bc donc bY thc Electricol Conroclor. thc elecl]icol porlion of this permit sholl not ba volid unlil o lobel ho: been signed by on Electricol Controclot and ottqched to thc cleclricol Pcnel. s lrue ond correct, ond I further the Lows of the Stote of Oregon of the Building Division. I further the bosis for exemPtion is noted Bosis for Euilder's Boord exemplion: L)SIGNATURE DA {A/rtE (pleose Print) FON, OFTICE USE ONIY Typei Const' V-N unil, Flg. Access x Vo lue Ftg. Other-x -Volue TOIAT VATUATION, Sq. Ftg. Moin a -------Volue Job Ro ENERGY SOURCES: Heot Woter Heoler Sq. Ftg' Moin Sq. Ftg. Access. Fence .-Demo-Chonge/Use Otner A lrar A-n -New A Volue of Work: Bu (i.e., Build SingleDescribeWork Phone 7 Address 406 W. 28 th Street @l\)oH G)(rl Phone Address (lics. no.) DESIGN TEAM (nome) Oct 826664 935-311 247.ISFred F Electricol ETECTRICAL Mechonicol MECHANICAL PIUMBING CHARGEFEENO.CHAR,GEFEE furnoce/burner to ,sResidence of {r.le fixtureEoch Applionce vent teNew circuils, olterqtions or exlensionsRelocoted building fix. odditionol)Slolionory evoP. lerSERVICESS.F. Residence I both)Vent fon with single ductConslructioneochVenl syslem oPort from or A.C. Additionol both Mechonicol exhousl hood Woler rervice PumTEEDERSStorm Sewer Air hondler to CFM Air hondler over ISSUANCE OF PERMIT TOTAT CHARGESTOTAT CHARGESTOIAL CHARGES NASystems DevelopmentrChorqe (1.57o)slB-20 Pd 3-4-BiPlon Ck. Comm/lnd Per Fee #8581 49 Plon Ck. Res 3oo/o/Blds Per Fee2 ___J 28- 00 Totol Comb. Permit Fence Demo c Sidewolk IOTAI. s?9.12 Curb Cut Bedrooms Amps. Wood slove/heoler Sewer COMBINATION APPLICATION/PERr\^' r (CAP) l. Applicont to furnish A. Job Address B. Legol Descriptionl. exomple-tox lor 100, Lone County Mop Reference l7 03 432. exomple-Lor I. Block 3,2nd Addiiion ro Springfield EstotesC. Nome, etc. of owner ond construction lender D. Energy Sources l. exomple-heot/electricol ceiling./or forced oir oos2.e:o-mFG-woterTEote-TelEctric-rcol/"r;;ffi E. Squore footoge o. ,rolrotionlel._ I Agr!js-,l,zl9 tq.foot ho.use, 500 sq. foor sorogez. ex.o.mpte-rt new proiect, check new_if oddition, checkodd, etc. F. Building permit informotion: .1. exomple-construct single fomily house with on oltochedgoroge 2. glomple-remodel existing goroge into fomily roomJ. exompte-convert single fomily residence intorEGuIEnr (chonge o1 use) G. Volue of work os defined in Section 303 (o) of theStructurol Speciolty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction deloys, Building DivisionStoff must be oble to contoct oppropriot" p"rro-n. ,"goJingdesign informotion or iob site correltions, elc. ll. Abbrevioted Plumbing, Mechonicol & Electricol SohedulesA' Except where blonk spoces occur in the descriprion portionof the Mechonicol ond Elecrricol Schedules,ii; ";pil;;;,need fill-in only the No. Boxes odiocent roif,. "p[op.i"r"item(s) to be instolled B. Full Plumbing, Mechonicol, ond Electricol Schedulesore ovoiloble ot the Building Divisionl. To conserve spoce on the permit form the scheduleshove been obbrevioted 2. ll the item(s) to be instolled ore nor covered on the obbrevi-oted schedules you should consult the full schedules - - C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANDCHARGES ON THE SCHEDULES lll. Applicont to sign ond dote Whenever possible, the initiol opplicotion will be used qs o. worksheer only. where possibre, 'Buirding Division sroff wiilprepore o. typewritten copy ond return it to the opplicont otthe time the octuol permit is issued for his signotuie. lV. Fees ond Chorges Plon check fees ore due ond poyobre ot the time of the oppricotion,ond no plons will be processed until these fee, ore p"U. iii -- other fees ond chorges ore due ond poyoble ,"t,"n rt" p"iiitis issued. V. FOR OFFICE USE ONLY PERMIT VALIDT,IION Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: {x\\.ts \r-s c t )la-Dr \J Q.S-\ Additionol Proiect lnformotion: PLANS REVIEWED BY:r) signolure clotenome W, =_eFpfqf--fiElq re sl 406 ooN)O FJq) (Jl Legol Dercription Bu Describe Work (i.e., Build Single (lics. no.) -Other 5 Phone (nome)(oddress)no.) 406 l^.l. 28th Street Phone 7 t reel, Springf-i-eld 80 Pernr i tng Residence With Atto Volue of Wort<: Sq. Frg. OtherrLDonalio ?L3 C)wner Address Address DESIGN TEAM Ron INSPECIION tINE 7263769'CIIY OF SPRINGFIETD COMBTNAIION APPI.TCAIION/PERMIT INFORMATION TINE 7?63753 Sq. Ftg. Moin Sq. Ftg. Access. -New --Add-Alter-Rep, . Fence -Demo-Chonge/ Use ENERGY SOURCESI Heot - Woter Heoler - 6664 935- 73 1 Electricol Oct 82 i\{echonicol CONTRACTORS no Fred Francis 247 k m Electrico I Mechonicol PTUMBING ETECTRICAT AAECHANICAL NO.FEE CHARGE NO.FEE CHARGE NO.FEE CHARGE Eoch single fixture Residence of +t, furnoce/burner to Relocoted building (nerv fix. oddirionol) New circuiis, olterotions or exlensions Applionce vent sepqrq le S.f. Residence (l both)SERVICES Slotionory evop. cooler Duplex (l both) eoch Temporory Consiruclion Vent fon with single duct Additionol both Amps Vent syslem oport from heoting or A.C. Woter service Mechonicol exhousl hood ond duct Sewer Wood stove/heoter Slorm Sewer FEEDERS Heot Pump Ampr Air hondler ro r0,000 crM Air hondler over r0,000 cfM ISSUANCE Of PERMIT TOTAT CHARGES TOTAI. CHARGES TOTAT CHARGES WHERE STATE IAW REQUIRES ths, rhe Electricot work be done by rhc Etacrricot labct hor been signed by on Elecrricot conrroctor cnd ottqchcd to the elecrrical I conlrooor. the elecrricsl porrion of this permit rholl not bc volid untit oponel. opplicotion for permit, ond do hereby certify rhor oll informotion hereon is rrue Crl SIGNATURE EXAMINED the completed oll work performed :holl'ony lo the Oregon further proiect, I HAVE CARETULTY ond correct, ond I furthercertify thot ond be done in qccordonce with the Ordinonces of the Ci ty of Springfield ond the Lows of the Stote ofwork described herin, ondPertoining thot NO OCCUPANCY will be mode of ony structure wilhout the permission of the Building Division. Icerilfy thot my ,egistrotion with. the Builder,s Boord is in full {orce ond effect os required by ORS 70I.055, thot if exempt the bosis for sxempt;on is noiadheron, ond thot only subconlroctors ond employees who ore in complionce w ith ORS 701.055 will be used oorrS-/*4P4 Bo:is for Builder's Boord exemption: NAA,IE (pleose print) B2Group Oecv Lood FOR OFfICE UsE ONLY Zone Sq. Ftg. AccessFire Zone-Bedrooms Flood Ploin TOTAT VATUATION t42 .typ"/conrr. V-N Unirs --Sq. Frg. i{oin Sq. Ftg. Other.............-.- x Yolue x -Yolue a -[slss Plon Ck. Comm/lnd 65026/Bldq Per Fee $18.20 pd 3-4-Rt Systems Development Chorqe (1.59l.)NA EUITDING PERMIT Chorges ond Surchorges ---128-L0 1 Plon Ck. Res 30%/8lds Per Fee #8581 4q Fence PI.UMBING PERMIT Chorges ond Surchorges Demo fotql Comb. Permit Sidewolk ETECTRICAL PERMIT Chorges ond Surchorge s A/C Povino Curb Cut MECHANICAT PERMIT Chorger ond Surchorges ttl TOTAL $2e .12 SorinofiF'ld- 0R 97 477 Ncw rnnf Con:truclion Lender -BTI.J'S COMBINATION APPLICATION/PERMIT (CAP) l. Applicont to f urnish A. Job Address B. Legol Descriptionl. exomple-tox lot 100, Lone County Mop Reference.IT 03 43 2. exomFle-Lor l. Block 3, 2nd Addition to Springfield Estotes C. Nome, etc. of owner ond construction lender D. Energy Sources /. I . elS11plg- h.o t/q! t{1lgllqllng /or f orced o i r gos 2. exfiFE-w o te r T-eEiF/6lE-ct ri co l / "r @ PERMIT VATIDATION CITY OF SPRINGFIETD City Holl Springfield, Oregon Deportmenl of Public Works OFFICIAT RECEIPT E. Squore footoge or voluotion, elc.I. exomple- l 250 sq. foot house, 500 sq. foot goroge 2. exomFE-iT-new proiect, checkiEi-if oddition, cher odd, etc. F. Building permit informolion: .1. exomple-conslruct single fomily house with on otlc goroge 2. exomple-remodel exisling goroge into fomily roon 3. exompfe-converl single fomily residence inlo reEtolront (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 Divis Stoff must be oble lo contocl oppropriote persons reg design informotion or iob site correclions, elc. ll. Abbrevioted Plumbing, Mechonicol & Electricol Sc,heduler A. Except where blonk spoces occur in the description pc of the Mechonicol ond Electricol Schedules, the opplic need fill-in only the No. Boxes odiocent to the oppro; item(s) to be instolled B. Full Plumbing, Mechonicol, ond Electricol Schedules ore ovoiloble ot the Building Division I. To conserve spoce on the permil form the schedule hove been obbrevioted 2. lf the irem(s) lo be instolled ore nol covered on thr oted schedules you should consull the full schedul, C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES A CHARGES ON THE SCHEDULES lll. Applicont to sign ond dole Whenever possible, the initiol opplicotion will be used o . worksheet only. Where possible, Building Division Stoff prepore o typewritten copy ond return it to the opplicon the time the octuol permit is issued for his signoture. lV. Fees ond Chorges Plon check fees ore due ond poyoble ot the lime of the , ond no plons will be processed until these fees ore poid other fees ond chorges ore due ond poyoble when the J is issued. +- V. FOR OFFICE USE ONLY PLANS REVIEWED BY: i'l ( r,J B 58160 (l (lar9 0 ( (' (o C (l ('' I (l.) (,\r ( ( (. ( BY ( ( ( ('' nt Received HORIZEO SIGNATURE SHELfO(.iURTEULL FiIIIERS, EUCEXE, OR 97'Ot Permit Clerk -l PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: -- C t )laSr \-j $s-\-$n\.C Additional Proiect lnformofion: nome Dan Sml th signorure dote 3-d-82 i" For: **