HomeMy WebLinkAboutPermit Building 1981-03-09vu \
IN'PECTION IINE
72C3769
CITY INFORMATION TINE
72L3753col\t8tNA TION / PENMTI
ng Permit lnfo:
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Describe Work (i.e., Buiid Single
Volue oI Work:
Sq. Ftg. Access.!r\-ENERGY SOURCES:
Hesl
-
Woter Heoler
Sq. ftg. Moin
Sq. Frg. Other
-New
--Add -Alter--ReP.
-Fence-,Demo-Chonge/
Use
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Addrerr Phone
(lics. no.)(expires)(nome)no.)DESIGN TEAM
Primo
E lectri col
Slrucfurol
Mechonicol
CONTRACTORS (nome)(oddress)(lics. no.)(expire s)(phone no.)
Cjt^)-ru-fGenerol
Plumbinq
E lectricol
Me<hqnicoi
ELECTR!CATPIUMBING MECHANICAT
No. i FEE CHARGE No.i I rEE CHARGE NO.FEE I CHARGE
I Eoch sinqle fixture
Residence of
-sq.
ft,
furnoce/burner lo
-BTU'S
Relocqted building
(new fix. odditionol)
New circuils, olterotions
or exlensions
Applionce vent
seporote
S.F. Re:idence
(I both)SERVICES
Slotionory evop.
cooler
Duplex (l both) eoch Temporqry Conslruclion
Vent fqn with
single duct
Additionol both Amp:.
Vent syslem oport from
heoting or A,C,
Woter tervice
Mechonicol exhsust
hood ond duct
Sewer Wood stove/heoter
Slorm Sewer TEEDERS Heot Pump
Ampr.
Air hondler lo
r0,000 crM
Air hondler over
10,000 cFM
ISSUANCE OT PERMIT
TOTAL CHARGES TOTAI. CHARGES
WHERE STATE LAW REOUIRES lhot the Electricol work be done by rhe Electricol Conrtoctot. rho slxtricgl portion of this permit :holl not bc valid until o
lobel hos been rignad by on Elcctricol Controctor ond ottoched to the elactricul ponel.
TOIAI. CHARGES
I HAVE CAREFULLY EXAMINED rhe completeri opplicotion for permit, ond do hereby certify rhot oll informotion hereon is true ond correct, ond I furthercertify ihoi ony ond oll work performed :hoil be dcne in occordonce with the Ordinonces of the City of Springfield ond the Lows of the Stote of Oregonpertoining to ihe work described herin, ond lhot NO OCCUPANCY will be mode of ony strucrure without ihe permission of the Building Division. I furiherertlfy thot my tegitlrotion with the Builder's Boord i: in full force ond gFfect os required by ORS 70I.055, thot if exempt the bosis for exemption is noted
heron, ond thol only subconlrocfors ond employees who ore in omplionce wirh ORS 7O1.055 will be used on this proiect.
DA'
Bosis for Builder's
NAA{E (pleose
FOR OFFICE USE ONI.Y
Ftg. Other-x
-Volue
-
ToTAL YAr.uAT pN Z@to;@-
Arl ,15 .Type/Conrt.g-A/lt
lood
-Sq.
crorp tVI-/ sq.
Flg. Access
Zone
OrvFire Zone Bedrooms
Flood Ploin .-t Storier-Occy
nilr / Sq. Ftg. Moin x Vo lue
x Yolue
Systems Development
Chorqe (I.5%)
BUII.DING PERMIT
Chorget ond
Surchorges
Plon Ck. Comm/lnd
Fee
b
Plon Ck. Rer e,qf-/,i"s cL{t,CC o/, .41r-kl
PTUMBING PERMIT
Chorges ond
Surcho rges
Fence
Demo Totol Comb. Permit ^ 1^, '^J'L,.) , e-
ETECTRICAT PERMIT
Chorges ond
Surchorges
Sidewolk
MECHANIC.AT PERMIT
Chorges ond
Surchorges
Curb Cut
TOTAT
'o Lo,g3
,
- .'4 7L4-
c.l
(oddress)
Nttr-vrDl-
2o,ca
t rlc
a/c p.";^.
COMBIN.ATION APPLICATION/PERMIT (CAP)
l. Appliconr to furnish
A. Job Address
B. Legol Description
F. Building permit informotion:I. exomple-construct single fomily house with on ottcgoroge
2. exomole-remodel existing goroge inlo fomily roon3. exompfe-convert single foiily r-esidence into
restouront (chonge of use)
G. Volue of work os definecj in Section 303 (o) of the
Structuro I Specio lty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction deloys, Building DivisiStoff must be oble to conlocl oppropriole p"rron, ..g,design informotion or iob site corrections, efc.
ll. Abbreviored Plumbing, Mechonicol & Elecrriccl Scheciules
A. Except where blonk spoces occur in the description poof the Mechonicol ond Electricol Scheciules, the oppiicr
need fill-in only the No. Boxes odiocent to fhe opprop
item(s) to be instolled
B. Full Plumbing, Mechonicol, ond Electricol Schedules
ore ovoiloble ot the Building Division
'1 . To conserve sDoce on the permit form the scheduie:
hove been obbrevioted
2. lf rhe item(s) to be instolled ore not covered on the. oted scheduies you should consult the fuil scheduler
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AN
CHARGES ON THE SCHEDULES
lll. Applicont to sign oncj dote
Whenever possible, the initiol opplicotion will be used os
worksheet only. Where possible, Building Division Sroff w
prepore o typewriilen copy ond return it to the opplicont ,
the time the octuol permir is issued for his signotuie.
lV. Fees ond Chorges
Plon check fees ore due ond poyoble ot the time of
snd no plons will be processed until these fees ore
ofher fees ond chorges ore due ond poyoble when
is issued.
V. FOR OFFICE USE ONLY
the op
poid. I
the per
I. exomple-tox lot I00, Lone County Mop Reference I7 03 432. exomple-Lot I. Block 3, 2nd Addition to Springfield EstoresNoif, JIof owner ond construction lender
Energy Sources
I -:*E-h.u"r*l**+!F/or forqed oir sos ( ,l. exomple-woter heoter., etectricol.,'or solor
Squore footoge o. rolrotioilJ.-
l. exomple-I_250 sq. foot house, 500 sq. foot gorogez. ex.o.mpte-ii new proiect, check new_if oddition, cheodd, etc.
PERMIT VALIDATION
CITY OF SPR!NGFIELD
City Holl
Springfield, Oregon
Deportment of Public Works
OFFICIAT RECEIPT
0. B 560ii2
Received For
Amount R
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AUTHORIZEO SIGNATURE
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Permit CIerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project lnformotion:
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PTANS REVIEWED BY:
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