HomeMy WebLinkAboutPermit Building 1981-01-13)
INSPECTION LINE
,26-3769 CIIY OF SPR,INGfIEtD
COMBINAIION APPI.ICATION / PERMII
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TNFON,MATION LtNI:
72L3753
Heo t
ENERGY SOURCES:
h/1,1r, ('2i.-rr--
Wo ler Heoler
Sq. Flg. Acces:.
, JN ew
-
Add -!iAlte r-Rep.
- . -Fence-Demo-Chongef Use
-Other
Sq. Frg. Other
Sq. Frg. Moin
Addre:s Pho ne
Building Permit lnfo: Describe Work (i.e
Volue of Work:
soclo.o.9
Build Singie
d GoroRe
n der
Addres:Phone
00
c
c
g)
_o
DESIGN TEAM (lics. no.)(ex pire s)
(nome)
no.)
Primo
,},'le ci, o n ico I
RACTOKS
Slructv;ol
Electricol
FEE
PLUMBING
CHARGE CHARGE
EtECiR tCAL MECHANIC,AL
NO.FEE
Mcchonicol
Electricol
Plunr
ILO. L rEi lcrilscr
Residence o{
tt.
furnoce/burner loEoch:ingle fixlurg llRelocoted building
(new fix. oddirionoi)
New circuits, olterqtion:
or exrensions
,''Appiionce vent
seporc te
).
S.F. Residence
(l both)SERVICES
Stolionory evop.
cooler
Duplex (l both) eqch Temporory Consiruclion
Veni fon with
single ducr r :1:J
Additionol both Ampr.
Veni system oport from
heofing or A.C.
Woler tervice
Mechonicol exhousl
hood ond duct
Sewer Wood :tove/ heoler
Storm Sewer FEEDERS
Ampr.
Air hondler to
Heot
Air hondler over
10,000 cFM
ISSUANCE OF PERA{IT 1 i-' .
I HAVE cAREFULIY EXAMINED rhe completed opplicotion for permil, ond do hereby certify thot oll informotion hereon is true ond correct, ond I furthercertify thof ony ond oll work performed shqll be done in ocordonce with lhe Oidironce, of tha Ciry of Springfield ond the Lows of the itqte "f O;e;o;Pertoinlng Jo the work dercribed herin, ond rhot NO OCCUPANCY will be mode of ony structure without the lrmirsion of rhe auilling Division. I furlherc€rllfy thot my tegittrolion wiih lhe Builder's Boord is in full force ond effect os requirej by oRs 701.055, thot if exempt the boris for exemption is notedheron,ondthotonlyrubcontroctor3ondemployeeswhoqreincomplionewiihoRS7ol.o55willbeur;donrhisproiect.
TOTAT CHARGES TOTAL CHARGES
SIGNA DATE
WHERE STAIE tAW REQUIRES thot rhG Elccfricqt work be done by rhe Elertricol
lobrl hor been rignad by on Elcctricol Cotrtroctor ond ottoched to thc elcctricol
I conrrccror. tho clcttricol patioa o( rhir permit rholl not bc valid unril o
Pon€1.
NAME (pleose prinl)
TOTAL CHARGES
Bosir for Euilder's Boord examption:
FOR ONTY
Syslems Development
Chorqe (1.5?6)
BUILDING PERir lT
Chorges ond
Surchorges
Plon Ck. Comm/lnd
'lA
PerB.(Y
Plqn Ck. Res tr'7.'9 ?E ?a ) La i:;'.,
PTUMBING PERMIT
Chorger ond
Surchorges
Demo Totol Comb. Permit <.{o
ETECTRICAT PERMIT
Chorger ond
Surchorges
Sidewolk
MECHANICAI PERMIT
Chorget ond
Surchorgos
Curb Cut
Lrt[
/ t>u
TOTAT
Zone .Iype/Conrt.:rf\,j gn;1.Sq. Frg. i{oin
Flood Ploin Gro"pj€-Sq. Frg. other
x
x Yolue
x
-Yolue
TOTAT VATUATION r> -.inA
I
?
rl z-
,r,t)l>,'-.
I
r ,; i'3---VoluaI..' I
Foncc
A/C Pavino
coMBtNATION AppUcATtoN/prranlT (cAp)
Applicont tg furnish
A. Job'Address
B. Legol Descriptionl. exomple-tox lot.l 00, Lone County Mop Reference L_ ?: ffi-Lot l. Btock 3, 2;;;jii; ro sprinsfietd EC. Nome, etc. of owner ond construction lenderD. Energy Sources
exo m p I e - h e o r., 9lS!Illjr.!j"{.Ljlsr,exo mple-woter heoter.;elEctrico I
PERMIT VAI.IDATION
OF SPRINGFIETD
Ci?y Holt
^_
Springfield, Oregonueportmenl of public WorkrOFFIC,AI RECEIPT
No. B 556362.
or forced oir gos
or solor
E. Squore footoge or voluotion, etc.I. exomple-l 250 sq. foot house, 500 sq. foot goroge
2. exE mijE- iTT-ew pro i ect, ch eck iEi-i i o dd i ti-o n, c,-h ec t;A-r..
F. Building permit informotion:
I. exomple-construct single fomily house with on ollo(
PLANS REVIEWED BY:
( ctTY
(.,
{
sxc!,to*.-u"*"uaa r",rra"]
goroge
2. exomple-ren,odel existing goroge into fomily roorn
3. exomple-convert single fomily residence into
rGst6u?6nt (chonge of use)
G. Volue of work os defined in Secrion 303 (o) of the
Struclurol Speciolry Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construcrion deloys, Building Divisi
Stoff must be oble to contcct cppropriole persons regr
design informotion or [ob site corrections, etc.
Abbrevioted Plumbing, Mechonicol & Electricol Schedules
A. Except where blonk spoces occur in the description pc
of the Mechonicol oncj Electricol Schedules, rhe oppiic
need. fill-in only the No. Boxes odiocent fo the oppro;
item(s) to be instolled
B. Full Plumbing, Mechonicol, ond Electricol Schedules
ore ovoiioble ot the Building Division
l To conserve spoce on the permit form the schedul,
hove been obbrevioted
2. lf the item(s) to be insrolled ore not covered on th
oted schedules you should consult the full schedul
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES I
CHARGES ON THE SCHEDULES
Applicont to sign ond dote
Whenever possible, the initiol opplicotion will be used r /worksheet only. Where possible, Building Division Sroff rttprepore o typewritten copy ond return it to the opplico/, .
the time the octuol permit is is.ued for his signoture. '\
lV. Fees ond Chorges
Plon check fees ore due ond poyoble ot the time of the opplicotion,ond no plons will be processed until these fees ore poid. ill -
ofher fees ond chorges ore due ond poyoble when ihe permit
is issued.
V. FOR OFFICE USE ONLY
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SIGNATURE
EUGENE oi ,7aor aa5|.6
+
Permit Clerk
i
i:'r'1J-t-
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PROJECT CONDITTONS TO BE sATISFIED BEFCRE OCCUPANCY
Additionol proiect lnformotion:
nomc Tlre <.Li i(_)tJ signoture dole l:tL - 14 e:
(