The URL can be used to link to this page

Home My WebLink AboutPermit Building 1981-09-10CITY OF SPRINGTIETD COMBINAIICN APPTICAIION / PERMIT INFORMAIION TINE 72C37 53INSPECIION TINE 72(-X769 iel 6n 61 5TAddre sr legol De<cri 5q. Ftg. Moin -New-Add -Alter-ReP'- -Fence-Demo-Chongei Use ENERGY SOURCES: Heo t -Olher Ro Woter Heoter Volue of Work: Bruce P Build SinqleBuilding Permit lnfo: wirh A GoFo De rcr i be Work (i.e Pho neAddrer:exiBuild a deck next to 6 O(tl Ol! PhoneAAddrerr res)(lics. no.)(oddresr) DESIGN TEAM (phone (nome) Primo Str ucturol nicol (nome Plumbin ETECTRICAT NA?TUMBING NA FEE C A^ECHANICAL NA NO. Electrico I l'{echonicol FiE ARGENO.CHARGE furnoce/ burner lo '--BTU'SResiCence oi fr.Eoch:ingla {i:tre Appiionce vent sepo ro teNew circuils, olteroliorrr 6y glfgp5icnsRelocoted building (new fix. odcjitionoD SERVICES S.F- Reriden5e (l both) Slolionory evop. cooler Vent fsn with sinqie duclTemporory C9ry!IY!!!L-Duo le x 'I both) eoch Vent sysiem oPorl from heoting or A.C.Ampr.Aciditionol bqth Mechonicol exhoust hood ond duct Woler rervice Wood :tove/ heoler Sewer Heol PumpFEEDERSSior.m Sewer Air hondier to 10.000 cF,iiAmpr. Air hqndler over 't 0,000 cFM ISSUANCE OF PERA{IT Eosis for Builder': Boord exemption! TOIAI. CHARGESTOTAL CHARGESTOTAT CHARGES P ,4t/*SIGNATU ,e /oDATE unrilYolid orhisof:holl banotelectricolthapcrmilConlroc:or,porliontheE!e.lricalworkcoldonebeEOIRESihethotElectribysrWHERE,TEA w UTA lhc elscrricoltoLOsncnltoqtor Panea.ottothed€lEcrricol9nnodhorIobelbeenrigby EXAMINEO the comPleied oll work performed sholl be mode of ony effect os required ond furtherIiioninformor5hereonondtrueco..ecl,do thotforcertifyh erebyondtiont,pplico permiETU Lt YHAcA8VE nd Lo wslhe theof ofStoteofnqnce5the Oregono(lhewith (Jrdl City SpringfieldIdoneoccordqncenbethotqndonycertify furtherofSStOnBuildilheDi3ton.withoutstructure ngthepermiYwillftthoiondOCCUPANC'NOthekoCercribehen,lonlngpertoi ts noted70oRsIthstfhetorbosis.055.exempl exemptionndbytnt5IulloforeBuiBoordIder'slhethotwithrtrotionmyre9erlily 70ORS .055 bewill onucd rhistnwith proieGt,afewho omplioncettrosubconondctorsondlhoemployeesheron,only NA,lv{E (pleose prinr) zon, R 1 typuiconrt. V-N unit, fire Zone-Bedrooms occY Flood Plcin ----Stories----OccY a Yo lue x _..--Volue 1-Volue TOTAT VALUATION FOR OfTlCE UsE ONIY Sq. Ftg. Moin Ftq. Access Frg. Other-"--- Lood _--5q. crorp R3 sq. Sy5tems Development Chorqe (1.5".'o) Plon Ck. Comm/lnd 6596/Bld-d Per Fee Plon Ck. Res 30".6/ Bldg Per Fee BUITDING PERMIT Chorges ond Surchorges ----$5'oo .20 Fence Totol Comb. PermitDemo PTUMEING PERMIT Chorger ond Surchorger Sidewoik A/ C Povino I I Chorger ond Surchorget ETECTRICAI PERMIT Curb Cut TOTAI $5. 20 MECHAN ICAI. PER}AIT Chorger ond Surchorge s coMBlNATroN ApplrcATroN/pERMii rcap) l. Appliconl ro furnish A. Job Address PERMIT VATIDATIQP{ Legol Description 'l . exomple-rox lor lO0, Lone County Mop Reference I7 03 43 :: efi;'pl;-Lor t. Btock 3, 2^d AJJirl; iJsp.i,",sfiuld EstoresNome, etc. of owner ond construction lender Energy Sources I -:g!+: heov'eteolicol feitilg/or forced oir sosz. exomore_worer heoter eleiJii-col ior@ Squore footoge or voluotion, etc. I =++-.Elg rq.foot house, 500 sq. foot sorosel. exomple-if new Droiect, checkie-w-if oddition, cieck;Ja.;,c. F. Building permit informofion:I. exomple-construct single fomily house with on ottochedgoroge 2. exomple-remodel existing goroge into forriily room3. eG;EE-convert single fir;iiy residence inro. restouront (chonge of use) G. Volue of work os defined in Section 303 (q) of theStructurol Speciolty Code H. DESIGN TEAM AND CONTRACTORS To ovoid design or construction cjeloys, Building DivisionStoff must be oble to contoct oppropriote p.rrJr,, r."goidingdesign informo?ion or iob site corrections, etc. ll' Abbrevioted plumbing, Mechonicor & Erecrricor schedures.A. Except where blcnk spoces occur in the description portion. of the Mechonicol ond Electricol Schedules, ,i: ";pi;;;;;need fill-in ":ly rl.u No. Boxes odiocent t" ti," "pii"pri"t"irem(s) to be instolled B. Full Plumbing, Mechonicr:1" ond Electricol Schedulesore ovoiloble or the Building DivisionI. To conserve spoce on the permit form the schedules .jhove been obbrevioted2. lf the item(s) to be instolled ore not covered on the obbrevi-. oted schedules you should consult the full schedulesC. BUILDING DIVISION STAFF WILL FILL OUT,AtL FEES ANDCHARGES ON THE SCHEDULES lll. Appliconr to sign ond dore Whenever possible, the iniriol opplicotion will be used os oworksheet only. Where possible, 'Building Division Stoff willprepore o typewrilten copy ond return it to the opplicont otthe time the octuol permit is issued for his signotule. --"' -' lV. Fees ond Chorges Plon check fees ore due ond coyobre ot the time of the oppricotion,ond no plons will be processed until these fees ore p"U. ijiother fees ond chorges ore due ond poyobre,"t.n'trt. p".irtis issued. V. FOR OFFICE USE ONLY B. c. D. E. Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additionol Proiect tnformotion: PLANS REVIEWED BY: nome signoture dote IN5PECTIQ'' tINE 77G375. Job Addrcl 5195 ol Dercri OESIGN TEAM CIIY OF SPTINGTIETD COMSINAIICN APPTICATION/ PERMIT EN€RGY SOURCES: Heot - Wote? Heolea Ro INTOPMAIION TINE 72e3753 Sq. Frg. Moin Sq. ttg. Accerr. Sq. Ft9. Orh.' -New -Add -Alter-RcP.- -tencc-Demo-Chongc/ Urc iel @ O(,r O)!e- Volue of Worl: (nomei (oddrers)(lig. no.)(expirer)no.) P rino Slructuro I ctricol RACIORS (nom e)te no. netol Plum € !eclr;co I idechonicol MECHANICAL NA FEE CHARGT ISSUANCE OF PER,IAII TOTAT CHARGES WHERE SfAIE tAW REOUIRES thot ,he Elccrricol work ba done by thc Elc.tricol Conlroctor, lha rlcctricol portion of thir pcrmit rholl not br valid ualil o lobcl hor bccn rigned by on Elactricol Controdor cnrj oltoched to lhc clcaricol ponel. IHAVE CAREFUttY EXAf'{tNED the complcied opplicotion for parmit, ond do hercby Eertify thot oll informotion hcreon ir ,rue qnd correct. ond I furthcr (ertify rhor ony ond oll work pcrformed sholl bs done in qccordqnce with the Ordinoncer of the City of Springfield ond the Lows of lhe Slote of Oregon perroining to rhc work Ccrcribeci herin, ond rhot NO OCCUPANCY will bc mode of ony struciure withoui tha pcrmirsion of rhe Building Divi:ion. I furthar certify thot my,cAirr?otion with the Builder's Boord is in full force ond effect or required by ORS 701.055, ?hot if oxempr rhe bqsir for excmption ir noted heron. ond thor only rubconrroctoru ond cmploycer who ara in omplionce with ORS 701.055 will be usd on thit proic<t -r&.o.n P ,e ,/os?/ 8/NA,lr{E (pleore print) Zone R1 Typc/ Conrt.iir Fire Zone--Sedrooms Flood Plcin (torier-Occy SIGNATU DATE FOR OFFICE UsE ONTY lood -- G.orp R3 So-Ftg. Moin Sq. Ftg. Acce:r Sg. Ftg. Othcr- x --Voluca -Voluq x --Volue TOIAL VATUATION ;**, Bruce P. A*WfLkUsq< Fomi Re sr de nte Building Permit lnfo: Dercribe Work (i.e., Build Singlo Phone 741-0258Addrerr 6195 Thurston Road Build a deck next to the existinq house. ne PhoneAddror NA NA EI.ECTR ICAtPTUMBING NA NO.No. i I FrE i CHARGENO. 'raa i c!-rA.RGE iurnoce/'burner !oResiience oi ioch rinqle iixturc I I Appiionce veni reporotr New circuilr. olteroliorrr or exten:icngII Relocored bvilding lnew tix. odcjirionol) SERV ICES Slolionori, evop. coolerI I S.F. lerrdence (l both) Vent fqn with rinqic ductTemporory Conrtruction Venl !y3l.m oport from heoting or A.C.Am or- Duo le x I both) coch Aciditionol borir Mechonicol exhourt hood ond ductWolcr rervice Wood rtove/ heo terSewer i I Heot PumpF EEC ERSSlor.m Scwer I Air hondler to I0.000 Ct.iiAmpr. Air hondler ovar r0,000 crM I I I TOTAT CHARGESIOIAL CHARGES BUII.DING P:RMIT -$5-oo 651e1 Per Fee 30e6/ Bl Per Fec Pton Ck. Comm/lnd Plon Ck. Res Chorgcr ond Surcho rges Toiol Comb. Permir PLUMEING PERA^IT Chorger ond S urchorger Fen<e De mo Chorger ond Surchorger ETECTRICAT PERMII c Sidewq ik ATECHANICAT PER'TIT Chorqer ond Surchorger TOTAI Sy:tem: Developmant $400.00 __3TU',r I I I cha;ar /r 50,^r Ccrb Cut Borir for Builder'r Boord axemptioni 4 COMBINATION APPLICATION;PER,\A'IT (CAP) l. Appliconr to furnish A. Job Address B. LegoI Description I. exomole-tox lot 100, Lone County Mop Reference I7 03 43 2. ex;;re--Lot l. Block 3. 2nd Addition to Springfield Estotes C. Nome. etc. of owner ond construction lender D. Energy Sources l. exomple-heot/'electricol ceiling,/or forced oir gos 2. e xo6.;E-*o te r -hETEIGIFT ri co I i or@-. E. Squore footoge or voluotion, etc. l. exomole-1250 sq. foot house,500 sq. foot gorog, ( 2. e-EEre-i?;;w proiect, check-new-if oddition, ci" odd, efc. F. Building permil informotion: ( l. exomole-construct single fomily house with on ot goro9e 2. exomoie-remodel existing goroge inlo fomily roo ,' 3. exfiEj-e-convert single fomily residence into ( rffii76nt (chonge of use) G. Volue of work os defined in Section 303 (o) of the . Structurol Speciolty Ccde H. DESIGN TEAM AND CONTRACTORS To ovoid design or construclion cieloys, Building Divi Stoff must be oble lo contocl oppropriote persons re, ,'di design informction or iob site corrections, etc. ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedult A. Except where blcnk spoces occur in the description p ,ior . of the Mechonicol onci Electricol Schedules, the oppli need fill-in onlv 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 l. To conserve spoce on the permit form the schedul hove been obbrevioted 2. lf the item(s) to be instolled ore not covered on th . oted schedules you should consull the fuil schedul C. BUILDING DlVlslON STAFF wlLL FILL OUT ALL FEES A ( CHARGES ON THE SCHEDULES lll. Applicont to sign onci dote Whenever porsible, the iniriol opplicotion will be used o ( worksheet only. Where possible, Building Division Stoif ' prepore o lypewrilten copy ond return it to the opplicon the time the octuol permit is issued for his signolure. i' PERMIT VALIDATION CITY OF SPRINGFIELD CilY Holl Springfiold, Oregon Deporlmenl of Public Works OFFICIAT RECEIPT d -:t :{ .; i _l ... ;; -1: l :: .-.1-l q .11 '1 ..t- ,'J i, . -,.i qi .: :.: *fr .: ll. :.. .: B 57tel Dole I9 F S Received For Amounl ReceivedlY. Fees ond Chorges Plon check fees ore due ond poyoble ot the time of the c ond no plons will be processed until lhese fees ore poid. other fees ond chorges ore due ond poyoble when the p ir issued. V. FOR OFFICE USE ONLY BY t' AUAHORIZED SIGNATURE SHELTON.?UNTBULL PiIIT€RS . EUGETE OT 97'OI PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additionol Proiect lnformotion: dotenqmesignoture PLANS REVIEWED BY (