HomeMy WebLinkAboutPermit Building 1981-02-19I
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INSPECTION r.INE
72(-.3769 DEu i u rrE0 INFORTAAIION tINE
72.F3753
CITY OF SPRING'IEID,roN AppucATrox/ penmtrNOT IED
Job
lDescription 17 03 27 44 TL 800
1225 Water Street Exist qasWoter Heoler
Ronge
Volue of Work:
11m880.00
-New-Add-Alter-Rep.
-tence-Demo-Chonge/
Use
-Other
Sq. Ftg. Moin 43?
Sq. Ftg. Acce5r.
Sq. Ftg. Other
PhoneAddrers
Building Permit lnfo: Describe Work (i.e., Euild Single
Fomily Residence With Atoched Goroqe)
Springfield, Oregon 97477 Rpsr'dpntia'l Addition
Address Phone
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DESIGN TEAA{ (nome)(oddress)(lics. no.)(expires)(phone no.)
OwnerPrimory
Electricol
/r{echo nicol
CONTRACTORS (nome)(oddress)(lics. no.)(expires)(phone no.)
Generor 0wngr
r!{echonicol
PTUMBING ETECTRICAT MECHANICAT
NO.rEE CHARGE NO.FEE CHARGE NO.FEE CHARGE
Eoch single fixlure
Residence of
fr.
furnoce/burner fo
Relocoled building
(new fix. odditionol)3
New circuits, olterotions
or extensions 15.00 1
Applionce vent
seporote 3. 00
S.F. Residence
(l both)SERVTCES
Stolionory evop.
cooler
Duplex (l both) eoch Temporory Construction
Vent fon with
single duct
i Addirionol bolh 10. 00 Amps.1
Yent syslem oport from
heoting or A,.C.3.00
Woler tervice
Mechonicol exhoust
hood ond duct
Sewer Wood stove/heoter
Storm Sewcr FEEDERS Heol Pump
Ampr.
Air hondler to
r0,000 crM
Air hondler over
10,000 cFA^
rssuANcE oF PERMTT 10.00
TOTAI. CHARGES 10.00 TOTAT CHARGES 15. 00 TOTAI CHARGES 15-00
WHERE STAfE fAW REOUIRES thot ,hc Ehctticol work bc done by tha Elacrrical Conlroctor, thc clcctricol portion of this pcrmit rhott not bo volid until olobal hos bon signed by on Elachicol Contractor ond ottoched to the clectriccl ponel.
I HAVE CAREFULIY EXAMINED the completed opplicotion for permit. ond do hereby certify ,hot oll informotion hereon is true ond correct, ond I furthercerlify thot ony ond qll work performed rholl be done in occordonce with the Ordinonces of rhe City of Springfield ond lhe Lows of the itote of O.egon
Pertoining to the work described herin, ond thot NO OCCUPANCY will be mode of ony siructure without the permission of the Building Division. I furiirercertlfy thot my regislrotion with the Builder's Eoord is in full fore ond effect os required by ORS 70I.055, thot if exempt ihe bqsis for-exemption is noiedheron. ond thot only tubcontrqctors ond employees who qre in omplione with ORS 7OI.055 will be used on rhis proiect.
-{SIGNATURE DA
Bosis for Builder's Eoord exemplion:
NA,IY{E (pleose prinr)
Sq. Ftg.
Lood
Group
So Flg. Access
Sa Ftg. Moin
P-
x lueConst.tsTvp" I
B€d rooms
FOR OFTICE UsE
ri.u Zon" NA
Zone
Flood Ploin N0 Sto
1-[qlss
x
-lslqs
TOIAT VATUATION
Plon Ck. Comm/lnd
6595/Blds Per Fee
I sy,r"-,
I chorqe
Development
(1 .s%)
Plon Ck, Res
30%/8ldg Per Fee 18.00 PD 11-20-l i0
Fence
REC# 55233 Home owners
20
PTUMBING PERMIT
Chorges ond
Surchorges
10.00-----;{0-
EUITDING PERMIT
T4A
Chorges ond
Surchorger
60.00
Demo
tvql l gtrg
Totsl Comb. Permit 1 5
SidewolkChorget ond
Surchorger
5.00
.67
PERMIT
1
A/C Povinq
Curb Cut
MECHANICAL PERT'tlT
Chorger ond
Surchorges
q.go
.64
1
TOTAT 115.?4
1??5 Watar Strpot
Construclion Lender
Structurol
Plumbing
Electrico I
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coMBTNATTON APpLTCATTON/pERMrT (CAP)
l. Applicont to f urnish
A. Job Address
B. Legol Descriptionl. exomple-tox lot I00, Lone County Mop Reference
2. exomple-Lot l. Block 3, 2nd Addition to Springfield
C. Nome, etc. of owner ond construction lender
D. Energy Sources
I. exom e-heot ,/electricol ceiling,/or forced oir gos
2. exom heoler /or solor
E. Squore foologe or voluotion, etc.l. exomple-1250 sq. foot house,500 sq. foot goroge
2. exomple-if new proiect, check new-if oddition, che
odd, etc.
F. Building permit informolion:
l. exomple-conslruct single fomily house with on olt(
gqroge
2. exomple-remodel existing goroge into fomily roor
3. dAmFfe-convert single fomily residence into
relTEui6nt (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 construction deloys, Building Divir
Sloff must be oble to conlocl oppropriote persons re(
design informotion or iob site correclions, etc.
Abbrevioled Plumbing, Mechonicol & Electricol Schedule
A. Except where blonk spoces occur in the description p
of the Mechonicol ond Electricol Schedules, the oppli
need fill-in only the No. Boxes odiocent to lhe 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 nol covered on th
oted schedules you should consult the full schedu
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 <
worksheet only. Where possible, Building Division Stoff
prepore o lypewritten copy ond return it to the opplico,
,"," L' [ <d ,,glo' B 55S 44
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CITY OF SPRINGFIEID
Ciry Holl
Springfield, Oregon
Deportment of public Works
OFFICIAL RECEIPT
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Received For:
PERMJI VALIDATION
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Amounl Re ceived
Permit Clerk
AUThORIZEO SIGiATUR€
SXELTON.YUiX!ULL P{INTEIS . EUG€NE OR 97'OI
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the time the octuol permit is issued 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 lhese fees ore poid. All
other fees ond chorges ore due ond poyoble when the permit
is issued.
V. FOR OFFICE USE ONLY
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additionol Proiecl lnformolion:
PTANS REVIEWED BY:
DAN SMITH 1 1 -25-80signoturedoteno
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