HomeMy WebLinkAboutPermit Building 1981-03-26IN5PECIION UNE
72&.3769
CITY OT SPRINGfIELD
coMBlNArlgN APPtlcAIloN / PER,rilr
INFORMAIION TINE
72U3753
,-f,2-ENERGY SOURCES:Sq. Ftg. Moin
Heot 5q. Ftg. Accerr.
Sq. frg, Olher
-New -Add-Alter-ReP.,- -Fence--Demo-Chonge/ Ure
\ryoler Heoler
Ro
Volue
a1 of Work:oo,o -Other+
Permit lnfo: Describe Work (i.e., Euild Single
Addrer:Reridence With Atlo
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Conrruction tender
Addre rs Phone r
DESIGN TEAM (nome)(oddress)(lics. no.)(expi re s)(phone no.)
Primo r y
Structu.ql
Electricol
>4 Z"
Electricol
Mechonicol
PIUMBING ETECTR ICAT MECHANICAL
No. i I FEE C!IARGE NO.FEE CHARGE NO.FEE i CHARGE
I
I Eoch ringle fixlure
Residence of
-sq.
ft.
furnoce/ burner to
Relocoted buiiding
(6sw fix. qdiitionoi)
New circuits, olterotions
or exlensions
Applionce vent
seporo re
5.F. Reridence
(l both)SERVICES
Slolionory evop,
cooler
Duolex (l both) eocn
I
i Temporory Construcrion
Vent fqn with
single duct
Additionol boih .Ampr.
Vent syslem cport from
heoting or A..C.
V/oler rervice
Mechonicoi exhousl
hood ond duct
Sewer Wood stove / heoier
Slorm Sewer FEEDERS Heol Pump
Amps.
Air hondler to
10,000 cFM
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Air honciter over
t0,000 crM
ISSUANCE OF PER}TIT
TOTAL CHARGES TOTAT CHARGES TOTAI, CHARGES
WHERE STAIE (AW REQUIRES rhor rho Electricql work be o'one by lhe Electri<ol Conrrsctor, the clectricol portion of this permir :holl not ba volid until o
lqbel hos b*n rigned by oo Electricol Controstor snd ottached lo tho eleclricol ponel-
I HAVE CAREFULIY EXAMINED the compleied opplicotion for permil, ond do hereby cerrify thot oll informorion hereon is irue ond correci, ond I further
certify ihoi ony ond oll work performed sholi be done io occordonce with the OrCinonces of the Ciiy of Springfield ond the Lows of the Slote oi Oregon
perroining lo rhe work de:cibed herin, ond thor NO OCCUPANCY will be mode of ony struclure without lhe permission of lhe Building Division. I further
ertlfy ihot my regiskorion with the Suilder's Boord is in full force ond effeci os required by ORS 701,055, thol if eremPt the bosis for exemption is'noted
heron, oncl thot oniy rubcontrosrors ond empioyees who ore in complione wiih ORS 701.055 will be used on lhis proiect.
Eosis for Builder': Boord exemption:3
DATEU rcNC {,(Son a
NAME (pleose prinr)A'
FOR OfTICE UsE ONTY
Zone
-Type/Const.-Units
-.--.-..--Sq. Ftg. /r1oin x Volue
x
-Volue
x
-Yolue
Fire Zone-Bedrooms occY Lood
-So.
Flg. Access
FloodPloin-slofig'-occyGroup-Sq.F'g.other
TOTAT YATUATION
BUITDING PERMIT
Chorges ond
Surchorge r
lz-co PIon Ck. Comm/l.d
6596/ Blclq Per Fee
irrrr"-, Development
I Choroe ll.5?i)
Plon Ck. Rer
3096/Bldq Per Fee
PIUTNBING PERMIT
Chorges ond
S urchorge r
Fe nce
Demo Tolol Comb. Permit
ELECTRICAL PERMII
Chorges ond
Surchorger
Sidewolk
A/C Pcvino I
A^ECHANICAT PERMIT
Chorgcr on4
Surchorger
Curb Cut
IOTAT lz4A
Job Addrasr
resor Dercriprio^ (tnpfth 5 W ASO.
V I
?h</q-q?2it)
Mechonirol
(norne)(odCress)(lics. no.)(expire s)(phone no,)CONTRACIORS
-BTU':
4">
. COMBINATION APPLICATION,: UIT (CAP)
l. Applicont to furnish
v
A. Job Address
B. Legol Description
I. exomole-tox lot i00, Lone County Mop Referenc2. e;;GG-Lor t. Btock 3,2nd Addirio^,Jsp.j"gJr.
C. Nome, etc. of owner ond construction lender
D. Energy Sources
l. exompie-heolrelectricol ceiling,r,or forcecj oir oos2. e,6ilEiE- w o te r IEo tEFllEIdo t .,.o.ijE?.-.:
E. Squore footoge or. uolrotiofE]_l. exomple-1.,3!0 rS. foot house. 500 sq. foot gorogt2. ex,ollE-iFnEw proiecr, .hei[ nu*-lf ocidition, chooo, etc.
F. Building permit informorion:I. exomple-construct single fomily house with on ollgoroge
2. excmpie-remodel existing g<:rqge inlo fomily roo3. @-ccnverr single fomily risidence intJreslouront (chonge of use)
G. Volue of work os defined in Section 303 (o) of theStructurol Speciolry Code
H. DESIGN IEATA AND CONTRACTORS
To ovoid Cesign or construciion o,eloys, Building Divi,Stoff must be oble to contoct oppropriote purrJn, ..1desiEn informction or [ob site corrections, etc.
ll. Abbrevioted Plumbing, Mechonicor & Erectricor schedureA, Exceot where blonk spoces occur in fhe description orof the Mechonicol ond Elecrricol Schedules, rh; ";pii,need fill-in oniy the No. Boxes od[ocent to the oppro;item(s) to be insrolled
8. Fuil Plumbing, Mechonicoi, ond Eleciricol Scheciulesqre ovoiloble or the Building Di.risionl. To conserve spoce on the per.mit form the schedulr
ho-ve been obbrevioted2. lf the item(s) to be instolled ore not covered on tht. oted scheduies you should consult the fuil schedulC. 3UILDING DIVIS|ON STAFF WILL FILL OUT ALL FEES ACHARGES ON THE SCHEDULES
lll. Applicont ro sign ond dote
PERMIT VALIDATION
( ctTY oF SPRtNGFtELD ?Ciry Holl
Springfleld, Oregon
Deportment of Public Workt
OFFICIAT RECEIPT r
No. B 50188 (
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Received For:
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ORIZEO SIGNATURE
SHELTON.'URNB
Permit Clerk
Whenever possible, rhe iniriol opplicorion will be used o:worksheet oniy. Where possible, 'Builciing Division j.,"ff , 1. Ey
prepore o typewrilren copy ond rerurn it to the opplicont -T
Ithe rime rhe octuol permit is issued for his signotuJe.
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lV. Fees cnd Chorge, \
Plon check fees qre due ond poyobre or the time of the olptrcorion,ond no olons will be processed until these fees ore p"i". ii -
other fees ond chorges ore due ond poyoble ,"t "n
'ti" p..iitis issued.
V. FOR OFFICE USE ONLY
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additicnol Pro[ect lnformqtion:
nqme signoture dote
PLANS REVIEWED BY:
{mount aeceivea i7- 4 ( V-,