HomeMy WebLinkAboutPermit Building 1981-03-24INSP€CTION I.INE
72(..3769
_-
CIIY OF SPRINGfIETD
COMBINAIION APPTICAIION i
]NFONMATION IINE
726^3753
lDe oo
5
Add re rr
(oddre rs)(licr. no (phone no.)
a 6
SinglePho ne
Phone
(nomc)
$<too
Lct
8vr Permit nfolding WorkDercr i be .e(i
Fo i,Re Atto.h d
5q. FrE. Orhrr
ENERGY SOURCES:
Volue of Work:
Heol
nttlu(lion
Addrer:
OESIGN TEAM
Pr imo r
Wolar Heoter
Rqn
oo _-Othcr
-
Sq. ftg. Moin
Sq. Fts. Acccrr. SlJo+-
.-New,.-Add .-Alter-Rep.
- -Fence--Demo-Chonge/ Usc
Structvrol
Electricol
Ate cho nico I
AcioRS
Plu
Elecrricql
Mechonico I
PTUAlEING ETECTR ICAt
CHA.RGE CHARGE
Residence oflc fixture
FEE r.lo.FEE
Eoch fr
MECHANICAL
NO FEE CHARGE
furnoce/burner to
I R"lo.or"J
I (new {ir-
buiiding
odditionol)2+New circuils, olterqtions
or exlensions l5#tlS,*/Appiionce vent
sporote q 2oo
S.F. Rcridence
(l borh)SERVtCES
Slolionory evop,
cooler
Duolex I both) eqch Temporory Conslruclion I Veni fon with
single duct aao
Additionol borh ,n.p'.26D 2s99 oR06 Yent syslem oport from
heofing or A.C.
Woler rervice Mechonicoi e:hourl
hood ond duct
Scwcr Wood slove/heoier
Slorm Sewer FEEDER S Heqt Pump
I Ampr.
Air hondler to
t0,000 cFM
Air hon<iler over
I0,000 cFl
I5SUANCE OF PERHIT OC,
# 2s,qTOTAT CHARGES TOIAI CHARGES S q6.o9
WHERE STAIE IAW REOUIRES tho, th. Elactricol work be dona by thc Eleclricol ConrTsctor, rhc ctectricol portion of rhis pcrmit 3hq1 not bc vclid unril olcbcl hor bmn signrd by on Elcctricol Conirdcror ond ottoched to ihc elecrricol ponel.
ooIOIAI CHARGES
JDATEATURE
CAREFULTY
'ony
lo ihe I be mode of ony
effect os required
HA VE EXAMINED comlhe forcotion ndo do lhot olloPPlirpletedir,Perm hereby cer tify informotion Ithereon irue ond qndcorrect,furtherthooondwithncaOrdinoncethesholldonebeoccordooftheofcertifypcrformedCiiyndgLqw sthe ofSpringfield lhe ofStote Oregon
f,hedercribcd q rhond NO PANCYOCCU will restruclupartoining thoul tha 5lronpermi of Buthe ldin Division.furtherIthotndwithBuithclder'Boord ir{'fu fcre o 70oRs4rrlf\t 6Y regitlIotion by .055,iflhot the bo€rompt 5r3 tor ls tednoexemption
onl tuoco n o,ro glort nd ho qre e ORSirh 701complion be onusedemployear this proiect.
NAME (plaore
heron, ond thot
8o:is for Buildcr's
FOR OTTICE UsE CiNtY
flood Plcin - SrorierJ-f-
-occy
Group 11 I Sq. Frg. orhcr-
:EI:i::
x
--lqls6TOTAI VAIUATION,nFP-
So Ftq, Muin
Frl.,rccers 8lt?,."a '.f- tcFire Zonc , Bedroomr---tA- ry pr i co n rt. -J{-AI-U ni tr
Systems Developmeni
Chorqe ( I .59i,)
BUILDING PERMII
Chorger ond
Surchorge r
da oO
1,79
65?',"1 B Pet
Btd,Per
Plon Ck. Comm/lnd
Plon Ck- Rer q, bg ')lbt Qua ?la*Clccl 2bo
ffb1t{J.B o.46,oe-.__PTU}'{8ING PERIAIT
oo Demo
Chorgc: ond
Surchorgcr
Totol Comb. Permit /33,q9
{o."9--r-6E---lO-
PERMIT
A
SidewolkChorger ond
Surchorges
MECHANICAI. PERMIT
Chorgcr ond
Surchorger _t_b!9____
o.bJ IOTAI,
1<q zs.e9
Zone
Fance
Curb Cur
COMBINATION APPLICATION, PERMIT (LA'
l. Appliconf. to furnish
A. Job Address
B. Legol Description
l. exomple-rox lot 100, Lone.Coynty Mop Reference 'l 7 03 .43
2. ero-"lE-Lot l. Block 3,2nd Addition to Springfield Estotes
C. Nome, etc. of owner ond construction lender C ID. Energy Sources i-
l. exo m p le- h eo t
"
e_!Sc!rr ccte{rn g,/or forced o i r gc
2. il" m;6-- o te r IEEIE?lEIil.i co I ror-lEior-.--
E. Squore footoge or voluotion, etc.
l. exomple-l 250 sq. foot house, 500 sq. foot goro,
2. elffio-G-iTi& proiect, check-new-ii oddition, <
odd, e?c.
F. Building permit informolion:
l. exomple-construcl single fomily house with on o
goroge
2. excmple-remodel exisfing goroge into fomily ror
3. exompie-convert single fomily residence into
EliEI?6nr (chonge o1 use)
G. Volue of ,^zork os definecj in Section 303 (o) of the
Structurol Soeciolry Code
H. DESIGN TEAI.I AND CONTRACTORS
To ovoid design or construciion deloys, Building Divi
Stoff must be obie to contoct oppropriote persons re(
design informction or [ob site corrections, etc.
ll. .Abbrevioted Plumbing, Mechonicol & Electricol Schedule
A. Except where bionk spoces occur in the description p(
of the Mechonicol ond Electricol Schedules, the opplic
need fill.in oniy the No. Boxes odiocent to the opprop
item(s) to be instolled
8. Fuil Plurnbing, Alechonicol, ond Electricol Schecjules
ore ovoiloble ot the tsuiiding Division
I. To conserve sooce on the permit form the scheduler' hcve been cbbrevioted
2. lf the item(s) to be instolled ore not covered on the. oted scheduies you should consult the fuil schedule:
C. sUILDING DIVISION STAFF WILL FILL OUT ALL FEES AN
CHARGES ON THE SCHEDULES
lll. Applicont to sign onci dote
Whenever possible, the initiol opplicotion will be used os c
worksheet oniy. Where possible, Builciing Division Stoff wi
prepore o typewritten copy ond rerurn it to the opplicont o
the rime the octuol permit is issued for his signoture.
PER;!VAIIDATION
TY OF SPRINGFIELD
CirY Holl
SPringfield, Oregon
o.oJ-"-nt of Public Works_
OFFICIAT RECEIPT
No. B
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5 6152 r(
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Amou nt
l ORIZEO SIGNA TURE
SHELION'iUTiBULL PRIT1EF3 ' EU6ENE OR 97'OIlV. Fees ond Chorges
Plon check fees ore due ond poyoble ot the time of the cpp
ond no plons will be processed until these fees ore poid. Al (
other fees ond chorges ore due ond poyoble when the pernl_
is issued.
V. FOR OFFICE USE ONLY Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additionol Proiect lnformotion:
nome signotuEra <r'rcrr.bon
dote 3-21:l9bl
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