HomeMy WebLinkAboutPermit Building 1981-12-29INSPECTION l]NE
726-.3769
CIIY OT SPRINGFIEID
COIAEINATION APPUCATION/ PERiItf
INFORIAAIION IINE
7263753
rob Address 201 South 18th Street
lesol Description 'l 7-n?-?6-nn - T I 5nn
ENERGY SOURCES:
Woter Heoler
Heot
Sq. Ftg. Other
-New
Add Alter Rep.
-Fence-Demo-Chonge/
Use
- Orhe'
--
Sq. Ftg. lvloin
Sq. Frg. Access.
Volue of Work:
(AnRn no
Building Feiri'it-t-nfoi -Describe Work (i'e.,Build Single
Fomily Residence With Attochqd Goroge)726-3682n. Di vi s i on PhoneAddress Traffi c Mai
Lender
@Ho
@(o
F
Address Phone
(lics. no.)(oddress)DESIGN TEAM s)(nome)
il
Pri
Structuro I
lics. no
I
Electrico I
Mechqnicol
MECHANICALETECTRICATPTUMBING
FEE CHARGEFEECHARGENO,CHARGE NOFEENO.furnoce/burner loResidence of
fr5.00Eoch single fixture
Applionce vent
seporo te10-00
New circuits, olterotions
or exlensions1
Relocoted building
(new fix. odditionoD
Slolionory evop.
coo lerSERVICES
s.F
(r
Re si de nce
borh)
Vent fqn with
sinqle ductTemporory ConstructioDuplex (l both) eoch
Vent syslem oport from
heotinq or A.CAmps.Addirionol both
Mechonicol exhoust
hood ond ductWoler rervice
Wood stove/ heoterSewer
Heot PumpFEEDERSSlorm Sewer
Air hondler lo
10,000 crMAmps.
Air hondler over
r0,000 cFrtt
ISSUANCE OF PERMIT
TOTAI- CHARGESTOTAT CHARGESTOTAT CHARGES
notrholl volidbe ountilelcclricoltheoflhistheConlroEleclricolclor,porlion parmitbeworkdonethotIRESElectricothebySTAWHEREtAwTEREOU
rhe eledricollo ponelottochedondConlrsctolqnElactricolhoslobelbeensignedby
Bosis for Euilder's Boord exemption:
DATE
H-2Fire Zone-Bedrooms - ocGY
Flood Ploin stor;", ]' OttY
6onr1. III-N unirtP.
So Ftg. Access
CAREFULI.Y EXAMINED the completed
oll work performed sholl City of
withoulcertify thot ony
pertoining to the of ony
req uired
furtherndl5hereonondlruecorreci,thot nformotionollIondcertifydolorherebyopplicotionpermil,VEHA the sLow theof ofStote OregonldondoftheSpringfieththeOrdinonceslndonencescordobendDivision.furtherfheoftheBuildingstructurePermrsSlonmo dewillbendlhoNOOCCUPANCYdescribedworkhe ri qn,bosis for sI noted701thotiftheexemptionORS.055,exempteiffectsbytsIfnforeullondBuilder'Boordthethotwilhcertlfymyregi strotion ,hisonoRswirh.05570r bewill usedteon@ proiect,ond who compliosubcontroclorsthotqndonemployeesheron,ly
NAME (pleose print)
Group
Lood
IOR OFFICE UsE ONIY
Zone Fts. lYloin 100 Sq . ft. x
--volue
SIGNATURE
Sq. Ftg. Orher-
x
-Volue
x
-Volue
TOTAT VATUATION
61.?0Systems Development
Choroe (1.5%)20. 80Plon Ck. Comm/lnd
65o16/Blds Per Fee
Plon Ck. Res
3o%/Blds Per Fee
BUITDING PERMIT
Chorges ond
Surchorges
}L
Fence
48.88 _Totol Comb. PermitDemo
PTUMBING PERMIT
Chorges ond
Surchorges
_5-
ELECTRICAL PERMIT
Chorges ond
Su rcho rge s
Sidewolk____ 10=00
$130.88
TOTAT
CITY PROJI
MECHANICAT PERMIT
Chorges ond
Surchorges
Curb Cul
-BTU'S
$ 10. 00$5.00
A/C Pdvind
coMBTNATTON APPLTCATTON/PERMIT (CAp)
l. Appliconr to furnish
A. Job Address
B. Legol Description
I. exomple-tox lol 100, Lone County Mop Reference I7 03 43
2. exomple-Lot I. Block 3,2nd Addition to Springfield Estotes
C. Nome, etc. of owner ond construction lender
D. Energy Sources
PERMIT VALIDATION
l. exomple-heot,/eleclricol ceiling,/or forced oir gos
2. exo mFle-wo te rTEoGr/el-ect ri co I / ", @-
E. Squore footoge or voluotion, elc.l exomple-I250 sq. foot house, 500 sq. foot goroge
2. exomple-if new proiect, check new-if oddition, check
odd, etc.
F. Building permit informotion:I. exomple-construcl single fomily house with qn otlqched
goroge
2. exomple-remodel existing goroge into fomily room
3. E."-pE-convert single fomily residence inlo
restor-rront (chonge of use)
G. Volue of work os defined in Section 303 (o) of the
Structurol Speciolty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction deloys, Building Division
Stoff must be oble to contoct oppropriote persons regording
design informotion or iob site correclions, elc.
ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedules
A. Except where blonk spoces occur in the description portion
of the Mechonicol ond Electricol Schedules, the opplicont
need fill-in only the No. Boxes odiocent to the oppropriote
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 schedules
hove been obbrevioted
2. lf the item(s) to be instolled ore not covered on the obbrevi-
oted schedules you should consult rhe full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
lll. Appliconl to sign ond dote
Whenever possible, the initiol opplicotion will be used os o
worksheet only. Where possible, Building Division Sroff will
prepore o lypewritten copy ond return it to the oppliconl ot
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,
qnd no plons will be processed until these fees ore poid. All
ofher fees ond chorges ore due ond poyoble when the permit
is issued.
V. FOR OFFICE USE ONLY Permit Clerk
PROJECT CONDITIONS TO BE SAIISFIED BEFORE OCCUPANCY:
Additionol Proiect lnformotion:
nome signoture dote
PLANS REVIEWED BY