HomeMy WebLinkAboutPermit Building 1981-01-27r
CITY OF SPRINGTIETD
COMEINATION APPTICAIION / PERMIT
INFORIAATION [tNE
72C3753rNsPEciloN uNEj f iFiiD
72&376i
1029 North 4th StreetJob Address
Ronge
ENERGY SOURCESI
Heot
Woter Heoler
n
Sq. Fts. Access. ----jZA-
Sq. ftg. Other
-New -Add-Alrer-ReP.
-Fence-Demo-Chongei
U se
-Other
-=--
Sq. Frg. Moin
Volue of Work:
1 ,600.00Bault, James
Fqmil
ng Permit lnfo: Describe Work (i.e., Build Single
PhoneAddress 1029 North 4th S
Carport for storage of mobile h omengfiel d, Oregon 97477
Lender
@H
OO
(4)
(r1
Address Phone
DESIGN TEAM (nome)noJ( lics.(oddress)
Slructuro I
nico I
Owner
Plumbi
Electricql
Mechonicol
MECHANICALEI.ECTRICALPTUMBING
rEECHARGENO,rEETEECHARGENO.
furnoce/burner lo
='--BTU'S
Residence of
- --sq. ft.Eoch single fixture
Applionce vent
se po ro le
New circuils, olterotions
or extensions
Relocoted building
(new fix. qdditionol)
Stotionory evop.
coo lerSERV ICES
S.F. Residene
(l both)
Vent fon with
single ductTemporory ConslruclionDuplex (l bolh) eoch
Vent syslem oport from
heotinq or A.C.Amps.Additionol both
Mechonicol exhousl
hood ond duclWoler rervice
Wood siove/ heoter
Sewer
Heol PumpFEEDERSSlorm Sswer Air hondler to
r0,000 cFMAmpr
Air hondler over
r0,000 cFM
ISSUANCE OF PERA{IT
IOTAT CHARGESTOTAT CHARGESTOTAT CHARGES
Bosis for Builder's Boord exqTnption:
U nitsType/ Const.3'20
ra DATE
_5ro-l:
,
M1 Sq. Ftg. Other
notrholl volidbc ntilU ocollhisofConlrqelectripermitthedoneElectricqlclor.portionlhsbeworkI RE5REQU thelhot byElectricslsfA'WHERE tAwIE
electricollhe ponel.ottoched loandContrqclorElectricolonhqrlobelbeenbyrigned
qnd further5olruecorrect,nd
ofLows Stotethe ofthe Oregon
5to n.Divi furlheroftheBuilding
bo tt for notedtstheexempiion
NAME (pleose prinr)
Zone
Sq. Flg. Accers
Sq. Frg. Moin
FOR OFFICE USE ONIY
SIGNATURE
TOTAT VATUATION
Lood -
Group
x
x
lue
lue
Flood Ploin
-_Storie
Fire Zone- Bedrooms 1._-Volue
Syslems DeveloPment
5.10 Chorqe _5"/"\
REC 555974.s0 PD 1-15-81
Plon Ck. Comm/lndBUITDING PERMIT
68
17. 00 Per
Plon Ck. Res
Per Fee
Chorge: ond
Surchorge s
60Pl n Ck Due
--.-ou
L7.68Totol Comb. Permit
PtU,\ BING PERMIT
Demo
Chorges ond
Surchorges
ELECIRICAL PERMIT
Chorges ond
Surchorges
Sidewolk
Curb Cut
MECHANICAT PERMIT
Chorges ond
Surcho rges
TOTAI.18.28
NO
A/C Povino
I '^' ' oi ,
COMBINATION APPTICATION/PERMIT (CAP)
l. Applicont to furnish
A. Job.Address
B. Legol Description
i. exomple-lox lot I00, Lone County Mop Reference l7
2. exfiFle--Lot l. Block 3,2nd Addition to Springfield Est
C. Nome, etc. of owner ond construction lender
D. EnergY Sources
l. exomple-heot,/electricol ceiling/or forced oir gos
2. exo mil6-wo te r T e i-id7Gl6Et-ri co I /o ill *-
E. Sguore footoge or voluotion, etc.
l. exomple-1250 sq. fool house,500 sq. foot goroge
2. exomE]E-',T "ew pro[ect, check n&-if oddition, check
odd, etc.
F. Building permit informotion:
l. exomple-construct single fomily house with on otloch
goroge
2. exomple-remodel existing goroge into fomily room
3. exompfe-convert single fomily residence inlo
iEliEEEnt (chonge of use)
G. Volue of work os defined in Section 303 (o) of the
Strucrurol Speciolty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction deloys, Building Divisio
Stoff must be oble lo contocl oppropriote persons regol
design informotion or iob site corrections, etc.
ll. Abbrevioted Plumbing, Mechonicol & Eleclricol Schedules
A. Except where blonk spoces occur in the description porl
of the Mechonicol ond Electricol Schedules, the opplico
need fill-in only the No. Boxes odiocent to the oppropr
item(s) to be instolled
B. Full Plumbing, Mechonicol, ond Electricol Schedules
ore ovoiloble ot the Building Division
I. 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
oted schedules you should consull the full schedule
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AI.
CHARGES ON THE SCHEDULES
lll. Appliconl to sign ond dote
Whenever possible, the initiol opplicotion will be used os
worksheel only. Where possible, Building Division Stoff r
prepore o typewritten copy ond return if to the opplicont
the time the octuol permit is issued for his signolure.
lV. Fees ond Chorge, *
Plon check fees ore due ond poyoble ot the lime of the opplicotion,
ond no plons will be processed unlil these fees ore poid. All
other fees ond chorges ore due ond poyoble when the permit
is issued.
V. FOR OFFICE USE ONLY
i,,. CITY OF SPRINGFIELD
Ciry Holl
_ Springfield, Oregon
Deporlment ol public WorksOFFICIAI. RECEIPT
(
PERMIT TION
IIo. B
(t
(t
rC
f
t
{
55680
t9
,d
(
(
(
\
R
{
(
(
t..
(.
For:
Amou nt Received
BY
(
(
(
(
(ll _(laraato*.tr"*"raa ar,*rai]
SIGNATU R E
€u6Era oi graor !a5rr.a
(r
_l
Permit Clerk
I
PROJECT CONDIIIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Proiect lnformolion:
PTANS REVIEWED BY:
, TOM SHEIRBON
l
1-24-81signotu'nome dote
(