HomeMy WebLinkAboutPermit Building 1980-10-24-*-----ng Z t 1980
I HAVE CAREfULtY EXAMINED the completed opplicotion for permit, ond do hereby certify thol oll informotion hereon is true ond correct, ond I further
certify thot ony ond oll work performed sholl be done in qccordonce with the Ordinonces of the City of Springfield ond the Lows of the Stole of Oregon
pertqining to the work described herin, ond thot NO OCCUPANCY will be mode of ony structure without the permission of the Building Division. I further
certlfy thot my registrotion with,the Builder's Boord is in full force ond effect os required by ORS 701.055, lhot if exempt lhe bosis for exemplion is nofed
heron, ond thot only subcontroctors ond employees who ore in complione with ORS 70I.055 will be used on this proiect.
Bosis for Builder's Boord exemption:
NAME (pleose prinr)SIGNATURE
INSPECIION TINE
72&3769
CITY OT SPRINGFIETD
COMBINAIION APPTICATION/ PERMIT
INFORMATION I.INE
726375t
151 North 4th StreetJob Addresr
oflDeLot 4,Block 35, Extended ma
Woter,
rin fieldS
Vqlue of Work:
$4,830. 00
Sq. Ftg. A{oin
-N"*-Xldd-Alter-Rep.
-Fence-Demo-Chonge/
Use
-Olher
Sq. Ftg. Access.
Sq. Frg. Orher
owner Modv Prooerties
Phone 7 47 -1261Address 15'l North 4th Strept
Building Permit lnfo: Describe Work (i.e., Build Single
Fomily Residence With Attoched Goroqe)
Add suspended ti I e cei I r'nqSpringfield, 0regon 97477
Add pnuinmpnt car\ri.a e/..occConsiruclion Lender
Add heat pumpAdd re ss Phone
@o
O(no
DESIGN TEAM (nome)(oddress)(lics. no.)(expire s)(phone no.)
Marorrecq Fnninoov.inn 141 Nnv.th 4th Qtr^aof 747 -7261Primory
Structurql
Electricol
,lv{echonicol
CONTRACTORS (nome)(oddress)(lics. no.)(expires)(phone no.)
P lum
Ere*ricor McPheeters El ectri c 7 26-7 649
Mechonicor chase company 726-7981
PTUMBING ELECTRICAT MECHANICAL
NO.CHARGE NO.FEE CHA,RGE NO.I FEE FEE CHARGE
Eoch single Iixture
Residence of
-sq.
ft,
furnoce/burner lo.=_--8TU':
2
New circuils, olterolions
or exlensions 15.00 Applionce vent
sepqro le
Relocoted building
(new fix. odditionol)
SERVICES
Stolionory evop,
cooler
S.F
(r
Reside nce
both)
Temporory Conslruction
Vent fon with
sinqle ductDuplex (l both) eoch
Additionol bolh Amps
Yent system oport from
heoting or A.C.
Woier service
Mechonicol exhous,
hood ond duct
Wood slove/ heoterSewer
Slorm Sewer FEEDERS Heot Pump 6.00
,Ampr.
Air hondler to
t0,000 cFM
Air hondler over
r0,000 cFM
rssuANcE oF PERMTT 10. 00
16. 00
TOTAT CHARGESTOTAT CHARGES TOTAT CHARGES 15. 00
WHERE STATE tAW REQUIRES thot the Electricol work be done by thc Electricol Conltsclor, the electricol porlion of this permit shall not bc volid until o
lobel hos been signed by on Elecricol Conlroctor ond sttqched to lhe eleclricol ponel.
x Vo lue
x
-Volue
x
-Yolue
c-3 typ./conrt. V- 1HoUF unir,So Ftg. /rloin
4.8
Zone
TOTAI. VATUATION
Sq. Ftg. Access
Group
Lood
Sq. Ftg. Orher-
32. 00--12d--
BUITDING PERMIT Plon Ck. Comm/lnd s Developmenl20.80 PD 10-17-
RECEIPT 54930Plon Ck. Res
Per Fee
Chorges ond
Surchorges
Tolql Comb. Permit 65.52
PI.UMBING PERMIT
Demo
Chorges ond
Surchorges
Chorges ond
Surchorges
15.00---.-60 --
IT
Sidewolk
ETECTR I At
MECHANICAI. PERMIT
Chorger ond
Surchorges
Curb Cut16. 00
.64 TOTAT
65.52
ENERGY SOURCES:
n"or El ect HP
,o,,Q/$t'i
FOR OFFICE USE ON .Y
Bedroomr
Flood Ploin
OrrvFire
Fa nce
A/C Povino
";dtinf;
PERMIT VATIDATION
:ITY OF SPRINGFIELD
City Holl
Springfield, Oregon
Deportment of Public Works
OFFICIAL RECEIPT
(
(
(No. B 54992
F
ived For
s4
CC
o
>unt Received
THORIZEO S
SHELTON-TUi(AULL PRINTERS €UGEXE OR 97'Ot !A!It.'
Permit Clerk
(
(
(
q9 coMBtNAT|ON AppLtcATtoN/pERMlT (CAp)
l. Applicont to furnish
A. Job Address
B. Legol Description
I. exomple-tox lot 100, Lone County Mop Reference .l 7 03 432. exomple-Lor r. Brock 3,2nd Addiiion ro springfierd EstoresC. Nome, etc. of owner ond construction lender
D. Energy Sources
I exomple-
exomple-
heot,/electricol ceili /or forced oir gos
r solor2,woter eoler,o
E. Squore footoge or voluotion, etc.I. exomple-1250 sq. foot house,500 sq. foot goroqe
2. exEmElE-ifiew proiecr, check .rew-ii odditi'on, cieck
odd, elc. '
F. Building permit informotion:I. exomple-construct single fomily house wifh on ottoched
goroge
2. exomple-remodel existing goroge into fomily room3. @-convert single fomily residence into
restouronl (chonge of use)
G. Volue of work os defined in Secrion 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 conlocl opproprioie persons regording
design informolion or iob site correclions, etc.
ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedules
' A. Except where blonk spoces occur in the descripiion 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 Divisionl. To conserve spoce on the permit form the schedules
hove been obbrevioted
2. lf lhe item(s) to be instolled ore not covered on the obbrevi-
oted schedules you should consult thg full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
lll. Applicont to sign ond dote
Whenever possible, the initiol opplicotion will be used os o
worksheet only. Where possible, Building Division Sroff will
prepore o typewritten copy ond return it to the opplicont ol" 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 these fees ore poid. All
other fees ond chorges ore due ond poyoble when the permit
is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SAIISFIED BEFORE OCCUPANCY:
IIt,
Additionol Prolect lnformotion:
PLANS REVIEWED BY:
. DAN SI.IITHnome sig noture dote 10-21-80
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