HomeMy WebLinkAboutPermit Building 1981-05-15I
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INsPECTION IINE
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INFORMATION IINE
72U3753
CIIY OF SPRINGf IETD
COMBINAIION APPTICATTON / PERI\,IIT
1981 North sth StreetJob Addrerr
Ronge
ENERGY SOURCES:
Heot
Woter Heoler
-
n? ?6 ?4 Tl 48tegol Descriptio " 17
-New-Add-Alter-RcP., --Fence-Demo-Chongc/Usa
-Olher
-_.=-.-_.--.=.-
Sq. Fts. Moin
:z38Sq, Ftg. Access,
Sq. Ftg. Other
Volue of Work:
$1 ,213.80OwnerVirsiI Schulenberq
Fomily Residence With Atloched GEroge)
Building Permit lnfo: Describe Work (i.e.. Build Single
Addresr 486 Lantana Street Phone 688-3874
Extend carDort and install new97 401Euqene, Oreqon
200 amp serviceConitruclion Lender
PhoneAddress
(odd ress)(lics. no.)DESIGN TEAM (expires)(nome)
Sfructurol
E lectri cq I
Owner
Mechonicol
Electricol
Mechonicol
MECHANICALETECTRICATPTUMBING
TEE CHARGENO.FEE CHARGENOFEECHARGENO.
furnoce/burner lo
-BTU'T
Residence of
-sq.
ft.Eoch single fixfure
Applionce vent
seporq re
New circuits, olterqtions
or exlensions
Relocoted building
(new fix. odditionol)
Stotionory evop.
coo lerSERVICES
S.F. Residence
(l borh)
Vent fon with
single ductTemporory ConslruclionDuplex (l both) eoth
25. 00
Vent sysiem oport from
heoting or A.C.i Amps. 200Additionol borh
Mechcnicol exhousl
hood ond ductWqler rervice
Wood stove/ heoterSewer
Heot PumpFEEDERSStorm Sewer Air hondler to
r0,000 cFMAmps.
Air hondler over
10,000 cFM
ISSUANCE OT PERMIT
IOTAT CHARGESTOTAT CHARGESTOTAT CHARGES
I HAVE
5=DATE
Plon Ck. Comm/lnd
L.25
25. 00
b.nol u nlilvolid olhisolrhollalectricoltheConlroctot.portion parmitElcctricqlbedonetheElcctricolbythcREQUtAwlhotIRESSTAIEWHEREtheelectricoltoponel.ottochedondContlaclotElectricolonhoslsbclbeonbysigned
furlhertsondlrueondollthotrmotioninfocorrect,hereonondtertifydoforherebythepermit,EXAMINED opplicotioncompleted of the oiStoteondtheLows OregonolncescilheofrhwithOrde:no ty Springf ieldocordoncenetndo furthertheDivision.without rhe of Buildingof5iruclurePermr3sronbeIdemoonyOCCUPNOANCY ts noiadifexembosisthefor70ORSexemptionthotored.055,ptfu ll ondforce effect requ!bytsBoordlnthewith will be onu sed thi sirh70roR5.055 proiect.toneorewhonIcomplond
N,Ar\{E (pleose Print)
D€Yelopment
copi es
Bosis for Builder's
Zone
Sq. Ftg. Moin
Flood Ploin
fire Zone
.Type/ Consr.
Per fee
Plon Ck. Res
Per Fee
FOR OTFICE USE ONIY
SIGNATURE
heron, ond lhot
cartlfy lhot mY
BUITDING PERMIT
Chorge: ond
Surchorges
___ 13_-_00_
.5?
, 5.10 vo1,.
I --J---Volue
x
-Vqlue
TOTAI, VATUATION.
Lood
-5q.
Ftg. Access
ororp M-1 Sq. Ftg. other-
NA Bedrooms
certify thoi onY
perloining lo lhe
.QO
Tolol Comb. Permil
PI.UMBING PERMIT
Demo
Chorger ond
Surchorges
ETECTRICAL PERMIT
Chorges ond
Surchorges
__25-!0--
1.00
Sidewolk
Curb Cut
MECHANICAT PERMIT
Chorges ond
Surchorges
4E.ffi(TOTAT
r[il|
(
work
_D
COMBINATION APPTICA RM|T (CAP)
l. Applicont to furnish
A. Job Address
B. legol Description
l. exomple-tox lot I00, Lone County Mop Reference
2. exomple-Lot I. Block 3,2nd Addition ro Springfielr
C. Nome, etc. of owner ond construction lender
D. Energy Sources
l. exomple-heot,/electricol ceiling/or forced oir gos
2. e xo m, plE-w o te r T-EEre iTEIEiffio I /o r solE r ---i-
E. Squore footoge or voluotion, elc.I. exomple-1250 sq. foot house,500 sq. foot goroge
2. exomFiE-iT-new proiecr, check-new-ii oddirion, iie
odd, etc.
F. Building permit informotion:l. exomple-construct single fomily house with on oltl
gcrroge
2. exomple-remodel existing goroge into fomily roor
3. exornpl-e-convert single fomily residence inlo
GiEITdnt (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 Divis
Stoff must be oble to contocl oppropriote persons reg
design informotion or iob site corrections, elc.
!1. Abbrevioted Plumbing, Mechonicol & Electricol Schedule:
A. Except where blonk spoces occur in the description p<
of the Mechonicol ond Electricol Schedules, the oppiic
need fill-in only the No. Boxes odiocent to rhe oppro;
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 schedule
hove been obbrevioted
2. lf the item(s) to be instolled ore not covered on the
oted schedules you should consult the full schedulr
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES A]
CHARGES ON THE SCHEDULES
lll. Applicont to sign ond dote
Whenever possible, the initiol opplicotion will be used o: (
worksheet only. Where possible, Building Division Stoff \ \
prepore o. typewritten copy ond return it to the opplicont
the time the octuol permit is issued for his signotuie. /.
tV. Fees ond Chorge, \
Plon check fees ore due ond poyoble ot the time of the o!-prrcoond no plons will be processed until these fees ore poid. Xll
ofher fees ond chorges ore due ond poyoble when ihe permit
is issued.
V. FOR OFFICE USE ONLY
PERMIT VALIDATION
CITY OF SPRINGFIELD
City Holl
Springfield. Oregon
Deportrnent of Public Works
OFFICIAI RECE!PT
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BY
Amount Received
lron,
Permit Clerk
AUTBORIZED SIGNATURE
ritNTfi3 - Euctxc oh tTaot !a!tt.a
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s-15-81sig nolunome dote
PI.ANS REVIEWED BY:
TOM SHEiRtsOi{
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