HomeMy WebLinkAboutPermit Building 1980-11-30INSPECTION TINE
7263769
INFORMAIION tINE
726-3753
CIIY Of sPRINGTIETD
COIAEINATION A?PTICAIION /PERMtt
L43B North gth Street
TL 4600 tlal 77 03 26 43legol Description
.lob Addres:
Ronge
ENEROY SOURCES:
Heot
-
Woter Heoter
--Volue of Work:
500.00
Sq. Ftg. Moin
-New-Add-Alter-Rep.
-Fence-Demo-Chonge/
U se
-Other
-
Sq, Ftg. Accesr
Sq. Frg. Orher
o*.". Douelas Taylor
Address 1438 North gth Street pr,"n"746-9569 Fomily Residence With Attoched Goroqe)
Building Permit lnfo: Describe Work (i.e., Build Single
Springfield, 0regon 97477 Foundation
Conslruclion Lender
Address Phone
DESIGN TEAM (nome)(oddress)(lics. n6.)(expires)(phone no.)
Primory
Slructurol
Electricol
Mechonicol
(nome)(oddress)(lics. no.)(expires)(phone no.)CONTRACTORS
Generot DOuq Tavl or Owner
Plumbinq
Electricq I
Mechonicol
PTUMBING ETECTR ICAt MECHANICAT
FEE CHARGE NO FEE CHARGENO.FEE CHARGE NO.
Eoch sinqle fixture
Residence of
fr.
furnoce/burner to
-BTU'S
Relocoted buiiding
(new fix. odditionol)
New circuits, olterotions
or extensions
Applionce vent
seporore
S.F. Residence
(l both)SERYICES
Slotionory evop.
cooler
Duplex (l both) eqch Temporory Conslruclion
Vent fon with
single duct
Amps.
Yent syslem oport from
heotinq or A.C.Addirionol borh
Woler service
Mechonicol exhousl
hood ond duct
Wood stove/heoterSewer
FEEDERS Heot PumpStorm Sewer
A-Pr.
Air hondler to
I0,000 crM
Air hondler over
I0,000 cFM
ISSUANCE OF PERAAIT
TOTAT CHARGESTOTAT CHARGESTOTAL CHARGES
WHERE STATE tAW REQUIRES rhoilhe Electricot work be done by rhe Electricol Contrqctor, the electricol portion of this permit sholl not ba vslid until s
lobel hss been signed by on Electricol Contraclor qnd ottoched to the eleclricol ponel.
I HAVE CAREFUTIY EXAMINED the compleled opplicotion for permit, ond do hereby certify thol sll 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 rhe City of Springfield ond the Lows of the Stote of Oregon
perioining to the work described herin, ond thot NO OCCUPANCY will be mode of ony slructure without lhe permission of the Building Division. I further
certlfy thot my regiitrotion with the Builder's Boord is in full fore ond e4fecl os required by ORS 7O1.O55, lhot if exempi the bosis for exemption is noted
heron, ond thot only subcontrocrors ond employees who ore in omplione with ORS 701.055 will be used on this proiecl.
SIGNATURE DATE
,.l1
Bosis for Builder's Boord exemption:
NAME (pleose
tl FON OfFICE USE ONIYal
R{.Type / Const.
R;3
lJni
500 -nn
Zone
TOTAT YATUATION
Sq. Ftg. Access
ls --.Sq. Ftg. ,v{oin
Flood Plqin stories-Occy Group
Fire Zone-Bedrooms ccy Lood
x
--Volue
x Volue
Sq. Frg. Other-x
-Yolue
Syslem s
Chorqe
Development
(1.5Y"\
BUITDING PERMIT
Chorges ond
Surchorges
Plon Ck. Comm/lnd
5
20
Per Fee
Per Fee
Plon Ck. Res
Fence
Totql Comb. PermitDemo
Chorges ond
Surchorges
PTUMBING PERMIT
Sidewolk
A/C Povinq
ETECTRICAT PERMIT
Chorges ond
Surchorges
{_
tH{ "uEb .
MECHANICAT PERMIT
Chorges ond
Surchorges TOTAT
5.20
@
C)o\o
(J)
\l
Curb Cut
coMBrNATloN APPLTCATION/PERMlr (CAP)
l. Applicont to furnish
A. Job Address fB. Legol Description
I. exomple-lox lot I00, Lone County Mop Referen<
2. exomEie-Lot l. Block 3,2nd Addition to Springfie fC. No*", "1. of owner ond construclion lender {
D. Energy SourcesI. exomple-heot./electricol ceilingz/or forced oir gos
2. exomFle-woter166tE@q!, ot tolg'
PERMIT VATIDATION
CITY OF SPRINGFIELD
CilY Holl
Springfield, Oregon
Deportment of Public Works
OFFICIAL RECEIPT
J{0. B 55G75
t4
(
(
E. Squo re footoge or voluotion, elc.
exom I 250 sq. foot house, 500 sq. foot gorog'
2. exom proiect, check new -if oddition, cl' fnew
c etc.
F. Building permit informotion:
l. exomPle-conslruct single fomiiy house with on ol
goroge
2. exomple-remodel existing goroge into fomily roc
3. exo;pfe-convert single fomily residence into
Est6Iront (chonge of use) )
G. Volue of work os defined in Seciion 303 (o) of the
Struclurol Speciolty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction deloys, Building Divi
Sloff musl be oble to contocl oppropriote Persons re
design informction or iob site corrections, eic.
ll. Abbrevioted Plumbing, Mechonicol & Electricol Scheduh
A. Except where blonk spoces occur in the description p
of the Mechonicol ond Electricol Schedules, rhe oppli
need fill-in only the No. Boxes odiocent to the opprc
item(s) lo be instolled
B. Full Plumbing, Mechonicol, ond Electricol Schedules
ore ovoiloble ot the Building Division
l. To conserve spoce on the permit form the schedul
hove been obbrevioted
2. lf the item(s) to be instolled ore not covered on th
oted schedules you should consull the full schedu
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES I
CHARGES ON THE SCHEDULES
lll. Applicont to sign ond dote
Whenever possible, the initiol opplicotion will be used c
worksheet only. Where possible, Building Division Stoff
prepore o typewritten coPy ond rerurn it io the opplicor
ihe rime the octuol permit is issued for his signolure. +-
Received
tOr
Amount Received
'n+
((
BY
{
AUTXORIZED SIGNATURE
FRINIERS . EUGENE OR 974OI
I
I
Permit Clerk
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 SATISFIED BEFORE OCCUPANCY:
Additional Proiect lnformolion:
signolurenome5I.{TTH 6o1. 10-3-F0
PTANS REVIEWED BY:
0p
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