HomeMy WebLinkAboutPermit Building 1981-05-04.ffi
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MECHANICAL PERMIT
Chorge: ond
Surchorge s
17. 50
VO,
INSPECIION I.INE
7263769
I- ,nro."oroN uNE
72G3753
CIIY Of sPRINGFIEI.D
COMSTNAIION APPI.ICATION / PENMIT
2243 North 1lth StreetJob Address
legol Descripiion 17 03 26 Ll, TL 5700
Vslue of Work:
$7 ,ooo. ooRoy F. Holcomb
Fo Residence With Attoched
Permit lnfo: Describe Work (i.e., Build Single
Addrers 2243 North 11th Street Phone
Remodel Kitchen
S rin
Construciion
@
O(,c)O
Address Phone
(expireDESIGN TEAM ( nome)(phoneno)(oddress)
r nPrim 25689 l2-7-8L 74
rol
Mechonico
no
Ambassador Construction Nor
Plumbi
Electricol
Mechonicol
MECHANICAL
PLUMBING
FEE
ETECTRICAL
NO,CHARGENO.CHARGEFEE furnoce/burner to
5
Residence of
fr.
4 fixtureEoch Applionce vent
ro lese5.00New circuits, olterotions
or extensions2+
(new fix. odditionol)
Relocoted building
Stotionory evoP.
coolerSERVICESS.F. Residence
3. 00Vent fon with
le duct1
ConstructionTeochlexI
heoti or A.C.
Venl syslem oPort from
10.00i0. 0cAdditionol both1 +.501Mechonicol exhovrt
ond
Woler service
FEEDERS
Sewer
t Pum
Air hondler lo
Air hqndler over
CFM'I
10. 00ISSUANCE Of PERMIT
Bosis for Builder's Boord exemption:
SIGNATURE
DATE
NA|IE (pleose Print)
FOR OTFICE UsE ONLY
x Volue
r Volue
x Volue
TOTAL VATUATION
n itsConst.Zone
Flood Ploin
Group
Lood
Fire Zone Bedroomr
Ftg. Moin
Sq. Ftg. Olher
s DeveloPment
PD 4.$12.{
40. 00
1. 60
Plon Ck. Comm/ lnd
Fee651',.
Plon Ck. Res
Per Fee
BUITDING PERMIT
Chorges ond
Surchorges
Totol Comb. Permit
PLUMBING PERMIT
Chorges ond
Surchorges
30. 00----1-.20--Demo
Sidewolk15
c
PERMIT
Curb Cut
o0__
.60Chorges ond
Surchorges
.70
TCTAT
106. 60
lSff'tr ect BB
Woter Heoler
Ronqe
-
Sq. Ftg. Moin
So. Fto. Accesi.
sq. rt!. orhe, 238
-New.
--AddX-Alter-Rep.
-Fe
nce-Demo-Chongc/ Uso
Other
---
,n nnEnn
Amps.
Wood stove/ heoter
Storm Sewer
1nA 6n
i*E
I ctTY oF SPRTNGFIELD
City Holl
Springlield, Oregon
Deportmenl of Public Works
OFFIC!At RECEIPT
Itlo. B 57?'
'98/
Rec'd From an
I
For
E7 tJzt ao
14?*/ r&o
P-"^Va. oo
t72-/-20EZ1-*'-
f42o €oI /Vn / ?, u4'
..7a
coMBTNAT|ON AppL|CAT|ON/pERM|T (CAp)
l. Applicont to f urnish
A. Job Address
B. Legol Description
l. exomple-tox lot 100, Lone County Mop Reference I7 03 432. exomple-Lor I. Block 3,2nd Addition to Springfield Estotes
C. Nome, etc. of owner ond construction lender
D. Energy Sources
I. exomple-heotz'electricol ceilinq i or forced oir oosz. exomple-woter heoter.'electricol./or solor
E. Squore footoge o. ,oluotio[Ill-
I. exomple-l=2lg tq. foot house, 500 sq. foot goroge2. exEmFIE-iT new proiecr, check new-ii oddiri-on, cieckodd, etc.
F. Building permit informotion:
I. exomple-construct single fomily house with on ottochedgoroge
2. exomple-remodel existing goroge into fomily roomJ. exompte_convert single fomily residence inlorelTdwEnr (chonge of use)
G. Volue of work os defined in Section 303 (o) of rheStructurol Specio lty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction deloys, Building DivisionStoff must be oble to conloct opprop.iot" p".ro-n, r."go-Jingdesign informotion or [ob site correcrions, etc.
ll. Abbreviored plumbing, Mechonicol & Electricol SchedulerA. Except where blonk spoces occur in the description pdrrionof the Mechonicol ond Eleoricol S.h"d;il;;;; ";;iil;;'need fill-in only the No. Boxes odiocent r. tf,. "p-p?oiri"r"item(s) to be instolled '-
B' Full Plumbing, Mechonicor, ond Electricor Scheduresore ovoiloble ot the Building Division'I . To conserve spoce on rhJpermitlo.. the scheduleshove been obbrevioted2' rf the item(s) to be instored ore nor covered on the obbrevi-ored schedures you shourd consurt rhe fuil *i.ari."--'C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANDCHARGES ON THE SCHEDUTES
lll. Appliconr ro sign qnd dore
Whenever possible, the initio.l opplicotion will be used os o a
workshee, only. Where p"rribt"lErillinig Oiririon Sroff willprepore o typewrilten copy ond return iito rhe "ppf;;.;';;the time rhe octuol permir i. ir*uJ i"l 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 Lntil these tees ore pqid. All
i,ti,:::::' ond chorses o,e d," "iJ piy"ui";;;; ii. pJ-r,
V. FOR OFFICE USE ONLY
(
(a
,l
,l
Amounl Received (lo
BY
(AUTHORIZED
,ION URNEULL PRINYEIS EUGENE OR !llr.a
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additionql proiect lnformotion:
nome 5-4-81sig netu dote
PTANS REVIEWED BY:
TOM SHEIRBON
I
nddress Z2<%) ,// 7t 57-
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