HomeMy WebLinkAboutPermit Building 1980-02-23CIIY OF SPRTNGTIETD
COMBINATION APPTICATION/ PERMIT
INFORMAIION TINE
72U3753INSPECTION IINE
726-.3769
rth 17th StreetL964
25-2 I ILegol Description 17-el
Heot electrENERGY SOURCES:
woter Heorer elect.
C.H.
Sq. Ftg. Other
- New-Add-Alter-ReP'
-Fence-Demo-Chon
ge/ Use
-Other
--_
460Sq. Ftg. Access.
Sq. Ftg. Moin
60L*73
Volue of Work:
S. Martin
Building Permit lnfo:Describe Work (i.e., Build Single
Residence22ndPhoneAddress
Ie Famil ttachedODVA
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Address Salem Phone
(expires)DESIGN TEAM no.)no.)(odd ress)(nome)
nico I
7 46-646400003858Daveken Elect.3505 Main St.Electricol
Jt{echo nicol
MECHANICALETECTRICATPTUMBING
FEE CHARGENO.FEE CHARGE
furnoce/burner lo
-BTU'S
Residence of
fr.le fixtureEoch
Applionce vent
rqle
New circuits, olterotions
or extensions
Relocoted building
fix. odditionol)
Stolionory evop.
cooler25.00 SERVICES
S.F. Residence
lbox
Vent fon with
le duct1ConstructionDeoch
Vent syslem oport from
or A.C,heoAmAdditionol both
41
Mechonicol exhousl
hood ond ducl3erYrce
heolerWood10. 00Sewer
HeotFEEDERSStorm Sewer
Air hondler to
ctM
Air hondler over
I CFM
ISSUANCE OF PERMIT 10. 00
?.o.50TOTAT CHARGES25. 00TOTAI CHARGES35. 00TOTAT CHARGES
WHERE STATE tAW REQUIRES thot rhc Electrical work be done by the Electricql Conlroclor, the electricol Porrion of this permit shEll nor be volid until o
lobel hos bccn signed by on Electricot Controclor cnd cttoched to the electricol ponel.
I HAVE CAREFULIY EXAMINED the completed opplicotion for permit, ond do hereby certify thot oll informotion hereon is lrue ond correct, ond I further
tertify thot ony ond oll work perfor-ej shsll be done in occordonce with the Ordinonces of rhe City of Springfield ond the Lows of the Stote of Oregon
1*rtoining to tile work described herin, ond thoi NO OCCUPANCY will be mode of ony structure wiihout the permission of lhe Building Division. I further
,-ealfy thit my registrotion with, the Builder', Boord is in full force ond effect os required by ORS 701.055, thot if exempt the bosis for exemption is noted
heron, ond thot Jnty subcontroctors ond employees who ore in complione with ORS 70I.055 will be used on this proiect.
I
DATESIGNATURENAME (pleose print)
Bosis for Builder's Boord exemplion:
FOR OFFICE USE ONIY
Zon. R-l Type/Consr. Y-irI gn;1t
Fire Zone Bedrooms Z occ'l
Ftq. ,yloin o1 2 x --33-30volre
Ftl. Acce,, 460 , 9 ' 50 Yo1u.
p1oo6 p1o;n lrIO stories 1 occy Group-&l-Sq. Ftg. other
34
.I So.
-So.
Lood
TOIAI. VATUATION
x
-Volue
Systems DevelopmenlPlon Ck. Comm/lnd
65%l
521.0953Plon Ck. Res
30%Per Fee
44.40 paid #55
L42.OO
5
BUITDING PERMIT
Chorger ond
Surchorges
.20IabelFence
Totol Comb. Permit
PIUMBING PERMIT
Chorges ond
Surchorges
___35._qL
L.40
Sidewslk
ELECTRICAT I
Chorges ond
Surchorges
_ 25-OO
1. 00
Curb Cut
TOTAT $752.69
MECHANICAT PERMIT
Chorges ond
Surchorges
20. 50
.82
FEE CHARGENO.NO.
15-OOx
3^OO 6-OO10-oo 2
t
Amor-
fi.50/")
23L.40Demo
A/C Povino
coMBtNATTON AppLtcATtON/pERMtT (CAp)
l. Applicont to furnish
A. Job Address
B. Legol Descriptionl. exomple-tox lot 100, Lone County Mop Reference I7 03 432. exomple-Lor l. Block 3, 2nd Addirion ro Springfield Esrotes
C. Nome, etc. of owner ond construction lender
D. Energy Sources
PERMIT VALIDATION
I. exomple-heot,/electricol ceiling,/or forced oir gos
2. exomple-woter heoteiTelectricol/"@-
E. Squore footoge or voluotion, etc.l. exomple-l 250 sq. foot house, 500 sq. foot goroge
2. exEmFiE-iT new proiect, check-new-ii odditi-on, c-heck
odd, etc.
F. Building permit informotion:
CITY OF SPRINGFIELD
Ciry Holl
Springfield, Oregon
Deportment of Public Works
OFFICIAT RECEIPT
No. B 55886
r9
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I. exomple-construct single fomily house wilh on oltoch
goroge
Z. exo-ple-remodel existing goroge into fomily room i
3. exomple-convert single fomily residence inlo
iEEi6!?Ent (chonge of use)
G. Volue of work os defined in Section 303 (o) of rhe (
_ Structurol Speciolty Code
H. DESIGN TEAM AND CONTRACTORS
To o-void design or construction deloys, Building Division :
. . Stoff must be oble to contoct oppropriote persons regord
design informotion or iob site correitions, elc.
ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedules
A. Except where blonk spoces occur in the description portic
of the Mechonicol ond Electricol Schedules, the oppiicont
need fill-in only the No. Boxes odiocent to the opproprioi
item(s) to be insrolled
B. Full Plumbing,/Mechonicol, ond Electricol Schedules
ore ovoiloble ot the Building Divisionl. To conserve spoce on the permil form the schedules
hove been obbrevioted
2. lf the item(s) to be instolled ore no, covered on the ob
oted schedules you should consult the 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 qs o
worksheet only. Where possible, Building Division Sroff will
prepore o typewritten copy ond return it to the oppliconl ot
. 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 oppli
ond no plons will be processed until these fees ore poid. All
other fees ond chorges ore due ond poyoble when the permi
is issued.
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S\\nNtr)a-,(.OO
Rec'd
Address
Received For
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Amounl Received
!or EY
AUTHORIZEO
SHELTOT.TURftEULL PRINIERS EUGENE OR 9"OI
V. FOR OFTICE USE ONIY L
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Additional Project lnformotion:
PLANS REVIEWED BY:
nome signoture dote
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