HomeMy WebLinkAboutPermit Building 1982-06-16IIISPECTION LIIIE.
726-37 69
CITY OF SPRINGFiELD
corlBI |IATI ot'l AppL i cATI0N/pERMII
INFORI1AIION LIiiT
726-37 53
@f\)oOr
Or!
Job Address lll0 North l8th Street EIIERGY SOURCES
Hea t
l.Jater Heater
Ranqe
Sq. Fto. t'lain_
sq. Ftg. Access.
-\*l5,8ffiiarm"-
_Fence_Demo_Cha nge/ U se
0ther
l-esa1 Description l7_03_25_34. 6g00
Va.l ue of l,Jork:
$7 ,172.00OwnerDr. Clark W. Roeder
Address I 7l 7 Centennial Bl vd. nnone/{g_g!!n In Desc i l,Iork .e. , Bui I Single
G
Remove a wall, alter and put in a bath
Construction Lender with Z fixtures, put in a small storage
Addres s Phone
r00m
DESIGN TEAI.I name 'ics. no.exoi res phone no
Primary Darrel I 14. Wi I son
Structura I !
E l ectri ca I
l''lec ha n i ca I
Darrel I M. l,Ji I son I71 7 Centenni a'l 584 10/1/82 ilza-ostg
Electrical 3-Way Electric
l'lechani ca I
PLUI1B I NG ELECTR I CAL MECHANICAL I
N0.FEE CHARGE NO FFF C HA ACF I't0 FFF CHARGF
2 Each single fixture 5 .00 I 0.00 Residence of
SQ FT
furnace/burner to
BTU' s
Relocated building
(new fix. additional)2
New circuits alts.
or extensions I5.00
Floor furnace
and vent
S. F. Residence(l bath)SERV I C ES Recessed wal I
Soace heater and vent
Duplex (l bath) each
Additional bath Temporary Constructi on Apol iance vent
seoa ra te
l,later servi ce Change in existing
res'i dence
Stati onar-v evap
cool er
Sewer multifamily,comrn. or
Indust-rial 1
Vent fan with
sinole duct 3. 00
Storm Sewer 0f s.Vent system apart from
heatinq or A.C.
c0r.1r.'!. / IND. FEEDERS Mechanical exhaust
hood and duct
Instal I /al terlrei ocatedistrib. feeders ['lood stove/heater
0f amp s.
ISSUANCE 0F pFRr{IT I 0.00
TOTAL CHARGES 10.00 TOTAL CHARGES 1 5.00 TOTAL CHARGES 13.00
I./HERE
shal I not
STATE L.lN REQUiRES that the Electrical work be done by an Electrical Contractor, the electrical portion of this permitbe valiC until the label has been signed by an Electrical Supervisor and returned to the Buildin! Division
HAVE comp e ap r)ca t 'l o n fo r 0erm r t a nd do here b.y cert v that a I I n forma ti 0n hereon I t rueand correct, and I furth r cert I f_v t hat any and a1
tate of 0regon
I trrO rk perfo rmed sha I I be do ne 1 n a ccordance wl th L he Ordi na nc es of the City
be madeof Springfiof any stru
Board is in
only subcon
e I d and the Laws of the Sut the permiss
and effect as
DC rta 'I n 1 n s to the wo r k de SC r 'I bed h ere 'I n and tha t NC OCCUPANC 'I I Icturew'l t ho I n of the Bu 'I I d 'I ng Di vl 5t 0n I fu rther cert 'I fy th a t my reg I s trat i 0n vJl th t he B u 1 1 de r q
fu l I force requ i red by 0Rs 701 055 tha t 'I f e xempt t he ba s 1 s fo r exemp t 1 0n 'I not ed hereon and tha ttractorandempIoyeeswhoare'I n comD
.I ,l ance WI th OP,S 701 nq 5 'I u 5 ed n th I s orojec
T
llAtlE(p1ease print)lL I GNATURE DA\E/'//-82
Zone ypelconst. V-N uni ts
Fire Zone_fu1fl_Bedrooms ll/d Occy Load sq Ftg. Access.I Ip
Flood Plain llO Stori I n.c.y Grou B-2 Ftg . other Remodel Val ue7 ,172.00
$17,172.00TOTAL VALUATI
BUILDING PERMIT
Charges and
Su rc ha rges I 7
Plan Ck. Comm/Ind
65%/81dq Per Fee
ntrLslPu ltf,ylo:f
28.60 Dd 6/14ts ivstenrs Deve'
)harqe (1.51 opment
Plan Ck. Res
30%/B1dq Per Fee
PLUI4BING PERMIT
Charges and
Su rcha rges
_ _ _ lQ--09___Fence
D6mo
ELECTRICAL PERIlIT
Charges and
Surcha rges
Sidewal k
A/C Paving
Curb Cut
Total Comb. Permit $85. 28
,
I$es. ze
IlECHANICAL PERI',IIT
Charges and
Surc ha rge s
.l3.00
.52 TOTAL
ACTORS name a ddrp< c
ptumbinq Beeson P'lumbing
Ftq. l'lain x Value
PERMIT VALIDATION
Receifi #ill$
/QrL
rmit Cle
44. 00
1.76
I 0.00
.40
I 5.00
.60
.I3.00
.52
Bu i'l di ng
4%
P1 umbi ng
4%
E'lectrical
4%
Mechani ca'l
4%
TOTAL PAID $ES. ZA
COf,IBINATION APPLICATION/PERMIT (cAP)
I. Applicant to furnishA. Job AddressB. Legal Description
l. example- Tax Lot 100, Lane County Map Reference
17-05-4:2. example- Lot 1. Block 3, ?nd Addition toSpringfield EstatesC. Name, etc. of owner and construction 'lender
D. Energy Sources1. exampl e- heat,/?. example- waterE. SquareTioGge or
to the appropriate item(s)FulI Plumbing, Mechanical,
a 1i or forced air gas
or soiar
to be instailed
and Electrical Schedules
e 'I
r
va I uat oflt
II.
1. example- i250 sq. foot house, 500 sq. foot garage2. example- if new project, check new - if addition,
check add, etc.F. Building permit information:l. example - construct single family house with an
attached garage
2. exarnple - remodel existing garage into family room3. example - convert single family residence into
restaurant (change of use)G. Value of work as defined in Section 303 (a) of theStructural Specia lty CodeH. DESIGN TEAIL1 AND CONTRACTORS
To avoid design or construction delays, BuildingDivision Staff must be able to contact appropriate
persons regarding design information or job sitecorrections, etc,
Abbreviated Plumbing, Mechanical, & Electrical SchedulesA. Except where blank spaces occulin the descriptionportion of the Mechanical and Eiectrical Schedules,the applicant need fi1l-in only the No. Boxes adjacent
are available at the Building Divisionl. To conserve space on the permit form the schedules
have been abbreviated2. If the item(s) to be installed are not covered onthe abbreviated schedules you should consult theful I schedulesC. BUILDING DIVISION STAFF hllLL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULESD. As noted on the CAP, the'labej must be delivered to theelectrical contractor for signature by his electricalsupervisor. The general contractor is .not authorizedto sign the electrical label.III. Applicant to sign and date
Hhenever possible, the initial application wilI be used asa worksheet on)y. Where possible, Building Division Staffwil) prepare a type written copy and return it to theapplicant at the time the actual permit is issued for his
s i gna ture .IV. Fees and Charges
PIan check fees are due and payabte at the t.ime of theapplication, and no plans will be processed until thesefees are paid. All other fees and charges are due andpayable when the permit is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPAI{CY:
Permit applicant exempt from registration with the Builder's Board because:
Add'itional Project Information
PLANS REVIEWED BY:
NAMC LORNE PLEGER s i gnature date June I 5 1 982
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