HomeMy WebLinkAboutPermit Building 1984-07-31INSPECTION IINE
7263759 \/, COI,IBlNATIONAPPTICAIION/PERiIIT
INFOR'UATION tINE
7263753
CIIY OF SPRINGEIElD
robAddress 2Lo N ?t L9
Ronge
ENERGY SOURCES:
Heot
-
Woler Heoler
----Iegol
-New-Add-Altar-ReP.
-tence-Demo-Chonge/
Use
_Orh:.
-.....---
Sq. Ftg. ltoin
Sq, Ftg. Access
Sq. ftg. Other
Volue of Work:
Build SingleWorkIPermitnfo:Describe (i.e"Building
Attochedwirhpno^J 1Address
N\\as+
Da
Address Phone
(lics. no.)DESIGN TEAM
no.)s)(oddress)(nome)
Prim
(^J
Electricol
Mechonicol
MECHANICAL
NO.
ETECTRICAT
FEE
PTUMBING
FEE CHARGE
furnoce/ burner to
---BTU'S
Residence of
fr.rle fixtureEoch Applionce vent
seporo le
New circuils, olterotions
or exlensions
Relocoted building
(new fix" odditionol)Stotionory evop.
coolerSERVICES
S.F. Residence
(l borh)Vent fon with
sinqle ductTemporory ConslructionDuplex (l both) eoch
Vent system oport from
heoting or A.C.Amps.Additionol both
Mechonicsl exhoust
hood ond ductWoler service
Wood stove/ heoterSSesilc-,L/Sewer
Heot PumpTEEDERSStorm Sewer Air hondler to
I0,000 cFMAmpr.
Air hondler over
r0,000 crM
ISSUANCE OT PERMIT
TOTAI- CHARGESTOTAT CHARGESTOTAT CHARGES
benot uvolid ntilelectricoltheofrhisshqllConltoclot,permittheElectricolbeworkdoneporlionIRESElectricolbythottheSTAWHEREtAw,TE R,EOU
loattoched electricoltheond pcnol.ConttoGtorbeenonElectricolhosbylqbelsigned
I HAVE CAREtULty EXAMINED the completed opplicotion for permil, ond do hereby cerlify thol. oll, infomotion hereon ir
certiff rhot ony ond olt *orf frfor-ei .holl be done in qcordqnce with the Ordinonces of the City of Springfield ond
p"*"ining to rire work described herin, ond rhot NO OCCUPANCY will be mode of ony structure without the permission
cerrlfy rh-ot my registrolion with the Builder's Boord is in full force ond effect os required by -OR!.701 '055, thot if exempt
h"ron, ond thot Jnly subcontroctors ond employees who ore in complionce with oRS 7O1.055 will be used on this proiect.
4z 0 | zt : oo.,H-!i-!-t l,\Ur SIGNATURER
s true ond correct, ond I further
the Lows of the Stote of Oregon
of the Building Division. I further
the bosis for exemption is noted
,l+NAJvtE (pleose prinl)
Bosis for Builder's Boord exemplion:
FOR OFFICE USE ONIY
Flood ploin Stories-Occy Group-Sq' ttg. Other-..-
x -------Voluex Volue
a
-[qlug
So-Ftg. Access
TOTAT VATUATION
Zone
Fire Zone-Bedroom: occY Lood
Const.-Units -.-Sq. Ftg. lv{oin
Systems Development
Chorqe (1.5%)
Plon Ck. Comm/lnd
65%/Blds Per Fee
Plon Ck. Res
3o%/Bldg Per Fee
BUITDING PERMIT
Chorges ond
Surchorges
tence
Totol Comb. PermitDemo
PTUMBING PERMIT
Chorges ond
Surchorges
Sidewolk
A/C Povino
ETECTRICAT PERAIIT
Chorges ond
Surchorges
Curb Cut
TOTAT fio.FEE
MECHANICAT PERrrtlT
Chorges ond
Surchorges
COMBINATION APPLICATION./PERn.if (CAP)
l. Applicont to furnish
A. Job Address
B. Legol Description
l.-exomple-tox lot 100, Lone County Mop iefere-nce.l7 03 43
2. ex#;E-Lot L Block 3, 2nd Addition to Springfield Estotes
C. Nome, etc. of owner ond construction lender
PERMIT VATIDATION
D. Energy Sources
I. exomple-heot,relectricol ceiling.io
2. exo m FIE-wote rT-eEi6 r/EIEE?-i co l,
r forced oir gos
oaldsI
E. Squore footoge or voluotion, etc,
'I . exomple-.I250 sq. foot house,500 sq. foot goroge
2. exomple-if new proiect, check new-if qddition, check
odd, elc.
F. Building permit informotion:I. exomple-construct single fomily house with on ottoched
gqroge
2. exomple-remodel existing goroge into fomily room
3. exomprc-convert single fomily residence into
restouront (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 Division
Stoff must be oble to contoct oppropriote persons regording
design informotion or iob site corrections, etc.
ll. Abbrevioted Plumbing, Mechonicol & Electricol Schedules
A, Except where blonk spoces occur in the description porlion
of the Mechonicol ond Electricol Schedules, the opplicont
need fill-in only the No. Boxes odiocent to the oppropriote
item(s) to be instolled
B. Full Plumbing, Mechonicol, ond Electricol Schedules
ore ovoiloble ot the Building DivisionI. To conserve spoce on the permit form the schedules
hove been obbrevioted
2. lf the item(s) to be instolled ore not covered on the obbrevi-
oled sc,hedules 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 os o
worksheet only. Where possible, Building Division Stoff will
prepore o typewritten copy ond return it to the oppliconl ol
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 opplicotion,qnd no plons will be processed until these fees ore poid. All
other fees ond chorges ore due ond poyoble when lhe permit
is issued.
V. FOR OFFICE USE ONLY
7 /,/vq
Permit Clerk
PROJECT CONDIIIONS TO BE SAIISFIED BEFORE OCCUPANCY:
Additional Proiect lnformolion:
PLANS REVIEWED BY.
nome signolure dote