HomeMy WebLinkAboutPermit Building 1981-06-19CIIY OF sPRINGTIEID
COATBINATICN APPIICAIION / PEEMIT
INFORMAIION LIN€
l2t37s3INSPECTION tINE
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ENERGY 5OURCES:
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Volue of Work:
Building Pe,mil lnfo:
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PhoncAddrarr (phone no.)(lic. no.)
DESIGN TEAM (nomc)(odd re rr)
ETECTRICAL
Mcchonicol
PTUMEING
fi rtura!ocn
r?2 I CHARGE furro."/burner to
tRe:idenca of
-rq:
fr.
Applionce vent
!eporo te
Ncw <ircuils, olterolionr
or exlensionsRalocored building
(ncw fix. odditionol)Stotionory evoP
ccolerSERVICESS.F. Reridence
(l both)Vent fon with
sinqle ductTemporory Cgq!ry:I9"-Oupler (l both) coch Vent tyrtcm oporl from
heotinq or A,C.Ampr.Acidirionol both Mechonicol exhoutl
hood ond ducr
\l/oter te.vice
Wood rtove/ heoter
Hest PumoFEEDERSStor.m Scycr Air hondler ro
I0,000 CFrriAmpr.
Air hondler ovcr
10,000 cFM
lssuANcE oFnPeRA\lT
t HAVE CAREf ULLY EXAMINED thG comPlci€d oPPlicotion for permit' ond. do h
cerrify lhot any ond oll work pcrformcj r!ot] fc. -done in oc@tdonce with lh
pl""irr.g t" lira work d:rriixd hcrin, ond lhot NO OCCUPANCY will be mo
taify $-ot my .Ggitt?otion wilh lhc Esilde/r Boord ir in full forcc ond effcct o
h..o., ond rhor Jnly rubontroctorc ond employeer who ore in complioncc w
ereby certify rhot oll informotion hereon ir lruG ond correcl, ond I further
e Oi.iinon.", of the City of Springfield ond the lows of the Slot' of Orcaon
da of ony rtructure without the pcrmirrion of rh.e Building Divirion. I further
s rcquirej by ORS 701.055, lhot if cxempt tha boris for cxemplion is noled
irh oRs 701.055 will be usd on thir proiccl.
Bo:ir for Euilde/r Eocrd cxcmPtion,
TOIAT CHARGESTOTAI. CHARGESTOTAT CHARGES
nilr
---Volue
1/ ' \'7 -t Ya,'aLood
--5q.
G.o,pJLJ-sq.
I
xFtg. Accer!
onotunlilbcvolidthisoIrlcclricslrhaPGrrnitConlrqcroe,porliotE!arlriccldoncthcworkElcrtricolbrthcbyRESthotAIESIwTA'NEOUIWHETE lhe clcclrisol ponel.ottochsd loondC o ntto Glc lonElacricolhorlobolbonb,1rigncd
Ftg. Moin
NAIAE (pleorc prinr)
FOR OFFICE UsE ONIY
fire Zonr-Bcdroomr
Flood Ploin
Zone .Typc / Conrt.
Frg. Olher-r
-Volue
IOTAL VAIUAIION
SIGNATURE DATE
Plon Ck. Comm/lnd
651Llgl<1q ?et fee
Syttemt Devclopment
oroc (1.593)
Plon C!. Rer
3096/Bldq Per Fe"
BUITDING P:RMIT
Chorger ond
Surcho rg c r 1q
Totol Comb. Permil
PlUMBING PERMIT
Chorger ond
5 urcho rg e r
Demo
Sidewoll
tl crlt / eTOIATCurb Cul
MECHANICAL
No.
Chorgcr ond
Sur chorgc r
MECHANTCAT PERI'\IT
Chor-oer ond
Surchorgcr
rrl. rcce,r. llg 4
-New-Add -Alrcr -RaP'
5q.
CHARGEFFF
Sewar
rholl
':1, {, rn
Fcnte
a/C Po"ino
Addirionol Prolect tnformqrion:
PLANS REVIEWED 8Y
nome signo ture dole
I
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coME|NAI|ON AppLtcATtoN, PERMIT (CAp)
l. Applicoru to furnish
A. Job Address
B. Legol Descriprion
l. exomole.rox lot 100, Lone County Mop Reference I7 03 432. elii,-ore--Lor l. Elock 3, 2nd Addition ro springfierd Estotes
Nome, etc. of owner ond construction lender
Energy Sources
r forced oir go
or soloi
PERMIT VALIDATION
CITY OF SPRINGFIELD
CirY Holl
Springfield, Oregon
Deportment of Public Works
OFFICIAT RECEIPT
I{0. B 56768
r9
I. exomole-heotr electricol ceilinq/o2. ;E;;E-,",o re r Jr-ilIilEGEiiio t r'
Squore footoge or roluorio[IIl-
l. exomole-1250 sq. foot house, 500 sq. foot gorog i2. eE"-6iE-iTE^/ proieo, .h".[ ,rui-ii oddirlon, c, L;aa:,.
F. Suilding permit informotion:
I. exomole-construcr single fomily house with on o (h,
s,oro9e2. exomole-remodel existing goroge into fomily roc3. exo'.npE-converr :;ngle fomily rlsidence into (ffiro-nt (chonge of use)
G. Volue of work os defined in Seciion 303 (o) of the
Structurol Speciolry Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction cieloys, Building Divi
Stoff musf be oble to contoc, oppropriote persons re(designinformo'ionor]obsitecorrections,etc.
Abbieviored Plumbing, Mechonicol & Etecrricol Schedule
A. Excegt where blcnk spoces occur in the description p,
of the Mechonicol on<j Electricol Scheiules, the oppiir
need fill-in only rhe No. Boxes od[ocent to the opprol. ilem(s) to be insrolled
B- Full Plumbing, Me<honicol, ond Electricol Schedules
ore ovoiloble or the Building Division
l. To (onserve spoce on rhe permit form the schedule
hove been obbrevioted
2. lf the irem(r) to be instolled ore nol covered on the. oted schedules you should consul, the fuil schedule
C. BUILDING DIVISION STAFF WILL FILI OUT ALL FEES AI
CHARGES ON THE SCHEDUTES
lll. Applicon? to sign onci dore
Whenever possible, the iniriol opplicotion will be used os
worksireei oniy. \?'here possible, Buiijing Divisi,rn Sioff -prepore o typewrirten copy ond relurn it to the opplicont
lhe lime the octuol permit is issued for his signoture.
lV. Fees ond Chorges
Plon check fees ore due ond ooyoble ot the time of the op
ond no plons will be procersed until lhese fees ore poid.'/
other fees ond chorges ore due ond poyoble when ih" pe,
is issued-
V. FOR OFFTCE USE ONLY
C.
D.
E.
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For:
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Am ounl Received
Permit Clerk
SIGXATURE
EUCENE. Ol aTaot
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PROJECT CCNDTTIONS TO BE SATISFIED EEFORE OCCUPANCY:
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