HomeMy WebLinkAboutPermit Building 1981-6-4
INSPECTION LINE
776-.3769
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CITY OF SPRINGFiElD .
,COMBINAflON APPLlCAflON/pERMIT'~7..."~'
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INFORMATION LINE
726-.3753
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Legal Description
~(~ S/'/~.:L 17~ ;fc; IVCF?
;2,~ .- /4-
Sq,,1 dPrJ'
/frlc rC c> fr., k'rf
c' .~
I Water Heater
RanQe _
I Value~Work:
// "de?
110
Sq. Ftg. Main ~r7
Sq. Ftg. Accen.
Sq. Ftg. Other
_New _Add_Alter_Rep.
__Fence_Demo_Changel Use
_Other
Job Addreu
.E1l';~ .
r:lbf/JV/T/a. YO) L
I~d,
Owner
s. ec-l~e ~
/:!~
Add'e" ..;2 C, ,p, '5-
7[. ~ ()0fI'
Phone .74tn-
04K~
Building Permit Info: Describe Work (i.e., Build Single
Familv Residenc"" With Attached GaraCle!
.(..((J(1 fr)'-()J{jJri mu
'17.lkl Q~_ . NY) , DeLilrrml T
54b " . .
-.... -- ~--- ,
Construction Lender
OuJ",-,p~-
Addre"
Phone
DESIGN TEAM
(name)
(address)
(lies. no.)
(expires)
(phone no.)
...." I Primary
, Structural
I Electrical
I Mechanical
I CON.fk.".CTORS
I Gen"al /:'!..e....0..u .Cr, r /C~- ilJJ/Ir!":~Qll..IJ<)'tA:",. ~.!fSi._ 3S--7SR
I .. ;.:"'? <",.",c~
Pur,lrJHl:q ._._..' ___
/?D,6 (N r
#.
We.'/'ev
3/.5"3.7
&~~ -t/,I1<1..
:5 S.J S,f
/;) ';;) '..f./
,5</.?.;I. V?O
(nome)
(uJJrl::.l~s)
(ljcs. no.)
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/,;2-:;2;2-0'/ . :f'h-Z(/.;>fJ:
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!:Iecr,ical
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!.I,'..~hanicClI
~_~~:~~-=_,~~_~~~:~~,~-;~'==-:~-'~~~I~' ._"~~~. .___~ ._~l.~".~ICA:' ---.- - ~ ~~,'--~:r--~
J.!O. !i-..-- . il. fer: .1 CHARGE,' NO. Ret:dollCll (.of" . "".'O._-!-.I~-FEt- nlARG': NO.
." Eacn sinqle fbtlure sq: ft.
., . "'1 Relocaled building I ~ . N"v! circuits,.alieratit'ns .
__ _. (ne"! fLw:. odditionol) _....._ _ _~ _ ~r eJlltens:ons ___ _ __ _. ~~t)()
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MECHANICAL
f...I"f..J~e/bl,;rner to
C.TU's
'~'-:'-'--rErt ~ -2HAi;,..:!i_l
. I
/ll.o..o.. _
;'.:nps.
I
Applianco vent
Kp....ate
S'"tirJnarj-' eyap.
cool~r
1-/-- -Vent fan with
1ingle duc;
I . Vent Sy. stem aporl frf.m
heatinq or A.C.
A'.e::har.ical exhaust
i hc.ood o~ld duC"i"
,/
J
SII'O','er
1/f1.~~' --
I
I
I
I
-1__- __,
Wood slove/heoter
I
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,-
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S.F. Ri!~idenc.
__.._.J!.lo:"i.,_
SERVICF.S
Du:,lex (1 both) each
/ I Addjtion~1 bo;h
~Wate;ser"'ice
Temporcry Co"structlo"
Stor,m Sew"r
FEEDEk:;
Heat Pumc
Air handler to
10.000 CFM
Air hondler over
10,000 CFM
Amp,.
I
I
I TOTAl CHARGES do.od TOTAL CHARGES
Ix WHERE STATE LAW REQUIRES that lh. Electrical-wOI. be don. by the Elt!t~iical. Controcto!'"
laLel has bean signed by an Eleth'ical Controdor Gna ottached .to Ihe eledrica: panel. .
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-_.=-~= =~~_ __u_I:,C~~
l ~ ISSUANC!:: Of PERMIT IO~c'" I
/ s: Or) I TOTAl U1A'G,S /3.00
the III~ctTh.ol -poltion o~ Ibi. permit shall i10t b. o:did until r.l
I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that 011 infonnatlon hereon, is !j'U. and CUrle<t, 0.1.-1 I furth:!"
certify thot any and 011 work performed sholl b. don. in accordance with the Ordinances of the. City of Springfield and the lows of the State :.f Orege,;:
p01"taining to the work described herin, and Ihat NO OCCUPANCY wjll b. made of ony structure- without th. perr.liuion of the Building Division. I further
certIfy that my registration with the Builder's Boord is in full force ond effect 0 s required by ORS 701.0.55, thot if exempt the basis for e,.emption is notefl
heron, and that only subcontradors and employees who ore in complionce with ORS 701.05.5 will b. used on this project.
Bosis for Builde~s Board exemption:
.,GNATURE _12~ )6? u/. ~
DAT~ tt,-~#...
NAME (please print)
-~"-~--_._.-. ~--_.-
fOR. OFfiCE USE ONLY
lone Typel Canst
Fire lone Bedrooms
Flood Plain ---:- _--Storie,
I 'nits
nccy Lood
n..y Group
Sq. Ftg. Main
<-'l. Ftg. Acces~
Sq. Ftg. Olher
,C)t,.o
--'---~--.-'"
x j 9. c, (/ Yalue / (, ccr."'''
x
Val'J.
x Vo!..-
TOTAL VALUATION
~..
/1,000. -
BUILDING PERMIT
Charges and
Surchorges
_____ $(.,.00
;:J .:4':'/
,;lO.DO
,'!!D
/.5.,co
. ('0
_____.8-'ooJ
,S;1.1
Plan Ck. Comm/lnd
65~;,1 Blda Per Ftre
Plan Ck. Res
30%/ BJdo Per Fee
/97 .00
Systtrms Developm~nt I
ChoroQ (1..5%J
5 - 2.2 - )S 1 f Q..{' jJ0::JJ{)
PLUMBING PERMIT
Charges and
Surcharges
Fence
Demo
Total Comb. Permit
//)g,/ta
ELECTRICAL PERMIT
Charges and
Surcharges
Sidewalk
Alc Pa..,inQ
I
I
I T?TAl
Z"/iJ~Jb
MECHANICAL PERMIT
Charges and
Surchargtr,
Curb Cut
......,......::._.....04..:._,~.,.
. '.";':-'"-_.,,,--
I. Applicant to furnish
A. Job Address
B. Legal Description
1. exomale.tax lot 100. Lane County Mop Referencp 17 03 43
2. example,lot 1. Block 3. 2nd Addition to Spring fie C I T Y
C. Name. etc. of owner and construction lender (
0.. Energy Sources
1. exomole-heat/electrical ceiling/or forced air gas
2. examole.water heater/electrical/or solar
E. Square footage or valuation, etc.
1. examale,1250 sq. foot house. 500 sq. foot gorog.
2. example-if new project, check new-if addition, eh ,'-
add, etc. I,
F. Building permit information:
1. examcle-construct single family house with on at. (.'
garage
2. example-remodel existing garag~ into family roo
3. example-convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (0) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS (
To avoid design C?r construction delays, Building Divi ~
Stoff must be able to contact appropriate persons re,
design information or job site corrections, etc.
II. Abbreviated Plumbing, M~chanical & Electrical Sched~le
A. Except where blank spaces occur in the description p
of the Mechanical and Electrical Schedules. the appli
need fill.in only the No. .Boxes adiace~t to the appro
item(s) to be installed
. B. Full Plumbing, Mechanical. and Electric..1 Schedules
are available at the Building Division
1. To conserve space on the permit form the schedul,
have been abbreviated
.2. If the item{s) to be installed ore not covered on th
ated schedules you should consult the full schedul
C. BUILDING DIVISION STAFF WilL FILL OUT ALL FEES A
CHARGES ON THE SCHEDULES
COMBINATlO~ APPLICATION/PER. (~)
, ~
".
III. ,Applicant to sign and date
Whenever possible. the initial application will be used a
. worksheet only. Where possible. Building Division Stoff '
prepare a typewritten copy and return it to the applican
the time the actual permit is issued for his signatur(..
IV.
Fees and Charges ,"'
Plan check fees are due and payable nt the time of jffi, ;-"',.'
and no plans will be processed until these fees are poid.J,.,..
other fees and charges are due and payable when the permit
is i"ued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS. TO BE SATISFIED BEFORE OCCUPANCY:
'"
Additional Project Information:
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PLANS REVIEWED BY:
nam'""
...ignatur~
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.'PERMIT VALIDATION
OF'SPRINGFIElD
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City Hall
Springfield. Oregon
Department of Public Works
OFFICIAL RECEIPT
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\.. No B 56665
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Rec.i~~.m \nC b (l hS (\ ~ D\(1\'(\~. f\.
Address 73\ 'S~'"2-., \::MVYf\~P(~
Received For: ~\r\ ~ . . ~i() ,~
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Amount Received' '-I (J'fJ.11O
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$..t:lTO"'.TU"".Ull ".'NTI".. lue ..1:,010 '7"0'
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Permit CierI-
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