HomeMy WebLinkAboutPermit Building 1987-10-20
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INSPECTION LINE
726-3769 .t!O,TIFIEO
OCT 2 IJ 1991 C'TY OF '..'NGFlElD
.~""'BINATION APPLICATION/PERMIT
INFORMATION LINE
726-3753
Job Addreu
5Rq? M.in Street
. ENERGY SOURCES:
Heat ~lp('
Water Heate.Ele.C
, Range
Value of Work:
I Sq. Ftg, Mai~ ~AX
Sq. Fig. Acceu.
Sq. ftg, Other
LNew_Add_Alter_Rep.
\_FenCe_DemO_ChangefUI.
_Other
$1fl.,OOn
Building Permit Info: Desuibe Work (j,e.. Build Single
family Residence With AHoched Garaae'
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L.gol D",dp.;on I nt 1? Rljdames.a.5uD
-1J-=.D~34mO T I ? 1 00
Owner nr. rlriY'(( W_ RnpnoY'
Addreu
1Z17 r.pntpnnial Rlvrl
Phone
74fi-q55?
Add".. Mohawk Branch
Phone
Comolete two small l~a~~ n~f;rp <n.rp< -
shell permit for refprenre #R01107
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Con5trudion "Lender Fi rst Nati ana 1
DESIGN TEAM
(name)
{addren}
(lin. no.)
(expire5)
(phone no.)
Primary
General
Darrell M. Wilson
1717 Centennial
584
.;11
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;.< ~
(expire5) ~~ (.,hone no.)
9-11-82 7?fi-057q
Structural
EI...,;,ol . 3~Wav Electri'ca1
Mechanical
CONTRACTORS
(name)
(address)
(Iics. no.)
Plumb;no Beeson PI umbi no
Electrical 1-WrtV 1='1 ~rt-Y'i r;t i
Mechanical r.hrtC:p rn_
PLUMBING
ELECTRICAL
MECHANICAL
FEE I CHARGE HO. I , FEE I CHARGE
furnace/burner to
BTU's
Appliance vent
leparate
Stationary evap.
cooler
Vent fan with
:;> single duct 1_00 fi_nn
Vent system aport from
?5.00 heatinR or A.C.
Mechanical exhaust
hood and duct
Wood stove/heater
Heat Pump
Air handler to
10000 CFM
Air handler over
10.000 CFM
1 Extend Existin(1
Heat Pump System 6,00
NO. I
FEE I CHARGE NO. I
Residence of
F. Each sinqle fixture
Relocated building
(new fix. additional)
S.F. Residence
11 bath)
~ nn .n nn
1. ft.
New circuits, alterations
or extensions
SERVICES
Duplu (1 bath) each
Temporary Construction
Additional both
Amp.. ?OO
I Water service
I Sewer
10.00
10.00
Storm Sewer
FEEDERS
Amps.
ISSUANCE OF PERMIT
10.00
TOTAL CHARGES
~Il nn
TOTAL CHARGES
TOT At CHARGES
~~_'J'2
tM electrical portion of .hi. permit
n.oo
WHERE STATE LAW REQUIRES that the Electrical worle be done by the Electrical (antradar.
label ha, been ,igned by on Elutrical Contractor and attached to the eledrical panel.
shall not be valid until\o
I HAVE CAREFULLY EXAMINED the completed applicatton for permit. and do hereby certify that C11! information hereon i, true and corred, and I further
certify that any and all work performed ,hall be done in QccordClnce with the Ordinance, of the City of Springfield and the Laws of the Staht of Oregon
pertaining to the work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I further
certl"fy that my registrCltian with the Builder's Board is in full force and effect as required by ORS 701.055. thClt if exempt the basis far exemption is noted
heron, and that only subcontrClcton and employ_s who C1re in compliance- with ORS 701.055 will be used on this project.
HAME (pl.o.. pdn') I1IU!..,(?r!/ hl. LU ,}.r".....
SIGNATURE
(( t ~ 4vr){, Q<Jo<
DATE /" -i! ';! -RI
Bolis for Builder's Board exemption:
FOR OFFICE USE ONLY
Zone R ?
Fire Zone
Flood Plain
N
Type/Const.~
Redroom,
c.torie~
Units ?
I')ccy LOCld -----l?
'"'ccy Group D?
c:". ftg. Main ~Q
Sq. ftg. Acce,'
Sq. Ftg. Other
x 30 45 ~olu. 7" .1)00.00
x Value
x Value
TOTAL ~ALUATIOH \ 3R.000.00
BUILDING PERMIT
ChClrge5 and
Surcharges
____~LOO_
fi_04
50.00
Plan n. Comm/lnd
65%1 Bldq Per Fee
Plan Ck. Res
30%/ BldCl Per Fee
l.8....1 ~ Prl
Systems Development
Charoe (1.5%)
~70 00
i!R~7117T
PLUMBING PERMIT
Charges C1nd
Surcharges
fence
" ,,,,
Demo
Total Comb. Permit
?~7.q?
ELECTRICAL PERMIT
ChClrges and
Surcharges
25.00 S;d.wolk
1 . nn lAIC PavinQ
____-3~OO_J Cu,bCu'
TOTAL
MECHANICAL PERMIT
Charges and
Surcharge,
""
t"?7 a?
eo ,~j',~,""Lo,,!:gs.:1.~::<~"~~~~~;";,"-1~-!A~~I~::4~"'''c-!i!.l;,!;i. ,
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COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
, A. Job Address
B. legal Description
1. example-tax lot 100', Lane County Map Reference 1
2. example-Lat 1. Block 3, 2nd Addition to Springfield
C. Na,me, etc. of owner and construction lender
D. Energy Sources
1. example.heat/electrical ceiling/or forced air qas
2. 'example~water fleeter/electrical/or solar.
E. Square footage or valuation, etc. ,
1. example-1250 sq. 'foat house, 500 sq. foat garage'
2. example-if new project, check new.if addition, chee
add, etc.
F. Building permit information:
1. example.construct single family house with an aUe
garage
2. example.remodel existing garage into family roon
3. example-convert single family residence into
restaurant (change of ,use)
G. Value of wark as defined in Section 303 (a) af the
.. Structural Specialty Code
"H. DESIGN TEAM AND CONTRACTORS
To avoid design or construe'tion delays, Building Divil
Staff must be able to contact appropriate persons ret
design information or job site corrections, etc.
II. Abbreviated Plumbing, Mechanical & Electrical SchedulE
A. Except where blank spaces occur in the desc~iption p
af the Mechanical and Electrical Schedules, the appli
need fill-in only the No. Boxes adiacent ta the apprc
item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedu
have been abbreviated
2. If the item(s) to be installed are not covered on r
. .,' c, "ated sohedules you should consult the full sche.lI
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES
CHARGES ON THE SCHEDULES 00. 2S
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.. -- - .' PERMIT VALIDATION
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CITY OF SPRINGFIELD
City Hall
Springfield, Oregon
Deportment of Public Work.
OFFICIAL RECEIPT
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Date &i'~~l~rO, B 57495(1
Rec'd From o.....R. ~J ~Q~~o (\1r
Ad~ress t\ ""'\ \ ~ (\ 0 f\~ 0. 0 (I
Received For\.J~~L1q \ ~\ pc)
,l\ UP0 \0 ,0'1 (
\X ~JI'l\h ~ n.OO
, L{DA~- 2- CO
\:.~ ' '" ...a~,60 (
N \(1 If' J-..\ Lf~ - ,1100 (
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Amaunt Received
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III. Applicant to sign and date
Whenever possible, the initial application will be used ,
worksheet anly. Where possible, Building Division Staf
prepare a typewritten copy and return it to the applicl
the time the actual permit is issued for his signature.
IV., Fees and Charges I-
Plan check fees are due and payable at the time of the applicatian, '
and no plans will be processed until these fees are paid. All
ather fees arid cliarges are due ond payable when the permit
., is issued..
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. V. FOR OFFICE USE ONLY
Permit CierI-
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Additional Project Information;
nam-:-
Dan Smith
"'ignature
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daff"
10-19-81
PLANS REVIEWED BY,