HomeMy WebLinkAboutPermit Building 1981-12-2
~:~'~''''l' .1, ""~~~'~"!~';::==:~:~~~:'::'_'II\~~_""_'~!" :"'.;"':J~.~~:'O~';'~~. I~l'..
.~---~ ..'" -'~''''_'''~.:....l' h.r:'!'- ~ ........ ~ .....~---.::::: .~~..~~-:-.~"'___ _. . . :- '. ..
','
_ .. J' .. ~., ", _ . -' -..... . .~'..."., .~,.. -..
"c:..".~'/~,...;~~:.:.:~~~~.t<-5.~J.J.~~.;.:;~
I INSPECTION LINE
72~3169
CITY OF SPltlNGflElV
COMBINATION APPLICATION/PERMIT
INFORMATION LINE
726-3753
Job Add,... 3150 Main Street
legoIOe""ption 17-02-31-00. TAX LOT 00400
ENERGY SOURCES:
Heat
Water Heater
Ranqe
Value of Wor!.::
Sq. Ftg. Main ""uo
Sq. F'g. Accen.
Sq. Fig. Other
_Hew_Add_Alter_Rep.
_Fence_Dema_Change! Use
_Other
(X)
-
~
<J1
WHERE SlATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the .Iectrical portion of this permit shall not 1M valid until a I,
label has be.n signed by on Electrical Contrador and attached to the .redrieal panel.
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true and correct, and I further
certify that any and 011 work performed sholl be done in accordance with the Ord;nances of the City of Springfield and the laws of the State of Oregon
pertaining to the work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building Di...ision. I further
certify that my registration with- the Builder's Boord is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted
heron, and that only subcontractors and employ..s who ore in complian~ with ORS 701.055 will be uMd on this project.
Basis for Builder's Boord ex~mption.
NAME (pleo,e point) J~",-lJ. M c. WAI)C-
Ownepregon State Department of Forestry
Add,..U50 Main Street Phone726-3588
4,780.80
Building Permit Info: Describe Wark ,i.e., B1Jild Singl.
Familv Residence With Attached Garaae)
S~ringfield4-DregDn
Ga~ aT!.d....Vil Stnqge..Jluildip'!
(NOT neell~;p.~~
Q74J...7
Construction Lender
Address
Phone
DESIGN TEAM
(name)
(expires)
(address)
(lies. no.)
Primary De,!,artmeTlT of r:nrp~t-rv
Structural
Jr,
ltr
~1.5Q..MaiI1-Street > 5pr.ing.f-ie-1-d-,-O-r.egon
Electrical
Mechanical
CONTRACTORS
(name)
(expires)
(address)
(lies. nc.)
General Owner
Plumbing Ownpr
Eled"",1 Alert Electric
Mechonical
PLUMBING
elECTRICAL
MECHANICAL
NO,
FEE I CHARGE NO.
I I
I I
I I
I
11
I
I
I
Heat Pump
Air handler to
10.000 CFM
Air handler o...er
10,000 CFM
FEE I CHARGE NO,
Residence of
furnace/b1Jrner to
BTU's
Appliance ...ent
separate
Stationary e...ap.
cooler
Vent fan with
sint=lle duct
Vent system aport from
heatinQ or A.C.
Mechanical exhaust
hood and duct
Each single fixture
Relocated building
(new fix. additional)
S.F. Resid.nc.
(l both)
.....ft.
New circuits, alterations
or .xtensions
SERVICES
Duplex (1 bath) each
Temporary Construction
Amp" 100 to 200
25.0a
Additional bath
Water service
S.wer
Wood sto..../heater
Storm S.wer
fEEDERS
Amps.
ISSUANCE Of PERMIT
TOTAL CHARGES
25.00 TOTAL CHARGES
TOTAL CHARGES
Zon~ M- 3
fire Zone NA
flood Plain NU
~ '
<IGNAT'I-"-' ,_.k ~J~
FOR OFFICE ~ NlY
Sq. :tg. Main
Sq. Ftg. Access
Sq. ftg. Other
TJI _N
NA
1
Type/ Canst.
'l.edroom'
O;:tori~'
Units
f"lccy load
"ccy Group
?RR
Value
x 1 A An Value
x Value
. TOTAL VALUATION
H2
BUILDING PERMIT
Charges and
Surcharges
Plan n. Comm/lnd
65%/ Bldq Per fee
Plan Ck, Res
30%/Sldq Per Fee
I Systems De...elopment
, Charae f 1.5%)
32.00
20.80
1.28
PLUMBING PERMIT
Charges and
Surcharges
fence
I {Qtqt _Co']'b. Permit _
[..tV' "'" ",vU'
startea l'lerore
I-G!:>t-a,ining-permic '
Demo
ElEORICAL PERMIT
~ Chaoge' ond
Surcharges
~l MECHANICAL ~ERMIT
Charges and
~UrChargeS
Sidewalk
____25....a0...._
1.00
A/C Pa...ina
Curb Cut
TOTAL
._I_~_~__-----_.
(phone no.)
(Dhon. no.)
/
FEE I CHARGE I
I ,
I
[
I I
[ I
I [
I I
I
I
I
I
I
,I
DATE
/ Z. - 2. ~ 'ire
4.7RO.RO
71. 71
<;0 7R
33.-28
185.07
_......;.,.-,,.,...,..:.:::. .:: .,. .~ ~""',,'~'~',~';'_~""""..~~........~.:',-~,,"':':',";."~'~_~.,..,;..,~'_' ; ",.., ._' ,_.. '_. ,'u . _.. .
"_J~,,":,'j'~~;k~~;';'~I~I~~~:~:~i"~~'~J,;i..i\I,;"IL';' b';'"';", ,~~,I ~(~;'~j~l.h~k;~:;;..~~~i~,1:~;:::;.-,~~w?~rg;~,:i^.":'~
'. H""_.'_.-., _p'. _.:,.....;.00.>. ,_..,_..,...::;..~.--,.,.....t....,. ."'""".....-.-: .-- :,::,:~..-...".,.,:--. '._~-:'~::;.':;...:.::.:::._........:,: "~"''':..:''-'.'':''''''_-:__
__....... .'
.''\,.
COMBINATION APPLICATION/PERMIT (CAP)
(Xj Applicant t~ ~~rnish
s~..
dJ
(VC.
,
D.
Jab Address
legal Description
1. example-tax lot 100. Lane County Map Reference r
2. example-Lot 1. Black 3. 2nd Addition to Springfield I
Name, etc. of owner and construction lender
Energy Sources
1. example-heat/electrical ceiling/or forced air qas
2. example..~.a-'er heater/electricalf.or solar
E. Square footage or valuation, etc. '_" .
1. example-1250 sq. foot house, '500 'sq. foot garage
2. example.if new project, check new-if addition, cheel
add, etc.
F. Building permit information:
1. example-construct single family. hous'e wi~~ c'n' attae
garage
2. example-remodel existing garage into family room
3. example.convert single family residence into
'restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural,Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Divisi,
Staff must be able to contact appropriate persons rege
design information or job site corrections, etc.
II. Abbreviated Plumbing. Mechanical & Electrical 'Schedules
A. Except where blank spaces occur in the description pOI
of the Mechanical and Electrical Schedules, the applicc
need fill-in only the No. Boxes adjacent to the apprap
item(s) to be installed
B. Full Plumbing, Me<:hanical, and Electrical Schedules
ar~ available at the Building Division
1. To conserve space-on the permit form the schedule
have been abbreviated
2. If the item(s) to be installed are not covered an the
ated schedules you should consult the full schedule
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES At
CHARGES ON THE SCHEDULES '
III. Applicant to sign and date
Whenever possible, the initial application will be used as
worksheet only. Where possible. Building Division Staff, (
prepare 0 typewritten copy and return it to the applicant
the time the actual permit is issued for his signature.
IV. Fees and Charges <::
Plan check fees are due and payable at Ihe time of the "+-
and no plans will be precessed until these fees are paid. All
ather fees and charges are due and payable when the permit
is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
},,? - s. - ~'. \
.~:~ ...:. L.-J 1).\ y-' ; J.j~},...q;f-,""
PERMIT VALIDATION
(te
CITY OF
(
SPRINGfiELD
"
City Hall
Springfield, Oregan
Department of Public Works
OFFICIAL RECEIPT
'f'
_L _ No. B
~. ~d19 %\
~' Rec'd Fram'~~,\O&~~
Address 2> \ ~ D N{~ J:'...)
(
S 7 7 91 (I
Date
tI
(
'(I
Received Far:
(
,(I
\'_\::\.N.~ ~ ,CD
l{O4,_ I . dB
~Qo_ct:'- ~ r4~ ,00
Ll~, 1.00
dO .80
/(1
<::
n
(
\,
~
1~tiJr' ~ '\ \.\ \
~ ~l r\ ~ AA t:::O
~-~ \ lJfh .. ! 'd8
Amount Received f R..3 .01 c." K.
.....r.!J/P4i:::L .... (
(I
,(I
(~r
CI
c
(I
(]
(I
Permit CierI-
.-' .
/
-..\t)l, i.N ) jVJ ,I.)
" /
\~ gQ.......
i '
.- 1/
(1) As required\by Section 304 (a) of the..State Structural Specialty
Code, the fees specified in Table No 3-A have been doubled, singe work I
Additional Project Information:
, & 'Fire and Life' Safety
was started w1thout the required permit.
m TIlE GAS PUl-lP AND GAS PIPING.
_r..,,, o\N Anf\TTTtiu,,"' ~lR (In Dt:'I)\fT'T' T~ m:::QlnQpn PP()M 'l"'J-.1r. t:'TDJ: nr:D'^Rrr.1.,.rf::k1T CiJ.P 'T1.tl= llilD.I.E..Tr,vrrnNL
';"
;',1 .
fr 'I)'~ '~ J
. . ' . '. f
,..\..--;: "f ." . .-/_ .
. ( i " (. L'i 1 .. /, J lJt:7'.,J - (}r::_
','gnature ) J7l....j!1 Ll (f' 1/J'Jr >,. date .I Jr-;'hJ !(L
PLANS REVIEWED BY:
name