HomeMy WebLinkAboutPermit Building 1981-11-25
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INSPECTION LINE
726-3769
CITY Of SPRINGFIELD-
COMBINATION APPliCATION/PERMIT
INFORMATION LINE
726-3753
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OwMPregon State Department of Forestrv
ENERGY SOURCES:
Heat
Water Heater
Ran...q.
I Value of Work:
I 4,780.80
~- -
Sq. Ftg. Main ,,"uu
Sq. Fig. Acteu.
Sq. fig. Oth.r
_New_Add_Alter_Rep.
_Feno_Demo_Change/ Use
_O,h.'
Job Add,... 3150 Main Street
legaIO...,;p"on 17-02-31-00. TAX LOT 004,QO
Address
DESIGN TEAM
Phone
I Building Permit Info: Ducribe Work (i.... Build Single
fomily Residence With Attached Garaael
I
I
!i.as-IDld Oil S_tQ1'age-Buildin~
("Jot' n('r.l'pie.d~
Add,..J150 Main Street
~~~JLngfip.l~gon
Phon.726-3S1111
Q747..7
Construction lend.,
(nome)
(address)
(IiCl. no.)
(expiru)
.
(phone no.)
P'imor~n~l'_:::I_-rt'T'}eIl't_ of FOTP<;.t.:rv
_1 ,n '4ain...Stre~', <:pnng,Held,-O-r-egoJ:
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Structural
Electrical
Mechanical
General
CONTRACTORS
Owner
(name)
(address)
(lies. no.)
(expires)
(phone noJ
Plumbing
Own ,,~
Electrical
Alert Electric
Mechanical
PLUMBING
ELECTRICAL
MECHANICAL
/
NO,
fEE
CHARGE NO_
FEE . CHARGE NO.
FEE I CHARGE
Additional bath
1
Amp., 100 to 200'
2S.0C
furnace/burner to
I~TU's
Applian~ vent
separate
Stationary evap.
cooler
Vent fan with
sinQle duct
Vent system apart from
heating or A.C.
Mechanical exhausl
hood and duct
Residence of
Each sinqle fixture
Relocated building
(new fix. additional)
S.F. Residence
(I bath)
'9, ft.
New circuits, olteratians
or eKlensions
SERVICES
Duplex (1 bath) each
Temporary Construction
Water service
Sewer
Wood stove/heater
Storm Sewer
FEEDERS
Heal Pump
Air handl.r to
10_000 CFM
Air handler over
10.000 CFM
Amps.
.ISSUANCE OF PERMIT
TOTAL CHARGES
TOTAL CHARGES
25.00 TOTAL CHARGES
WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall not be valid until a
label has been signed by on Electrical Contractor and alt;lch.d to the electrical panel.
I HAVE CAREFUllY EXAMINEO the completed applicalion for permit, and do hereby certify that all information horeon is true and carrect, and I further
certify that any and all work performod sholl be done in accordonce with the Ord:nances of the City of Springfield and the laws of the State of Oregon
pertaining 10 the work described herin, and that NO OCCUPANCY will be mode of any sfructur. without the permission of the Building Division. I further
certIfy that my registration with Ihe Builder's Board is in full force and eoffect os required by ORS 701.055, that if exempt the basis for exemption i. noted
heron, ond that only subcontractors and employ_s who are in compliance with ORS 701.055 will be used on this project.
Ba.i. for Builder's Board exemption:
NAME (please print'
c:'r..NATURE
DATE
FOR OfFICE USE ONLY
Ion"
fjre Zone
Flood Plain
M-3
NA
NU
Type/Canst.
ll.edrooms
C:tori-~
T~l-N
1
Units
t""Iccy load
n .cy Group
H2
c:~. ftg. MClin
Sq. Ftg. Access
Sq. Ftg. Other
?RR
Value
x 1" hO Value ~7RO _ RO_
x
Value
TOTAL VALUATION
1.28
Plan Ck. Comm/lnd
65.,'0/ Bldq Per Fee
Plan Ck. Rei
30%/ Bldq Per Fee
20.80
Systems Development
Charqe (1.5%)
71.71
BUilDING PERMIT
Charge. and
Surcharges
32.00
PLUMBING PERMIT
Chorges and
Surcharges
Fonce
ELECTRICAL PERMIT
Charges and
Surcharges
Demo
.__~25.....oD-__1 Sidewalk
1. 00 Ale PaviM
lql:al ~Col1tb. Permit _
..Iv . ."" ,"un,
Sl:ar~e,? l'>erore.
.a-btai.ni.'u6 :t-'...._~..~;
,0 ?R
33.28
MECHANICAL PERMIT
Chorges and
Sl,lrchorges
Curb Cut
TOTAL
185.07
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COMBINA nON APPLICATION/PERMIT (CAP)
PERMIT VALIDATION
"
I. Applicant 10 furnish
A. Jab Address
B. Lega I Descri ptian
1. example-lax lot 100, Lane Counly'Map Reference 17 03 43
2. example-Lot 1. Black 3, 2nd Addition 10 Springfield Eslales
C. Name, etc. of owner. and construction lender
D. Energy Sources
1. example-heal/electrical ceiling/or farced air gas
2. example-water heater/electrical/or solar
E. Square footage or valuation, etc.,.. ..
I. example-1250 sq. fool house, 500 sq. foot garage '
2. example-if new...project, check new-if ad.dition, check
add, etc. .
F. Building permit information;
1. example-construct single family'house whh an "attached
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 Division
Staff must be able to contact appropriate persons regarding
design information or job site corrections, etc.
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II. Abbrevialed Plumbing. Mechanical & Eleclrical'Schedules
A. Except where blank spaces occur in the description portion""
of the Mechanical and Electrical Schedules. the applicanl
need fill-in only the No. Boxes adjacent 10 Ihe appropriate
ilem(s) 10 be inslalled
B. Full Plumbing, Mechanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are nol covered on the abbrevi-
ated schedules you should consult Ihe full schedules
C. BUILDING DIVISION STAFF Will FILL OUT All FEES AND
CHARGES ON THE SCHEDULES
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III. Applicant 10 sign and date.. "
Whenever possible, the initial application will be used os a
worksheet only. Where passible, Building Division Staff will
prepare a typewritten copy and return ilia Ihe applicanl at
the time the actual permit is issued for his signature,
IV. Fees and Charges
Plan check fees are due and payable allhe time of the applicalion,
and no plans will be processed until these fees are paid. All
olher fees and charges are due and payable when Ihe permit
is issued. .
V. FOR OFFICE USE ONLY
Permil Cler~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
;".
. Additional Project Information:
&'Fire and Life Safety
(1) As required by Section 304 (a) of the State Structural Specialty
Code, the fees specified in Table No 3-A have been doubled since work
was started w1thout the required perm1t.
-c?) ~lllTIONAWl8...0n oco,,'''' Je; IlE'1".ocn con" 'rUC cTIlE DEP^QTI""1'T' cI)ILX..n:: "nn'''lC^TTO/.j<:
TO TI1E GAS PU~W AND GAS PIPING.
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PLANS REVIEWED BY,
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