HomeMy WebLinkAboutPermit Building 1980-12-10
-
INSPECTION LINE
726-3769
.
Job Add"" ~7dr />14-l~
I legal Description ht .2 L J:du...l
7.'-.~/O<!:', 17-<)2-;.3/-'31
Own., Kn.L<;' t- K< lLk...C ~ ~
'N.
Add,... L/ 5 t: ~'7 p, -
<:o/J~I.
..
Construction lender
~.
Addreu
DESIGN TEAM
&.J."
(nomel J&1~
Primary
Siructurol
Electrical
LYAJ
1"1~",r2...<"
Mechanical
CONTRACTORS
{nomel
Gp.nerol
Plumbina
Elect;icol
Mechanical
PLUMBING
NO
I fEE I CHARGE
5:--- ~-
I
I
'f
Each lin~.le fix.ture
Relocated building
(new fbe, additional)
S.F. Residence
(1 bath)
Duplex (l both) each
Additional both
Water service
Sewer
Storm Sewer
I
r
I TOTAL CHARGES
CITY OF SPRINGFielD
COMBINATION APPLICATION/PERMIT
.
INfORMATION LINE
726-.3753
P'..
~
I ENERGY SOURCES:
Heo,r.../""C!. <"..,.........,-
1 .
I' Water Heater 41 If ..6
Ranqe __ ~~
Vatue of Work:
i Sq. Ftg. Main -.l.,..5tX:J
Jk.f) /....1/1 Sq. Ftg. Accen.
Sq. Frg. Other
_New__Add ~Altllr _Rep.
_Fence__Demo_Chongel Use
_Other
--
~OOO
Buildi;;-g .P~~mil Info: Describe Work (Le., Build Single
Fomily Resicl..nt"': Wit~~hed Garaoel
~~-
..
Phon. 7~/-1<(~?
C'.O-.L> 104 Iv:"" .
.. ,
UA/'~
S"IL<'-y.f':pJeI : PI... .......hf......r
~(O Nln.."JLQ ~ I
Phone
(address)
(lies. no.)
(address)
(lies. no.)
ElECTRICAL
NO. I
I CHARGE
FEE
Residence of
U~: ft.
/' New circuits, alterations
or extensions
6".-
SERVICES
Temporary Construction
Amps.
FEEDERS
Amps.
1...0. <:"e-
IL'"
.....
~,
-'
N
N
luI
I
I
I
I
I
I
I
I
I
I
FEE
'CHARGE I
/1
I
(expires) (phone no.)
~
y ....
(expires)
(phone no.)
3. - 6. 0Cl
Basis for Builder's Boord exemption:
NAME (please print) /~~I-
I:S-<-L<: S" -....
'1GNATURE d' c. c'/ ~_
FOR OFFICE USE ONLY
DATE I e-/o-Rei
MECHANICAL
NO,
.2.
furnace/ burner to
:lTU's
Appliance vent
separato
Stotionory evap.
cooler
Vent fan with
single duct
Vent system aport from
heating or. A.C.
Mechanical 'exhaust
hood and duet
I
I
I
I
I
I
I
I
I
I
"2~'- TOTAL CHARGES
ISSUANCE OF PERMIT
15:.- TOTAL CHARGES 6. -
Woad stove I heater
Heat Pump
Air hpndrer to
10.000 CFM
Air handler over
10,000 CFM
WHERE STATE lAW REQUIRES that th. Electricgl work be done by th. Electrical Cantratlar, the electrical pomon DE this permit shall not be vnlid until a
label hgs been signed by on Electrical Cantrodar and attach.d to th. .1.clricClI panel.
I HAVE CAREFUll'f EXAMINED the completed C1pplicatian Eor permit, and do hereby certify that C111 information hereon is true and correct, and I Eurther
certify that any and all work. performed sholl be dono in accordance with the Ordinancll5 of the City of Springfield and the laws of the Statlt oE Oregon
pertaining to the worll described herin, and Ihat NO OCCUPANCY will be mode aE any structure without the permission of the Building. Division. I further
certify that my registration with the Builder's Board is in full force and effect os requirltd by ORS 701.055, that iE e.xempt the basis for exemption is noted
heron, ond that only subcontractors and employ.es who ore in compliance with ORS 701.055 will be used on this project.
20n-
<:.1.{
Type/Const.:IZ:":..AI
Bedrooms
c.torie.
Fire Zone
Flood Plain
BUilDING PERMIT
Chorges and
Surcharges
"Z8.-'"
/./<
20.-
..30
1,<). ...
.60
____6.:......~ __
.'";I~
PLUMBING PERMIT
Charges and
Surcharges
elECTRICAL PERMIT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
Units
r\,.cy load .
Occy Group--1!-2.
C;q. Ftg. Mtlin
Sq. Ftg. Access
Sq. Fig. Other~cJIWf~
Plan Cll. Comm/lnd
65%1 Bldl:l Per Fu
Plan Ck. Res
30%1 Bldq Per Fee
{8.~O ,.,-'.
/2_-Be>
Fence
Demo
Sidewalk
Alc Pavinet
Curb Cut
x
':clue
YI~-
..x Value
I::,;o-~ ~&jolu.
TOTAL VALUATION
Systems Development
Chorae (1.5%1
Total Comb. Permit
7/.7""
TOTAL
V'
I
COMBINATION APPlICATION;PER. (C~-;j- :-. -:. -.."' ", ";,~' : :ePERMIT:YALiD{TIQN' ~_ _,'_~ F '
. -~ "p,,-.~.,,~__. .. . 'Y . "!.;.. .,1'. ,~':~~ :;'".,:".:
, t~;~m:;~:.;;~:~oo. CO" ';O;':M~;~::1::,,~"rri3;;~~;~i,~~~~_t~;1~~$~
2. example-LotI. Block 3, 2nd Additio.n to"Springfie!d Es -' ,<,~ . .__".'" , '"., , ';.'; ,. ,-:., , .. , " ,[."
C. ~ome, etc. of owner andconsfriJctioh: 1~1;der~,._ .rf:~:'!"_', b, .~;r:.::)f;':,~~~~,':;;'::':~:.~J';.,..--.~:;~,..i:;.~.: ~;,_ _"''';';;;''~'~'<~{~:~
D. Energy S~urces ' '_.-.- ";.: ,-... ~"i.;?::' ._:-"~:(-':.t:"-C:I:T Y..:~Of' ',5 eRtr,rG'E, fEL 0/ ".:
1. example-heat/eleCfricolceiling/or forced_ott" qas<.....-. ,;.:-~~.... ",-<;:: . ,....'. . Cfi!~~all~:' ',. ~ 'c~ _~', .... ~.)t' t..... r (
2. exomple~woter heater/electrical/or solar -. . Y"
. ,E. _ Square.footage or voluoti'on. etc. --;- .f _'~ ; .\ ~pringfield, Oregon . t^.
1. example-1250 sq, foot house, 500 sq. foot garage Department of Public Work.
... "" ..~..2..exqmple-if- new proiect"check new-if addition, check ...... ,,"" ",.. 0 F F I C I A L R E CIE I P T
odd, etc.
F. Building permit information:
1. example.construct single family house with on attachl
garoge "~'. _. ~"""-''''~____-:,.
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 ..
Struct~ral Specialty Code ' , ',." - ~,
H. DESIGN TEAM AND CONTRACTORS '" ". ' j'.'
To avoid desigri:or:.construction.delays; Buildiri'g'.,Divis'ion
Staff !l1ust be able to ~co~tC;;ct appropriate perso'n'fregcirc
design information or job site corrections, etc.
I
~~;J-
I
.
.
ij
.
!
II. Abbreviated Plumbing, Mechanical & Electrical Schedules
A. Except where blank spaces occur in the description porti.c.:
of the Mechanical andEleclrical Schedules, the applicant
need fill.in only the No. Boxes'adjacent to the approprio
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 schedules
hove been abbreviated (.'
2. If the ite:m(s) to be installed ore not covered on the 01
ated sdiedules you should consult the full sched~les" ,_"
C. ,BUILDING DIVISION STAFF WilL FILL OUT 'ALL FEES,AND i
CHAlIGES ON THE SCHEDULES ,< ,__::'5'.?--.-
(
( Dote '-8. \ 'cl19'~~~,~~_. ~ ~ 3 7 ~,'~
(.:::~,::~~%;1f&~
( -" -.~.. - '-_'::'-~--<, -:, ().J
"." Receiv;d 'F+~, 'D\.r\ f) ,'. ". ': ,. "Q?<. ,", (
( , . ., . "\ '40ty., ")',/ 2-' (
, 7 LmXJ , ::yj".CD
(L \ Q \LO N-~~"3~"(
d.AfJ . leD (
\'f\J r-.H @;:) \ 0 .14,:(
3
~
!
~
~
......
(
,( '~
.I.;
(
III. Applicant ta sign and date
Whenever possible, the initial application will be u.~ed as a
worksheet only. Where possible, Building Division Staff.w.ill
prepare 0 typewritten copy a~d return it to.the.-oppli~ant..a.l
the' time the actual permit is issued for his signature~ .~e'.
(
IV.
. ",..
. Fees and Charges ~,,'
Plan check fees are due and payable at the time of the app
and ,no plans will be processed until these fees ar~ paid_ AI, C'
other fees and charges are due and payable when the ,perr -
is issued. ,,,. t- .
(
.~...'
_Amaunt'Received ,.::-.\ n\O _',~'
'.;, ~\UJJX:t
~UT:~~:ZEl'~NA.TUR~ .~ .' .' , ~('
SHUTO"'T"''''''ULL ~""'Tl"S . lUGIEHl. 0.. .7"01 : ..5.....
.'
, :',(
~ r.. .
V; FOR OFFICE USE ONLY
Permit CierI-
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
AdditionQI Project Information:
I
I,
J
I
".'
. .~
.'~ ,
I
1.
.'
PLANS REVIEWED BY:
na"';e L-oifNcS- R..;<:;: e-'-k
'.:'
Signa:uro ~~. f~~~
''''ate
-, "
'.
/:;>;;;"..3 e c,
-
~
tl