HomeMy WebLinkAboutPermit Building 1981-4-28
I INSPECTION LINE
726-3769
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CITY OF SPRINGFielD
COMBINATION APPLICATION/PERMIT
INFORMATION LINE
726,..3753
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Phon. 7'f~- ;1 7 J 1
ENERGY SOURCES: I Sq. Fig. Main J / '9t!:>
Heat ~ : Sq. Fig. Access.
Water Heater tEt..G<7 ~____ Sq. Ftg. Other
Range #'A. _N~w_AddXAlter_Rep.
Value of Work: __Fence_Demo_ChangefUs.
/"ur/>...... __Olh..C""",,!,,~7"~
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Building Permit Info: Oescr-ib';-Work (i.e., Build Single
family Res:dence_ ~~Ih Allotned GorOQe\
Job Add".. 310 ~ /vIA-11Y ~T./ -':;v/TI!!: '8'
LegalOewiption ltPr Z Or '18'5
r./.,Slot)/ MAP/7-e:J2,-?j/-"3/'
J::AP";/ Er€;??~SMA
Add".. '1Stb AI 7:?"'P :57'.
"'~j:''''P. . pp,
Owner
Construction lender
Address
DESIGN TEAM
Phone
.&?P W~~/N ~~~..e:;, McM c:..-f5""'-"
EJ//'IR',. h-~ !"~......-...' ~""S~~'"'A>~
I.~-=-:Pc::> 5T<>R'~r1'?'::'NT ~k G:if/f5~ ~c.;
(name)
(address)
(expires)
(phone no.)
(lies. no.)
/Jw,(J,$: ~
G.n",ol M. "'_. )'?a(.~$. _!i' qqc>~ fl. ~N~;D:r?/::>~
Plumb;n. C;PPIf.XbF/tfEl.Z::> rl..~ RIHC::,
EI"td,ol t. "'-Vb", €lel!:-/'
M"hon;,ol G '5" 4iDP~A-"'<:':=:
Primary
Structural
Electrical
Mechanical
CONTRACTORS
I NO,
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Each sinqle fixture
Relocared building
(new fix. additional)
S.F. Re,idcnce
(l both)
Duplex (1 both) each
Additional bath
Water service
Sewer
Storm Sewer
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I TOTAL CHARGES
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(name)
(address)
(lies. no.)
(expires)
(Dhon~ noJ
b.
2C:6G S-"O
7'1~. 7028
72~' BOIS'
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PLUMBING
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MECHANICAL
ElECTRICAL
I FEE ! CHARGE I NO.
15.-1 <'$:-
V
FEE I CHARGE
-, /5. <>>
NO I
FEE
CHARGE
Residence of
furnace/burner to
R.TU's
Appliance vent
separate
Stationary evap_
cooler
Vent fan with
sinqle duct
Vent system apart from
heotinq or A.C.
I Mechanical exhaust
hood and duct
I Wood stove/heoter
I~so
Il
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'0.' It
New circuits, alterations
or extensions '?CJ;;? ~ ~
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SERVICES
I Temporary Construction
1 Amps.
I
FEEDERS
Heat Puma
Air handler to
10.000 CFM
I Air handler over - 1
10,000 CFM
I 'f?9coM/'7" /'S:J<JC D '1-2, 8/
~Nlr #<S',+7f!!:JO: I
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Amps.
Lp~
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/.:7, uol
17'.~1
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TOTAL CHARGES
ISSUANCE OF PERMIT
/~ 00 I TOTAL CHARGES
WHERE STATE LAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall not b. valid until a
lobel has been signed by an Electrical Contractor and attached to the electrical panel.
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that 011 information hereon is true and correct, and r further
certify that any and 011 work performed shall be done in accordance with the Ordinances 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 Division. I further
certify that my registration with the Builder's Boord is in full force and effect as required by ORS 701.055, thaI if exempt the basis for exemption is noted
heron, and that only subcontractors and employees who ore in compliance with ORS 701.055 will be used on this project.
SIGNATU~~
Basis for Builder's Boord ~xemption:
N~ME (please print)~~
Zone .::...tt
Fire Zone II.A'
flood Plain NO
BUILDING PERMIT
Charges and
Surcharges
PLUMBING PERMIT
Charges and
Surcharges
ELECTRICAL PERMIT
Charges and
Surcharges
MECHANICAL PERMIT
Chorges and
Surcharges
!:.
R;:> L-F;
DATE '1-231-81
Type/Canst.
Bedrooms
crarie"
3-N
fOR OFFICE USE ONLY
<;q. FIg. M;;Jin --L~90
Sq. Ftg. Access
Sq. Ftg. Other
6'/ SO. "'0
x 5,-
"alue
?; '/5't!P. -
Units
("I-cy Load
Occy Group
R-2
x . Value
x . Value
TOTAL VALUATION
I
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Plan Ck. Comm/lnd
65%/ Bider Per Fee
Plan CII. Res
30'lM Bider Per Fee
I Systems Development
ChOrD" (1.5%\
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";2 6. ...-
/.6o:!>
S ""CO
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/, .....
/5'. "'0
.Go
1'/. -:;0
------: t>S -I
fonce
I Demo
Total Comb. Permit
~8. zs
Sidewalk
Ale Payina
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I
1 TOTAL
Curb Cut
.# /2,/.28
COMBINATION APPLICATION/_IT (CAP)
I. Applicant:Ja furnish
.
PERMIT VALIDATION
A. Job Address
B. legol Description
1. example-tax lot 100, lone County Map Reference 17. n~ 43
2. 'example-Lot 1. Block 3, 2nd Addition to Springfield E ,_
C. Nome. etc. of owner and construction lender 1\
D. Energy Sources
1. example-heat/electrical ceiling/or forced air qas
2. example-water heater/electrical/or solar
E. Square footage or valuation, etc. -
1. example-1250 sq. foot house, 500 sq. foot gorage
2. exam~le-if new project, check ""iieW-if addition, check "(
add, etc.
F. Building permit information:
1. examj:)le-construct single family house with an ottce!
91'1rage
2. example-remodel existing garage into family room
3. example-'convert single family residence into
restaurant (change of use)
G. Volue of work os defined in Section 303 (0) of the
Structural Speciolty Code
H. DESIGN TEAM AND CONTRACTORS (
To ovoid design or construction delays, Building Divisic ~
Staff must be able to contact appropriate persons rega '
design information or job site corrections. etc.
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CITY OF SPRINGFIELD
City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
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Dote (L\i\. .31) 19RrO. B 56407 (
Rec'd From c\'\C) \\flt ~\\~~
Address ~l 0 (\ fl ~ 1'\(1 ,ir
Received For: tlf\~ 40 CJ:)
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II. Abbrevioted Plumbing, Mechanical & Electrical Schedules
A. Except where blank spaces occur in the description por
of the Mechanical and Electrical Schedules, the opplica
need fill.in only the No. Boxes adjacent to the appropr
item(s) to be installed
B. Full Plumbing, Mechanicol, ond Electricol Schedules
are available at the Building Division
1. To conserve space on the 'permit forrn the schedules
heve been abbreviated
2. If the Hem(s) to be installed are not covered on the
oted schedules you should consult the full schedule,
C. BUILDING DIVISION STAFF WILL Fill OUT All FEES A~
CHARGES ON THE SCHEDULES
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III. Applicont to sign and dote
Whenever possible, the initial application will be used as
worksheet only. Where possible. Building Division Stoff VI (,'
prepare a typewritten copy and return it to the applicant
the time the actual permit is issued fur his signature.
IV. Fees and Charges .
Pion check fees ore due and poyoble ot the time of the 0 ,"-
and no plans will be processed until these fees are paid. b.,. ,
other fees and charges are due and payable when the permit
is issued.
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Amount Received
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V. FOR OFFICE USE ONLY
Permit Cler~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
1- E.tJ./-4L PHsE J:>c7'7'_ /,<./5P.€c.r/oN KcPauJ'.o:?cz;>
Additional Project Information:
-5t1Fc ,bB;;I'B(/I;;>~: ~R $rTS A I,
5<F~ /<:)!-? #i'3./t!>16S ~R Sc:.u 7~ 'c'
PLANS REVIEWED BY,
L .-,,~___ ~ L"./~_
name .....~rv<= r"~"""",-
signatur'"
-fat....
". <'7-81