HomeMy WebLinkAboutPermit Building 1981-8-24 (2)
INSPECTION LINE
726-3769
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Job Add",~_I.if)(J J.1"1/1 ~.
"90' o.",;p';on l'l-e>~ -'3cC- 'f ~ 7:t.. .Seo.
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."Cltv"O"SPRINGFIElD ~
COMBINAJlCN APPlICAflON/PEA.MIT
INFORMAJlON LINE
726-3153
ENERGY SOURCESl
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Addre"
Phone
I Sq. Ftg. Main
I SQ. FIg. Accon.
Sq. fig. Other
. _Ne.,., __Add .KAlter ,KR.p.
1_.._F.nce_oemO_ChOng.iU,.
~ _ 5"~ _Olh"
8uilding Permit Info: O.,cribe Work ii.e.. 8uild Single
Fam.l, R",iden~,,; Wit" Attached Garottel
l?CP;#.R J)fl/n.4'::"ED 57&.6"
7JTi'vs,s_ ~~-V}P $-~k
W'~C./;>lbG, J~P ,;r€;:hc.>b~'
Heot
WOler Healer
RanCle -
Value of Work:
Owner
rkH,
Pc!f(rf'
Crei'....:J~ flr.
-".., ~7'"
Phone (, /- /IF /C"
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I Addr."
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Conuruction Lender
oESIGN TEAM
(nome;
(address)
(Iics, rio.)
(upitlu)
(phon. no.)
Primary
CONT~ACTCRS
])A't/D c..~WC!F?;>Y.
(nomel
(addr.ss)
flies. no.)
~
(.xpires) " (,)hane no,)
Structural
Electrical
Mechanical
G"neral
plumbinq
flectrical
ifo:w &'Pt!!"(..4ND e'-~r.
Mechanical
PLUMBING
ELECTRICAL
I
CHARGE I NO.
MECHANICAL
NO. I
r-::I"
l CHARGE I NO.
FEE
FEE
'CHARcr:..
SERVICES
I
I.
I
furnace;burn.r to
llTU's
Appiia~ce ....nt
yparate
Stationar;' e...ap.
cooler
Vent fan with
single duct
Vent .sydem apar' from
heating or A.C.
Mechanical exhaust
hood and d~ct
<
Residenu of
E:Jc;, ,inale fi...lure
Ro1locored building
(new fi.... addition<'1il
S.F. il:~liden~.
(I both)
Sq: ft.
New circuill. alteraliolls
or extenlions
, .
Duoln (1 bOlh) each
Temporary Conltruction
.Addilianal bath
Amen.
Wotllr sen'ice
S......r
Wood sto..../h.olor
Sto(m Sewer
FEEOERS
Heat PumD
Air hondl.r to
10.000 CFM
Air handler 0'"
10,000 CFM
Amps.
'!..
ISSUANCE OF PERMIT
TOTAL CHARGES
TOTAL CHARGES
TOTAL CHARGES
WHERE STATE lAW REQUIRES Ihot the Electrical work be don. by the E!."'rical ContraCfor, the .I.ctricol portion of this permit .hall nol b. valid unlil 0
lob.1 has been signed by on Electrical Contractor and attached to the .Iectrical panel.
I HAve CA.,REFULl Y EXAMINED the compl.ted opplicotion for permit, and do her.by certify thai 011 information h.r.an is tru. and co".ct, and I furth.r
certify that any and 011 work performed shall b. don. in accordance with th. Ordinances of the City of Springfield and the lows of the Stat. of Oregon
p.rtaining 10 the work delctibeQ h.rin, and thot NO OCCUPANCY will b. made of any structur. without the permiuion of the Building Di...i,ion. I further
certify that my regill'falion witn the Build.r's Board is in full force and mect 01 required by ORS 701.0.55, that if .xempt th..bosis for .x.mption i. noted
h.ron, and that only subconltactars and .mploye.s who or. in compliance with OKS 70~ W;l'lI be ~d on his project.
Basil for Build.r's Boord f4\mption' /1 I ,
NAME (p"'"p.;n') Uv.'iI/d L~'c..Je/~:Y '1GNATURE li;b,." . {Jf"~ DATE g'~?'I-4~
v
fOR OFFICE USE ONLY
Zone ----' - ,,_
fir. Zone
Flood Plain
Type/Const....:;z:t'....JI../ .
IlIAdraams
.
"alu.
Vol".
Value
C:'orie,
I
Units
?ccy load .
Occy GfaupK-:::z.
0::_. Ftg. Main
c;q. fIg. Access
Sq. Fig. Olh.r
.
.
TOTAL V AlUA TlON
~<=>
plan Ck. Commilnd
65~;,/8IdQ Per F~.
Plan ClI. R.s
30~;'/Bldq Per FelIt
I Sylleml De....lopm.nt
; CharQ. (1.5~;' \
I
+~
PLUMBING PERMIT ~
Chargel and
Surcnarge.
I-li .
i
I
BUILDING PERMIT
Chorg.s and
Surcharges
s.
~
s.
'oco
Fence
<e>
Oemo
I Talol Comb. Permit
/<!).
'10
ELECTRICAL PERMIT
Charges and
S,\c.."o,gel
Sidewalk
Alc Pew'in"
TOTAL
"/0. 'f~
MECH.ANICAl PERMIT
Charge 1 and
S",rcharg..
Curb CuI
Applica~ to furnish
A. Job Address
B. legal Description
1. examole.tax lot 100, Lane County Map Reference 17 03 43
2. examoie.Lot 1. Block 3, 2nd Addition to Sp,ingfield Estates
C. Name, etc. of owner and construction lender . I C I T Y ,OF
D. Energy Sources r,
1. examole-heot/electrical ceilinq/or forced air qc
2. cxomole.water heater/electrical/or solar
E. Square footage or valuotion, etc.
1. examole,1250 sq. foot house, 500 sq. foot gara'
2. examoie-if new project, check ne;,-if addition, c
add, etc.
F. Building permit information:
1. exam ole-construct single family house with an 0
garage
2. exam ole. remodel existing garagE:: into family roc (
3. example-convert single family residence into
restQurant (change of use)
G. Value of work as defined in Section 303 (a) of the
St,uctural Specialty Cede
H. DESIGN TeAM AND CONTRACTORS
To 'ovoid design or construction delays, Building Divi
Stoff must be able to contact appropriate persons re~ ;.~;
design information or job site corrections, etc.
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COMBINATION APPLICATION/PERMIT (CAP)
I.
II. Abbreviated Plumbing, Mechanical & Electrical Schedule
A: Except where.blcnk spaces occur in the description pc
or the Mechanical and Electrical Schedules, the applic
need fill-in only the.No. Boxes adjacent to the approF
item(s) to be instolled
B. Full Plumbing, Me<:hanical, and Electrical Schedules .
'ore 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 on the
ated schedules yau should consult the full schedule:
C. BUILDING DIVISION STAFF WILL Fill OUT ALL FEES AN
CHARGES ON THE SCHEDULES
111. Applicant to sign ana dote
Whenever possible. Ihe initial application will be used as (
worksheet only. Where possible, Building Division Staff wi
prepare a typewritten copy and return it to the applicant c
the time the actual permit is issued for his signaturE..
Fees and Charges
Plan check fees are due and payable at the time of the apF
and no plans will be processed until these fees cue paid. AI
otner fees and charges ore due and payable when the perr4-
is issued.
IV.
V. FOR OFFICE USE ONLY
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PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
PLANS REVIEWED BY,
name
";gnature
" .' '--
~RMIT VALIDATION
,t.'
SPRINGFIELD
(
City Hall
Springfield, Oregon
Department of Public Works
OffiCIAL RECEIPT
No. B 5714 2 (
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DoteAf.Lt:l.F-~T-~ 'I. 19 81
Rec'd From PA\JI D Lo'V/cfi' V
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Address ,g>7~?
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Received For:
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,Amaunt Received #L (!),. lfO
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Permit Cler~
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