HomeMy WebLinkAboutPermit Building 1981-1-27
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IN5PECTI")N LINE
';'26..3769' .
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CITY Of "SPRINGFIELD
COMBINATION APPLICATION/PERMIT
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INFORMATION LINE
7260.3753
Job Add,o.. 1..,h'7 '? )4 pJ/,y' "'i'T 9?j;l/L/,;rrit:tl)
Logal Dm';Pti~n QSM 1 I/o -;; '?i 0~)7-
ENERGY SOURCES:
Heat
Waler Heale,
RonC'Je
Value of Work:
Sq. ftg. Main
Sq. Ftg. Access.
Sq. FIg. Other
_New_Add _Aller _Rep.
_Fence_Cema_Chonge' U,.
_Olne
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Address
Phone
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Owner
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1""'/7 /.<f:~LI
Address 0("./ ','1 q If)' A....,.
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Con\truclion Lender
DESIGN TEAM
(nome)
(address)
(lies. no.)
. (e)(piun)
(phone no.)
Primary
Structural
CONTRACTORS IMme)
Generol . /)U./ .l/e~tZ?
(addren)
(lies. no.)
, l
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Electrical
Mechonicol
Plumbinq
, '
Electrical
(""v)f\('.6nl6
7_/~
C\rr ! 17 J3jUo/
2f)-I/fJe (p-3<Yj /
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Mechanical
PLUMBING
ELECTRICAL
MECHANICAL
NO"
FEE
CHARGE NO. I
FEE
CHARGE NO.
FEE
I CHARGE
I
1
(
,
Residence of
furnace/burner to
~TU's
Appliance vent
seporofe
SfDfionory evop.
cooler
Vent fon with
single duct'
Vent system apart from
heoting or A.C.
Mechanical e)thoust
hood and duct
Each '1inqle fill.ture
Relocated building
(new fix, additional)
S.F. Residence
(1 both)
'1Q: ft.
New circuih, oherotions
or extensions
SERVICES
Duplex (1 bOlh) eacn
Temporory Construction
Additional both
Amps.
Wator service
SeWIlT
'Wood stove/heater
Storm Sewer
FEEDERS
Heat Pumn
Air handler to
10.000 CFM
Air hondler over
10.000 CFM
Amps.
ISSUANCE OF PERMIT
TOT At CHARGES
TOTAL CHARGES
TOTAL CHARGES
WHERE SlATE lAW REQUIRES thot tho Electrical work b. done by Ih. Electrical Contractor, the electrical porlion of this permit shall not b. valid until.a
label has b_n ligned by an Electrical Contrador and attached to Ihe electrical panel.
I HA Vi:: CAREFUllY EXAMINED the completed application for permit, and do. hereby certify that all information hereon il true and correct, and I furthor
certify that any and 011 work performed sholl be done in accordance with the Ordinances of the City of Springfield and the lawl of the State of Oregon
pertaining to the work described herin, and that NO OCCUPANCY will be made of any structure without Ihe perminion of the Building Division. I further
certify that my regiltrOlion wit'" the Builder's Board is in full force and e-ffect as required by ORS 701.055, that if exempt .the basis for exemption is noted.
heron. and that only subcontractors and employees who are in compliance with ORS 701.055 will be used an this project.
Bosis for Builder's Board exemption.
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NAME (please prinr, ~/_J 'f' -L
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4 Cu/ U (,;' 5" SIGNATURf;.r;t;::tt.,~A""'-?~.-:'-
FOR OFfiCE USE ONLY
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DA~._J
Zone
Fir. Zone
Flood Plain
Type/Canst
Bedrooms
<;tari~.
Ilnits
""ccy Load
n..cy Group
Sq. Fig. Main
Sq. Fig. A<<ess
Sq. F,g. Olher
Value
x Value
x Value
TOTAL VALUATIOr-
BUILDING PERMIT
Charges and
SUI charges
2500
Plan CIc. Comm/lnd
65%/BldQ Per Fee
Plan Ck. Res
30%/ Bldq Per Fee
Systems Development
Chorqll (1.5%1
PLUMBING PERMIT
Chargos and
Surcharges
Fence
ElECTRICAL PERMIT
Charges and
Surcharges
/ () . 00
?I()
Demo'
I Sidewalk
Total Comb. Permit
MECHANICAL PERMIT
Charges and
Surcharges
I
1
---------1
AIC Pavino
TOTAL
I
36. c:v
Curb Cut
COMBINATION APPLICATION/PERI (CAP)
I. Applicapt ta furnish
A. Jab Address
B. Legal Description
1. example.tax lot 100, lane County Map Reference 17 03 43 ,
2. example.lot 1. Block 3, 2nd Addition to Spri.-t",-" T Y 0 F
C. Name. etc. of owner and construction lender. ( C I .
O. Energy Sources
1. example-heat/electrical ceiling/or forced oj,
2. example-water heater/electrical/or solar
E. Square footage or valuati"on, etc. -
1. example.1250 sq, foot house, 500 sq. foot gc
2. example-if new project, check new-if additio
add, etc.
F. Building permit information:
1. example-construct single family house with Q:
\:toros.e (,
2. example.remodel existing garage into family rr
J. example-convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of th. (
Structural SpecialtyCode .
H. OESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building 0 (0
Stoff must be able to contoct appropriate persons
design information or iob site corrections, etc.
.
PERMIT VALIDATION
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SPRINGFIELD
City Hall
Springlield, Oregon
Department al Public Works
OffiCIAL RECEIPT
No. B S5673(
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Rec'dF~a.mArtrl/)r . <.:..;.
LOoCf IY/rlf.Jt:!- \J ..
Address ,_ ,
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Received For:
II. .Abbreviated Plumbing, Mechanical & Electrical'Schedl' (
'A.
Except where blank spaces occur in the description
of the Mechanical and Electrical Schedules, the apF
need fill.in only the No, Boxes adjacent to the appr
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 schedu
have been abbreviated
2. If the item(s) to be installed are not covered on th
ated schedules you should consult the full schedul
C; BUilDING OIVISION STAFF WILL FILL OUT ALL FEES A
CHARGES ON THE SCHEDULES
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Amount_~:.~~i~~~__
55 .Dtn (' ,( )
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III. Applicant to sign and dale
Whenever possible, the initial application will be used a~
worksheet only. Where possible, Building Division Staff y
prepare a 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 ore due and payable at the time of the OF f.a.
and no plans will be processed until these fees are paid. J
other fees and charges ore due and payable when the petk...
is issued.
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V. FOR OFFICE USE ONLY
Permit Clerk
.,
PROJECT CONDITIONS ,TO BE SATISFIED BEFORE OCCUPANCY:
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AdditionQI Project Information:
PLANS REVIEWED BY,
nom....
.'ignotur...
""ate
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