HomeMy WebLinkAboutPermit Miscellaneous 1981-10-23
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INSPECTION LINE
726-3769
CITY Of SPRINGfiELD
COMBINATION APPLICATION/PERMIT
INFORMATION LINE
726-3753
legol Description 17-03-35-U--T I
'iSOO !I. 'iFiO(l
Heat
Water Heot.,
RO"_9.
Value of Work:
. Sq. Fig. Main
Sq. Fig. Acceu.
Sq. Ftg. Other
_New_Add_Alter_Rllp. ~
I_Fence_DemO_Change, Use ::)
LOth.,Gr~r1ing !I. ~tnrm '"
$.30,..375.00 sewer
Building P.'R1it Info: Describ. Work (i.... Build Single
Family Re,id.nce With AHach.d GoroC'le)
))
. ENERGY SOURCES:
JobAdd,...loDl Main St (lOth !I. Main)
Owner
Snrinnfip1r1 lltility Rn~..rl
Add,... 250 N "A" Street
phon. 746-R451
Address
Phone
lrlS.tall ~+'Jrm rlI"'Qinagp nirin~ lI. -:atch ba~ls
& grading & base rock'& A.C. Davina I
I
Construction Lender
DESIGN TEAM
(name)
(address)
(liCl. no.)
(expire I)
";;-~;43
Primary n.es..i 2" <::yc: h:amc:
PO
Box 3435, FIJ'l"np, I)R
q74(l"1
Structural
Electrical
Mechanical
CONTRACTORS
(name)
(address)
(liCl. no.)
(expired
lohone no.l
Go..,ol <;~..ingfip1 <! Q'Iarry PrgdIH:'::
<; ?Rth <;t, 5pf<!. (lD
7Ab.1?1 "1
Plumbi",~
Electrical
Mechanical
PLUMBING
ELECTRICAL
MECHANICAL
NO. '
fEE . CHARGE NO.'
, FEE ' CHARGE NO.
Relidence of
furnace/burner to
QTU'I
Appliance ....nt
separate
Stationary evap.
cooler
Vent fan with
single duct
Vent Iylfem apart from
heatinq or A.C.
Mechanical exhault
hood and duct
. fEE . CHARGE I
Each linR;le fixture
Relocated building
(new fix. additional)
S.F. Relidence
(1 both)
.-. ft.
New circuih, alterationl
or extenlionl
SERVICES
Duplex (1 both) each
Temporary Construction
Additional bath
Amps.
Water service
Sewer
Wood stove/heater
180' St.,mS.w., 10.00/100 LF ~0.00
I
I
I
I
I
I
I TOTAL CHARGES
I WHERE STATE LAW REQUIRES that th. EJ.ctrical work be done by the Eledrical Contradar, the electrical portion of this permit shall not be valid until a
label has been signed by an Electrical Contractor and attached to the electrical panel.
FEEDERS
Heat Pump
Air handler to
10.000 CFM
Amps.
Air handler over
10,000 CFM
ISSUANCE Of PERMIT
20.00
TOTAL CHARGES
TOT At CHARGES
I HAVE CAREFUllY EXAMINED the completed application for ptlrmit, and do hereby certify that 011 information hereon is true and correct, and I further
~rtify that any and all 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 thClt NO OCCUPANCY will be mode of Clny structure without the ptlrmillion of the Building Division. I furth.r
cornfy that my registration with the Builder's BoClrd is in full fOt"co and effect CIS required by ORS 701.055, thClt if exempt the balis for exemption is noted
N:':'f:I~:U:::::::~~~~:I:::~ o~::: who 0'. ;. ~mpn:~:N:~:R~~ uitJt. DATE t) ~?JI,
FOR OFFICE USE ONLY I
Zone r It
Fir. Zone
Flood Plain
Type/Canst
ledrooms
c;toril"-
I 'nits
'Jecy loCld
Oeey Group
Sq. Ftg. Main
Sq. Ftg. ACC&J
Sq, Ftg, Oth., 40, '.iO(l
PLUMBING PERMIT
Charges Clnd
SurchClrges
?O.OO
Rn
Fenc8"
1R.on
x Value
x Value
;O~~ALUA:I~~. jjg: j;~: gg
Systems Development ~
Charoe 0.5%\
Storm Sewer Con ection
Fee-.03x4llS0n = 1.?15.oo
I
I
I
I
I
Total Comb. Permit
BUILDING PERMIT
Charges and
SurchClrges
Plan Ck. Comm/lnd
65%1 BldQ Per Fee
Plan Ck. Res
30%/ Bldq Pe, Fee
84.50
elECTRICAL PERMIT
Charges and
SurchClrges
Demo
I Sidewalk
lAIC Pavina
I Curb Cut
130.00
MECHANICAL PERMIT
Charges and
Surcharges
TOTAL
i1 .4FiIL 10
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III. Applicant ta sign and date
Whenever possible, the initial application will bl
worksheet only. Where possible, Building Divisic
prepare a typewritten copy and return it to the I
the time the actual permit is issued for his signa
, r
IV) Fees and Charges \.
Plan check fees are due and payable at the timj....
and na plans will be precessed until these fees are paid. All'
ather fees and charges are due and payable when the permit
is issued.
COMBINATION APPLICATION/PERMIT .(CAP)'
I. Applicant to furnish
A. Job Address
B. legal Description
1. example-tax lot 100, lane County Map Refer<
,2. example-Lot 1. Block 3, 2nd Addition to Spring
C. Name, efe; .of owner and construction lender '..
D. Energy Sources
1. example-heat/electrical ceiling/or forced air ~
. 2. example-water ~~ater/electricall.or solar .
E. Square footage or valuation, etc.
1. exomple-1250 sq. foot house, 500 sq. foot g'a,
2. exampleRif new project, check new-if additior
add, etc.
F. Building permit information:
1'. example-construct single family house with a
garage
2. example-remodel existing garage into famil)
3. example.convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of t
Structural Specialty Code
H.' DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Buildinf
. 'Stoff must be able 10 contact oppropriote persc
design information or job site corrections, etc.
II. Abbrevioted Plumbing, Mechanicol & Electrical'ScI
A. Except where blank spaces .occur in the descriF
of the Mechanical and Electrical Schedules, thE
need fill-in only the No. Boxes adjacent to the
item(s) to be installed
B. Full Plumbing, Mechanical, ond Electrical Sche
are available at the Building Division
1. To conserve space on the permit form the!
have been abbreviated
2. If the item(s) to be installed are not covere
oted schedules you should consult the full
C. BUILDING DIVISION STAFF WILL FILL OUT ALl
CHARGES ON THE SCHEDULES
V. FOR OFFICE USE ONLY
PERMIT VALIDATION
Id
CITY OF SPRINGFIELD
CIIy Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
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No.8
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Received For: '1' )
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Permit Cler~
J..R()~~C:!. ~<?NI:ml~NS..TCl .~E_ ~~TISFIED BEFORE OCCUPANCY:
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Additional Project Information:
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PLANS REVIEWED BY:
name....Lnrnp Pl2g2r
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dete 1O-221181