HomeMy WebLinkAboutPermit Building 1981-11-19
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\ INSPECTION LINE
72~769
I Job Address
I Legal Deuription
r
1001 Ma;n Street
17-03-3.;;-41 T I
CITY OF SPRINGFIELD
COMBINATION APPLlCATION/pERMIT
I ENERGY ~OURCES:
Heat E lee
Water Heater
Ran~e
Value of Work:
INFORMATION LINE
726-3753
~ ~ill1
Sq. Ftg. Main~l
Sq. Ftg. Access.
Sq. Ftg. Other
_New_Add_Alter_Rep.
_Fence_Demo_Changel Use
_Other
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Address
250 N. "A" Street
Sor;nofipld. nR q7477
Owners' reo.
Phone
746-8451
$20.000.00
Building Permit Info: Deurib. Work (i.e., Build Single
Fomil-r Residence With Attached Garaae)
Owner
c::;,"'r'innfip,lrl
II+;';+~J Rn;:avorl
Remodel ex;st;nC' office hllilciina
Construction Lender
Randv Beraanpn
Address
Phone
DESIGN TEAM
(nome)
(address)
(lies. no.) \
(expires)
(phone no.)
(name)
(Iics. no.)
6R1-~141
~-,
Primary
Des;on Systems
P.O. ~nx 1415. Flln"n,,_ OR
Structural
Electrical
Mechanical
CONTRACTORS
(address)
(expires)
General
Plumbin!1
Electrical
Mechanical
PLUMBING
ELECTRICAL
MECHANICAL
NO. I
FEE I CHARGE NO. I
FEE ' CHARGE NO.
FEE CHARGE
15.('0
furnace/burner to
D,TU's
Appliance vent
separate
Stationary .vap.
cooler
Vent fan with
single duct
Vent system apart from
heating or A.C.
Mechanicolexhaust
hood and duct
Residence of
Each sinAle fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
2
s9.ft.
New circuits, alterations
or extensions
SERVICES
Duplex (1 both) each
Temporary Construction
Additional bath
Amps.
Woter service
Sewer
Wood stove/heater
Storm Sewer
FEEDERS
Heat Pum")
Ail handlel to
10.000 CFM
Ai, handlel ovel
10,000 CFM
Rp; nc: tt:\ 11 f'; 'It'tllr 0
g Ilr
AmDs.
min in~1J r:hn
"1in mech in~n
mavinC' duct svs.
1<;.00
ISSUANCE OF PERMIT
10.00
TOTAL CHARGES
1 ~. (1(1 TOTAL CHARGES
15. on TOTAL CHARGES
?~ fln
WHERE STATE lAW REQUIRES that the Electrical Walk be done by the Eledrical Contrador, th. electrical portion of this permit sholl not be valid until a
label has been signed by on Electrical Contractor and attached to the eledrieal panel.
I HAVE CAREFULLY EXAMINED the completed application fOl permit, and da hereby certify that all information hereon is true and COiled, and I furthel
certify that any and all wOlk perfolmed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Oregon
pertaining to tho wOlk described herin. and that NO OCCUPANCY will be made of any structule without the permission of the Building Division. I further
celtlfy that my registration with the Builder's Boald 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 on this project.
Basis fOl Buildel's Boald exemption:
NAME (please print) (V...~~
SIGNATURE
DATE II. ff ~ I
FOR OFFICE USE ONLY
Zone
File Zono
Flood Plain
r 4
Type/Const. V-N
:l,edrooms
C',torie-
Units 2
I""\tcy Load _____\ ~
Occy Group-B.?
c:.~. Ftg. Main 147Ft 4l1.
Sq. Fig. Access
Sq. Ftg. Othel
x
13.55 Valu.$20. 000. no
x Value
Value
TOTAL VALUATlON$?n, onn nn
BUILDING PERMIT Plan Ck. Comm/lnd
Charges and .___3? nn 65%/Blda Per Fee
Surcharges Plan Ck. Res
3.68 30%1 Bldq Per Fee
PLUMBING PERMIT
Chalges and ____-15...nn Fence
Surcharges
<;n DeMO
ElECTRICAL PERMIT
Chalges and 15.00 Sidewalk
Surcharges .fiO
Ale Pavinn
MECHANICAL PERMIT
Charges and 25.00 CUlb Cut
Surcharges --------
l.nn
<;0 Qn
Systems Development
Char(le (1.5%\
Pl rk "p"
<;q.Rn
Total Comb. Permit
11:? 00
,
TOTAL
$212.68
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COMBINA nON APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example-tax lot 100, Lane County Map Reference 17 03 4~'
2. example-Lot 1. Block 3, 2nd Addition to Springfield Estates
C. Name, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceilinq/or.forced air gas
2. example-water heater/electrical/or solar
E. Square footage or valuation, etc.
1. example.1250 sq. foot house, 500 sq. foot garage
2. example-if new project, check new-if addition, check
odd, etc.
F. Building permit information:
1. example-construct single family hous'e with an attach~d
gorage
2. example-remodel existing garage into family room
3. example-convert single family residence into
restaurant (change of use)
G. Value af work os defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Division
Staff must be able to contact appropriate persons regarding
design information or job site corrections, etc.
II. Abbreviated Plumbing, Mechanicol & Electrical'Schedules
A. Except where blank spaces occur in the description portion
of the Mechanical and Electrical Schedules, the applicant
need fill.in only the No. Boxes adjacent to the appropriate
item(s) to be instolled
B. Full Plumbing, Mechanical, and Electrical Schedules
are ovailable at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on the abbrev
ated schedules you shauld consult the full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
III. Applicant to sign and date
::::Whenever possible, the initial application will be used as a
: worksheet only. Where possible, Building Division Staff will
.' . prepare a. typewritten copy and return it to the applicant at
. 'the time the actual permit is issuec:l for his signature.
IV. Fees and Charges (
Plan check fees are due and payable at the time of the applicatit-
and na pions will be processed until these fees are paid. All
. .:other fees and charges are due and poyable when the permit
is issued.
V. FOR OFFICE USEONL Y
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
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III. .,,,,.,1.1111 "Ul,jllll
PERMIT VALIDATION
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CITY OF SPRINGFIELD
City Hall
Springfield, Oregan
Department of Public Wark.
OFFICIAL RECEIPT
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AUTHO"RIZI:D SIGNATUiIIll: ( . .
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Permit Cler~
PLANS REVIEWED BY,
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. name . 'Oan Smiti~...
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