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HomeMy WebLinkAboutPermit Miscellaneous 1982-2-2 "<'~""~'.i:-::.- \:';~'?':_0.'~~~"'%;>~'-':':: .' ,. '. Y'.. '.:-,,:41:: :,""'-'p ~ ':"C'~'"~::!!Z1.~1'~~:;'"f-.. ...., ".'i,;,:::~,?ef.V,"-":' ";"'.: ;,';.;' .:.. . -. jJ{''''~~':;:~~;:~&::~'=:~~;-'''~.~~~JI..;i;;,:.:i;J~tJJ'~J~'' ~~f;~,f:ifj'b~J.;;;;"~;*I~:~,,,~;,':"':;"i,f':,:,;;;:::~::~;::;j~tt':~,~i::,,;~ '''~'._'_''_' '"'h'- -;0','.'.'-"""_."__'_' ,__..~,::.'.,.~.,,:'~~~._.....;.<,......,._,_~.... . '. ,- "",,"-"F.,.,~-._.' .,:X _'.. ..'._.~";-:,~~. :.~~.~_ .'_. .. .~~:.~~.-" ~= ....~..."'-,. - ".~I.....""",,!!,....,r;,' - " _.....,~" '~'l"""'~ INSPECTION ,i.;t< "-'~ 726-3769 -- CITY Of SPRINGFIELD COMBINATION APPLICATION/PERMIT INFORMATION LINE 726-3753 Job Address 1001 Main Strppt Heat Water Heater I Sq. Fig. Main Sq. Fig. Accen. Sq. Fig. Other _New_Add_Alter_Rep. _Fence_Demo_Change/Us. ..xOlh., p~\dn~ ". ",5 $16.800.00 ~'l. ft. ~rpi'. Building Permit Info: Describe Work (i.... Build Single Famil., Residence With Attached Garaae) - ~ ::> ::0 '''"' '" I ENERGY SOURCES: Legal Description l7-03-:l~-41 T <;<;nn Ran_ge Value of Work: Own., Sorinqfield Util itv Baarn "'dd,... 250 North "A" Strppt Sorinofield. OR 97477 Phone 746-8451 Storaop and oar~g ~rp~ naY;n~ Construction lender Address DESIGN TEAM Phone (name) (address) (lies. no.) (expires) (phone no.) Primary D~sion Sv~t~mc;, ~. Rox :l435. Funpnp. OR Q7401 ~'R3-'3'J Structural Electrical Mechanical CONTRACTORS (name) (address) (lies. no.) (.xpir.s) (phone no.) General Wilrlic::.h f.onc::.t.rllf"tinn rn_ 74h-?<;71 Plumbinq Electrical Mechanical PLUMBING ELECTRIC"" MECHANICAL NO. I FEE I CHARGE NO. l I FEE I CHARGE NO. FEE CHARGE t, Additional bath Amps. furnace/burner to BTU's Appliance vent separate Stationary evap. cooler Vent fan with single duct Vent system apart from heating or A.C. Mechanical exhaust hood and duct Residence of Each sinl:lle fixture Relocated building (new fix. additional) S.F. Residence (1 bath) '9' ft. New.circuits, alterations or extensions SERVICES DUDlex (I both) each Temporary Construction Water service Sewer Wood stove/heater 1 Slorm Sewer 10.00/10) L.F'lO.OO fEEDERS Heat Pump Air handler 10 10.000 CFM Air handler over 10,000 CFM AmDs. , ISSUANCE Of PERMIT TOT"" CH....GES 1 n. nn TOT"" CHA.GES TOT"'L CHA.GES WHERE STATE LAW REQUIRES that the EJedricaJ work be done by the Eledrical Contrador, the electrical portion of this permit Iholl not be valid until a label has been ligned by an Electricol 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 corred, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the Slote of o,egon pertaining to the work described herin, and that NO OCCUPANCY will b. mode of any structure without the permission of the Building Division. I further certlfy that my registration with the Builder'1 Board il in full form and .;FEect 01 required by ORS 701.055, that if exempt the basis for exemption il noted heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project. Basis for Builder's Board exemption: NAME (please print) CIGNATURE fOR OffiCE USE ONLY DATE Zone-C.--.i! fire Zone Flood Plain Type/Canst. Il.edraams "'tori'~ Units n'Ccy Load nccy Group Sq. ftg. Main x Sq. Fig. Access x Sq. ft.. O,h., Pavinn 11.116 Value Value Valu. $lh,ROO 00 TOTAL VALUATION BUILDING PERMIT Charges and Surcharges Plan Ck. Comm/lnd 65%/ Bldq Per Fee Plan Ck. R.s 30%/ Bidet Per fee ~5?on Systems Development. Charae {J .5%\ Storm sewer c('nnprtJ.on. fpp ll,JIb x .UJ PLUMBING PERMIT Charges and Surcharges ""ma Total Comb. Permit ~ '3Q 4R ~ ('Olin ____liQ...QQ_ .40 fence ELECTRICAL PERMIT Chorges and Surcharges Sidewalk ~ Alc Pavina ~Rnnn J ,"-ECHANIC...' PERMIT . ...cl I SurchorgOl. r:~,,'" Ca" 1-- .li4/il.iiK ,,;'~Z:,=:i~:;:~~~,,-,~'.:~:.~;t:~;'~;~l~~,:.~,:,~;,;gi~- \;t-~:-:~'~ ~~~ ~^J,cF:I"'~-~~'-" '. ~~-' COMBINATION APPLICATION/PERMIT (CAP) I. Applicant ta furnish A. Jab Address City Hall Springfield, Oregan C'''' Department of Public Works OFFICIAL RECEIPT (! No. B 57951(1 &'.2- . "-i . B. C. D. E. F. legal Description 1. exomple-tax lat 100, Lane Caunty Mop Reference 2. example-Lat 1. Black 3, 2nd Additian ta Springfield Name, etc. of owner and construction lender I Energy Sources , 1. example-heat/electrical ceiling/or forced air gas 2. example-water heater/electrical/or solar Square footage or valuation, etc. '\. 1. example-1250 sq. foot house, 500 sq. foat garage 2. example-if new project, check new-if addition, chec add, etc. . Building permit information: : 1. example-construct single family house with an atto' garage l 2. ~example-r~model exi~ting garage into family room 3. example-convert single family residence into ... restaurant (chan"ge of use) G. Value 01 work as defined in Section 303 (a) of the. Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Divisic Staff must be able to contact appropriate persons rego design information or job site corrections, etc: ( .2 -..2 Dote 19 C Rec'd From suA 'T Address ,-',t.,~ ;I) ';tj 1/ :sf, c -\\ Received For: . i~ c J yJA/l'1- t~;/; ~) ( PI (oj,~'jP' ~/(I , ',:" . (j ( ~<- A.J~J :l1~. tJiJ .I/li (I s:;.~..,.. to, (;r. 33Q./ff II (I ( -A -hI. { ~ n II. Abbreviated Plumbing, Mechanical & Electrical'Schedules (' A. Except where blank spaces occur in the description por af the Mechanical and Electrical Schedules, the applica need fill-in only the No. Boxes adjacent to the appropr ~ 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 schedules have been abbreviated 2. If the item(s) to be installed are not covered on the l (' ated schedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ANj-,. . CHARGES ON THE SCHEDULES II Amount Received c.J. -----. U .'(1 (I q "UTHORIZEO SIGNATURE ," , I,,'HI \ SHlLTO".TU"".U"L "",NTl"S, luGlNl, Oil '7.01 q III. Applicant to sign and date Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Divisian Staff will prepare a typewritten copy and return it to the applicant at the time the actual permit is issued for his signature. IV. Fees and Charges Plan check fees are due and payable at the time of the application, and na plans will be processed until these fees are paid. All other fees and charges are due and payable when the permit is issued. ,,, V. FOR OFFICE USE ONLY Permit CierI- PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: . ' Additional Project Information: PLANS REVIEWED BY: :;~r':'"';:o Lorne P'l eger signature __L~..~-~'" ,>--; ~ .. ,-,-; -~....