HomeMy WebLinkAboutPermit Miscellaneous 1982-2-2
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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)
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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
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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
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Received For:
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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.
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"UTHORIZEO SIGNATURE
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SHlLTO".TU"".U"L "",NTl"S, luGlNl, Oil '7.01
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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~..~-~'" ,>--;
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