Loading...
HomeMy WebLinkAboutPermit Miscellaneous 1982-6-15 ~L~L'~_~.': ! I INSPECTION LINE 726-3769 I Job Addren \ \. ..,-.....",.-.- -, . ._. ,'-- '~:":.' ...,..+jL:>;.:iJ.;;:;:::;'~:~~F.:~,,>.. ..1 ----"" "".. .".' '.~~..' j'.' ,...'-" 'f \ \ \ ...'. ~-".. --,.;. ..... ~...,.......".',........... Jt- .~~. .' ..........,'.1..1 i 1lI,IIlIn a,.. CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT INFORMATION LINE 726-3753 Legal Description 17-=.03=35dJ T. L_.3A_QO ENERGY SOURCES: Heat Water Heater Ran~- Value of Work: Sq. Fig. Main Sq. Ftg. Access. Sq. ftg. Other _New_Add_Alter_Rep. _fence_Demo_Changel Use _Other co N o 01 0.0 N 1124 M~in St~ppt #A I Addren I I I I Own" Mit.rh Hfl.t.chi~nn 1124 Main Street Sorinafield. OR #A 97427 Phone 726- 71 04 ~? <;(In (1n Building ~ermit Info: Describe Work (i.e., Build Single Familv Residence With Attached Garace) PrlvinS-fo~rlrk;n~ l~t Construction lender Address Phone DESIGN TEAM (name) (address) (lies. no.) (expires) (phone no.\ Primary nnnrl: 1 rl 'kaP"h U?",!ln" C::tV",u:d' 'r"-C!...--(lO ~ 74fi-01RQ Structural Electrical Mechanical CONTRACTORS (name) (address) (lies. no.) (expires) (phone no.) General PlumbinCl Electrical Mechanical PLUMBING ELECTRICAL MECHANICAL NO. FEE CHARGE NO.' FEE . CHARGE NO.' FEE I 'CHARGE I SERVICES furnace/burner to ~TU'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 singlp fixture Relocated building (new fix. additional) S.F. Residence (1 bath) sq. ft. New circuits, alterations or extensions Duplex (1 both) each Temporary Construdion Additional bath Amps. Water service Sewer Wood stove/heater ?"l Storm Sewer 10_nn/lf:l l-f In nn FEEDERS Heat Pume Air handler to 10,000 CFM Amps. Air handler over 10,000 CfM ISSUANCE Of PERMIT TOTAL CHARGES 10.00 TOTAL CHARGES TOTAL CHARGES WHERE STATE LAW REQUIRES that the Electrical work be done by the Eledrical Contrador, the electrical portion of this permit shall not b. valid until a lobel has been signed by an Electrical Contractor and attached to th. eledrical panel. I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon is true and correct, 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 State of Oregon pertaining to the work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division. I further certify that my registration with the Builder's Boord is in full force and effect 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 for Builder's Board exemption; NAME (please print" 1?ek_ L'?t)J..,,,, kf!.'rL "IGNATURE ~ 0 )l# _ r DATE r;//.r/.PL FOR OfFICE USE ONLY Zone r d Fire Zone flood Plain Type/Const, PriV; n9 Bedrooms <:to,i~'. Units o(cy load "ccy Group --B.? Sq. Ftg. Moin Sq. Ftg. Access Sq. Ftg. Other Priving x "alue BUILDING PERMIT Charges and Surcharges Plan Ck. Comm/lnd 65%/ Bld~ Por Fee Plan Ck. Res 30%/ Bld~ Per fee $15.60 Plan Ck Fee ;OTAl VALUA~I~~:B~ Systems DltYelopment I . Charae (1.5%) Storm S~wer I rnnnprt,nn ~oo t l?n nn I PLUMBING PERMIT Charges and Surcharges $10.00 .40 FenCl! Demo Total Comb. Permit I I I \ll.lcO ElEORICAL PERMIT Charges and Surcharges Sidewalk 1 n I X 1:' ...., IY.J ,. ~T {- ?/I nn <;? ~? Alc PaviM MECHANICAL PERMIT Ch:ltges and Surcharges Cu,b Cut 35 X .12 12 16.20 TOTAL $-1jf - k1.t.==- I - \ ." J ,'.7': ''-. . ": ;f:i:~~!i.:.:0:--;.:.~';;::::~'~ 1:':,::.: ~::~, _ - ,. I .....\ ...._~.....~. '~'. ......;.-:-.: ..-.....,...--.-.. ........+ ...........< ~". "; -, :..~._,,~. :~;~~. """':':':. '-' . \II. Applicant to sign;'nd date Whenever possible, the initial application will be used O! . worksheet only, Where possible, Building Division Staff \ prepare a typewritten copy and return it to the applicant ( the time the actual permit is issued for his signature.-' Fees and Charges Plan check fees are due and payable at the time of the application, and no plans will be processed until these fees are paid. All other fees and charges are due and payable when the permit is issued. -- . ~ ~",",,,. . ~. COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Jab Address B. legal Description 1. example-tax lot 100, lane County Mop Reference' 2, example.Lat ], Block 3, 2nd Addition to Springfield C. Name, etc. of owner and construction lender D. Enugy Sources 1. example-heat/electrical ceiling/or forced air gas 2. example-water heater/electrical/or solar E. Square footage or valuation, etc. ], example.] 250 sq, foot house, 500 sq. foot garage 2. example-if new project, check new-if addition, chec add, etc. F. Building permit information: 1. example-construct single fomily)i'buse with an atta garage 2. example-remodel existing garage into family room 3. example-convert single family residence into restaurant (change of use) G, Value of work as defined in Section 303 (a) of the Structural Specialty Code H, DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Divisi Staff must be able to contact appropriate persons rege design information or job site corrections, etc. \I, Abbreviated Plumbing, Mechanical & Electrical Schedules A. Except where blank spaces occur in the description po of the Mechanical and Electrical Schedules, the applic, need fill-in only the No. Boxes adjacent to the approp' ,e item(s) to be installed \. B, Fu\l Plumbing, Mechanical, and Electrical Schedules are available at the Building Division 1. To conserve space on the permit form the schedule have been abbreviated 2, If the item(s) to be insta\led are not covered on the ated schedules you should consult the full schedul. C, BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AI CHARGES ON THE SCHEDULES . IV. V, FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: PLANS REVIEWED BY: PERMIT VALIDATION c " CITY OF SPRINGFIELD <I City Hall Springfield, Oregon Department of Public Works (1 OFFICIAL RECEIPT No. B 59181ct Daw \\~M \S19M . C Rec'd1~~ '\u,~ ~~\\\ U.t'1\(')'(I(T Address '\~~ ~()T+ 01\ \ ,~ G~ II '(I Received For: (\ aD DQ \.."J, '. tA~ IJ m D \(') cu '.40 " 00 rOJ ,co 1(0.0-0 Ian co ( ( ( ( u LJPJo c C'uu t ~))\J~ ~ r' J Nf\\--m 11 \ )f' (1 ( CI CI c (I (' - (I \-r) It:O (\LJ c Amount Received t1\' "^ . \~^J\) -- AlIrHORlZfOSJGNATURE " . (I BY '...'1 -:-( . '~.... .. ( , DAIGGS PRINTIERS'UTHOGRAPHIIRS.IEUGIINII. OREGON ,. .....1__. . Permit Clery - ,. ., " name___Lorne~l~ger ~ignoturo ~.~ ". -late 6- 1 0-82