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