HomeMy WebLinkAboutPermit Building 1981-10-8
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INSPECTION LINE
72..376. i"OTlfIED
OCT X 7 1:131
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CITY OF SPRINGFielD
COMBINATION APPLICATION/PERMIT
I ENERGY SOURCES:
HeatEVi <::ti n~--Elg,..t
INFORMATION LINE
776-3153
Sq. Ftg. Main
Sq. FIg. Accen.
Sq. ftg. Olher
_New_Add_Alter_Rep,
__Fence_Cemo_Change/ Use
_Other
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legal Oe,cription
17..=n3.=.3~.l, T.
1613 East Main. Sprinqfield. OR
48(1n
Water Heater
Ranqe
Value af Wark:
Job Address
Own" Pacific Northwest Bell
Addross 421 SW Oak St. Rm 111
Portlanrl 0R--9720A
, .
Construction lender S.: fflj:l
Address
DESIGN TEAM
(name)
Pdmo'Y Moreland/llnruh/Smith
5',",'.'01 John Hekri ck
pr
Electrical W"Tnpr l='f1g
Mechanical Roaers Eno
CONTRACTORS
(name)
Gene',:,1
1 ~nnmnrk r.nnc:. trllrti nn rn
Plumbinq
Electrical
FII9pnp Mnrnen'
Mechanical Brainard Heatina
PLUMBING
NO. I I FEE I CHARGE
2 fa'hD.lng~f!il.~. wash s,nn In,nn
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (I bath) each
Additional bath
Woter service
Sewer
Storm Sewer
phone
~07 , 'ZPt7 ,nf'\.
Building Permit Info: Describe Work ).e., Build Single
Familv Residence With Attached Garage)
phone
1600 S.F. additinn ~nn~i~ti~f niling f11S
reinforced concrete strll~tllrp. m~"-.nrv wi\lis
. for sl"itchi no pOlli nmpnt nn 1 v.
(address)
(Iics. no.)
(expires)
(phone no.)
P 0
1188
A
"W'A
)"(\....
1"".1..
686-2014
Rnx lfi~n. F"2""" , np
Olive Street. Fllo"np. OR
~
78A
Rnv 7726. Eugp"~.. 0"
r.pnt"nn;ill Innn. I'llnpnp.
nR
(addren)
(lies. no.)
(expires)
(phone no.)
133 N. Garfield
689-1329
Salem
3fi3-PQ4fi
elECTRICAL
MECHANICAL
NO. I
FEE
'CHARGE
FEE
CHARGE
NO. I
Residence of
furnace/burner to
I!TU's
Appliance vent
seporate
Stationary evap.
cooler
Vent fan with
single duct
Vent system aport from
heating or A.C.
Mechanical exhaust
hood and duct
sg. ft.
New circuits, alterations
? or extension,
15.00
SERVICES
Temporary Construction
Amps.
Wood stove/ heater
FEEDERS
Heat Pump
Air handler to
10.000 CFM
Air handler over
10,000 CFM
'~Iter & ex ten a
jll~twork
f.,nn
Amps.
I(\n
In nn
x
ISSUANCE OF PERMIT
1:1 nn
TOTAL CHARGES
10. 00 TOT At CHARGES
25.00 ; TOT At CHARGES
16.00
WHERE STATE lAW REQUIRES that the Electrical work b. dOM by the Electrical Contractor, the electrical portion of this permit shall not be valid until a
lobel has bun signed by on Electrical Contractor and attached to Ih. electrical ponel.
I HAVE CAREfUllY EXAMINED the completed applicotion for permit, and do hereby certify that 011 information hereon is true and correct, and I further
.:ertify that any and 011 work performed sholl be done in accordance with the Ordinances of the City of Springfield and the lows of the State af Oregon
pertaining to the work described herin, and that NO OCCUPANCY will be mode of any structure without the permission of the Building Division. I further
certify that my registrolian with the Builder', Board 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 employee, who ore in compliance with ORS 101.055 will be used on this project.
Ba,is for Builder's Boord exemption:
NAME (please print) E~"-'v (~"i <.
Zone_r _ll
fire Zone-HA
Flood Plain _Nn
T
Type/Canst.
Bedrooms
Storie"
BUilDING PERMIT
Charges and
Surcharges
.____28;L00
11. 32
In,nn
M
25.00
------
1.00
16.00
PLUMBING PERMIT
Charges and
Surcharges
ELECTRICAL PERMIT
Charges and
Surcharge,
MECHANICAL PERMIT
Charges and
Surcharges
.64
~ r-
SIGNATURE ~ ('
FOR OFFICE USE ONLY
-Q
'ATE(?).;T. ~ Jill
, ,/
Units
n..cy load
nccy Group-H.~
Sq. Ftg. M~in
~1. ftg. Accen
Sq. Ftg. Other Ann
Value
Value
Volue
$97.787.00
$Q7,7R7 nn
x
x
lfiOO
x
TOTAL VALUATION
Plan Ck. Camm/lnd
65%/ BldQ Per fee
Plan Ck. Res
30%/ BldQ Per Fee
Systems Development
Pet ~1 O.6.-3D-..a-l-~ !'thorqe (1.5%)
Cred1tFPl an
~R~7?nA r.~pr. pp
$ 1.469.Rl
-12.35
Fence
Demo
Total Comb. Permit
347.36
Sidewalk
A/ C Pavinq
Curb Cut
I
$ 1.804.82
TOTAL
" \ -
_~l,:r~llijl!"_"~~'~'J~,ll!..L.,i) ", _.,10'1('"'''"''' "" '. ~~" '," _ _ \. "'''~.' n.l'.'~,I'",- "," ''', :>'~'!NI",I,'.':\~,_~,~,~'''''i'~''1)},''':'"~,,,,;:,-,,-;,l''''~,",,~re~~":
". .. \~ . . '
A. Job Address
B. legol Description
1. exomple-tox lot 100, lone County Mop Reference 17 03 43
2. exomple-lot 1. Block 3, 2nd Addition to Springfield E,-.-.-
C. Name, etc. of owner and construction lender
D. Energy Sources ....
1. example-heat/electrical ceiling/or forced air qas
2. example-water heater/electrical/or solar.
E. Square footage or valuation, etc.
1. exomple.1250 sq, foot house,-500'sq. foot goroge
2. example-if new project, check r;;w.jf addition, check
add, etc.
F. Building permit information:
1. example-construct single family house with an cttocl
garage
2. example-remodel existing garage into family room
3. example-convert single family residence into
restaurant {change of use}
G. Volue of work 05 defined in Section' 303 (0) of the
Structurol Speciolty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Oivisio .' ,
Staff must be able to contact appropriate persons regal
design information or job site corrections, etc.
III. Applicont to sign ond dote
Whenever possible, the initial application will be used as
worksheet only. Where possible, Building Division Stoff "
prepare a typewritten copy and return it to the applicant (
the time the actual permit is issued ~or his signature. ~ I
IV. Fees ond Chorges , \,:
Pion check fees are due ond poyoble ot the time of the 0 ,fce
ond no pions will be processed until these fees ore poid.-
other fees and charges are due and payable when the pJnnl1
is issued.
COMBINA nON APPlICA nON/PERMIT (CAP)
I. Applicont to furnish
II. Abbrevioted Plumbing, Mechonicol & Electricol'Schedules
A. Except where blank spaces occur in the description par
of the Mechonicol ond Electricol Schedules, the opplico
need fill-in only the No. Boxes odjocent to the oppropr
item(s) to be instolled
B. Full Plumbing, Mechonicol, ond Electricol 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 instolled ore not covered on the
oted schedules you should consult the full schedule,
C. BUILDING DIVISION 5TAFF Will Fill OUT ALL FEES Ai'
CHARGES ON THE SCHEDULES
V. FOR OFFICE U5E ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
PLANS REVIEWED BY:
nome I '-'rnQ Pl Qgo~
signoture ~--=-<..
PERMIT ,VALIDATION
(
CITY OF SPRINGFIELD
City Hall'
Springfield. Oregon
Department of Public Works
OFFICIAL RECEIPT
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~ No_ B 57424
Dot~ "1~1 (
Rec'd From ~ ~(f(} l\ t. 0 rnl'tJ\ .
Address ""~~ \\') v G~tOQ&
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Received for: \?)~ ? 9, "J..{:P - (
4O/n ". 'B Z (
~b '. - I'f'>CO'
(L1>JLr-7::% ;j~~cf:_
47ft) 7 ,60 (j -
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Amount Received
\ gcy.t 82.::.(H7:> ~ (I
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AUTHORIZED SICNATURE
S..t:LTO".TU"".ULL "'''''TE''S. EIIGE..E, 0" .,.0,
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Permit CierI--
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9-29-8!