HomeMy WebLinkAboutPermit Building 1981-4-20
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CITY Of SPRINGFIELD
COMBINAJlON APPLICATION/PERMIT ....1
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legal Des,,*~on "1-/1 - O'?,.. . i _ 'l.:. Rcnqe. /J _Ne....._Add_Ahctr_Rep.
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Addres. ~/eol) 1J"iJ"hhfvJ... ~ Phone ~-("1Y' L.. Famil... R...idenc.. With A.tt('lch"d Garaae\
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I Add".. PO' Bri /Is~ ~ Phon. :,'fY-'Y).'f.?,/'IA,.JJ-rM 1''1. I'YY~,-, f!1.u~
I DESIGN TEAM (nome) t7 (address) (lies. no,) (expirel) (phone no.)
I Pril'nary
I $rructuraJ
I I~rectricol
"
I~"PECTI!)N LINE
726.3769
INFORMATION LINE
726-3753
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Mechaniccl
CONTRACTORS
(nome)
(address)
(lies. no.)
(ellpires)
(phone no.)
PlumbinQ
(:t) II y'h,//t...
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1/
General
Electrical
Mechonical _-.!../
Each single fillture
Relocaled buildjng
(new till:. odditianal)
S.F. Residen~e
(l both)
PLUMBING I
---r'.FEElOiARGElNO:" I
I I
1:<.+
I J
ElECTRICAL
MECHANICAL
Re.lldence of
l1...o/D 51:1: ft.
New circuits, alterotions
or ell:tensions
./5.09 15,~
').~ :<5.ce
furnaceJ burner to
Il,TU's
Applionco vent
separate
Stotionary evap.
cooler
Vent fon with
sin~le duct
Vent system aport from
heating or A.C.
M.chonical ell:haust
hood and d~ct
;EE-----rc.;i:RGE I
NO, '
FEE
I CHARGE
I
NO. I
Duoln (1 both) eoch
SERVICES /2.'5 ,,-""p
"" 2000."""
Temporary Construction
Additional bath
Amps.
Water service
Sewer ""JDO'
I().~
Wood stove/heater
Storm Sewer
I<atDCA1'EP 6"U.oIN", 15.0!] 15.f),!!.
FEEDERS
Heat PumD
Air handler to
10,000 CFM
Air handler over
10,000 CFM
Amps.
TOTAL CHARGES
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$15.0;;
ISSUANCE OF PERMIT
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TOTAL CHARGES
$> 4D.~
TOTAL CHARGES
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WHERE STATE lAW REQUIRES that the Electrical work be done by the Elertricol Contractor, the .Iectrical portion of this permit shall not be valid until 0
label has been signed by an Electrical 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 correct, arid I further
ct!rtify that any and all work performed shall be done in occordanCfl with the Ordinances of the City of Springfield and the lows of the State of 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 regislTation with the Builder's Boord is in full force and effect os required by ORS 701.055, that if uompt the basis for uemption is noted
heron, and that only subt"Ontractors and employees who are in compliance with ORS 701.055 will be used on this project.
Basis for Builder's Boord ell:emption'
NAME (please print)
J:LL ,3
G.SMqf,
SIGNATURE -.f.M~
FOR OFFICE USE ONLY
JJ. L.:F-'
OA,,4-LO-P,,/
Zone -f.!
Fire .Zone U~A
Flood plain ;..10
Typ./Can.._~1 "-\
Bedrooms
C:,lorie"
('),."t::
Units
("lccy load
Occy Group
nu~
~IO
~"'-
Sq. Ftg. Main
Sq. Ftg. Access
Sq. Ftg. Other
Value
x Value
ll: Value
TO~j, VAt!l1'~~~~...-d
.;.J,/ 29>1'> ~v
-Sy'st2ms 1>ev;loPmllnt "'::11 a ~ (!)
Chafae (1.5%1 ...::> /.-
Lah, I Ff'JI. 0. 2.E
2- LDp;~S 0, ~
I Total Comb. P..m;t 1f.402,'~!I.
BUilDING PERMIT I/.D~ Plan Ck. CommJ Ind
Charges and 65%1 Bide Per Fee
Surcharges O. ttl. Plan Ck. Res :5. :?9-
30%/ Bldg Per Fee
PLUMBING PERMiT 1.5.0.9-
Chofge.s and Fence
Surcharges 100
,I.~ Demo
ElECTRICAL PERMIT 40,~
Chofges and Sidewalk
Surcharges 1_102
Ale PaviM
MECHANICAL PERMIT -er
Chorges and Curb Cut
Surcharges --------
I TOTAL
COMBINATION APPLICATION;. (CAP)
'I. Applicant to furnish
A. Job Address
B. Legal Description
1. example-tax lot 100, Lane County Map Reference 17 03 43
2. example.Lot 1. Block 3, 2nd Addition to Springfield Estates
C. Nome, etc. of owner and construction lender
D.. Energy Sources
1. example-heat/electrical ceiling/or forced oir gos
2. example-wafer heater/electrical/or solar
E. Square footage or valuation, etc.
1_ example.1250 sq. foot house. 500 sq. foat garage
2. example-if new project, check new-if addition, check
odd. etc.
F. Building permit information:
1. example-construct single family house with an ottoched
garage
2. example-remodel existing garog6 into family room
3. example.convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 {oj of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Division
Staff must be able to contact appropriate persons regarding
design information or job site corrections, etc.
II. Abbreviated Plumbing. Mechanical & Electrical Sched~les
A. Excepf where blank spaces occur in the description portion
of the Mechanical and Electrical Schedules, the applicant
need fill-in only the No. Boxes adjacent to the appropriate
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 fo'rm the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on the abbrevi.
ated schedules you should consult tlie full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
. PERMIT VALIDATION
,
"
"
,
/
III. Applicant to sign and dote
Whenever possible. the initial application will be used as a
worksheet only. Where possible, Building Division Stoff 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 ore 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.
V. FOR OFFICE USE ONLY
Permit Cler~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Additional Project Information:
PLANS REVIEWED BY:
\
nome ,-", IA^ c;\I\ P I vjQl"'lll\..
signature Jf!YtA ~~ .lA.~
date S.28-8 ,
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, CITY Of SPRlNQfOElD _ INfORMAIION LINE
,.~:J COMBINAflON APPllCAflONJPERMIT . /;, ':"" 726-3753
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I 1;$'1/ 0/' " II 7 O. Building Permit Infb: . De'tribe Work (i.e.. Build Sing I.
Add"". jCOU lllvl'Y.\.. n:,,{' Phoo. 'ff..-l,Vl. Fn~~';~,"~~ Wi.h ~'!;.~ 0a,ao.I "
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I DES!GN TEAM (nomel - - - -c.1- (address) (lies. no.) (expir.,)
FOunPiq nDrl r-:'nC ~'I (')!7~'()
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I TOTAL CHARGES
I WHERE STATE lAW REQUIRES Ihal Ih. Electrical work b. daM by tho Elortrical Contractor, tho electrical por,ion of ,his permit shall not 1M valid u"til a
label has b_n signed by an EI8Ctrical Contrador and attached to the eledricol panel.
"
I HAVE CAREFUllY EXAMINED Ihe campleted application for permit, and do hereby certify tho. all information hereon is truo and corroct, and I fur.her
certify that any and all work performed shall be done in occardgnce with the Ordinances of tho City of Springfield and the laws of th. Stat. of Orogo,"
pertaining to the work deICribed herin. gnd that NO OCCUPANCY will b. mad. of ony struelur. without the permission of the Building Oivision. I (urthe. I
certify t"at my rttgiSlTation with the Builder's Bcgrd is in full force and effecI os roquired by ORS 701.055. that If uompt the bgsis for olCemprlon II nolee I
hefon. and that only subcontractors and employees who are in c:omplianco with ORS 701.055 will be uHd on Ihis project. I
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INSPECTION LINE
72~769
Primary
Slruetural
!Jeclrical
Mechanical
CONTRACTORS
General
Plumbinq
Electrical
Mechanical
NO. I
Eacn linqle fixture
Relocated building
(new tb. additional)
S.f, R.uiden~.
(I balh)
10
-,
()
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J
(phone no.)
t'J7J rrUA )
(name)
(addren)
(ohana no,)
flic,. no.)
(oxpiresl
;.11) J1 "" 1/-0_
1/
1/
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-~"F'E: -CH'A'R'GEi"NO:' I
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PLUMBINC
ELECTRICAL
MECHANICAL
FEE
NO,
FEE!CH':ii~1
.,
CHARCE
Re\idence of
~"",c, ,q: ft.
furnaco/burner to
:t.TU's
Applionce yent
separot.
.'
New circuits, alterations
or extensions
I
/5.09 J:i,~
'}.~:J.5.";;'
Stationary eyap.
cooler
SERVICES 12.:; CI ;,',1 ""
c"g. 20Ual'.-\f
Temporary Construction
Vent fan with
single duct
Venl system apart from
heating or ....C.
I Mechanical ex"aust
hood and duct
I Wood stoye/hoatar
I Heat Pump
" Air handler to
10.000 CFM
I Air hondlef oyer
10,000 CFM
I
/,
...dditional both
DUDlu (1 bOlh) eoch
Star,m Sewer
"R!:?!_.':'clYn::.~' SVIWI,'ll:\1 500 5.00
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4:. /5.0~ I
Wot., son ice
I
11 Sewer
I
Amps.
-IDOl
IO,~'
fEEOERS
Ampl.
ISSUANCE OF PERMIT
TOT...l CH...RGES
.:p 4DPg I TOTAL CHARGES
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NAME (please print)
Balis fOf Builder's Boord elCemption:
SIGN...TURE
Zone -R.!-
fire 'Zone U/A
Flood Plain 1-l0
BUILDING PERMIT
Charges and
Surcharges
PLUMBING PERMIT
Charge, and
Surcharges
elECTRICAL PERMIT
Charge, and
SurchargltS
MECHANICAL PERMIT
Charge I and
Surcharge I
J:LL..S
tcl~
.1J.~'
DATEl.t-'"lt> -1"/ .
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fOR OFfiCE USE ONLY
Typ./ Conll.
Bedroom'
\1/0..\
Yolue
Volu.
Value
, TQIAl VAOUAT'ON 19.,%'::!=' _
'-{"iP """"P',,~ lV' ,,,-,
':'<1 2~ ~.~
"'Sy-sr2ms lleY~I;Pm"nt .:3} a ~ 0
Chorlle {l.5%\ I .
02.0
O,~
$ 4 OZ.:~.:1
Ilt_!c
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~~,
Units
nccy load
nccy Group
<.,. Ftg. Main
c,. Ftg. Acceu
Sq. FIg. Other
x
<tori"'"
",,-, t::
I f C>.:) Plan Ck. Comm/lnd
____~~ ___ 6S%/Bldll Per Ftte
0."11.
~5,O2-
! 00
'-
40.'~
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"'-.-:;'0
v,-
Plan Ck, Res
30%/ BldQ Per Fee
Lal-u I f~f'
2.. ('OP(~-5
I Total Comb. Permit
Fence
Demo
Sidewolk
Ale Payjn~
I Curb Cut
._-------,
-s-
TOTAL
CITY OF SPRIN.IELD c-
City Hall
Springfield, Oregan
Department ..f Public Works (
OFFICIAL RECEIPT
No. B S 6 6 0 3 rer
Date .5 'd.zj 19 8/
Rec'd From E~ ~ ,(
Address '1/&(30 -LJrn/>1t!).;(Jd~~61 .'
-c.
Received Far: &-
A~d .a
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. 4ij;. . 0.44
..,o()/W)/~ d5.o9
4~/.!' I. 00
f= h/'_ 4().o2
4 dfo !A2
~ 6.Q2
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, ..;. 01.0
,~,JY7 ...3/9. -
C). 50
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Amount Received
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A,UTHOJUZIlO SIG...."TURIE
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(
. City Hall
Springfield, Oregan
Department of Public Works
OFFICIAL RECEIPT
(
( N~ B 56604(
Date .~-275 19 X /
( Rec'd From r-'-eh'<:o ~k.t..).,t.,. (
Address q I(,,{,O /1:nMI1.. RJ- ~
( -\'
Received Far: ;(3 Ll.- ,
( ~ 77J....,.,~./ (
~/ ;'1'/1rJrr..
(' T0o.p. 1..6-.0_0 (
. 0
A/I~il.....ln __ ""')1) 0_
C ' ~ 1 /";;4J2.!J. mJe/J_~ taJ- "..so ';:' (
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<; --18~,f4_A__L. (
tp Amount Received _ V\, L#lJLGFL
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A,UTHORIZl!:D 5IGN....TURIE
."UTo...r"'''''.ULl "..'NT"".' IEUCIE"IE. 0.. .,.0,
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, ' 'IIi. App'li~~nt io .ign' a'nd d~ie - - - , . . - - - ,
Whenever possible. the initial application will be used as a
worksheet only. Where possible, Building Division Staff will
prepare a typewritten copy and return it to the applicant at
the time the actual permit is issued for his signaturE.
IV. Fee. and Charges
Plan check fee. 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.
V. FOR OFFICE USE ONLY
--.
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Additional Project Information:
PLANS REVIEWED BY,
name---=rD V,A <'VI P 1 'I b~\" signature c==:J.JlI'.A _S;:J~ ~",.)
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date .s, 2.8- ,'U
.