HomeMy WebLinkAboutPermit Sewer Connection Record 2003-10-22
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COMMERCIAL/INDUSTRIAL
PERMIT APPLICATION
225 Fifth Street, Springfield, Oregon 97477
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LOCATION OF PROPOSED WORK: <\Q\'2..
ASSESSORS MAP' 1~-b3 -03 -\-4
JOB NUMBER 9<:; /7:2t;::
INSPECTION LINE: 726.3769
OFFICE: 726.3759
( WaA'JS J, ?(tWf:J" ~ i J tJB-
TAX LOT' 'wooh..= I
OWNER'
WII..'DiSH. TND'-'~T12.'''''L J)i:,\I,,-l-o?MEA)', C.aRp
PHONE: 4R'i-IlCCl..(KS',\-II,"".LkJ
ADDR~"'" Po O(X 141..R
CITY: E 1.c.G,!::t..l(!"
STAT~'
OR.
DESCRIPTION OF WORK'
NE~){ REMODEL
3""",',-i...~ <;:;.~ ~v'Q.<....:n \J"\
ADDITION DEMOLISH OTHER
NAME
ARCHITECT'
CONTRACTOR'S NAME ADDRESS
lJ; Icl:~ Cm..S.N-lA.C-HcM Cu
GENERA' '
PLUMBING'
MECHANICA' .
ELECTRICAl'
PLUMBING
NO.
FEE
I ~HARGE
I
I
l-::z S": - I
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I
Single Fixture
Relocated Bldg.
(new fix. addtl)
Water Service
)C
sanitary Sewer
Storm Sewer
ft.
26ft,
It.
Backflow Device
TOTAL PERMIT
ADDRESS
CONST,
CO NT RACTO R -
.# bq5
ME~HANI~AL
IOn
Furnace/burner & vent
< 100.000 BTUs
Furnace/burner & vent
> 100,000 BTUs
Floor furnace and vent
Suspended wall or floor
mounted unit heater
Appliance Vent
separate
Stationary evap.
cooler
Vent Fan/Single
duct
Vent System apart
from AC or htg.
Mechanical exhaust
hood and duct
Permit Issuance
TOTAL PERMIT
aUAD AREA'
- OFFICE USE -
FLOOD PLAIN'
HANDICAP ACCESS:
- OF BLDGf'
LAND US~'
- OF UNIT~'
OCCY GROUP'
- OF STORIES'
CONSTR, TYP~'
HEAT SOURC~'
sa. FT,
$/sa. FT,
sa, FTG MAIN
X
X
X
sa, FTG ACCESS
sa. FTG OTHER
. PLAN CHECK FF~
RCPT-
I BUILDING PERMIT
I v'~State
SurchalJl.e
MECHANICAL
-7 ",State
Surcharoe
I PAVING
I PLUMBING
I J~, State
tiurcharge
I FENCE
VALlIF $
I SIDEWAL~
FT.
I CURBCUT
FT,
I
'1
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ZIP' 'HIiOP.l
VALUE:
PHONE
EXPIRES
io{).Z./03
PHONE
l\S~- nco
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t""l-fl1R(H:
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$10.00
ZONING:
LIGHTING POWER BUDGET,
WATER HEATER,
VALUE
TOTAL VALUE OF .PROJECT
DAT~
BY
~~ ~- I DEMOLITION
I :?tf: I
I
I SUBTOTAL
PERMITS
I SYSTEMS
DEVELOPMENT
TOTAL PERMIT FEES
EXCLUDING ELECTRICAL
I
I
I
I 27.-S-0
~3. ?'2
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I
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