HomeMy WebLinkAboutPermit Building 1981-4-27
<<:00 87."3
I INSPECTION LINE _,., CITY OF SPRINGfiELD .
7260.3769 COMBINATION APPLICATION/PERMIT
I I 1111/\ 1'_-""'= I MI A"t"" L~ ENERG~~'2't':,_ LlP Sq. Ftg. Ma;n
Jab"'ddren~ OMII .~J U.......-- Heat - pi Sq. ftg. Accan._
I Water Healer Sq. fig. Other
l.gal D.",;poan 11I.:l?T ~F_7- (. . ~ <,fc::le>... /?'()3. 22'Z Range _ _New_Add XAIt,,_Rep.
t " jfr'olue of Work: _._Fen(e__Dem~ChOnge/~ i
~ L~1r - ~LteK-RLJrB ~ .5J)()Q 00 (~,;;'/J-~~;p:;:;-."='''',
., "'" ~'" 11 ~ ,;. J I ,~eo ~AJt. h Buildin4 Permit Info: Describe Work (i.c.. Build 5i"91.
I Add",. 4j,.A.J l..UVl\.l I I\. 1 ~r"\ PhanOlmtJ_ '::-D;;;ti tih;;;d ..e')2', $b- n . ,
'I' Can.'M';an '.nd.. r'b'W-.l.p ~ ~~ A~A- ~G>;;;".4#C::"'" 'I
Address Phone 'U
I DESIGN TEAM
INFORMATION LINE
7'26-3753
~
~
(\
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~
IV
"
(nomel
(address)
(lies. no.)
(expire1)
(phone no,)
Primary
Mt1
pI:) W ".;4~t;
1tl!l{)')..,
~~~/A'2,4!2-1,
Struclurol
Electrical
Mechanical
CONTRACTORS (name)
G.n..al ~bTflS~.
(address)
(ljcs. no.)
(expires)
(!)hane- no.}
Ah A~.
Plumbinq
Mechanical
~If !0
r.Otift.>RT fl ,OW
flectrical
NO. I
---
. FEE
I
CHARGE' NO.
I
Ix
I
I
I
ELECTRICAL
MECHANICAL
PLUMBING
FEE
I CHARGE
NO. I.
FEE
CHARGE' I
Residence of
1
157-
furnacel burner to
Q,TU's
Appliance vent
separote
Stationary evop.
cooler
Vent fan with
sinqle dUct
Vent system aport from
heating or A.C.
Mechanical exhaust
hood and duct
./
Each ,;nqllt fill:ture
Relacaled building
(new fix, additional)
S.F. Ruidcn!=e
(1 both)
Sq: ft.
New circuits, alterations
or entensians =<dR:~/f ~
SERVICES
Sewer
Wood stove/heater
I
I
I
I
I
Ouolelt (1 both) e-och
Temporary Con,truction
Additional bath
Amps.
Water service
Star,m Sewer
FEEDERS
Heat Pump
Air handler to
10,000 CFM
Air handler over
10,000 CFM
". AOD S...llC'<:'" D~ c7-
b.<>O
Amps.
TOTAL CHARGES
I TOTAL CHARGES
ISSUANCE OF PERMIT I.::P. <>C>
15."'" TOTAL CHARGES 16...."'"
WHEKE STATE LAW REQUIRES that the Electrical worle. be done by the eTerlrh:al Contractor, the .Iectrical portion of Ihis permit shall not b. valid unlil a
label has been signed by an Electrical Conlractor and attached .10 the eleClricol panel.
I HAVE CAREFULLY EXAMINEO the completed application for permit, and do hereby certify thai 011 information hereon is true ond correct, and I further
certify that any ond all work performed shall be done in accordance .....ith the Ordinanns of the City of Springfield and the laws of the Slate of Oregan
pertaining to the worle. described herin, and that NO OCCUPANCY will be mad. of any slructure without the permiuion of the Building Division. I further
certify that my reghrration with the Builder's 80crd is in full force and effect aJ required by ORS 701.055, that if exempt the basis for exemption is noted
heron, ond that only subcontractors ond employees who ere in compliance with ORS 701.035 will be uled on this project.
Basis for Builder', Boord exemption:
NAME (please print) ~~
A.
6M r-n4
c:.tGNATURf
FOR OFfiCE USE ONLY
(\~
Zone C. .. 1./
fire Zone_No ~
Flood Plain No-
Type/Can".X::flfl?
Bedrooms _AI. ~ '
I
Unih
-Occy Load _t7
Occy Group-F....2
Sq. Ftg. Main
Sq. Ftg. Access
Sq. ftg. Other
x Value
x Value
/7~t>T'c..C'A~~C'E Valu.
TOTAL VALUATION
DAT~
I
I
~,torie~
:'.__ -.0
.;: ""-=-- .....".
PLUMBING PERMIT
Charges and
Surcharges
N4.
Fence
flo.W~~c:5b3dO 75".-
-\-f1m L\-l~)-P51
I
BUILDING PERMIT
Charges and
Surcharges
'='-:z ...- -ffilan Ck. Cammllnd
___.-:?_-=-__ 6S'lO/Bldo Per Fe.
I ':) B Plan Ck. Res
.' . 30%1 BJdq Per Fee
Demo
l Total Comb. Permit ~ .r: 5"'2.
ELECTRICAL PERMIT
Charges and
Surcharges
IS". -0
be:>
Sidewalk
Alc Pavino
MECHANICAL PERMIT
Charge, and
Surchargel
____/~.~
.b~
Curb Cut
I TOTAL
I '(e;. '><
COMBINA TlON APPLlCA TlON/PERM~AP)
I. Applicant, to furnish
A. Job Address
B. legal Description
1. example-lax lot 100, lane County Map Referenc~
2. example-loll. Block 3, 2nd Addition to Springfiel
Name, etc. of owner and construction lender
Energy Sources
1. example-heat/electrical ceiling/or forced oir gas
2. examole-water hearer/electrical/or solar
E. Square foologe or valuation, etc. -
1. examole-125D sq. fool house, 500 sq. foot garage
2. example-if new project, check new-if addition, ChE
add. etc.
Building permit information:
1. exam ole-construct single family house with an aftl
garage
2. example-remodel existing garagt. into family roon
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 Divis
Stoff must be able to contact appropriate persons reg
design information or job site corrections. etc.
II. Abbreviated Plumbing. Me~hanical & Electrical Sched~le:s
A. Except where blank spaces occur in the description po
of the Mechanical and Electrical Schedules, Ihe applic,
need fill.in only the No. Boxes adjacent to the approp
item(s) 10 be installed
B. Full Plumbing. Mechanical. and Electrical Schedule. .
are available at the Building Division
1-. To conserve space on the permit form the sched"ule:
have been abbreviated
2. If the item(s} to be installed are not ~overed on the
aled schedules you should consult the full schedule
C; BUilDING DIVISION STAFF Will Fill OUT All FEES M
CHARGES ON THE SCHEDULES
C.
D..
. F.
III. Applicant to sign and dale
Whenever possible. the initial application will be used as
worksheet only. Where possible, Building Division Staff w
prepare a typewritten copy and return it to the applicant
the time the actual permit is issued for his signatur&.
Fees and Charges
Plan check fees are due "I'd payable at the time of the aF <-
and no plans will be processed until these fees are paid. A-
other fees and charges ore due and payable when the permit
is issued. .
IV.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
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.
PER.MIT VALIDATION
17 03 43
CITY
SPRINGFIELD
OF
.
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City Hall
Springfield, Oregan
Department of Public Work.
OFFICIAL RECEIPT
.
56354.
f;
/ I No. B
-, - ~ 3 19~ I
C Rec'd From f)!)J..~ ~A
Address P ,0 . t:>O X ~ l\ 3~
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Received For:
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Date
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SDC-
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('- Received
Amount
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j, :18
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, (a4
ryS-. CO
4'711
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170
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...UTHORIU;D 5IGN....TURII:
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'H.UO"'TI,"""'U~1. ....'..TIl~. . t:uca.u. 0" ,,..0'
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Permit Clerk
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PLANS REVIEWED BY,
"Qme_~/9--\.""",::
-
/~ <!= ~.,,;::,..,.
signatur'"
-
..late
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