HomeMy WebLinkAboutPermit Building 1980-12-1
CITY OF SPRINGfiElD INFORMATION LINE
COMBINATION APPLICATION/PERMIT 726-3753
P I ENERGY SOURCES: /. Sq. FIg. Main
0. cl"-t 13 Heot . ~n.. - / /1 Sq. FIg. A,,,,u,
-<!.l' -- ". 1 1(') I'!J
T l _ Ii' 0 ,. _ 21 _ <.I 2'" I Wo'" Heot" L.o n! . r Sq. Ft.. O,he' -+ .
legal Oemiption ~ I ~"t:J Ranqe" /1~_~_ _.New__Add_Aho,_R.p.
?O~eal... '"P 1ol1_ ;'\~ ..l ~.li ~ 'tiq "'-0 re tlX.. VIU':lue of Work: ___Fel\ce_Demo_Chonge/U.se
~ r 'F" .. Lt.. <l. 1.$ .~Other t"''''^,,~ I # .L. ,"'-('I,
Own" ~,... eJ.O.;....I.. rl~....,,\:.,,"'.,.. ...." .."_"..1,()~ll. ."Est~- c."T'.l.!L~
Budding Permit Into: Describe Work (..e.. BUIld SHlgle
PhClne 'j~'1=-hqll:'~n. ~~~~?y Residence With AttochQd Gorou,;\
t<c.~U.\:.... ?.....<I!-I ul\"U
.~ OJ\..~o.., 2 L\ l<. Il,.,
" 1-/!.:. A~ ./' r ~ ~
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INSPECTION LINE
726-3769
~~~
Job Add,eu
t'te.o I
Addrou
Construction Lender
Addroll
DESIGN TEAM
(nome)
Primary
n 'I
~ Cl..L~. (no'
~~ 1.J;:u.~. t..~<
Slructur::J1
Electrical
Mfllchonicol
CONTRACTORS (no,.-,e)
General ~a...jJ, t.n~ ~~~t.'U.lt'.t;: 6."..
S+-t~ ? )..........)....;.~ 1
'Bv......,''''U--\.il fJ....1'...
Mechanical <!""'~o-.vJ""'1 1..J.1.o,)
Plumbinq
Electrical
PLUMBING
NO. I
FEE
CHARGE NO.
I
1/
I
Each sinqle fixture
Relocated building
(new fix. additional)
S.F. Residenc.
(1 both)
Duplex (I both) each
Additional bolh
Water service
Sewer
Storm Sewer
Phone
(address)
(lies. no.)
112 ~
;: v... dC'.',I.r.. h,\. 7 '2. ~,.
(address)
'- Cj ?,
("'...,''') (/jes. no.)
;:- v\ .)..(';'H".:. h h~ ., 2 3. ~,
~\,,),! 1()2~ 9
}\it..~,',J\l--.C ;~'" 2.0-)21,.
..Jl.,,:v.......'l L 1 .36 Lj 10
JILt)
IS'S' 1'1
J~
I!.. b S;
elECTRICAL
FEE
CHARGE NO.
Residence of
Sq: ft.
Hew circuits, altorations
or extensions
/!),(]C
SERVICES
Temporclty Construction
Amps.
FEEDERS
I
I
I
I
I
I
.1 TOTAL CHARGES
TOTAL CHARGES
Amps.
(phon. no.)
(,,-,q.~ )
~I '< S'.O S i!.,
(expir.s)
{chane no.l
I~ -JCj'>iI
I.}' !-.-.t\ '<7"1'.")
1.-30-~)
(., -3a-S'
- S )
7 Y 1-06 ;> .:-
''-Ie~--'''')~7
I
/:., ~ ~"" -JJ..;:l1
I
Ie
MECHANICAL
FEE
CHARGE !
furnace/burner to
Il.TU's
Applianco vent
separate
Stationary evop.
cooler
Vont fan with
sinClle duct
V.ent system aport f,om
heatinq or A.C.
Mechanical exhaust
hood and duct
,
'.
Wood stove/ heotol
Heat Puma
Air hondlor to
10_000 CFM
Air handlel onr
10.000 CFM
It; on. TOTAL CHARGES
ISSUANCE OF PERMIT
WHERE STATE LAW REQUIRES thai th. Electrical walk b. done by Ih. Eledlieol Contractor, the .Iedlicol portion of this permit sholl not bo valid until 0
label has b..n signed by an Electrical Contlaclor and onach.d fa th. electrical panel.
I HAVE CAREFULLY EXAMINED the comploted application for permit. and do hereby cllltify that all information h.reon is true and correct. and I fUlth.,
cllltify Ihol any and all work perf aImed shall be done in oCl;Qrdonce with the Ordinances of the City of Springfield and the lows of the Slata of Ologon
pertaining to the work described herin, and thot NO OCCUPANCY will b. mod. of any structure without the permission of 1he Building ~ivision. I fur,h.,
certlfy thot my registration with the Build.r's Boold is in full force and effect 0 I requir.d by ORS 701.055, that if exempt the bosis for exemption is noted
heron, and that only subcontractors and employee. who at. in complianco with ORS 701.055 will be used on this project.
Basis for Builder's Board exemption:
NAME (pl.o.. Pdntll< &. e.;i J. ~ 0';,1 d"\.
lone_P-1
Fire Zone
Flood Plain _IV n
Typel Const. -""?, -)/
Bedrooms -?
"for-ill" .~
<IGNATURE ~ Y\rt..vt" ,1 ,.,,.l.r.v..J..tf")r
fOR OFFICE USE ONLY
I
Sq. Ftg. Milin
cl. Ftg. Access
JIA-=1- Sq. Ftg_ Other
7~t'i
Unih
"ccy Load
'Jccy Group #.?-:.
. I Plan n. Comm/lnd
J../ IJ. ()/'J 65<:0/ Bldq Per Fee
I Plan Ck. Rei
/ . (p 0 30%/ Bldq Per Fee
j<J. /J , I Fence
I Demo
BUILDING PERMIT
Charges and
SUlchorges
PLUMBING PERMIT
Charges and
Surcharges
ELECTRICAL PERMIT
Charges and
Surcharges
DATE 12-1-~a
x Value
x Value
x Value,
TOTALVALUATION-..r ?"'t:JDCO
? q Systems Development
S5Z} . Choro::ae n .S~ol
/2.0':>~f
-r
I tJ. 00 S;d.wolk
,,40 Alc Povino
MECHANICAL PERMIT
Charges and
Surcharges
..1Y!J}...:...._____ Cl,Irb Cut
I
I
I
I TOTAL
,
Total Comb. Permit
.~l.(]o
Ps,!), CO
...---.--.- -.----------- - - -- _._-----
Ak~ L~L-/
COMBINATION APPlICATlON/PE. (CAP)
I. Applicanl..19 furnish
A. Jab Address
B, legal Descriptian
1, example.tax lot 100, lane County Moa Reference 17 03 43
2, example-lot 1. Black 3, 2nd Addition t~ Springfield Estates
C. Nome, etc. of owner and construction lender
D. Energy Sources
1. example-heat/electrical ceiling/or forced air gas
2. example-water heoter/electrkal:'or solar
E. Square footage or valuation, etc. -
1, example-1250 sq, foot house, 500 sq, foot garage
2. example-if new project, check new.if addition, check
add, etc.
F. Building permit information:
1. examole-construct single family house with an attoched
g:Jrage
2. e::omple-remodel existing garage into family room
3. example-convert single family residence into
restaurant (change of use)
G. Value of work as defined in 5ectian 303 (0) of the
Structural Specialty Code
H, DESIGN TEAM AND CONTRACTORS
To avoid design or.construction delays, Building Division
Stoff must be able to contact appropriate persons regarding
design information or job site corrections, etc.
II. Abbreviated Plumbing, Mechanical & Electrical Schedules
A. Except 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, Me<:hanical, and Electrical 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 installed are not covered on the abbrevi~
ated schedules you should consult the full schedules
C, BUilDING DIVISION STAFF Will Fill OUT All FEES AND
CHARGES ON THE SCHEDULES
III. Applicant to sign and date
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. Fees and Charges
Plan check fees are due and payable ot the time of the application,
and no plans will be processed until these fees ore paid. All
other fees and charges are due and payable when the permit
is issued.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
PLANS REVIEWED BY,
nam'"
~ignatvre
. PERMIT VALIDATION
CITY OF SPRINGFIELD
/
City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
No. B
;;;1 - ,-q 19 ye'
c'd Fram.;$' o'--'J~17 r2'7;?Cl.:t.
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Idress 1/:).0 fur LA..e./Y'...\..
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Permit CierI-
" date /..:2-3 - 8'" ()