HomeMy WebLinkAboutPermit Building 1981-5-18
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I ENERGY SOURCES,. ~,A'}-r,,,' Sq, "9, Main ~ 'f ~
Heol~ j/o .~-:~ Sq. Ftg. Aceon.
Water 1:ieale, tlL.iJ/ Sq. Fig. Oth.,
Ranqe ~ ~ _New.6dd-01ter_Rep,
Value of Work: _ __Fence_Cema_Chongel Use
~ 000,05' _Olh.,
---/, I
Bvilding Permit Info: Describe Work {i.Q., Build Sing I.
Fomilv Re'idenr~ With AUQched GarO('le)
If)/} J)p, -1...11 tJA- d 01ffi1 11) j
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INSPECTION LINE
726-3769
,
CITY Of SPRINGFielD
COMBINATION APPLlCAflON/pERMIT
Job Addrll!n
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/7-0,~,~5-3d. TL BooO
Legal OelCription
O.....n.r
MOv1VU 75" I~~ f-ey;
/43<; P/auawl--
phone
Addreu
Co",'ructiot't Lend.r
NoYle.
Addreu
Phone
DESIGN TEAM
(address)
(Iin. no.)
(nome)
Primary
f<n~ $
,/
3 'S'l/-c,?.
BUII_DIIJc:.
:;)YS,iEW/~
V
Structural
v'
Electrical
Mechanical
CONTRACTORS
(nomel
tZ"J" ,
(address)
(lies. no.)
Plumbina
III" r'7 e...
o "t.}J/]<'.,
I~sh[/,uj
13
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Po, f)".",
6U'l~M"'1.
DWI-/€. h )
10,37)
3Pk, :l-
:5 Ys rE7Uj
Gl!neroi
f)u/(_DIIJG
Electrical
Mechanical
PLUMBING
ELECTRICAL
NO. I
FE!:
I CHARGE
FEE j CHARGE
NO, I
2+1
RlIsidence of
I
/50!' 15,~ I
I
I
I
st~: ft.
New circuits. alterations
or extensions
Each sinqle fi..lure
RelocoTed building
(new tix. additional)
S.F. ilo!siden~.
(1 both)
SERVICES
Duoln (1 boTh) each
Temporary Construction
Additional both
Amps.
Water ,.rvice
Se......e,
Stor.m Se_er
FEEDERS
Amps.
I
I
I
I
r
INFORMATION LINE
716-3751
(eJtpi,es)
C>()
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\)
~
..D
I
I
(phone no.) 1
(,.n-~/.s-I
I
I
1
1
t:/b '~/,s-I
I
I
I
I
/-/(, ,-2:J-
(expir.s)
(phono no.) .
1-/~-R2-
MECHANICAL
NO,
FEE
ICHARGE
rurnace/burne, to
ltTU',
Appliance vent
separate
Stationary ."op.
cooler
Vent fan with
sing I. dud
Vent system aport from
heating or A.C.
M.cl1onlcol ....houd
hood and duct
,
Wood stove I heatar
Heat Puma
Air handler to
10.000 CFM
Air handler ov.r
10.000 CFM
ISSUANCE 'OF.. PERMIT
-
TOT AL CHARGES
-0-
TOTAL CHARGES
/ 5, O~ TOTAL CHARGES
-0'"
WHERE SlATE LAW REQUIRES Ihat Ih. EI.ctrical war. b. done by the Elertricol Contractor, Ih. electrical portion of this p.rmit shall not b. valid unlil a
lab.1 has been signed by an EI.ctrical Contractor and attClcn.d 10 tho eledricol panel.
I HAVE CAREfULLY EXAMINEO the completed application for permit. and do hereby certify thai 011 informotlon h.reon i. true and correct, and I further
certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and Ih. Lows of the Stat. of Oregon
pertaining to the work described herin, and that NO OCCUPANCY will b. mad. of any structure withoul the permission of the Building Division. I (urther
certify that my registration with the Build.,.. Boord is in full force and ~ff.ct as required by ORS 701.055. that if exempt the basi. for exemption i. noted
heron, and that only 5ubmnlloctars and employees who are in compliance with ORS 701.055 will b. used on this proj.ct.
Basi. for Builder's Board ell.llmprionl
NAME (pleas. print)
CIGNATURE
FOR OFFICE USE ONLY
9\
Type/Canst.~ M.
:l.adrooms
'Jnih \
n.,y Load ~, ~
'Jccy Group P "2..
Sq. Ftg. Main
Sq. Ftg. Access
C;q. Ftg. Other
Zone
Fir. Zone
Flood Plain
<::,orilt.
J-.'-A.Jt.~
BUILDING PERMIT 32- 00 Pion n. Comm/lnd
Chorges and --- .~:.......-_- 65~../8rdo Per Fen
Surchorges I. 'Z-~ Plan C\<. Res
30~../8IdQ Per Fee
PLUMBING PERMIT 0
Charges and Fence
Surcharge. -
Demo
ELECTRICAL PERMIT 15.~
Charges and Sidewalk
Surcharges ~.~
4./f'; Povil"lr::'
MECHANICAL PERMIT 0
Chargos and Curb Cut
Surchcuges --------
...
q (Pi? !>,s:-BI
, rtt'iln1J
"
DATE
x
'.'olue
'olue
x Vallie g
TOTAL VALUATiON -5l'0/!).. 0_
I Systems Development
Chor e 1.5%1
'\s"
Sl.m
~.~
50.3~
fT'p,'n/"'l (S \
L.c..~ ,I
Total Comb. Permit
1 TOTAL.
COMBINATION APPLlCATlON/PE. (CAP)
I. ApplicanJ. to furnish
A. Job Address
B, legal Descri ption
1. example.lax 101 100. lane Counly Map Reference 17.03 43
2, example.lot 1. Block 3, 2nd Addilion to Springfield Estates
C. Nome, etc. of owner and construction lender
D.. Energy Sources
1. example-heat/electrical ceiling/or forced air gas
2. examole-water heater/electrical/or solar
E. Square footage or valuation, etc.
1. examole.1250 sq, foot house. 500 sq, foot garage
2. exompie.if new project, check new-if addition, ehee (
add. etc.
F. Building permit information:
1. example-construct single family house with an otto Ii!"
garage
2. example-remodel existing garagb into family room
J. exompie;convert single family residence into
restourarit (change of use)
G, Value of work as defined in Seclion 303 (a) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To ovoid design or construction delays, Building Oivisil
Stoff must be able to contact appropriate persons regt
design information or job site corrections, etc.
It Abbreviated Plumbing. Mechanical & Electrical Sched~les
A. Except where blank spaces occur in the description por
of the Mechanical and Electrical Schedules, the applicc
need fill.in only the No. Boxes adjacent to the appropr
i1em{s) to be in~talled
B, Full Plumbing. Mechanical. 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,
ated schedules you should consult the full schedules
C. BUilDING DIVISION STAFF WilL Fill OUT ALL FEES AN
CHARGES ON THE SCHEDULES
III. Applicant to sign and date
Whenever possible. the initial application will be used as (
worksheet only. Where possible, Building Division Staff wi
prepare a typewritten copy and return it to the applicant (
the time the actual permit is issued for his signaturE.
IV. Fees and Charges
Plan check fees are due and payable at the time of the ap
and no pions will be processed until these fees are paid. A
ather fees and, charges are due and payable when the per
is issued.
V. FOR OFFICE USE ONLY
I--
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
'--
,
Additional Project Information:
PLANS REVIEWED BY,
namec4trPJ Sk~,-
. PERMIT VALIDATION
CITY OF SPRINGFIELD
City Hall
Springfield. Oregon
Department of Public Works
OFFICIAL RECEIPT
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No. B 36537CI
Date ~\ \ \ \q 19f5\ .
Rec'd From ~~~ ~t\~\ ~rf'w (I
Address ~J). ~ (D~~\r, dN
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Received For:
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Amount Received
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Aun"Ol'lI7.IID SIGNATUIlII
S14ILTO".tUII".ULL ""'''tI:II.. I:UOI"I. Oil .7.0,
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