HomeMy WebLinkAboutPermit Building 1982-2-10 (2)
INSPECTION LINE
726-3769
.
CITY Of. SPRINGFIELV
COMB~ATl6N l.PPlICATlON/PERMIT
ENERGY SOURCES,
.
INFORMATION LINE
726-3753
Job Address
IDRLI
.p~L
$tU-y
(j
Heat
Water Heater
Range
Value of Work:
Sq. Ftg. Main
Sq. Ftg. Accell.
Sq. Ftg. Other
_New_Add:-..-Alter_Rep.
_Fenclt_Demo_Chong./Uu
_Olhltr
~
C>
-
~
legal Description
If! .!..~." II d .
Owner Jf; .....J~
Add.... I:. t,.hr h ~ ('o,;~.
C.n"M".n L.nd., ~
(IA
Phone
Building Permit Info: Describe Work {i.e., Build Single
Fomi1", Residence With Attached Garoqel
k;uii:oJ.l :1.. t ;/H';l.t~A.lW
Ih./JU.p_ ... (1-
Address
DESIGN TEAM
Phone
(name)
(address)
(lies. no.l
(expires)
(phone no.)
Primary
Structurol
Electrical
Mechanical
CONTRACTORS (nome)
~~n...' J /L13
Plumbing
fA')
(oh~n'" no.l
~'?7tj~
laddress) mes. no.'
(I~A-jJ;jj~-hht /..k~_ ~tf.E (iJA./MJ0u ISr;-
(exoiresl
Electricol
Mechonical
PLUMBING
NO. FEE
Each single fixture
Relocated building
(new fix. additional)
S.F. Residence
(1 bath)
Duplex (1 bath) each
Additioncil bath
Water service
Sewer
Storm Sewer
I ~tU;jdjAn"')DJf7'~ .
p
ELECTRICAL
MECHANICAL
CHARGE NO.
FEE 'CHARGE NO.
FEE
CHARGE
s9' ft.
New circuits, alterations
or extensions
furnace/burner to
QTU's
Appliance vent
separate
Stationary eyap.
cooler
Vent fan with
single duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and duct
./
Residence of
SERVICES
Temporary Construction
Amps.
Wood stove/heater
FEEDERS
Heat Pumo:J
Air handler to
10.000 CfM
Air handler over
10.000 CFM
?50
Amps.
ISSUANCE OF PERM'T
TOTAL CHARGES
7,S7) TOTAL CHARGES
TOTAL CHARGES
WHERE STATE LAW REQUIRES thai the Electricol work be done by the EI.ctrical Contrador, the electrical portion of Ihis permit shaU not be valid until a
lab.1 has been signed by an Electrical Contrador and attached to the eledrical panel.
I HAVE CAREFULLY EXAMINED the completed application for permit, and do hereby certify that all information hereon Is true and correct, and I further
certify that any and all work performed shall be done in accardance with the Ordinances of the City of Springfield and the Laws of the State of Oregon
pertaining to the work described herin, and that NO OCCUPANCY will b. made of any structure without the permission of the Building Diyision. I further
c:ertlfy that my registration with the Builder's Board is in full force and effect a s required by ORS 701.0.5.5, that if exempt the basis far exemption is noted
heron, and that only subcontractor. and employees who are in compliance with ORS 701.0.55 will be used an this project.
80,;' I., Bu;'d.,', ~x:mpH." ~.......,
NAME (please prin~ J) I B~ ,. - ;.',
<IGNATURE -=r..~ 1\
"-
~,....Ltl\.""'"
,
DATE~ -ID'~
(
/
FOR OFFICE USE ONLY
~
Type/CoRst
Bedrooms
C:;rori.-
I ~nits
n..cy load
i"l"cy Group
Sq. ftg. Main
c:.~. FtB. Access
Sq. Fig. Olher
Value
x Value
Value
TOTAL VALUATION
Zan.'
Fire Zone
flood Plain
BUilDING PERMIT
Charges ond
Surcharges
plan Ck. Comm/lnd
65%/ Bldg Per Fee
Plan Ck. Res
30%/ BldQ Per Fee
System. Development
Charae (1.5%1
PLUMBING PERMIT
Charg.. and
Surcharges
7, .5""0
. _:VJ
Fence
Demo
Total Comb. Permit
ELECTRICAL PERMIT
Charges and
Surcharges
Sidewalk
A/C Pavina
MECHANICAL PERMIT
Charges and
Surcharges
Curb Cut
TOTAL
if 7 fo
COMBINATION
APPLICATION/PER. (CAP)
,
,
. ".
\..11 Y Of SPRINGFIELD
. City Hall
Springfield, Oregan
Department of Public Works
OFFICIAL RECEIPT
1
1
I
'"
~
No. B 580111i
. 19 Q, "
Rec'd From J ,)fA (]~ ,,/ '!.
. ~.Jt-'A'.(I
Address .f.t.L/.:)l:- ~A'M~ -
'.)..-/1)
I. Applicant 10 furnish
A. Job Addres,s
B. Legal Description I"
1. exomple.tox lot 100, Lone County Mop Reference ."" Dote
2. exomple.Lot 1. Block 3, 2nd Addition to Springfielc
C. Name, etc., of owner and construction lender
D. Enargy Sources
1. example-heat/electrical ceiling/or forced air qas
2. example-water heater/electric.al/or solar
E. Square footage or valuation, etc.
1. example.1250 sq. foat house, 500 sq. foat garage
. 2. example-if new project, check.new-if addition, ChE
.....- add, etc. "
F. Building permit information:
1. example-construct single family house with an aft
~~~ C.'
2. example-remodel existing garage into family'rool
3. example-convert single family residence into
restaurant (change of use)
G. Value of "'ark as defined in Section 303 (a) of the
Structural 'Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Building Oivi {,"
Stoff must be able to contact appropriate persons re ",.
,design information or job site corrections, et,c..
. '. ..:",,"~ '" .: '.
II. Abbreviated Plumbing, Mechanical & Electrical Schedul, (
A. Except wner~ blank spaces occur in the description F
of the Mechanical and Electrical Schedules, ,he appl
need fill.in only the No. Boxes adjacent to the apprc
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 form the sched... (
have been abbreviated
2. If the item(s) to be installed ore not covered on t
ated ~~hedules you should consult the full sched, (
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES ~
CHARGES ON THE SCHEDULES '," "j-,. .
III. Applicant to sign and d~te'~~~,~~~-.~.:. ~f~ ~;r ,~~:-. ~ ~;";L.';~ ;,'
. 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 Ch,arges , .
Plan check Fees 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. .
('
C
~.I
Received For:
(
,
tju--..JJJ~3 ~~
~. .
?,(Q)
47)
.( I
---
.( I
(
~7,SO
(
(
'"
(
('.
. Amount Received
"L_
~ - ----
1/7.!:.1)
(
.'
~r
"'UTHO"IZIED SIGNATUIn:
'$O'I[UO"'TU"".UlI. """<TI'" . IEUQefU, 001 ".0'
(
...".s (
(
'. _.'
... . ~- ....
.~~ .. ~...:..:.-':\
l....
V. FOR OFFICE USE ONLY
"'
. Permit Cler~
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
'..'
-~~'" .""
....
",. ".
" '.
'. _J
.1
,
'. I'~ '..
"
",'
Additional Pr~iect Information:
~
;r .~.
~. .~ '.
. ~~.
PLANS REVIEWED BY:
nam'?
"'ignotur"'"
~ate