HomeMy WebLinkAboutPermit Miscellaneous 1981-2-6 (2)
INSPECTION LINE
126-3169
..'~ .
~ _s~c~~~
;.. CITY OF SPRINGFIELD
,. COMBINATION APPLlCAflON/PERMlT \al J~
INFORMATION LINE
716-3753
~'H or
""'.,uO;;:"
J2.
ENERGY. SOURCES:
Heat ~ \ p c..
Water Healer ~ 1('; c.
p I t:~c....
ICM2
Job Address
{]:Jsfl P,UA(!/dI, ;;(O/YU J
iI- 0 ~... 2. 7 - Lj 2 ;2'-100
I ^' \-" e:'
Sq. Fig. Main
Sq. Ftg. ACC8n.
Sq. Ftg. Other
_New_Add_Alter _Rep.
_!Jl..nce_Demo_Change/ U,so
~Olher to\J",,~r,'h.:.~'\ f(...J,:
""'..('o"ll..) ~...,)~
'"Building P~rmil Info: Describe Work (Le.. Build Single
~?".,ily Re,;~:,!n~,:, Wit'!.. Att~~h.d Goro';!el
legal Description
\...v.-c..\....c:;..I~
.-
Add".. :;l. "7 'i '@,
Eu-~.........
Construcrion Lender
Addre"
DESIGN TEAM
(2,r~c.....,....
------
Ranqe
Value af Work:
o
9
.-1)
Fc'-..lLL..-
~t. 2 cow
1\1 ,-.r "".\-
0,....
L~ Phon.!.lBS-ILP:l
"f,Y.::> I
-
:- +d.r\ ./J'lv YYl fl( LO (jG
Vl(~ ....)
Phone
O'-..J~ / PUU-c...J,,"u../
(nome)
(addren)
(phone no,)
Primary
Slructural
::;l~ctricol
__f!~!,=~a~;~n;
CC,I~TIi.AC!'O:!S
General
P!'Jmbinco
Electrlc~1
Mbchal1i<::<:l1
k.t-...., ,""
(Iiu. no.)
(expires)
I
,
i
.... J
(.lame)
(address)
(pbon>! no.l
(Iic~. nco.)
(expires)
Y"'r--.o"L.<....
~; '- \... ......,.~ J ~
'2. 7:r'\--..
21z.c.1 ::ll
'3.'--1y- a",'&Jb
I
.l
,
,
S<-k",c..p
s...~",,^ # ~"2.c~'1
II S '-.J
-'~~=,:';-------'- -1----'''--
FEe: CHARGE f NO....
I
I
I
I
I
I
I I I P.tw.~{\Mu1A~~
I fCJIaco..fu1 fPAQ I
I 0
I
NO.
Ea~h sinl:!lo fixture
RelC'<:olttd builJing
(now fix. .:.driitionoJ)
S.F. Residence
(l balh)
Duplex (1 beth) each
Additional both
WQterser"ice
Sewe,
Storm Sewe,
---
.
TOT Al CHARGES
ELECTRICAL
'----1-=
.- ---.-:TFEi
ICHARG~
I
I
MECHANICAL
---
,
,
,
I
I
I
I
--Tm-
CHARGE
NO.
furnacel burnr.r 10
'lTU's
Applicnc:J vent
separate
Stationary ovop.
coorer
VEOnt fan with
single dud
Vent system apart from
heatinq or A.C.
Mechanic...1 exhaust
hood and duct
Residon,e "f
_Sq:ft.
New circuits, olterrlfions
or extensions
SERVICES
Temporary Construction
Amps.
'Wood stave/healer
/5,02
I
Amp,. I
. ~ IJ r
~ 10 f TAl LQ ~ ~(TIlIllU..l101L
Rd(rmhd 6.M~1
I
---.______1
I
ISSUANCE OF PERMIT
15. ~ I TOT At CHARGES
()-
FEEDERS
Heat Pump
Air handler to
10,000 CFM
Air handler over
10,000 CFM
/5.0S!
,
,
II
___. ___1...__.
15..o~ I TOTAL CHARGES
WHERE STATE LAW REQUIRES that tho Electrical work b. done by the Elodrical Contraclor, the electrical portion' of this p.rmil~sholl no. b. valid until.a
labet has b_n signed by an Electrical Contractor and attached -to the electrical panel.
I HAVE CAREFULLY EXAMINED the completed application for permit, and do herehy certify that 011 information hereon is trUf'. and currnct; and I further
certify that any and 011 worl( perforrrntd :sholl bo done in accordance with the Ordinances of th3 City "of "Springfield and the Laws of the Stale of Or.gon
pertaining 10 the work described herin, and that NO OCCUPANCY will b. made of any :structure without the permission of the Building Division. I furlher
certify that my r~isrrotion wilh the Builder's Boord is in full force and Irilect ":s required by ORS 701.055. that if ....empt the basis for .,xemptian is not3d
heron, and thot only subcontractors and employees who ore in compliance with'ORS 701.055 will bo used on thi:s proiect.
NAME (please print)
Basis for Builder's Boord e.lllemption-
?1(";l"A~
DATE
QA
Zone
Fire Zone
Flood Plain
"'-""
BUILDING PERMIT
Charges and
Surcharges
PLUMBING PERMIT
Charges and
Surcharges
ELEORICAl PERMIT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
',rcharg.s
I- ".
..
~\l4
~
2/b /6,
.~
C,IGNATURE
FOR OfFICE USE ONLY
Type/Canu. \J IJ
Bedrooms
clorie'-
Sq. FIg. Main
c1. Ftg. Access
Sq. Ftg. Other__
_Units
......tcy load
Occy Group_
x
"olue
Yolue
Value
R""-
x
TOTAL VALUATION :J.,(\OO. c:.v
I fI~ J e:(f..J,UUU.-':'
Systems Development
Chorae (1.5%1
10.00 PD2-'6-'lJ
IkeG> 6 ~J!tJX'
.QC\,09
,~
I 5. os.
,bO
15.09
,<<>3
D
---------1
Plan Ck. Comm/lnd
65%/ Blda Per Fee
Plan Ck. Ret
30%/ Bidet Per Fee
36D.O!}
Fence
Demo
Total Comb. Pormit
AI C Pavino
...f rt 0",0 Inn
I 0
,-;:),,0
Sidewalk.
Curb Cut
~5;<'. ~.E
TOTAL
~>
COMBINATION APPlICATI.ERMIT (CAP)
I. Applicant IQ furnish
A, Job Address
B. legal Description
1. examD.le-tax lot 100, lone County Mop Reference 17 __
2, example,Lal 1. Block 3. 2nd Addition to Springfield Est ,.
C. Name, etc. of owner and construction lender .
O. Energy Sources
1. example-heat/electrical ceiling/or forced air gas
2. exomole.water heater/electric'al/or solar
E. Square fOOl0ge or valuation. etc. -
1, example. ~ sq, foot house, 500 sq, foot garage
2. exom~le-if, new project, check new-if addition, check
add, etc.
F. Building permit information:
1. examole-construct single family "01'5e with an attached (
garage
2. example-remodel existing gorage into family room
3. exnmple-convert single family residence into
,:~~tciU"iOnt (chonge of use)
G. Value of work os defined in Section 303 (0) of the
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
. To avoid design or construction delays, Building Division
Staff must be able to contact appropriate persons regardjn~
design information or job site corrections, etc.
II. Abbreviated Plumbing, Mechanical & Electrical Schedules
A. Except where bJonk spaces occur in the description portion
of the Mechanical and Electrical Schedules, the applicant
need fill.in only the No. Boxes adjacent to the apprapriote
item(s} to be installed
B. full Plumbing, Mechanical, and Electrical Schedules
ore available at the Building Division .
1. To conserve space on the permit form the schedules
have been abbreviated
2, If the item(s) 10 be installed ore not covered on the abbre'
aled scheduies 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 dole
Whenever possible. the initiol application will be used os a
works heel only, Where possible. Building Division Stoff will
prepare 0 typewritten copy end return it to the applicant at
the time the actual permit is issued for his signoture.
IV, fees and Charges' (
Plan check fees ore due and payable at the lime of the applicatic
and no plans will be processed until these fees ore paid, All t-
other fees and charges ere due and payoble when the permit
is issued.
V. fOR OffiCE USE ONLY
.' " . . "PERMIT VALIDATION
CITY OF
SPRINGFIELD
City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
No. B 5 5 7 70
( Data. 1.0 0 . \..0 19~
Rec'd F~) h \ct.f\ ~ _ uJCrJ'l.....-"
Address!JfA?: n r \~ At'~
(' -. \ -n N\ - . t' au-
Received Far:'n.~ \\I\..\J l '\.n~ ' \. )0.' ct.]"
\\ b.L \'{\n ' (Jl.JUYu \- ~. . 'I
c \C:'1.cc l{ 1 ,,).,\ Q ,CO ,.
tJ\ M-- \J c:fJt) .0.0 _
(j 4-~) _ 3"0 ,I
r rf) h t~ PC) "
. 407/). (dJ
\. \:l (j 01:- \~OO
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( u....Q, ()(SI A ,&C),
~ . '-.4:l{'f). 00,
,~' Amount Receive-'--- ~ 4Jtl f:P c.!.K
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"'UT OIllIZI:D 5IG,....TURlt
'..Tll.... llUOI"I, 0.. .7.0'
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Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information: () +_/2. . J/) .--.A.
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PLANS REVIEWED BY:
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nome J()71.L5Vll!.;'rhr.1A.
signature
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