HomeMy WebLinkAboutPermit Building 1981-5-14
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INSPECTION LINE
726-3769
Job Address
legal Description
Owner
Address
Construction lender
Address
DESIGN TEAM
Primary
Structural
Electrical
Mechanical
CONTRACTORS
General
Plumbin!l
Electrical
Mechanical
...
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CITY OF SPRINGFIELD
COMBINATION APPLlCATlON/PE IT
5774 Camelli~ Street
Lot 3, Block 1, Everqlade Park
17 02 33 44 TL 1204
Jerry Tabor
87760 Cedar Fl at Road Phone 746-0179
Springfield, Oreqon 97477
Phone
(name)
(address)
Jerrv Tabor r.onstrllrtion
ENERGYr-SQUR.CES:C '1'
Heat tleCt el lng
Elect
Elec.t
INFORMATION LINE
726-3753
Sq. Ftg. Main 11 b ~
Sq. Ftg. Access. ---484
S~ Ftg. Other
_New_Add_Alter_Rep.
""':"Fence_Demo_Change/ Use
_Other
Water Heater
Ra nge
. Value of Work:
. ;
43,525..lO,
Building Permit Info: Describe Work (i.e., Build Single
Family Residence With Attached Gara!le)
1- S.F.RES; att ,gar
!
I
"
(lies. no.)
(expires)
';:l me...-a~a,DQ,Ve
(name)
(address)
Owne r
Bever
Davekin Elect
PLUMBING
(lies. no.l'
(expires)
,/ ~t ".
~ . .
~ 'dr
...:
ELECTRICAL,
MECHANICAL
NO. I FEE CHARGE I NO.
Each sin!lle fixture I 1 Residerl'.6'5
, sq. ft.
T ..
Relocated building New circuits, alterations
(new fix. additional) or extensions
1 S.F. Residence r--125.00 I
(1 bath) SERVICES
Duplex (1 bath) each I I 11 I Temporary Construction
1 Additional bath I 10.00 1-1 Am"
Water service ' I
1 Sewer I 110.00 I .
Storm Sewer I I I FEEDERS
I I I Amps.
I I I
I I I
I I I,
I I- I
I I I
TOT Al CHARGES
FEE CHARGE I NO'. I
I fur~ace/bur~~r 'to
.." B:rU's'
" I Appliance vent
, separate
1 I Stationary e'vap.
: ' , cooler
I I Vent fan with
l-flo-A(l 3 ' single duct -
, ~F--; - - - I Ven~ syst~m apart from
. Iieat."g or A,C. , ,
, -, Mechanical exhaust
hood and duct
'/ ,; ~: 'l I ,Wood stove/heater
I ,<. I,'" I Heat Pump
1 I lAir handler to
10,000 CFM
1 I.. I Air handler over
10,000 CFM
I T J
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'I I I
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25..00
I
'I
45.00 TOTAL CHARGES
ISSUANCE OF PERMIT
25.00 TOTAL CHARGES
00
......
o
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U1
(phone no.)
(phone no.)
FEE CHARGE
I
,
13.00 9.00
I I
I 14.50
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'I
I I I
I
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I I
I I
10.00
23.50
WHERE STATE' LAW' REQUIRES' that the Electrical work be done by the,Electrical Contractor,_ the electrical, portion of this permit shall not be valid until a
label has been signed by an Electrical Contractor and attached to the ehictrical panel.
I HA VE 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 accordance 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 wHl be made of any structure without the permission of the Building ,Division. I further
certify that my registration with, the Builder's Board is in full force and, eiffect as required by ORS 701.055, that if exempt the basis for exemption is noted
heron and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project.
' , \
Basis for Builder's Board exemption:-
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.lttAME (please print)
Zonp K-l
Fire Zone NA, '"
I~v
Flo~d Plai,!.
BUilDING, PERMIT
Charges and
Surcharges
PLUMBING PERMIT
~harges and
Surcharges
elECTRICAL PERMIT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges ..
~IGNATURE
FOR OFFICE USE ONl
Type/ Const.
Bedroam<
c;,tOriFU:
V-N
i
Units
0ccy load
'"'lecy Group
1
R-l
~q. Ftg._Main
C;q. Ftg. Access
Sq. Ftg. Other
U69
484
x 33, 30-Value
x 9.50 Value
'( Value
TOTAL VALUATION
-r69:00
6.76
Plan, Ck. Comm/lnd,
65%/ Bldg Per Fee
I Plan Ck. Res
30%/ Bldg Per Fee
I Fence
I
45.00
1.80
16~~
1 .DO I A/ C Pavinq
, 23. 5Jl I Curb Cut
-----~4 ~~I
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'--"~I..r-W,",I:\,;"IU.l.~~ .~~~~I~
, ".;," ,,' I.
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':{ "," ,- sr~r' : :""'"1"",
'~I
I Systems Development
Charqe (1.5%)
-I 50_ 70 pn, r:;-nJl
I REC# 56480 EP Labe 1
,.
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I Total Comb. Permit
I
I
I
I TOTAL
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'-~'
DATE 6~l6-~{
38.927.70
4,598 00
43,525.70
652.89
~
301.70
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9'5iJ:":7 9
q24 q5
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COMBINATION APPLICATION/PERMIT (CAP)
f'\~tr
I. Applicant to furnish
A. Job Address
B. legal Description
1. example-tax lot 100, Lane County Map Referenc
2. example-Lot 1. Block 3, 2nd Addition to Springfie
C. Name, etc. of owner and construction lend.er
D. Energy Sources
1. example-heat/electrical ceiling/or forced air gas
2. example-water heater/electrical/or solar,
E. Square footage or valuation, etc.
1. example-1250 sq. foot house, 500 sq. foot garag
2. examPle-if new project, check new-if addition, d
add, etc.
F. Building permit information:
1. example-construct single family house with an, a1
garage
2. example-remodel existing garage into family roc
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 Div
Staff must be able to contact appropriate persons re
design information or job site corrections, etc.
II. Abbreviated Plumbing, Mechanical & Electrical Schedul
A. Except where blank spaces occur in the description I
of the Mechanical and Electrical Schedules, the appl
need fill-in only the No. Boxes adjacent to the appn
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 schedu
have been abbreviated
2. If the item{s) to be installed are not covered on tl
" .ated schedules you should consult the full schedl
C. BUILDING DIVISION STAFF WILL FilL OUT ALL FEES.
CHARGES ON THE SCHEDULES
III. Applicant to sign and date
Whenever possible, the initial application will be used 6
worksheet only. Where possible, Building Division Stafi
prepare a typewritten copy and return it to the applica
the time the actual permit is issued for his signature.
PERMIT VALIDATION
(
CITY OF SPRINGfiELD
(
City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
(
<J I No. B 5 6 5 0 6
Date ~- t'5 19 ()l
Rec'd Fro~leJ.t At 1.1 ~1a,tJ0r (
Address ~l1 ~0 ~nd {lV'r1fjl t12d
, (
Receb!ed For: 1 8=l .00
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CDI to -:10
l')f/ . iO
,f0 LFy .00
\. 40 J 1)
I - 9--()
(fo yy .. ZC:J,OO
L,C/l) . r.D:')
( $O( ; I to':)? , '{Cf
rll~ , 'Z ~ .50
L-~ Lf
(0 6.. ,9
Received -7cs. C(\q (' j: _
'-. Amount
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BY
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AUTHORIZED SIGNATURE
I SHELTON-TUR ULl PRINTERS' EUGENE OR 97401
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IV. Fees and Charges +-
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.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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Additional Project Information:
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PLANS REVIEWED BY:
- ~ ~chnft^l
~ . j -" I
DAN SMITH
~ignature -'41;/)
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Permit Clerk-
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5-14-81
date