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HomeMy WebLinkAboutPermit Building 1981-5-14 ,- i I 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 ... ~- fLBI; - ' - "u 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 /, I I 'I I I J J 25..00 I 'I 45.00 TOTAL CHARGES ISSUANCE OF PERMIT 25.00 TOTAL CHARGES 00 ...... o W N U1 (phone no.) (phone no.) FEE CHARGE I , 13.00 9.00 I I I 14.50 I I I I \ I I I I 'I I I I I I I 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:- ,(; .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 I. I '--"~I..r-W,",I:\,;"IU.l.~~ .~~~~I~ , ".;," ,,' I. , .. ':{ "," ,- sr~r' : :""'"1"", '~I I Systems Development Charqe (1.5%) -I 50_ 70 pn, r:;-nJl I REC# 56480 EP Labe 1 ,. I~ I I~' I I Total Comb. Permit I I I I TOTAL ~"~-~", Jr--~::-;:..' '-~' DATE 6~l6-~{ 38.927.70 4,598 00 43,525.70 652.89 ~ 301.70 I , ' 9'5iJ:":7 9 q24 q5 /..1 .~ ./ ' ,.UIlC~l~~~c~J!jfJs..<Jjj:8i~~~.!!~IIl,.~,.~'~~~~"_~liI"'.}~e!~),~ll.'#l!~~~~9~I~J~~~c~,~v~~i~.::~ ;~~ . f-:; : ~\' , . \', \ ~ \\ ,-\";~ \ '\ I {'\ -~ ~ \ .' .-- o.:_~'~?:~>s;.:;'.:. 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 ( ~J 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 ( ( ( ( BY (1j? AUTHORIZED SIGNATURE I SHELTON-TUR ULl PRINTERS' EUGENE OR 97401 ( ( ( 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: ,-1 Additional Project Information: "=- PLANS REVIEWED BY: - ~ ~chnft^l ~ . j -" I DAN SMITH ~ignature -'41;/) .. Permit Clerk- JI ,~ 'J" .. \]c"'..... -.. ..........:., Q. l~~LVL J ep . I 5-14-81 date