The URL can be used to link to this page

Home My WebLink AboutPermit Building 1982-3-9 ,~ .:.~-..~' ".\ , . ~.-:-,:.~.~..' -~ . ';~,~~_.~~.;~,~~i~~:~.,'!l}~,{~~~'~;~~.;:,,~~!~~~~~:~,;,~~i~~~~:i~~~~~~*'~~-;':~:~~'~~;~~~'1;;'~~~ I INSPECTION UN!: 726--3769 I Job Address I Legel Description 1166 South 17-03-35-41 "A" Street CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT I ENERGY SOURCES: Heat INFORMATION LINE 726-3753 Addreu phone $10.000.00 Building Permit Info: Describe Work i.e., Build Single Fomih Residence With Attached GCHoqe) I Sq. fIg. Moin Sq. Ftg. Access, Sq. Ftg, Other _Hew_Add_Alter_Rep. _Fence_Demo_Changel Use _Other ex> N o ..... "" N Tax Lot 6600 Water Heater Range Value of Work: Owner S. Fleek (Cathv Roberson\ Alterations Construction lender People I 5 Ban k Add,... 5th & "B" Streets Phone DESIGN TEAM (nome) (address) (liu. no.) (expires) (phone no.) Primary Art.pmi n P;17 Structural Artemi 0 Paz 220 N. 5th Street 220 N. 5th Street 747-8823 747-RR?:'l Electrical Mechanical CONTRACTORS (name) (addreu) (lies. no.) (expires) (phone no.) Ge."ol L 1 ovd Seamans PlumbinQ Un known Elect;ical Unknown Mechanical Un known PLUMBING ELECTRICAL MECHANICAL 1 / s9' ft. New circuits, alterations or extensions I FEE I CHARGE Each single fixture Relocated building (new fix, additional) S,F. Residence (1 bath) FEE I CHARGE NO I FEE CHARGE NO. NO. I 2 15.00 furnace/burner to BTU's Applionce vent separate Stotionary evop. cooler Vent fon with sin!=lle duct Vent system aport from heoting or A.C. Mechanical exhau5' hood ond duct Residence of SERVICES Duolex n bath) eoch Temporary Construction r I I r I I Additional bath Amps. Water service Sew.r Wood stove/heoter Storm Sewer FEEDERS Heat Pum,) Air handler to 10.000 CFM Air hondler over 10,000 CFM Ck disconnected plumbing and compressor lines Am~s. I 15.00 ISSUANCE OF PERMIT frorAl CHARGES 15.00 I TOTAL CHARGES I WHERE STATE lAW REQUIRES that the Electrical work be done by the Electrical Contrador, label has been signed by on Electrical Contractor and attached to the electrical panel. I HA VE CAREFULLY EXAMINED the tompleted application for permit, Clnd 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 Oregan pertaining to the work described herin, and that NO OCCUPANCY will be made of any structure without the permission of the Building Division, I further cert1fy that my registration with, the Builder's Board is in full force and effect a s required by ORS 701.055, that if exempt the basis for exemption is noted heron, and that only subcontractors o~ employees who are in compliance with ORS 701.055 will be used on ,his proiect. 8asis for 8uilder'J Board 8)(omption: I"/t..,t.-) y 6k~_c~;...,t . NAMElpl.o..p,i.t) - SIGNATURE_/~ A4~ DATE3'-9-~2.. FOR OFFICE USE ONLY / 15.00 . TOTAL CHARGES the electrical portion of this permit shall not be valid until a Zon~ Fire Zone Flood Plain C 4 Type/Const.--Y-N Sedrooms C,tori-~ Units n-o:y Load "'ccy Group--B.2 Sq. FIg, Main Sq. Ftg. Accen Sq. Ftg, Other '-alue x Value '( Value TOTAL VALUATlON1li4Dnn. nn BUILDING PERMIT Charges and Surcharges #B5l157 Pd~-4-A;l. i~? nr 2.0E $15.0C .6C $15.0C Fe Plan Ck, Comm/lnd 65%/ Bide Per Fee Plan Ck. Res 30%/ Bide- Per Fee $33.80 Systems Development Charae Cl.5%1 NA PLUMBING PERMIT Charges ond Surcharges Fence Plan ck fee $ $ 33.80 33.28 Demo Totol Comb. Permit ELECTRICAL PERMIT Charges and Surcharges Sidewalk AIC Povina MECHANICAL PERMIT Charges and Surcharges Curb Cut TOTAL $ 67,08 ( \,,~ CI~ SPRIN'GFfEL"O .,,-'^~' City Hall '\ Springfield, Oregon Department of Public Works OFFICIAL RECEIPT -- -/ ' .." ' \. / ~~ll~\~,A'~!l!~"!JIJ'Mh#"Joh~ilW'~':~i!:',!,\Il-"I'V~"..' Cl III. Applicant to sign and dot~ Whenever possible, the initiol application will be used as a worksheet only. Where possible, Building Division Stoff will prepare a typewritten copy and return it to the applicant at the time the actual permit is issued for his signature. 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 ore paid. All other fees and charges are due and payable when the permit is issued. ' COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. JGb Address B. Legal Description 1. example-tax lot 100, lane County Mop Reference 2. example.Lot 1, Block 3, 2nd Addition to Springfield C. Name, ete, of owner and construction lend~r 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. exomple-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-cDnstruct single family house with an afte garage 2. example-remodel existing garage into family roon 3. example.convert single family residence into restaurant (change of use) G. Value of work os defined in Section 303 (a) of the Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Divis Staff must be able to contact appropriate persons re~ design information or job site corrections, etc. II. AbbreviDted Plumbing, Mechanical & Electrical'Schedule ( A, Except where blank spaces occur in the description p' of the Mechanical and Electrical Schedules, the appli1 need fill-in only the No. Boxes adjacent to the appro' (" 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 schedul \.. have been abbreviated . 2. If the item(s) to be installed are not covered on th oted sohedules you should consult the full schedu ( C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES J .. CHARGES ON THE SCHEDULES I-:- IV. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Additional Project Information: II (' ~. No. B .~-q 19l2- Rec'd From 'fiA1i.'t1- 7Pr../LlAAA-w_ Addr...~~ /J...k..t. ~~ ',4".sF q Date 58173(1 ( ( '(1 Received For: h Un>> ;:;:b~d ,~ --2.1..v ;0. '711 j),./M ; :f; (' Vtf% 11~ MfliifJf) c d2.{) 9 ,- IJ-rl /~ ' .(1 c , 1....11 (I IS-. I)-fJ . 1,.,7) R3. g() (I (. ( I .f1h 7.~g ( / Amount Received IIi.. lctL dJt7.bg ( ( ., (I A,UTHOIllIZED SIGNATURE .~KLTON'TU"N.Ull ""'NTI". " IUG.NI. 0" 17.0' ...". C ( ';", \ ",' ',if ..t.' .:.J Permit CierI- " namf" Dan Smith 4~ 3-5-82 PLANS REVIEWED BY, ",ignatur,'" ..Jotf"