HomeMy WebLinkAboutPermit Building 1981-12-11
INSPECTION LINE
726-3769
Job Address
legal Description
-.
.
INFORMATION LINE
726-3753
I Sq, Ftg, Main lUUU
Sq, Ftg, Access.
Sq, Ftg. Other
_New_Add_Alter_Rep.
_Fence_Demo_Change/ Use
lOther
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'~Y OF SPRINGFielD
COMBINATION APPLICATION/PERMIT
655-051 W. Centenninl
17-03-27-43 T.L. 5800
ENERGY SOURCES:
Heat -..E 1 ec H P
Water Heater -Ll pr
Range -RAe: ~
Value of Work:
Address
Owner r.entenn i 01 r.pntpr
Phone
q:R.~nn nn
Building .Perm'it-I;'fo: Describe Work (Le" Build Single
Family Residence With Attached Garaqe)
Construction lender
Address
DESIGN TEAM
Primary
Structural
Electrical
Mechanical
CONTRACTORS
General
Plumbing
Electri ca I
Mechanical
ComDlet~ lp~~p SpoCp.
p ):' ):'
Phone
(name)
(address)
(Iics. no.)
(expires)
(phone no,)
(name)
(address)
(lies. no,)
(expires)
(phone no,)
Hiott B.ms. r...o.nstrlJctinn
n01 W Centennial
! 4jJ'
9......JA -l12
TIA'; n R ; \JtH"~
Penslin Electric
PLUMBING elECTRICAL MECHANICAL
NO, FEE CHARGE NO, FEE CHARGE NO, FEE CHARGE
25.00 I Residence of furnace/burner -to
C; Each single fixture 5.00 "" ftc BTU's
--
Relocated building New circuits, alterations Appliance vent I
(new fix, additional) or extensions separate
S,F, Residence Stationary evap. I
(1 bath) SERVICES cooler
I Vent fan with 11 nnlh
Duplex (1 bath) each Temporary Construction ? single duct nn
I Vent system apart from I I
Additional bath Amps, heating or A,C,
I I Mechanical exhaust I I
Water service hood and duct
Sewer I I Wood stove/heater I I
Storm Sewer FEEDERS I I I Heat Pump I If; nn
11O.od20.00 I Air handler to I
2 Amps. 100 10,000 CFM
I I Air handler over I
10,000 CFM
I I I
I I
I I
I ISSUANCE OF PERMIT 10 .00
TOTAL CHARGES ? E) . nn I TOTAL CHARGES ?O 00 TOTAL CHARGES n,nn
WHERE STATE LAW REQUIRES that ,he 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 electrical 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 will 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 t>ffect a s 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 7017 will be used on this,project.
Basis for Builder's Board exemption:
(j' C/ 1 /' ___/'~
<;IGNATURE /-J' ../' < /1'-~ /I'
, /.- - - I.
FOR OFFICE USE ONLY
NAME (please print)
Zone _r ?
Fire Zone
Ffood Plain
BUILDING PERMIT
Charges and
Surcharges
PLUMBING PERMIT
Charges and
Surcharges
elECTRICAL PERMIT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
DATE
Type/ Canst.
Bedrooms
~tories
v_~
Units 2 "1. Ftg. Main 1..QQ(l
f)ccy load 1 (l p;u:LSq, Ftg, Access
Occy Group B2 Sq, Ftg. Other
x
8 50
Value $8> 500 00
Valu..
Value
x
x
TOTAL VALUATION
------A8..!l.O.-
1.92 I
25.00 I
1.00 I
?o.oo I
.80
Plan Ck. Comm/lnd
65%/ Bldg Per Fee
Plan Ck. Res
30%/ Bldg Per Fee
'11.20
Systems Development
CharCle (1.5%)
I
I Pl.
11 ?n
I
I
I
I~
I
1
rk Fpp
r Total Comb. Permit
Fence
Demo
11 9 . fiO
I
I
I
I TOTAL
______2L.nn
Sidewalk
I A/ C Paving
I Curb Cut
I
$1!10.RO
nn
. U\J
_____-L2.a.OD
Curb Cut
I
I TOTAL
$l!1n,Rn
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II. Abbreviated Plumbing, Mechanical & Electrical Schedules
A. Except where blank spaces occur in the description po
of the Mechanical and Electrical Schedules, the applicc
need fill-in only the No. Boxes adjacent to the appropl
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 schedules
have been abbreviated
2. If the item(s) to be installed are not covered on the,
ated schedules you should consult the full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AN
CHARGES ON THE SCHEDULES
III. Applicant to sign and date f....
Whenever possible, the initial application will be used as ~ ~ '
, worksheet only. Where possible, Building Division Staff will
:''- .. prepare a typewritten copy and return it to the applicant at
'Ii.., the time the actual permit is issued for his signature.
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.
COMBINA TION APPLICATION/PERMIT (CAP)
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 lender
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 garage
2. example-if new project, check new-if addition, ch
add, etc.
F. Building permit information:
1. example-construct single family house with an att
garage
2. example-remodel existing garage into family roor
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 Divis
Staff must be able to contact appropriate persons reg
design information or job site corrections, etc.
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
. \
.__.~~~~ ~~
Additional Project Information:
PLANS REVIEWED BY:
name
Dan Smith
signatur,-
.,
City Hall
Springfield. Oregon
Department of Public Works
OFFICIAL RECEIPT
No. B 577 6 2 (
Date / ci< - /"7 19 ~
Rec'd From rAffeL-:&!.-' ~ (1//77<::1-.
Address tL[J ~ IV, ('1l'1f 1i! 11/1/'1 0
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CITY
Of
SPRINGFIELD
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BY
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AUTHORf2ED SlGNATURE
SM'ILTON-TURNBUl.L PAINTlERS . EUGENE. OR 97.01
58911-8
Permit Clerk-
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.date
12-11-81
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