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Home My WebLink AboutPermit Building 1984-11-18 INSPECTION LINE 726-3769 CITY OF SPRINGFIELD COMBINATION APPLlCATION/pERMIT . INFORMATION LINE 726-3753 " ,,'iq, Ftg, Main 1. DOn Sq, Ftg, Access, SX' Ftg. O'ther -,-New_Add_Alter_Rep. _Fence_Demo_Change/ Use _O'ther 00 I--' Cl '-.J '-.J CJ1 Job Addres~ 655 Wes t Centenn i a 1 Legal Description 17 -03-27 -43 T. L. 5800 ENERGY SO'URCES: Heat El ectri c Water Heater El ectric Ro nge Volue of Work: Owner Hiatt Bras 663 West Centennial ~ Phone 741-14?O $7,500.00 Building Permit Info: Describe Work (i.e" Build Single Family Residence With Attached Garage) Address ~r~;n9T;e~~, Q~ 9?~?7 Construction Lender P I=' I=' Comolete leasp Sr~rA Address Phone (Reference BP #13308-1978) DESIGN TEAM (nome) (address) (liCs, no,) (expires) (phone no,) Primary Structural Electrical Mechanicol CO'NTRACTO'RS (name) (address) (lies, no,) (expires) (phone no,) General Hiatt Rras Plumbing Twi n Ri vers Electrical Pers 1 i n El er.t MechoniCal None ~~~ WAst ~pnt~n~;~l 1416 74l-l4?n PLUMBING ELECTRICAL NO', FEE CHARGE NO', Residence of 3 Each single fixture 5.00 15.00 ''1, ft, Relocated building New circuits, alterations (new fix, additional) or extensions S.F, Residence (1 bath) SERVICES Duplex (I bath) each Temporary Construction Additionol bath Amps, 1 Water service 10.00 Sewer 10 nn Storm Sewer FEEDERS 1 Amps, 100 MECHANICAL furnace/ burner to 1 nn _ nnn BTU's . Ap'pli~nce vent seporate Stationary evap, cooler Vent fan with single duct Vent system apart from heating or A:C Mechanical exhaust hood and duct FEE I CHARGE n.OO I 13.00 FEE CHARGE NO', Wood stove/ heater 10 nn Heat Pump Air handler to 10,000 CFM Air handler over 10,000 CFM ISSUANCE OF PERMIT In.OO TO'T Al CHARGES 11; nn TO'TAl CHARGES 1 n _ 00 TO'T Al CHARGES 10 nn 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 electrical panel, I HA VE CAREFUllY EXAMIN'ED 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 O'regon pertaining to the work described herin, and that NO' O'CCUPANCY will be made of any structure without the permission of the Building ,Division. I further certify that my registrotion with the Builder's Board is in full force and eiffect a s required by ORS 701.055, that if exempt the basis for exemption is noted heron, and that only subcontractors ~nd employees who are in compliance with ORS 701,% will be used on this project. Basis for Builder' s Board exemption: , NAME (please print) t5 E. /'Il: I-b A- li SIGNATURE /J~ r~~ DAT?'-n^ It-8l Zonp C-2 Fire Zone Flood Plain Type/Const,~ Bedroom' "torio' Units Occy load 9 Occy. Group--B,? FOR OFFICE USE ONLY "q. Ftg.'Main UOO <;q, Ftg, Access Sq. Ftg. Othe~ x L..5D x Value $ 7 , 500 00 Value "( Value - TOTAL VALUATlO'N $7.500.00 BUILDING PERMIT Charges and Surcharges $44.0n 1. 76 35.00 1.40 10.00 _dO Plan Ck, Comm/ Jnd 65%/ Bldg Per Fee Plan ck. Res 30%/ Bldg Per Fee $28. 60 Pd 3 ....~ste.ms Development 11- - :5c1harae (1.5%) Recot #B575nn, PLUMBING PERMIT Charges and Surcharges Fence Demo Total Comb, Permit $11?12 ELECTRICAL PERMIT Charges and Surcharges Sidewalk AI C Pavina MECHANICAL PERMIT Charges and Surcharges 19.00 ------~~-I Curb Cut TO'T Al ill? i? COMBINATION APPLlCA TION/PE. (CAP) I. Applicant to furnish , A. Job Address B. legal Description 1. example-tax lot 100, lane County Map Reference 17 03 43 2. example-lot 1. Block 3, 2nd Addition to Springfield Estates 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, check add, etc. F. Building permit information: 1. example-construct single family house with an attached garage 2. example-remodel existing garage into family room 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 Division Staff must be able to contact appropriate persons regarding design information or job site corrections, etc. II. Abbreviated Plumbing, Mechanical & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate 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 abbrevi- ated sohedules 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 date Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Division Staff will prepare a typewritten copy and return it to the applicant at 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. V. FOR OFFICE USE ONLY PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: AdditionClI Project Information: PLANS REVIEWED BY: name i~ ~ ~, T; signatur'" PERMIT V ALIDA liON Permit Clerlr date ,./ / ~~~~.~~~~~~~~~~sf;~~~~~ '~~'''''':c+~t~~~-~~~~;;?i~:i~~'', ~ . .:~~~~~~~~~ '. \ '-. INSPECTION LINE 726-3769 CITY OF SPRINGFIELD COMBINATION APPLICATION/PERMIT INFORMATION LINE 726-J7S3 Sq. Ftg, Main I . UUU Sq, Ftg, Access, Sx- Ftg, Other _New _Add_Alter_Rep, _Fence_Demo_Change/ Use _Other Job Address 655 West Centennial ENERGY SOURCES: Heat El ectri c Water Heater Electric Ra nge Value of Work: Legal Description 17-03-27-43 T.L. 5ROO Owner Hiatt Bras Address 663 West Centennial 'pcingfi e 1 d > OR !)J4?? Construction Lender P F F $7,500.00 Building Permit Info: Describe Work (i.e" Build Single Family Residence With Attached Garage) Phone 741-14?0 Comolete lPnSP sn~rp Address Phone (Reference BP #13308-1978) DESIGN TEAM (name) (address) (expires) (lies. no,) Primary Structural Electrical Mechanical CONTRACTORS (nome) (address) (expires) (lies, no,) General Hiatt Rrns Plumbing Twi n Ri vers Electrical Perslin E'lpc:t 1416 ~~~ WP~t rpntpnni~l Mechanical None PLUMBING ELECTRICAL FEE CHARGE NO. Residence of 5.00 15.00 ".,. ft, New circuits, alterotions or extensions SERVICES Temporary Construction Amps, 10.00 ln nn FEEDERS 1 Amps. 100 ln nn MECHANICAL NO, FEE CHARGE NO, 3 Each single fixture Relocated building (new fix. additional) S,F. Residence (1 bath) furnace/ burner" to l-An _ nnn BTU's Appli'ance vent separate Stationory evap, cooler Vent fan with single duct Vent system apart from heating or A.C. I Mechanical exhaust hood and duct I Wood stove/ heoter I Heat Pump I Air handler to 10,000 CFM I Air handler over 10,000 CFM I I I Duplex (1 bath) each Additional bath 1 Water service Sewer Storm Sewer ISSUANCE OF PERMIT TOT AL CHARGES TOTAL CHARGES 1 n, nn TOTAL CHARGES WHERE STATE LAW REQUIRES that the Eleclrical work be done by the Eleclrical Contractor, the eleclrical portion of this permit shall not be valid until a label has been signed by an Eleclrical Contractor and attached to the electrical panel, 1 Q ().O... ~" nn (X) - o "-J "-J (J1 (phone no,) (phone no.l 741-14?n FEE CHARGE 6.00 3.00 I I I I I I I I I 10.0n 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 sholl be done in accordance with the Ordinonces of the City of Springfield and the Laws of the Stote of Oregon pertoining to the work described herin, and that NO OCCUPANCY will be mode of any structure without the permission of the Building ,Division. I further certify thot my registration with the Builder's Boord is in full force and effect 0 s required by OR:; 701.055, that if exempt the bosis for exemption is noted heron, and thot only subcontractors and employees who are in compliance with ORS 70~Will be used on this project, Bosis for Builder's Board exemption:. A ' NAME (please print) 6 E.!!Ll: /-tLi1:..7r' SIGNATURE (/~ .~-4 FOR OFFICE USe. ONLY DAT~/r-r/ Zono C-2 "q, Ftg. Main .L.O..O.D <;q. Ftg. Acces" Sq. Ftg, Other Type/ Const. ~N Bedrooms "toriO" x L.5D Volue x Value x Value TOTAL VALUATION Units Occy Lood 9 ()ccy Group-.-B2 Fire Zone Flood Ploin BUILDING PERMIT Charges and Surcharges I Plan Ck, Comm/lnd $44.00 65%/ Bldg Per Fee I Pion Ck. Res 1. 76 30%/ Bldg Per Fee 35. 00 I Fence 1. 40 I Demo 10.00 I Sidewolk .40 I A/C PovinQ 19. 00 I Curb Cut ------~c -I TOTAL $28. 60 Pd 3 -.~stems Developmeni 11- - jdJ,orge (1,5%) Recot #R575fifi PLUMBING PERMIT Charges and Surcharges I Total Comb. Permit I I ELECTRICAL PERMIT Charges and Surchorges MECHANICAL PERMIT Charges and Surcharges $7,500 00 $7.500.00 $112.32 ill? ':l? "';.~,;.,I....~I.~,j~..r"!<l:,""'l"r~~~'~~ ~- ,'- " ...,,~...-. :":-'.~- '.""- -..:'.-"....~'~....,-..-..,.'.-..; Mll.!,i~~'~:7~l','!~~",~~~~~~~ f;ti".;.~~~."x'i:.!',::-"?]~.~;,(~ . .. COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job Address B. Legal Description 1. example-tax lot 100, Lane County Map Reference 17 03 43 2. example-Lot 1. Block 3, 2nd Addition to Springfield EstatE 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, check add, etc. F. Building permit information: 1. example-construct single family house with an attached garage ( 2. example-remodel existing garage into family room 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 Division ( Staff must be able to contact appropriate persons regarding design information or job site corrections, etc. II. Abbreviated Plumbing, Mechanical & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate 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 abbrE ated schedules 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 date Whenever possible, the initial application will be used as a worksheet only. Where possible, Building Division Staff will prepare a typewritten copy and return it to the applicant at 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 applica 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: Additional Project Information: PLANS REVIEWED BY: //"''; I nome 11:>. r. S-;r. i ~:l ! ,II / ..../...., 7 / ',.. - o;ignaturE" PERMIT VALIDATION CITY OF SPRINGFIELD ( City Hall Springfield. Oregon Department of Public Works OFFICIAL RECEIPT Dot. \\;1-:0 \ ~,~ ~O. B 576 4 ~ Rec'd Fro~r~ ~ ('\ Address\Jl\.~. ~()_~~ R.,.;v.d Fa'OO~ ,/4'-\ lCU ~K~ \ l'lo .R\ r\0C) - a"Jcp i\ ^ -I-- Z\P /0 \ .l\D cJ2\L\LU~.A \n po _ {)Plo - AU ~ \q (Y:) 1\C7)(,' l1h ( ( ( ( Amount Received \ \md..~~ .~ ( BY I \, ('I, +- AUTHORIZED SIGNATURE ...,,'. (. SHELTON-TURNBULL PRINTERS' EUGENE OR 97"",01 Permit Clerk -:late _//-1 ) - ;<"/