HomeMy WebLinkAboutPermit Building 1980-12-19
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OEe , {\ 1980
INSPECTION LINE
726-3769
CITY OF SPRINGFielD
COMBINA liON APPLlCA liON I PERMIT
INFORMATION LINE
726-3753
Ra nge
Value of Work:
I -
Sq. Ftg, Main
Sq. Ftg. Access. CO
~.F~.O~r 0
_New_Add_Alter_Rep, ......
_Fence_Demo_Chon~e/Use N
LOther ComD 1 ete I ea.s.a ~
Space
Building Permit Info: Describe Work (i.e., Build Single
Family Residence With Attached Garage)
1000
Legal Description
635 West Centennial Blvd
17 03 27 43, TL 5300
I ENERGY SOURCES:
Heat El ectr; c:
Water Heater El ectrfc
Job Addre..
Ow~r Sidney Thwing, Edward Wood, Gene &
ot:r"ldr,J liidLf.
Address 633 West Centennial Blvd Phone 741-1420
Sorinafield. Oregon 97477
Construction Lender PFF - Eugene
3,540.00
Sport Spot - Retail Sport Wear
Address
Phone
DESIGN TEAM
(name)
(address)
(Iics. no,)
(expires)
(phone no,)
Primary
Structurol
Electrical
Mechanicol
CONTRACTORS
(name)
(address)
(lies. no.)
(expires)
(phone no,)
Plumbing
Hiatt Brothers Investments
Twin Rivers Plumbina
Penselin Electric
Harvey & Price
Springfield
EUQene
Springfield
Springfield
20-96
20-48C
741-1420
683-1414
741-1186
746-1621
Generol
Electrical
Mechanical
PLUMBING
ELECTRICAL
MECHANICAL
NO.
FEE CHARGE NO.
FEE CHARGE NO.
FEE CHARGE
Duplex (1 bath) eoch
Temporary Construction
1
furnace/burner to
BTU's
Appliance vent
separate
Stationary evap,
cooler
Vent fan with
single duct
Vent system apart from
heating or A.C.
Mechanical exhaust
hood and duct
3.00'
3
Each single fixture
Relocated building
(new fix, additional)
S.F, Residence
(1 bath)
5.00 15.00
Residence of
sq. ft.
New circuits, alterations
or extensions
SERVICES
Additional bath
Amps,
Water service
Sewer
Wood stovel heater
1
Amps.
100
10.00
Heat Pump
Air handler to
10,000 CFM
Air handler over
10,000 CFM
Storm Sewer
FEEDERS
1 ,Heat Pump
I
I
6.00
ISSUANCE OF PERMIT
10.00
19.00
TOT AL CHARGES
~,
15. 00 TOTAL CHARGES
10 . 00 TOTAL CHARGES
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 EXAMINED the completed application for permit, and do hereby certify that all informatian hereon is true and correct, and I further
certify that any and 011 work performed sholl 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 effect 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 701.055 will be used an this project.
"
Basis for Builder' s Board exemption:
t:;2 /:. ,/<,~.- ~/ J/( <:.IGNATUREW/]:J,.-:Y5:. _ ~/P}~(
FOR OFFICE USE ONLY
y<J 1~-0
DATE !/'-- , .
NAME (please print) {J 1?:J./ IV L ?
Zone C-2 Typel Const 5-N Units 1
Fire Zone Bedrooms Occy Load
Flood Plain C:torie~ 1 ('lccy Group lj-i::
BUILDING PERMIT 28.00 Plan Ck, Commllnd
Charges and 65%1 Bldg Per Fee
Surcharges Plan Ck. Res
1.12 30%1 Bldg Per Fee
PLUMBING PERMIT 15.00
Charges and fence
Surcharges .60
Demo
ELECTRICAL PERMIT
Charges and 10.00 Sidewalk
Surcharges .40
Alc PavinCl
MECHANICAL PERMIT 19.00
Charges and -----....7-6- Curb Cut
Surcharges
Sq, Ftg. Main
<;q, Ftg. Access
Sq. Ftg. Other Lease Space
'(
x
'( 1500'
Value
Value
Value
3.540.00
3.540.00
TOTAL VALUATION
18.20
I Systems Development
Charge (1.5%)
Plan Check Due
18.20
Total Comb, Permit
74.88
1 TOTAL
93.08
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III. Applicant to sign and date
Whenever possible, the initial application will be used f'
worksheet only. Where possible, Building Division Staf \ill BY
prepare a typewritten copy and return it to the applicc
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+-. .
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.
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example-tax lot 100. Lane County Map Referel
.' ~ 2. example-Lot 1. Block 3, 2nd Addition to Springf
C. Name, etc. of owner and construction lender
D. Erergy Sources
1. example-heat/electrical ceiling/or forced air gc
2. example-water heater/electrical/or solar
E. Square footage or valuation, etc.
1. example-1250 sq. foot house, 500 sq. foot gara
2. example-if new project, check new-if addition, ,
add, etc.
F. Building permit information:
1. example-construct single family house with an c
garage
2. example-remodel existing garage into family rc
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 Di
Staff must be able to contact appropriate persons r
design information or job site corrections, etc.
II. Abbreviated' Plumbing, Mechanical & Electrical Schedl.
A. Except where blank spaces occur in the description
of the Mechanical and Electrical Schedules, the apF
need fill-in only the No. Boxes adjacent to the app'
item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Schedule~
are available at the Building Division
1. To conserve space on the permit form the sched,
have been abbreviated
2. If the item(s) to be installed are not covered on '
ated schedules you should consult the full sched
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES
CHARGES ON THE SCHEDULES
IV.
V. FOR OFFICE USE ONLY
PERMIT VALIDATION
(E
CITY
(
OF
SPRINGfiELD
(
City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
No. B S 5 4 3 3 (
(., Date [2 - fCf 19'){()
Rec'd From H/11 H R~Il~<:; r>( f)J }.
Address Pi) I:J ())( / d5Q-Z
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Received For:
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AUt.ORIZED SIGNATURE
SHELTON-TURNBULL RINTERS - EuGENE. OR 97401
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Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
AdditionQI Project Information:
PLANS REVIEWED BY:
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namf'
LORNE PLEGER
d1 '
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<;gna'u'e~ ~flfl Iter /J'/fJ,o
12-16-80
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