HomeMy WebLinkAboutPermit Building 1980-9-8
657 W. Centennial
Legal Description I, 6""52."1 4"3
400
CITY OF SPRINGFIELD
COt1BIiJATION APPLICATION/PERMIT
B 1 v d . ' EnERGY SQ.LU<, CES:t .
Heat tie c rl C
t'!ater Heater E 1 e c t r i c
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(j.'.
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'1 INSPECTION LINE
'1726-3769
Range
INFORf1ATION LlNt I,
726-3753 b
So. Ftg. r'la in 0 U U ::'.
:q. Ftg. Access.
Sq. Ftg. Other
New Add Alter Rep.
--Fence Demo Change/Use
--Other -- --
Job Address
i ValuE of l'lork:
Owner Sindey Thwing, Edward Wood, Gene ,,4,850
Address 663 W. &eljeerRanrda1Hlatt Phortdll 142JBui~t:inq P~rmit Info:
C nt 1 1~ - Famlly ~esldence Wlth
Describe Work(i.e., Build Single
j1,ttached Garaqe)
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Springfield, Oregon
Construction Lender Pacific First Federal
E u gene ,Or ego n
Carpet sales
Address
DESIGN TEN1
(name)
Phone
(address)
(lics. no.)
(exoires)
(ohone no.
Primary
Structural
Electrical
; 11echani ca 1
CONTRACTORS
(name) "
(address)
Sprinqfield
Euqene
Sorinqfield'
(1 i cs. no.)
(exoires)
(ohone no. )
i Genera 1
Hiatt Bros.
1416
20-96
20-48C
741-1420
683.1414
741-1186
, Plumbinq
Twin'Rivers
;
: Electrical
Ppnc;plin
; ~lechanical
PLur1B I NG
ELECTRIcAL
MECHANICAL
NO,
Each single fixture
I FEE I CH/\RGE I Nn
,.54'") /O,t:717
FFF
I rHARGF' NO,
I
furnace/burner to
BTlI's
I FH I rHARGF ,
'.A
Residence of
SQ. FT.
Relocated building
(nel'i f.ix. additional)
New circuits alts,
or ext~nsions '
Floor furnace
and vent
S.F. Residence
(1 bath)
I Duplex (1 bath)
Additional bath
each
I SERVICES
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. TOTAL CHARGES /'c.f/?ll TOTAL CHARGES
WHERE STATE L'I\1 REQUIRES that tile Electrical "Iork be done by an
shall not be valiJ until the label has been signed by an Electrical
COMM./IND. FEEDERS
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II
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IS- C{) I TOTAL CHARGES
Electrical Contractor; the electrical por~ion of
Supervisor and returned to the Building Division
Recessed wall
Soace heater and vent
Vater service
ITempOrary Construction
Chanae in existing
residence
multifamily, comm. or
Industrial
Of /00
amps,l
I
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I Apo Ii ance verit
seoarate
I Stationary evap.
cooler
II Vent fan with
sinole duct
, I Vent systerl apart from
heating or A,C.
I r1echani ca 1 exhaust
hood and duct
I \'/ood stove/heater
I ,q 112 f./-,/,.LlJ/l>1..E..R '
Iz"",..,
...I,c,)"'--.1
Sewer
Istorm Sewer
IInstall/alter/relocate
distrib, feeders
10f amps~
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116:r1JJ.1' P///Vl/~
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I S(sol
I/orCX'J '
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ISSUANCE nF PFRrllT
/(J.o') I
"-'3 c-...,'
,~[ J 'J '-' i
this permit
I HAVE CAREFULLY EXNlINED the completed application for Qermi,t, and do hereby certify that all information hereon is true
and correct, and I further certify thiit any and all \'iork performed shall be done in accordance with the Ordinances of the City
of Springfield and the Laws of the State of Oregon oertaining to the work described herein, and that NO OCCUPAI~CY will be made
of any structure without the permission of the Building Division. I fu~ther certify that my registration with the Builder's
Board is in 'full force and effect as required by ORS 701.055, that if exempt the basis for exemDtion is noted hereon, and that
only subcontractors andemflloyees \'iho are in compliance with ORS 7(11.055 "/ill be used on this project.'
, ,
NAME(please print),
S IGN.LITURE _" .., ",.,
FO~ OFFICE USE,ONLY
DrlTE
Zone C-::l
Fi re Zone -:-
Flood Plain ~jj-7
TYDe/Const. "-SZ:-,~,(j
Bedrooms
- Stories
r---
Units
Occy Load
Occy Group
x
x
t..J. >S" 0-0 ~'9
,3- ,.::2..
So. Ftc]. r1a i n X'CO
Sq, Ftg. Access
Sq, Ftg. Other
"'h",
Value
Value
Value
x
;;.....
TOTAL VALUATION Q5{So 00,
BUILDING PERr'1!T
Charges anc
Surcharges
""/ PlanCk.
--____{;}5.!_J2Q_ 65%/Bldo
/ . Plan Ck.
,;; r 30%/Bldq
~~,~?C) I Fence
-~-;---~~/-qO IDemo
----__iS~'2.QJ Sidew~lk
r&D I A/C Paving
Comm/lnd
Per Fee
Res
Pe r Fee
;2{), S"O
Systems Development
Cha roe (1. 5<r,)
, ~
PLur1BING PERt1IT
Cha rges and,
Surcharges
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-I :Jt),f?u
I
ELECTRICIl,L PERr~IT
Charges and
Surcha rges'
Total Comb, rermit
MECHANICAL PERMIT
Charges and
Surcharges
----~-t23.!..:{f)_ Curb Cut
q.,/
1,';1
LOT"' '
,I Al
J
j Permit C1 erk
,- '.'~'~~J ECT C~~~.I~~-~~-~'~-;A~;S;~';~-~E~;~; ~~~.; A~~;:- -- -- ,.- ., . ,
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I ___Additional Project Information:
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cb~~InATION APPLICATION/PERMIT (CAP)
1.
Applicant to furnish
A. Job Address,
B. ' Legal Description
1. example- Tax Lot 100, Lane County. Map Refere"-
17 03 43
2, examole- Lot 1. ,Block 3, 2nd Addition to
Springfield Estates , ,
C. ~ame, etc. of owner and construction lender
O. Energy Sources
1. examDle- heat/electrical ceilinq/or forced a
2. examDle- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. examole- 1250 sq. foot house, 500 sq. fodt gi ~
2. examp 1 e- if new proj,ec t, chec k ---rie\'1 - if add i' ~,
check add, etc, '
F. Building permit information:
1. example - construct single family house with
attached garage ' '
2. exar;;ple - remodel existing garage into famil;
3. example - convert single family residence in:
,restaurant (change of use)
G.' Value of work as defined in Section 303 (a) of tl
Structural Specia~tv Code
H. D~S I G:, TEM'l A;m CO:;T~ACTORS
To avoid design or construction delays, Buil~ing
Division Staff must b,e able to contact appropria1
persons regarding design information or job site
corrections. etc.
Abbreviated Plumbing, Mechanical, & Electric~l Schedl,
A. Except where blank spaces occur in the descriptic
portion of the Mechanical and Electrical SchedulE
the applicant,need fill-in only the No. Boxes adj
to the appropriate item(s) to be installed
R, Full Plumbing, Mechanical, and Electrical Schedul
are_available at the Building Division, '
1. To conserve space on the permit form'the SChE
have been abbreviated
2. If the item(s) to be installed are n~t coverE
the abbreviated schedules you should consult
full schedules
C~ BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AN.
CHARGES ON THE ~CHEDULES
D. As noted on the CAP, the label must
electrical contractor for signature
supervisor. The'general contractor
to sign the electrical' label~
Applicant to sign and date
Whenever possible, the initial application will be us
'a worksheet only. Where possible, Building Division
wi 11 prepa re a type wri tten copy and return it to the
applicant at the time the actual permit is issued for
signature.
Fees and Charges
Plan check fees are due and payable at the time of th
application, and no plans will be processed until the
fees ,are paid, All other fees and charges are due an,+-
payable when the permit is issued.
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PERMIT VALIDATION
F
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CITY
OF, 'SP RIN Gf I E l D
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be delivered
by his electr
is not author
IV,
v,
FOR OFFICE USE ONLY
Ga'
City Hall
Springfield, Oregon
Department of Public Works
C> F F I C I A LR E C E I P T
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DateUQ Dti. ~ 19~D
Rec'd From \\(C\tl) t\\ r:;S c
Address\Q \9:)\-;1- C~Q-~\\Q :rU-UClD
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Received For:
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, 1\.' lu 00/
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(.,9% &Jk{2 (
(' Amount Received I OL\ . ~____ (O,U ('
cCtlrD._)
~T,.(LJIGNATURE
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BY
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SHELTON'TUl'lNBULL PRINTERS, EUGENE- OR 97401
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Permit applicant exempt from registration with the Builder's Board because:
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?LANS REVIEWED BY: "
name
signature
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