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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 "H (j.'. {. "",. '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) \) (:) c5() '~ ~ 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 I II I I I I I I I . 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 I I I I I I;S".O(i I I I I I I I II I I' I 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 I 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~ I I I I 116:r1JJ.1' P///Vl/~ I I S(sol I/orCX'J ' I 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 I I Ii, c1R -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~~;:- -- -- ,.- ., . , ! I ! I' ; I ___Additional Project Information: I i, I I 1. . 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. ,)(1 PERMIT VALIDATION F ! CITY OF, 'SP RIN Gf I E l D ( II. 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 N B '-~-....O O ., /, '-,. I I ". '....<-tv.L..I..( DateUQ Dti. ~ 19~D Rec'd From \\(C\tl) t\\ r:;S c Address\Q \9:)\-;1- C~Q-~\\Q :rU-UClD ( (-. ,i" " ( Received For: \ )\~ iN ~ ~/\C:{), ( '-----" ',,-,,"-.l ,\ '- ",...- , 1"J , {~ ltolD I. dC1 \ ~\ f\"\.b : _, \ n ,00,' ( '-"'\~, (~ 70 - .Lt() \,'LLCL,tt . _, \~.ob ( , 1\.' lu 00/ ,--J\\~ t'k'\ CV~.~ ( '\ " L~Yo ' ,C{C~ , (.,9% &Jk{2 ( (' Amount Received I OL\ . ~____ (O,U (' cCtlrD._) ~T,.(LJIGNATURE -- , ( " ;" ': sl'l " c (". \, BY ( ( t SHELTON'TUl'lNBULL PRINTERS, EUGENE- OR 97401 l \.".. ( """'.U...........'" ~, "-~ -..~ .... ..>..................,. ............. ....... Permit applicant exempt from registration with the Builder's Board because: t---.-- ; ; ; ?-- j I . , I I '------ -~ ?LANS REVIEWED BY: " name signature ~ --,~....- ..i:io..... ....!IO. llIiJ!I!!!5. 1:;1......... .. ,.1......011;.. ,-'1,'" I. 1110..... 1111._ ..~..~, ... ......,.1 ..~1.11\o.1.'.1II .liI..: /2~ I ' , , da te 7- S' - 'fro --