HomeMy WebLinkAboutPermit Building 1997-1-27
Owner Hiatt. Hiatt. Thwing & Wood
Address 663 W. Centennial Phone74l-l420
Springfield, Or. 97477
Construction Lender PFF", ~')'~~D~,
$4,292.00
INFORMATION LINE
726-37 S3
Sq, Ftg, Main 7:> () s. 1: .
Sq, Ftg, Access,
Sq, Ftg, Other
_New __Add_A!ter__Rep,
_Fence _Demo__Change/ Use
_ _,_Other
,
~
INSPECTION LINE
726-3769
CITY OF SPRINGFIElD
COMBINATION APPLICATlON/ PERMIT
legal De.cription
;~649 W. Centennial
TL 5300, Map 17 03 27 43
ENERGY ftU~~l:ric
Heat ..,-
Water Heater neal, ,UllljJ
Range
Value of Work:
00
......
o
C>
.p.
-....I
Job Address
Building Permit Info: -- Describe-W~-;-k(i.e., Build Single
Fomily Residence With A"ached~oro~)
Ice cream parlor
Address
Phone
DESIGN TEAM
(name)
(address)
(lies. no,)
(expires)
(phone no,)
Primary
Hi A..tt Bro~
SprinE-Fipln
7Ltl_1Lt?()
Structural
Plumbing
Penselin Electric Springfield 20-48C
Harvey & Price Springfield
(nome) (address) (lies, no.) (expires)
Twin Rivers Plumbing Eugene 20-96
741-1186
746-1621
Electrical
Mechanical
CONTRACTORS
(phone no,)
General
683-1414
Electrical
Mechonical
PLUMBING
elECTRICAL
MECHANICAL
NO. '
5 !
I
FEE
CHARGE
NO,
FEE
CHARGE
NO.
FEE
CHARGE i
I
I
I
3.00 !
Temporary Construction
1
furnace! burner to
~TU's
Appliance vent
separaTe
Stationary evap.
cooler
Vent fan with
single duct
Vent system aport fram
heating or A,C,
I Mechanical exhaust
haad and duct
Duplex (1 bath) each
25.00
I
I
I
I
I
Residence of
Eacn sing Ie fixture
Relocated building
(new fix. odditional)
S,F, Residence
(1 both)
sq. ft.
New circuits, alterations
or extensions
SERVICES
Additional bath
Amps,
Water '5ervice
Sewer
. Wood stove/ heater
ISSUANCE OF PERMIT
6.00
I
I
I
I
I
10.00
Storm Sewer
FEEDERS
1
Heat Pump
Air handler to
10,000 CFM
Air handler over
10,000 CFM
1
Amp..
150
l5.00
TOTAL CHARGES
25 . 00 I TOTAL CHARGES
15 . 00 JOT AL CHARGES
1Q nn
WHERE STATE LAW REQUIRES ,hat the Electrical work be done by the Electrical C"ntractor, the electrical portion of this permit .hall not be valid until, a
label has been signed by an Electrical Contractor and attached to the electricol panel.
I HAVE CAREFUllY EXAMINED the completed application for permit, and do hereby certify that all inrormation 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 registratian with the Builder's Board is in full force and effect a. 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 on this project,
Basis ror Builder's Board exemption:
NAME (please print)
D ,(3P/V/ S
G,/- 6 J to::')!..
~' r
c;IGNATUR;;b~V-?~;7 ~.-o-/(
FOR OFFICE USE ONLY
DATE I-J.. '/-'/1
x
Value
Value
4292.00
NU
Type/ Canst
Bedrooms
<;',tories_
V-N
IInits
{'key load
Occy Group
1
jj
B-2
~q, Ftg. Main
~q. Ftg_ Access
Sq. Ftg. Other
750
Zone
Fire Zone
Flood Plain
C-2
'( Value -4292. GG
TOTAL VALUATION
BUILDING PERMIT
Charges and
Surcharges
32 00 Plan Ck, Comm/lnd
. 65%/ Bldg Per Fee
L L~I Plan Ck, Res
30%/ Bide Per Fee
20.80
Systems Development
Charae (1.5%)
Plan Check Due
20.80
PLUMBING PERMIT
Charges and
Surcharges
25.00
LUU
Fence
Demo
I Total Comb, Permit
94.64
elECTRICAL PERMIT
Charge. and
Surcharge.
15. OO! Sidewalk
.bU
I AI C Pavina
MECHANICAL PERMIT
Charges and
Surcharges
19.00 Curb Cut
---------:76
TOTAL
115.44
III. Applicant to sign and date
Whenever possible, the initial application will be us
worksheet only. Where passible, Building Division S
prepare a typewritten copy and return it to the app Int
the time the actual p....rmit is issued for his signature.\- '
Fees and Charges
Plan check fees are due and payable at the time of the application,
and na 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 \...AP)
I. Applicant t9 furnish
A. Job Address
B. Legal Description
1. example-tax lot 100, Lane County Mop Rt
2. example-lot 1. Block 3, 2nd Addition to Sp
C. Nome, etc. of owner and construction lender
D. Energy Sources
1. example-heat I electrical ceiling / or forced c
2. examole-water heater / electrical.' or solar
E. Square footage or valuation, etc.
1. example.1250 sq, foot house, 500 sq. foot,
2. example.if new project, check new-if addit
add, etc.
F. Building permit information:
1. example-construct singie family house with
gcrage
2. example-remodel existing garage into fami
3. example-convert single family residence int
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of
Structural Specialty Code
H. DESIGN TEAM AND CONTRACTORS
To avoid design or construction delays, Buildin,
Staff must be a ble to contact appropriate persc
design information or job site corrections, etc.
II. Abbreviated Plumbing, Mechanical & Electrical Scr
A. Except where blank spaces occur in the descripl
of the Mechanical and Electrical Schedules, the
need fill-in only the No. Boxes adjacent to the c
item(s) to be installed
B. Full Plumbing, Mechanical, and Electrical Sched
ore available at the Building Division
1. To conserve space on the permit form the scl-
have been abbreviated
2. If the item(s) to be installed are not covered,
ated schedules you should consult the full sd
C. BUILDING DIVISION STAFF WILL Fill OUT ALL FE
CHARGES ON THE SCHEDULES
IV.
V. FOR OFFICE USE ONLY
.(
t't'RMIT VALIDATION
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..
CITY OF SPRINGFIELD (
City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
(
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No. B 5 5 6 8 4 '
Date } - 7~ 19 ~J
- Rec'd From ~iccd, o..D~)~,
Address tn(n ~ (lYt-r--enj'1ikLO
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Received For: 32 _ 00
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pp I 2~,OO (
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f(!~ c-'"
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lull Amount Received 1 (5 ~_'i> 4 . { ~
(:-.40
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BY
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AUTHORIZED SIGNATURE
SHELTON.TU! NBULL PRINTERS EUGENE OR 97~01
58511-8
Permit Clerk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
Additional Project Information:
PLANS REVIEWED BY:
',ignature 'L)LltJ ~Mff j{ / Utb dote 1-27-81
- I - I
I
DAN SMITH
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