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HomeMy WebLinkAboutPermit Building 1980-7-28 ~ INSPECTION LINE 1726- 37 69 , , CITY OF SPRINGFIELD ~ . COMBINATIONAPPLICATION/PE~ EnERGY SOURCES: Heat E 1 e c tr i C ',1ater Heater :E!~:'':;(_, Job Address 575 W.Centennial, 81 vd. Legal Description i 7-(X~'" :J7-:L/3 ,-0, V [;."f ,it' Ot> Range Owner Hiat~, Hiatt, Wood 663 W. Centennial ~prlngtleld, uregon & Thwing 7 4 1 E.hjJ*2 0 '-;)/4// ValUE of \>Jork: $9,100 , \ Bui:lciina Permit Info: Describe t10rk(Le., Build Single Fami1 y fles i dence \~ith .A.ttached Garaae) _ , Address INFORI1ATION UN!: 726-3753 Sq.: Ftg. ',lain 'j L ':J ~q. ~tg. Access. Sq,. Ftg. Other New, Add, Alter Rep. --Fence Demo Change/Use " Other -- -- " \)\} 0' 0> v' <5' ~"- Construction lender Arts &cr~fts shop Paci'fic ~irst Federal , t'ugene t;; /-'3.45f.!" ~f/.;'.~?E /;(1 C ,':;eN?";'J...f-v///fo.1-l'.- c5.rv125/~ Address DES I GN TEAI~ Phone (address) (lics. no.) (exoires)' (ohone no.) 741-1420 (name) Hi at t. B r 0 s . P . O. Box 10392, E u gene , Primary Structural Electrical Penselin Electric 20-48C Mechanical' CONTRACTORS (address) (name) (lics.no.) General Hiatt Bros. Twin Rivers Penselin Electric ,20-96 20-48C Euqene Eugene Springfield Plumbinq Electrical , , ' , ~lechanical PLur,lBI NG ELECTRICAL NO. FEE ! CHARGE NO, FFF rHARGF NO. 3 Each single fixture Residence of S;:n ,/ .)..:~\~ SQ. FT. Relocated building (new, fix. additional) New circuits alts. or extensions S.F. Residence (1 bath) Duplex (1 bath) jAdditional bath Water service I I I I I ,/,:Sc61 SERVICES, each Sewer Temporary Construction Change in existing residence multifamily, comm. or Industrial / IOf Storm Sewer I I I ../.i;'~) amps. COMM./IND. FEEDERS Install/alter/relocate distrib. feeders /_~Jl:) amp s. , fA ,';" I' ot' ....;l ~.~./r._ I .I Of I I I , TOTAL CHARGES J"5~or.;'1 TOTAL CHARGES WHERE STATE L\\1REQUIRES that the' Electrical work be done by an sha11 not be vali'J until the label has been signed by an Electrical 741-1186 (exoi res)' (ohone no. ) 7 4 1 - 14 2 0 683-1414 741-1186 MECHANICAL I FFF rHARGF furnace/burner to BTU's Floor furnace and vent Recessed wall Soace he~t~r ~nd vpnt Appliance vent seoarate Stationary evap. coo 1 er' I Vent fan with sinale duc:t Vent system' apart heating or A.C. Mechanical exhaust hood and duct Wood stove/heater from I /!-cnt I I fl/A" ". /;,t/o 'ISSUANCE' OF PFR11IT .:; (;'(:7'?1 TOTAL CHARGES Electrical Contractor, the electrical portion of Supervisor and ret~rned'to the Building Division /1:) 0(") / / ',,:'voI 1(-$", .....(j thi s permi t I HAVE CAREFULLY EXMlINED the completed apnlication for Dermit, and do hereby certify that all information hereon is true and correct, and I further certify that any and a 11 work oerformed sha 11 be done in accordance wi th the Ordi nances of the City of Spri ngfi el d and the Laws of the State of Oregon oerta i ni ng to the work descri bed herei n, and that NO OCCUPAfKY 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 as required by ORS, 701.055, that if exempt the basis for exemotion is noted hereon, and that only subcontractors and employees who,are incorimliance with ORS 7('1.055 ~1i1l be used on this nroject. NAf.IE(please print);)~.//,), '0 (J...' Lv, J/~ /?. SIGi~i\TUR~--1~_#~.41~ OnE )........7-?......9:::) For QFF I CE USE Oi,L Y Zone (1.-'2-- Tyoe/Const. Units Sa. Ftc]. rIa in x Val ue ' Fire Zone Bedrooms Occy Load Sq. Ftg. Access x Value Flood Plain Stories Occy Group Sq. Ftg~ Other q,.?9 x Value TOTAL VALUATION L/ IOD ar:2 BUILDING PER~1IT Charges and Surcharges I Plan Ck. CommlInd , 5',..7.(DO 65%/Bl do Per Fee ------------ Plan Ck. Res /},t")';t' 30%/Bldq Per Fee _ _ _ _ _ _ _~~'::2d _I Fence , (.;.'O D~Rlo ~~- ~,~.-('}) PLUMBING PERMIT, Charges and Surcharges ~ ELECTRIC;',L PERI~IT Cha rges and Surcharges MECHANICAL PERMIT Charges and Surcharges _ _ _ _ _ _ ~-2J; ,-(Jr.) Sidewal k /,t)tJ AIC Paving ______..:..L<R~ Curb Cut / ,j ( L,:r7' 'Systems, Development Cha roe. n. 5:r.) /'-:Z: C l:::' .3.3. go Total Comb. Permit //,~ . Z~;t.." W/4'/ 'J'1 , / /&7"0<,, TOTAL Applicant to furnish A. Job Address B. Legal Description 1. examp 1 e- Tax Lot 100, Lane County Map Ref, (lCt 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 cei 1 inq/or force, 2. example- waterheater/electrical/or solar E. Square footage or valuation, etc. 1. example- 1250 sq. foot house, 500 sq. foo' 2. example- if new project, check-new - if al check add, etc. F. Building permit information: 1. example - construct single family house w' attached garage 2. examole - remodel existing garage into far 3. examole - convert single family residence to restaurant (change of use) G. Value of work as defined in Section 303 (a) O' Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS ( To avoid design or construction delays, Build' Division Staff must be able to contact appropl persons regarding design information or job S' corrections, etc. ( Abbreviated Plumbing, Mechanical, & Electrical Scl A. Except where blank spaces occur in the descri! portion of the Mechanical and Electrical Sche( the applicant need fill-in only the No. Boxes qac to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical SChE are available at the Building Division 1. To conserve space on the permit form the! edu have been abbreviated 2. If the item(s) to be installed are not CO\ the abbreviated schedules you should conSt full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEE: '. CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must be deliver electrical contractor for signature by his elE ~lC 11--1 supervi sor. The genera 1 contractor is not aut ": Amount Received ',' " '[' to sign the electrical label. --- Applicant to sign and date Whenever possible, the initial application will bE ~o a worksheet only. Where possible, Building Divisi BY ( ~ will prepare a type written copy and return it to , applicant at the time the actual permit is issued signature. Fees and Charges . Plan check fees are due and payable at the time o~..~ 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. COMBINATION APPLICATION/PERMIT (CAP) I. II. II!. IV. V. FOR OFFICE USE ONLY ~ PERMIT VALIDATION CITY OF SPRINGfiELD '- c City Hall Springfield, Oregon Department of Public Works OFFICIAL RECEIPT No. B 5 413 8 : Date '7 - ~. (? 190'G Rec'd From U,- cJJ+' (,/' Yl '<)~- Address (r-( ,~~ u' (:(/ ) l"( / ;; \~(l_l ( .' Received For: I : )~ I ( t--"-' . -;-( f r \ f' f. j ;.~~ )('1 . ,- ..., /-' (' f ") I '\. I. _ ,_ / 1...2) \- ~ /-r' '--," ' I .,' ' 7 r,'f': c ~ (-. (,e ' ~",J _ "__ .-'" !,~ (., ( '",'~~ I .I j t-_c~ 1~ '.- < '- i;- i- \ (,it'l -10; ,.. ., I _ ( ---. c.:..-- - -. . ~- /~ ) (/1,.' f./H-J L-ll..'/' I .' I J j (c ,,' /'.. ( ( rc) , 1\ (" L \ --") ::'_' CJ\f' --, ) , ) ,/ ", t .., . ,~~<', '(. C \-) ~ (1\ V\ ((:,_'. { (- n \.rYI 1>' (' /' / (i', . , 1-- } AUTHORIZED SIGNATURE SHELTON-TURNBULL PRINTERS' EUGENE OR 97401 ( ( ( Permi t Cl erk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: t J i I Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature //(I/-/~ ;, / .t"0", ();:J-J.--y? /_:7:/1, .' date 7- 25""-<6d