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:
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} AUTHORIZED SIGNATURE
SHELTON-TURNBULL PRINTERS' EUGENE OR 97401
(
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Permi t Cl erk
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
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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