HomeMy WebLinkAboutPermit Building 1982-10-22
I HAVE CAREFULLY EXA~1INED the completed application for permit, and do hereby certify that all information 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 herein, and that NO OCCUPAIKY 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 exemption is noted hereon, and that
only subcontractors and employees who are in compliance with OP.S 701.055 will be used on this project.
~ . , . 1$'1 \l~ l.)OOl2-l~es" '. . ~ ' I.
rm'1E(p1ease print)6-~~eJ2,.L ~ SIGW\TUREL)o ,~ '
FOR OFFICE USE ONLY
So. Ftg. t1a i n
Sq. Ftg. Access
Sq. Ftg. Other
...
, INSPECTION LINE.
726-3769
CITY OF SPRINGFIELD
C0/1BINATION APPLICATION/PERMIT
ErlERGY SOURCES:
Heat
Hater Heater
INFORt1ATION liNt
726-3753
Sq. Ftq. r'lain
:q. Ftg. Access.
Sq. Ftg. Other
New XAdd Alter Rep.
--Fence Demo Change/Use
--Other-- --
Job Address
525 Centennial Blvd. ~~S,-
Lega1.Description
17-03-27-4-3. T.L. 5300
Range
ValuE. of Hork:
23,000.00
Builciina Permit Info: Describe vJork(i.e.,
Family Residence With Attached Garaae)
Build Single
OwnerGeorl!e Morris
Address 525 .Centennial Blvd.
Phone
Springfield, Oregon
Construction lender
726-1645
97477
Complete additional 1000 sq. ft. of
Rental Space
Address
, DES I GN TEAr-1
Phone
(address)
(lies. no.)
(expires)
(name)
, Primary Van Voorhies, P. E.
1133 Lochaven, Springfield, Oregon 9717
'741-1004
Structural
Electrical
: t1echani ca 1
CONTRACTORS
(address)
(1 ics. no.)
(expires)
(name)
. General Hiatt Brothers
, P1umbinQTwin Rivers
, Electrical Penselin
. ~1echanic'al Harvey & Price
663 Centennial Blvd
2050 West Broadway, Eugene
90704 Alvador Road, Alvadore
2015 Nugget Way, Eugene
741-1420
683-1414
688-5455
746-1621
PLUf1B I NG
ELECTRICAL
MECHANICAL:
NO.
FEE CHARGE NO,
FFF
rHAR(;F NO.
Each ~ing1e fixture
Residence of
furnace/burner to
BTlI's
6
5.00 30.00
SQ. FT.
Relocated building
(new fix. additional)
New circuits alts.
or extensions
15.0015.00
Floor furnace
and 'vent
x
S.F. Residence
(1 bath)
IDuPlex(l bath) each
IAdditional bath
IHater service
Sewer'
I
I
I
I
I
or I
amps.1
I
I
SERVICES
Recessed wall
Space heater and vent
L
I
I
II
I
~;p~ ran~~'~nt
separate
I Stationary evap.
cooler
I Vent fan with
s i no'l educt
I Vent system apart from I'
heating or A.C.
I Meehan i ca 1 exhaust,
hood and duct '
1 I'iood stove/heater
I
l-
I
TOTAL CHJI,RGES
WHERE STATE LAW REQUIRES
shall not be valid until the
ITempOrary Construction
IChange in existing
residence
Imultifamily, comm.
Industrial'
IOf
ICOMM./IND. FEEDERS
IInstall/alter/relocate
distrib: feeders
1 10f 1nn . amps.1 10~ 001
I I,
I I
I .1 I ' ISSUANCE OF PFRr1IT
30.00 TOTAL CHARGES 25.00 I TOTAL CHARGES
that the Electrical work be done by an Electrical Contractor, the electrical portion of this
label has been signed by an Electrical Supervisor and returned to the Building Division
Storm Sewer
I
I
I
I
1
I
CP
~
-
n
\;""
JJ
(phone no.')
(ohone no. )
FFF
rHA~(;Fj
I
16.00 I
I '
I
13.00
I
I
I
I
I
I
10. Dei
19.00,
permit
Dim I b -2'2 -~c_
/
Zone, C2
Fi re Zone NA
Flood Plain NO
x
V'al ue
Value
Value
Type/Const. V- 1
Bedrooms NA'
Stori es 1
hOll'\tni ts
Occy Load,
Occy Group
x
B2
x
TOTAL VALUATION 23,000.00
BUILDING PER~1IT
Charges and
Surcharges
Plan Ck. CommjInd
65%/Bldo Per Fee
Plan Ck. Res
30%/BldQ Per Fee
6 D Systems Development
7,60 p Charge (1.5%)
RECEIPT, 59827
104.00
4.16
PLU~1B ING PERMIT
Charges and
Surcha rges
I
"
I
ITotal Comb. Permit
I
I TOTAL
ELECTRICAL PERtm
Charges and
Surcharges
30.00 Fence
------------
1. 20 . I D!;mo
_ ___ _ ~5 --=QQ.. __JSidewal k
1.00 IA/C Paving
19.00 ,I Curb Cut
------~;;-~-I :
MECHANICAL PERMIT
Charges and
Surcharges
$185,12
~
"ij
""'-="
COMBINATION APPLICATION/PERMIT (CAP)
I. Applicant to furnish
A. Job Address
B. Legal Description
1. example- Tax Lot 100, Lane County Map Reference
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. examp1e- heat/electrical ceilinq/or forced air qa
2. example- waterheater/electrical/or solar
E. Square footage or valuation, etc.
1. example- 1250 sq. foot house; 500 sq. foot garage
2. example- if new project, check-new - if addition,
check add, etc.
F. Building permit information:
1. 'example - construct single family house with an
attached garage
2. example - remodel existing garage into family roo
3. example ~ convert single family residence into
restaurant (change of use)
G. Value of work as defined in Section 303 (a) of the
Structural Specialty Code
H. DESIGN TEAN AND CONTRACTORS
To avoid design or construction delays, Building
Division Staff must be able to.contact appropriate
persons regarding design information or job site
corrections; etc.
II, Abbreviated Plumbing, Mechanical, & Electrical Schedules
A. Except where blank spaces occur in the description
,portion of the Mechanical and Electrical Schedules,
the applicant need fill-in only the No. Boxes adjacen
to the appropriate item(s) to be installed
B. Full Plumbing, Mecha~ica1, and E1ectrtca1 Schedules
are available at the Building Division
1. To conserve space on the permit form the schedu1 e
have been abbreviated
2. If the item(s) to be installed are not covered on
the abbreviated schedules you should consult the
full schedules . "..;.:.. .,,'. .
C. BUILDING DIVISION STAFF WILL FILL 9y,]\.A,lili\'iFEES.AND
CHARGE S O~ ,I~,~;::~C~~~QM.~~~,9gf~!t0',;<i;;'c.:<;;i!t;~("':' '.. ';{~'" .
D. As noted on 'the CAP;;!~'theVlabel::fifI.:is:t'~b'edel ivered
electrical contractor for signature by his electrical
supervisor. The general contractor is not ~uthorized
to sign the electrical label. ---
III. Applicant to sign and date
Whenever possible, the initial application will be used a
a worksheet only. Where possib1;e.,Butlding D.ivision Staf
will ,prepare a t~p~ w!0;itt:~;n 'C'~px~nd 'r.e;~~:r:rt . it~,9; the';~'1~~;:
app 11 cant at the t1me':the:;acJua'1~Ypermlt'q s 1 ssued:.for h1 s
signa ture. . ",,;:;..
IV. Fees and Charges .
Plan check fees are due and payable at the time of the
app1ication~'and no plans will b~ processed until these
fees are paid. All other fees and charges are due and
payable when the permit is issued. .
V. FOR OFFICE USE ONLY
I
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CITY OF 'SPRINGFIELD
r.
<:
City Hall
. Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
. .' . No. B 5988:
oate\Q . 2. fL195'L . .
Rec'd From 6.~'fC\ e ~'(Y'\ ~
Address a2.. ~ LJ.:) ~ r p ~tel\NoJ
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Received For:
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.. ~..~~ ~~ ..40~
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f I 12..0
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N\~(, B '-. \(1.00.
1. OJz:, . ,"(;.,:
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.'Amount Received
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. [J 'AUTHORIZED SIGNATURE
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BRIGGS PRINTERSlI.ITHOGRAPHERS. EU!iENE. OREGON
.-4-.
Permit Clerk
;;"
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
1
Permit applicant exempt from registration with the Builder's Board because:
Additi ona 1 Project I nformati on:
PLANS REVIEWED BY:
name
Lorne W. Pleger
Signature~b~ da~eOctober 21. 1982
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