HomeMy WebLinkAboutPermit Building 1980-10-30
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INSPECTION LINE
726-3769
CITY OF SPRINGFIELD
COMBINATION APPLICATION/PERMIT
ENERGY .sQUR~h C
Heat t I ec
INFORMATION LINE
726-3753
~uu
Sq, Ftg, Main
Sq, Ftg. Access,
Water Heater _ Sq. Ftg, Other
Range _New_Add_Alter_Rep.
Value of Work: _Fence_Demo_Chonge/Use
Sidniy--Thwing, Edward Wood, -Bernie Hiat1 $3,500.00 ,_Other
Building Permit Info: Describe Work (i.e" Build Single
Gene Hiatt 663 Centennial Phane 741-1420 Family Residence With Attached Garage)
Oregon 97477
Eugene
Job Addreu
525 West Centennial Blvd
Legal Description
TI
S10D~ 27 43
Owner
Address
Springfield,
PFF,
t~sP SpnCP for nttorney
See also Job # 800525
Construction lender
Address
Phone
DESIGN TEAM
(no"';')
(address)
Primary
Hiatt Brothers
Soriqfield
Structural
Electrical
Mechanical Ha rvev &. Pri r.e
CONTRACTORS
(name)
(address)
General Hi a tt Brothers
Sorinqfield
Plumbing T IA'; n R; \/(:>, V'c:
F'llgpnp
Sorinqfield
Electrical Pen s e 1 in
Mechanical
PLUMBING
ElECTR ICAl
NO. I
3 I
I
I
I FEE I CHARGE NO.
15.00115.00
sq, ft,
New circuits, alterations
or extensions
Residence of
I FEE
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I
I
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Each single fixture
Relacated building
(new fix. additianal)
S,F. Residence
(1 bath)
SERVICES
Duplex (1 bath) each
Temporary Canstructian
Additional both
1 Amps. 100
Water service
Sewer
Storm Sewer
FEEDERS
Amps.
TOT Al CHARGES
1 !:) _ n( I TOTAL CHARGES
WHERE STATE lAW REQUIRES that the Electrical work be done by the Electrical Contractor, the electrical portion of this permit shall not be valid until a
label has been signed by an Electrical Contractor and attached to the electrical panfil.
(lics, nd',)
(expires)
00
o
I->
o
+:>
.....
(phone no,)
741-1420
746-1621
(phone no.)
741-1420
683-1414
741-1186
FEE
CHARGE
(Iics. no.)
(expires)
3.00
r
I
I I
16.00 12.00
10.00
?l:innl
I HA VE CAREFUllY EXAMINED the completed application far 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 af 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 registration with the Builder's Board is in full force and effect as required by ORS 701.055, that if exempt the basis far exemption is nated~
heron, and that only subcontractors and employees who are in compliance with ORS 701.055 will be used on this project,
Basis for Builder's Board exemption:
MECHANICAL
CHARGE
I
I furnace/burner to
I\TU's
I Appliance vent
separate
I Stationary evap.
cooler
I Vent fan with
single duct
I Vent system apart from
heating or A,C.
I Mechanical exhaust
hood and duct
I Wood stove/ heater
I Heat Pump
I Air handler to
10,000 CFM
I Air handler over
10,000 CFM
I
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I
NO,
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I
115.00 I
I I
I I
I I 2
I I
I I
I I
I
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I
1
ISSUANCE OF PERMIT
11:i _ nn I TOTAL CHARGES
NAME (please print) .J//~./ /0,/'/ ")
~L4t/t:/(
SIGNATUR~--L-- h/ ~ ~ ~~j~r..
FOR OFFICE USE ONLY
Zone
Fire Zone
Flood Plain
r-=.?
NU
!j-~
~--:' Ftg. Main
~q. Ftg. Access
Sq, Ftg. Other
V.=1J
1
Type/ Canst.
Bedrooms
c:.toriFU
Units
nccy load
nccy Group
BUilDING PERMIT
Charges and
Surcharges
Plan Ck. Comm/lnd
65%/ Bldg Per Fee
Plan Ck. Res
30%/ Bldq Per Fee
28.00
------1~12
18.20
PLUMBING PERMIT
Charges and
Surcharges
15.00
Fence
_ nO 'Demo
_____ ,!:) no I Sidewalk
.60 I A/C Pavin<:!
25.00 I Curb Cut
------C 00-'
elECTRICAL PERMIT
Charges and
Surcharges
MECHANICAL PERMIT
Charges and
Surcharges
'(
Value
Value
Value
t>oo
x
x
TOTAL VALUATION
Systems Development
Charqe (1.5%)
Plan Check
Total Comb. Permit
TOTAL
DATE/0 -?cJ ..y-e
I
3.500.00
18.20
86.32
104.52
~~
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PERMIT V ALJDA nON
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. example-heat/electrical ceiling/or forced air gas
2. example-water heater/electrical/or solar
E. Square footage or vC,lluation, etc.
1. example-1250 sq. foot house, 500 sq. foot garage
2. example-if new project, check new-if addition, che<:k
add, etc. ;'
F. Building permit information:
1. example-construct single family house with an.attached
garage
2. example-remodel existing garage into family room
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 TEAM 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 adjacent to the appropriate
item(s) to be installed
B. Full Plumbing, Me<:hanical, and Electrical Schedules
are available at the Building Division
1. To conserve space on the permit form the schedules
have been abbreviated
2. If the item(s) to be installed are not covered on the abbrevi-
ated schedules you should consult the full schedules
C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND
CHARGES ON THE SCHEDULES
III. Applicant to sign and date
Whenever possible, the initial application will be used as a
worksheet only. Where possible, Building Division Staff will
. prepare a typewritten copy and return it to the applicant at
the t.me the actual permit is issued for his signature.
IV. Fees and Charges
Plan check fees are due and payable at the time of the 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.
.-
V. FOR OFFICE USE ONLY
PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY:
I
,
t
Additional Project Information:
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ITY OF SPRINGFIELD
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City Hall
Springfield, Oregon
Department of Public Works
OFFICIAL RECEIPT
No. B 5 5 0 6 5 ~
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AUTHORIZEd SIGNATURE
SHELTON-TURNBULL PfUNTEIil5 . t:UGE"'IE Olil g7..01 ~8~11'6
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Permit Clerk
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PLANS REVIEWED BY:
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. name
nAN SMiTH
signature
date
10-21-80